Integration of Adult Health and Social Care in Scotland: Consultation on Proposals

Annex C Workforce issues

C.1. This section provides a brief overview of the range of workforce issues that will need to be considered outside legislation as integration is taken forward. Further consideration of these important requirements will be taken forward in partnership between the Scottish Government, NHS Scotland, NHS Education for Scotland (NES), Local Authorities, the Scottish Social Services Council (SSSC), and staffside representation. In outline, we anticipate further work will be required particularly under the headings listed in this annex.

Organisational development

C.2. We anticipate further work on organisational development will be needed as listed below. This is not an exhaustive list, but is likely to include:

• Developmental work between Local Authority elected members and non-executive Directors of Health Boards.
• Developmental work between Chief Executives of Local Authorities and Health Boards and their teams.
• Jointly Accountable Officers - scoping the role, accountabilities, skills and behaviours needed for these posts, and devising a targeted programme of support on appointment.
• Developing senior professional teams including GPs and Chief Social Work Officers (building on existing developments, for example the primary care leadership initiative currently being taken forward by the Scottish Government, NES, SSSC and the Royal College of General Practitioners (RCGP); and on collaborative work being progressed by NES and SSSC).
• Support for staff working in non-statutory organisations.

Training and education of frontline staff

C.3. The success of our proposals will depend on the education, training and development of the workforce, and a set of targeted initiatives within an overall strategic framework will be essential.

C.4. In recent years, NES and SSSC have sought to ensure that the appropriate professional frameworks are in place which support national regulatory requirements. This includes scoping out the level of education, training and skills within the current workforce, compared to what will be needed in future.

C.5. Over the coming months, and beyond the immediate scope of this consultation, we will work with NES, SSSC and other stakeholders to define the priority education and training requirements within an integrated context; articulate what these will mean for individual frontline staff; and identify how to mobilise support through an education and training infrastructure which reflects a more integrated system of health and social care. In doing so, we will where possible build on existing developments and good practice (for example, the work undertaken to date by the Reshaping Care for Older People Workforce workstream).

Staff governance and partnership working

C.6. There is a well established model of industrial relations within NHS Scotland that sees employers, trade unions and professional organisations and Scottish Government working in Partnership. NHS MEL (1999) 59 sets out the partnership arrangements within which NHS Scotland employers are required to comply. The model demonstrates the extent to which good employee relations require the involvement of all stakeholders at the stage of formulating potential change or development before moving to the consultation stage.

C.7. In NHS Scotland, the principles of staff governance focus on how staff are managed, and feel they are managed. Staff governance makes up one of the 4 pillars of the governance framework (alongside clinical, financial and information governance) within which Health Boards must operate.

C.8. NHS Scotland's commitment to staff governance was given legislative underpinning by the NHS Reform (Scotland) Act 2004. The Staff Governance Standards Framework is the key policy document in support of the legislation, which aims to improve how NHS Scotland's diverse workforce is treated at work.

C.9. There are no equivalent national formal agreements on industrial relations or staff governance within Local Authorities.

C.10. Partner organisations in each Health and Social Care Partnership will need to carefully consider their approach to industrial relations and staff governance. There will be an additional requirement to review the scope of national partnership and staff governance arrangements to take into account proposals for integration.

Professional accountability

C.11. Arrangements for professional accountability of staff working within the Health and Social Care Partnerships will need to be further examined, particularly if there are to be shared management responsibilities in Partnerships.

Employment policies and procedures

C.12. There will be a requirement to examine the relationship of partner organisations' employment policies and procedures dependent on the particular model of the Health and Social Care Partnership that is implemented. Again, this will be particularly important in shared management situations, i.e. where health staff are managing social care staff, and vice versa.

Recruitment protocols and joint appointments

C.13. Further consideration will be taken forward to examine the implications of joint appointments within the context of introducing Health and Social Care Partnerships. When separate organisations develop shared staffing arrangements to recruit someone to work for all the organisations, they have created a joint appointment, with the explicit purpose of working more collaboratively and achieving shared objectives.

C.14. Full account must be taken of the impact of joint appointments on all the organisations involved, including the challenges of working across different cultures, employee relationships, pay, terms and conditions and many other factors. The importance of organisational development, training and workforce development enabling appointments to function effectively and flourish may take effect on a number of different levels.

C.15. Guidance on joint appointments was issued under the Joint Future Initiative in 2004, and this will be refreshed.

C.16. Guidance on the recruitment and contract status of Jointly Accountable Officers will also be produced.