Major study into NHS Scotland casts doubt on NHS England market-based reforms

A major report into the NHS in Scotland has cast doubt on the wisdom of its English counterpart’s continued and controversial pursuit of market-based reforms.

The two-year study reveals how a “mature and positive” approach to industrial relations has helped underpin NHS Scotland’s “commitment to high-quality patient care”.

By contrast, the NHS in England has recently faced heavy criticism from the Care Quality Commission, the Health Service Ombudsman and the Patients Association.

All raised fresh concerns that nurses have become detached from patients or too busy – prompting the government to unveil a new round of changes to NHS practices.

The Health Select Committee has also branded the overhaul of the NHS in England a “distraction” that is hindering its ability to make savings to protect its future.

Carried out by Nottingham University Business School, the NHS Scotland study examined how innovative industrial relations can help improve service delivery.

It concludes that the health service north of the border represents a “leading-edge example” and offers “important lessons” for public services throughout Britain.

The report says NHS Scotland’s decision to engage staff as fully as possible by developing partnership agreements at national and board level is key to its success.

The result of this approach, which followed political devolution, is that all levels of the organisation have a common agenda that helps deliver better healthcare.

Study co-author Dr Peter Samuel said: “Effective partnership working requires the development of a shared aim and an agreed approach on the way forward.

“Partnership in the NHS in England and Wales is also built on a shared commitment to high-quality patient care, but partnership in NHS Scotland is unique.

“That’s because from an early stage it was also based on a strong consensus over the organisational structure that would best deliver the NHS’s founding principles.

“This involved a move away from most of the market-based reforms introduced from the 1980s onwards – reforms the NHS in England continues to pursue.”

In recent years partnership agreements have come to cover approximately a third of all public sector employees in Britain – around 1.5m of them working in the NHS.

NHS Scotland’s partnership agreements represent the longest-established and most extensive set of such arrangements anywhere in the British public sector.

The study took the form of a detailed examination of scores of meetings involving the main forums associated with the agreements between 1999 and 2011.

The Scottish Partnership Forum (SPF) debates strategic direction, while the Scottish Workforce and Staff Governance Committee (SWAG) develops workforce policies.

A third forum, the Scottish Terms and Conditions Committee (STAC), handles any outstanding negotiations, and all three are supported by smaller secretariats.

Researchers attended many of the forums in person, as well as analysing relevant documents and minutes and interviewing participants to gain further insights.

They specifically set out to investigate the development, structure, frequency, scope, “voice” and behaviour of discussions held by the various interested parties.

The authors praise the way NHS Scotland separates broad-ranging debates over strategic issues from more detailed talks over individual workplace policies.

Dr Samuel said: “Many organisations focus on trivial matters, but the SPF has concentrated on the ‘big ticket’ issues affecting the future direction of the service.

“SWAG, meanwhile, has taken care of five workforce policy areas: planning; pay and conditions; health, safety and wellbeing; training and equality; and the staff survey.

“This kind of separation helps explain why partnership has endured. It also ensures participants attending both committees don’t feel they have ‘heard it all before’.”

The opportunity for staff representatives to add their voices to top-level meetings and so allow for “a broad range of views” is also highlighted by the study.

Between 1999 and 2011, for example, the SPF heard from 180 contributors – 99 representing government, 37 representing staff and 28 representing employers.

Dr Samuel, a lecturer in human resources management, said: “NHS Scotland clearly believes the best way to deliver better healthcare is to improve how staff are engaged.

“Employers and the Scottish government have fostered staff representatives’ commitment to health policies and organisational restructuring to improve patient care.

“As a result, in our view, partnership in NHS Scotland has grown into probably the most ambitious and important contemporary innovation in British public sector relations.”

The final version of the study – entitled Partnership in NHS Scotland and co-authored by Professor Nick Bacon, now of Cass Business School – is published this week.

Partnership in NHS Scotland 1999-2011