Lessons from the NHS in Scotland
- Published on Thursday, 02 February 2012 12:02
- Written by Dr Peter Samuel
The effectiveness of partnership agreements within the NHS can tell us a lot about what “works” in industrial relations. It might also tell us a little about the wisdom or otherwise of some of the choices made during the past decade by the UK’s national health services
In the wake of political devolution the NHS in England increased its reliance on a market-based approach. By contrast, as part of a strategy to engage staff in improving services, the NHS in Scotland set about developing partnership agreements at board and national level.
These agreements, the longest-established and most extensive of their kind in Britain, offer valuable evidence of the extent to which innovative industrial relations can contribute towards enhancing public service delivery. Understanding the role they have played in shaping NHS Scotland is especially significant when one bears in mind that such arrangements, in one form or another, now cover almost a third of all British public sector employees – nearly 1.5m of them in the NHS.
A two-year study by Nottingham University Business School provides a full and independent evaluation of the operation and outcomes of NHS Scotland’s partnership agreements. It identifies the key factors that have helped sustain a system that is able to nurture and deliver policies and initiatives, drive organisational change and devise and implement appropriate workforce strategies.
The study consists of a detailed examination of scores of meetings held by various NHS Scotland forums between 1999 and 2011. Researchers attended in person on numerous occasions, as well as analysing relevant documents and minutes and interviewing participants. The idea was to understand the enduring success of NHS Scotland’s partnership agreements by investigating aspects such as the development, structure and scope of discussions involving interested parties.
The overall picture to emerge is one of an organisation in which potentially disparate elements are united in benefiting from a remarkable collective agenda. In achieving this, all sides – government, employers and staff representatives – have worked hard to satisfy six crucial challenges:
• A shared aim
• Appropriate partnership structures
• Frequent partnership meetings
• Broadness of scope
• Voice (i.e. permitting diverse views to be heard)
• Positive behaviour (i.e. a willingness to listen)
Taken as a whole, there is a palpable maturity and positivity about NHS Scotland. This is plainly an organisation with a firm conviction that the best method of delivering change is to improve how staff are engaged. The enhanced participation of employees and their representatives not only constrains management unilateralism: it grants those employees and representatives a vital say in important decisions affecting their working lives and, in this case, the quality of healthcare provision across Scotland.
It was at no point the intention of the study to measure NHS Scotland’s approach against that of the NHS in England. Recent headlines, however, make comparisons – albeit perhaps purely casual in nature – sadly inevitable.
The Care Quality Commission, the Health Service Ombudsman and the Patients Association have all raised fresh concerns that nurses within the NHS in England have become detached from patients or too busy. The Health Select Committee, meanwhile, has branded the overhaul of the organisation a “distraction” that is hindering its ability to make the savings needed to safeguard its future.
The fact is that a frequently overlooked question surrounding the issue of public sector reform, not least in an era of dwindling budgets, is whether it is a problem for or of management. It might be argued that this point has divided opinion among the UK’s national health services for more than 10 years.
NHS Scotland reacted to political devolution by reclaiming its health service under a traditional centralised system of governance. It thus perceived reform as a problem of management. In other words, it acknowledged the need for reform is in the first place a product of a dysfunctional regime. We would contend that its ethos serves as an important lesson to not just the NHS but the public sector in its entirety.