Welsh Government Green Paper
Consultation on Working Together for Wales: The Public Service Workforce
Response from the Welsh NHS Confederation
Introduction
· The Welsh NHS Confederation, on behalf of its Members, welcomes the opportunity to respond to the Welsh Government’s consultation on Working Together for Wales: The Public Service Workforce.
· By representing the seven Health Boards and three NHS Trusts in Wales, the Welsh NHS Confederation brings together the full range of organisations that make up the modern NHS in Wales. Our aim is to reflect the different perspectives as well as the common views of the organisations we represent.
· The Welsh NHS Confederation acts as an independent voice in the drive for better health and healthcare through our policy and influencing work and by supporting members with events, information and training. Member involvement underpins all of our various activities and we are pleased to have all Local Health Boards and NHS Trusts in Wales as our members.
· The Welsh NHS Confederation and its members are committed to working with the nation’s sixty Assembly members, with Welsh Government and with partners to ensure there is a strong NHS which delivers high quality services to the people of Wales.
Overview
· The Welsh NHS Confederation represents the 10 statutory NHS organisations in Wales with a total of more than 85,000 employees - a very significant proportion of the number of people employed within the public service in Wales.
· The most recent figures for total staff numbers in individual organisations are highlighted below:
- Abertawe Bro Morgannwg Health Board 16229 (staff)
- Aneurin Bevan Health Board 13187
- Betsi Cadwaladr Health Board 16490
- Cardiff and Vale Health Board 14394
- Cwm Taf Health Board 8479
- Hywel Dda Health Board 8841
- Powys Health Board 1584
- Public Health Wales NHS Trust 1280
- Velindre NHS Trust 3098
- Welsh Ambulance Service NHS Trust 3034
· The Welsh NHS Confederation and its members believe that the vision for NHS Wales can only be delivered through strong partnership with staff and their representatives. This partnership must include the full engagement of all staff, which is critical to success in creating a common purpose and determination to succeed. Engagement with staff and key stakeholders may occur in a variety of settings depending on the matter being addressed - such as with clinical forums, local representative committees and/or professional advisory groups as appropriate.
· Based on “Working Differently Working Together – A Workforce and Organisational Development Framework”, NHS Wales organisations work with staff and Trade Unions locally to develop a partnership which is based on:
o An organisational commitment to deliver: A rewarding working environment, lifelong learning & development, motivating work, support to staff in delivering the care to patients, involvement in developing change, change managed well, dignity & respect for all. Staff who are: Flexible in their approach to work, supportive of and engaged with the vision, committed to safe, effective, efficient working practices. Partners who: Share the vision for the NHS in Wales and seek to break down boundaries.
· The ultimate aim of this partnership is to create an NHS that staff are proud to work in and at the heart of this activity are the shared values of NHS Wales.
NHS Wales Values
· The NHS in Wales is a vital part of the public service in Wales and working together with its key partners, including local government and the Third Sector, public service values and associated behaviours are, and must be, at its heart.
· The Welsh NHS Confederation and its members believe that NHS organisations must be value driven, rooted in high standards of public life and behaviour. NHS Wales’ values are:
o Putting quality and safety above all else: providing high value, evidence based care for our patients at all times.
o Integrating improvement into everyday working and eliminating harm, variation and waste.
o Focusing on prevention, health improvement and inequality as key to sustainable development, wellness and well-being for future generations of the people of Wales.
o Working in true partnership with partner organisations and with staff.
o Investing in our staff through training and development, enabling them to influence decisions and providing them with the tools, systems and environment to work safely and effectively.
· It is acknowledged that the NHS in Wales is working within a changing environment and in challenging times. All organisations face significant financial pressures within the current economic climate, coupled with increased expectations. There are also skills shortages in some areas of service delivery, a number of which are UK wide. The pressures faced by staff are very real and it is, therefore, all the more important that staff are supported by the very best in employment practices.
Summary
· Whilst the views of the NHS in Wales in relation to the specific consultation questions are outlined below, the key points of our submission are:
· The NHS in Wales is already signed up to a set of key values based on the Nolan principles for behaviour in public life. As such, the Welsh NHS Confederation and its members believe that if public service organisations adhere to these values and principles then further regulation is not needed.
· There is already a great deal of excellent partnership working between the NHS and Local Authority and other public service bodies. Indeed, Local Authorities have been asked to reflect Health Board boundaries when developing services. NHS organisations require the flexibility to continue to work with other public service bodies and the absence of harmonised terms and conditions will not necessarily be a barrier to this continued partnership working.
· The NHS in Wales faces unprecedented financial challenges in the future. As recent reports by both the Wales Audit Office and National Audit Office identify, despite having made significant savings for the last three consecutive years, the NHS in Wales still faces a real terms cut to its budget until 2014-15 and there is a major challenge for the NHS in Wales to manage within budget in the short term. In the current financial climate there is already a clear requirement for greater collaboration within the public service and an increasing understanding and desire for this to become the norm, so the impetus to work in this way already exists. It is not certain that a statutory duty would encourage the need to work more closely together than the current circumstances dictate.
· The NHS is currently facing unprecedented financial challenges. A legislative approach which closes off options both now and in the future could potentially affect the delicate balance of a fair and consistent approach to our workforce. There may be a need in any event to consider some flexibility in the way in which services are provided as a response to these ever increasing financial challenges.
QUESTIONS:
1. Are these the right priorities for a statutory framework to enact the
provisions of the Strategic Framework?
