NHS SCOTLAND
Lessons from Scotland
Nottingham University Business School’s Dr Peter Samuel, co-author of a partnership report on NHS Scotland, talks to NHE about working in consensus.
Scotland separates bargaining from problem solving to cope with the various challenges it faces, and aims to remove any arguments that do not focus on health improvements. He added: “It’s very much a consensus- driven approach, it’s quite devoid of politics actually – it’s very much health.”
Although this way of working has been extremely beneficial for Scotland, the price of partnership is purposefully hidden, Dr Samuel revealed. “Nobody knows the budget for this. As soon as you put a budget on something you could cut it, so they don’t cost it.”
Policy in partnership
Despite Scotland’s impressive track record in this respect, there are still areas for improvement.
Dr Samuel acknowledged: “Any health service needs improving.
In Scotland,
alcohol consumption and obesity are serious issues.”
I
n Scotland, long-established and clearly defined partnerships improve patient out- comes and ensure a common agenda for the health service to work towards, accord- ing to a new academic report, which details why this method of working practice is so effective and how the model could provide useful lessons for England.
Dr Peter Samuel of Nottingham University Business School, an expert in worker relationships and public sector reform, co- authored the report. He labels the impact of partnership working on the NHS “absolutely astonishing” and talked NHE through the benefits, and explained why there are few statistics on the overall costs and benefits of partnerships.
Why is Scotland so successful?
“It’s several factors really,” Dr Samuel said. “The opportunity provided by devolution is the fundamental difference. In England there’s an emphasis on the market. Scotland has got rid of markets post-devolution, and taken it back to the way the NHS used to be run – but this time around, they are far more inclusive of other groups.”
Particularly important, he says, is the Scottish Partnership Forum, set up in 1999
to support such working at a national level between staff, unions and employers. Dr Samuel said: “There’s equal status between technicians, nurses, and doctors; they’ve all got the same voice and representation on this committee. England isn’t doing that. The Social Partnership Forum in England won’t let us come in and observe what they do because of issues with confidentiality; it’s a different kettle of fish. They’ve got different agendas.”
In England the partnership forum is an elite organisation, Dr Samuel argues, compared to the open, transparent process found in Scotland. “The English minutes are just bullet points, you get no inkling of what’s really going on and it is far more secretive.”
Reaching consensus
Although England is significantly larger than Scotland, comparisons and improvements are still possible within the NHS. Dr Samuel said: “A proper partnership arrangement is based on open exchange of information before decisions are made. Policymakers in Scotland and Wales will seek soundings from staff representatives about what they should do, take those under advisement, and come back with an appraisal. It is all done by consensus.”
But he added that in terms of tackling these issues, putting ideas and solutions through the partnership forum allows the health service to support Government policy.
“The Cabinet would not propose anything to Parliament without the backing of the Scottish Partnership Forum. They don’t just make policy on the hoof,” explained Dr Samuel. This means that the SPF can act as a sign-off body to resolve and approve policy that will affect the health service.
And while England has even further to go in improving communication, striving for consensus and encouraging everyone involved to have their say, Dr Samuel predicted: “The powers that be in England will ignore it because it’s an alternative and that’s not on their agenda. They’ve got a vested interest in seeming to be successful and not appearing to copy from someone else. The NHS is always politically charged.”
Dr Peter Samuel
TELL US WHAT YOU THINK The full report, ‘Partnership in NHS Scotland, 1999-2011’, is available at
tinyurl.com/ NHSScotlandPartnership
national health executive Mar/Apr 12 | 53
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