NHS Scotland a role model for reform says English study

The NHS in England may be in turmoil, but a major new academic study claims its Scottish equivalent should serve as a role model for the public sector.

According to the findings of a two-year report, post-devolution healthcare in Scotland represents a “groundbreaking” approach to the art of industrial relations.

It has taken “arguably the most ambitious labour-management partnership so far attempted in the UK public sector” and made it work, say experts south of the border.

Academics from Nottingham University Business School studied the workings of NHS Scotland in an effort to enhance understanding of partnership agreements.

In recent years such arrangements have come to cover around a third of all public sector employees across Britain, some 1.5m of them working in the NHS.

After devolution the NHS in England increased its reliance on a market-based approach – now one of the various controversies surrounding its future direction.

By contrast, NHS Scotland set about developing partnership agreements at national and board level as part of a strategy to engage staff in improving services.

The result, according to a study funded by the Economic and Social Research Council, is an “incredible common agenda” among interested parties from all quarters.

Research co-author Dr Peter Samuel said: “Although partnerships are found elsewhere in the public sector, NHS Scotland’s stands out as distinct and novel.

“It has survived for over a decade, defying reorganisation and changes in administrations, and it can offer valuable lessons in how to improve industrial relations.

“Anyone wanting to understand how government, employers and staff should work together to deal with strategic and organisational challenges can learn from it.”

The study examined the frequency, scope, behaviour and “voice” of meetings involving various forums associated with NHS Scotland’s partnership agreements.

Chief among these were the Scottish Workforce and Staff Governance Committee (SWAG) and the Scottish Partnership Forum and Secretariat (SPF).

As well as attending many forums in person, researchers painstakingly analysed the published minutes from scores of meetings held between 1999 and 2009.

The study praises the way NHS Scotland separates broad-ranging debates over strategic issues from detailed discussions over specific workplace policies.

It also highlights the lack of repetition – the SPF addressed more than 133 topics in a decade – and the near-absence of a “We’ve heard all this before” mentality.

Dr Samuel said: “The policymakers of NHS Scotland clearly concluded the only way to deliver better healthcare was to improve the way staff were engaged.

“This led to the establishment of various structures at national and local levels to give staff more say in decisions affecting their working lives and healthcare provision.

“NHS Scotland has even passed into law a ‘staff governance code’ that compels all its health boards to engage and involve staff and their representatives.

“This innovation in industrial relations is arguably one of the biggest examples of industrial democracy to be found anywhere in the world – and they have made it work.”

Nottingham University Business School is an acknowledged leader in teaching and research in the fields of sustainability, innovation and entrepreneurship.

Dr Samuel carried out the study with Professor Nick Bacon, a fellow expert in human resources management, with the full co-operation of NHS Scotland officials.

The pair also examined the workings of NHS Wales, whose own approach currently sits between Scotland’s and England’s but is moving closer to the former.

Dr Samuel said: “Our research suggests NHS Scotland and NHS Wales are well placed to cope with the harsh realities of any future squeeze on the public purse.

“NHS Scotland in particular has a mutual commitment to improving patient care and staff involvement, with everyone sharing an incredible common agenda.

“On the other hand, the future for industrial relations in public sector organisations that choose to pursue purely market-based reforms might prove stormy.

“But it’s still not too late for public service managers and staff representatives to start building a meaningful dialogue around improvement rather than downsizing.”

Dr Peter Samuel is a Lecturer in Human Resources Management at Nottingham University Business School. His research interests include worker representation; labour-management co-operation; service sector employment relations; public sector "modernisation"; and comparative employment relations.