· The Welsh NHS Confederation and its members believe that the need for a Strategic Framework covering the public service workforce and support close working with staff side organisations is a logical step given the ambitions for a distinct vision for the public service in Wales. Changing ways of working to enhance public service delivery needs vision, leadership, training and development and a fully engaged workforce as recognised in the Strategic Framework. We have however, concerns about the legislative approach proposed in the Green Paper as this may not fit well with the essential cultural shift required. We feel that to move too quickly to enforce the Strategic Framework may be counter intuitive to public service partners, their staff and Trade Unions.
· It is hard to reconcile aspirations like “empowerment”, “engagement”, “culture shift”, “partnership”, “leadership”, “mobility” and “flexibility” within a legislative framework. These aspects of transformational change are best achieved when there is local ownership, passion and drive created from parties working together at a local level to co-create and own change. Oversight and central control therefore needs to be light touch and supportive with the use of legislative powers being a last resort.
· The embedding of partnership working is axiomatic in the effective working of public service organisations. The NHS has successful partnership working arrangements which have developed and matured over the past ten to fifteen years. There is now a preference for issues of commonality throughout NHS Wales to be resolved in a way that apply across Wales e.g. the mechanism for the development of employment policies which are effectively all Wales policies. So long as the proposals in no way undermine the current arrangements, there would be no concern if the priorities in respect of partnership working and the Wales Partnership Council (WPC) agreements are legislated for, as these can be seen to be working effectively at present.
· The two tier code is currently an issue specifically for local government and within this area there is a need to ensure that any proposals do not perversely impact upon the NHS in a ‘TUPE’ situation with Local Authorities. Terms and conditions (T&Cs) are already common across the NHS, albeit there are three different staff groups (the majority of staff are on National NHS T&Cs with the other areas covering Doctors and very senior managers/Executive Directors). It is important that the integrity of common terms and conditions in the NHS are not eroded due to their lack in other parts of the public service. Currently the NHS is not engaging in service transfers to non NHS providers and this is not, therefore, an issue at the moment. However, the two tier legislation could be a barrier to the NHS exploring opportunities and options for greater cost effectiveness at times of severe financial pressure on public services. The NHS is currently facing unprecedented financial challenges. A legislative approach which closes off options both now and in the future could potentially affect the delicate balance of a fair and consistent approach to our workforce. There may be a need in any event to consider some flexibility in the way in which services are provided as a response to these ever increasing financial challenges.
· Accordingly, in the current economic climate, a two tier code could arguably hinder modernisation and the movement of staff across sectors. The proposed scope of the application of this provision across the whole of the devolved public service in Wales therefore requires careful consideration.
2. Are there additional provisions within the Strategic Framework that would be better put on a statutory footing?
· It is vitally important in the context of recruiting and maintaining a talented, skilled and experienced workforce that the UK nature of the NHS ‘professional’ workforce is acknowledged and as such more work will be needed on the workforce mobility aspect of the Strategic Framework. The current recruitment difficulties in certain medical specialties are testament to this and the potential impact of the proposals on recruitment and retention of NHS staff must be factored into the impact assessment processes.
· The provisions set out in the document would seem to be sufficient at this stage whilst further work is done on addressing the potential consequences for specific sectors. This would include progressing the points set out in section 6.3, “Operating the Deal” and the potential consequences of removing barriers to increasing mobility between sectors within public services in Wales whilst potentially creating greater challenges for the movement of staff across the wider UK NHS e.g. any change to pension arrangements in Wales.
3. Do you agree that Welsh Ministers should have powers to give statutory force to decisions made by the Workforce Partnership Council? If not, why?
· It is a logical step given the ambitions for a distinctive vision of the public service within Wales. However, we believe it would be helpful if we had a more detailed understanding on the type of issues it is envisaged that the WPC will deal with and how it will effectively engage with public service organisations.
· We would not wish such powers to undermine in any way the local partnership arrangements which currently work well in health. Careful consideration needs to be given to ensuring that the decisions of the WPC do not undermine local leaders and managers. There should continue to be a focus on identifying enablers, on encouraging and supporting partnership working and on the sharing of best practice through case studies, rather than forcing compliance. Each public service organisation has its own governance in place and Boards (or equivalent bodies) have responsibilities for workforce matters which should not be compromised.
· The NHS sector (employers and unions) would need to be adequately represented at the WPC and it is important that Trade Unions seek a broader representation than that covered by the Wales TUC. The NHS partnership arrangements include non TUC affiliated Trade Unions that cover significant staff groups; doctors, nurses and midwives. It is essential that the Trade Unions on the NHS Wales Partnership Forum (WPF) are seen to be representative of the whole of the NHS workforce. In respect of the operation of the WPC, it will be essential for there to be a timely and effective engagement and consultation process with employers prior to any decisions being ratified at the WPC prior to legislative consideration.
· Paragraph 29 of the Green Paper states: “giving these (WPC) decisions statutory force takes forward the Welsh Government vision of a Wales-wide public service approach to workforce issues extinguishing the need to seek separate contracted agreements with each individual employer within the host of different organisations in Wales. This would substantially speed up the implementation of changes to workforce matters.” However, linking this question to question 5 below, within health, the Minister is already in a position to ‘direct’ employers in workforce matters, whether these are decisions by the WPC or more usually arising from the NHS Wales Welsh Partnership Forum or the UK joint pay/terms and conditions bodies. As this specific provision relates to the current limitations in relation to local authorities, we believe it is worth considering whether the legislation should be restricted to enabling the Minister for Local Government to ‘direct’ in the same manner as the Minister for Health and Social Care is currently able to.