DESIGNED TO CARE

Renewing the National Health Service in Scotland

118. The internal market has resulted in unnecessary fragmentation of policy and practice in the management of NHS staff. Not only has this created inconsistency in employment practice, it has also created duplication and bureaucracy. It has left staff feeling insecure and has undermined the nature of the 'NHS family', so vital to the team work and cohesion needed in the delivery of patient care.

119. The themes of partnership and co-operation set out in this White Paper apply equally to the recruitment, management and development of our workforce. Partnership in this context is about involvement, trust and openness, as well as fairness. In order to recruit and retain staff we need to develop a meaningful and practical partnership with them. To achieve this, we need effective employment practices, along with a commitment to training and development across the entire workforce, underpinned by a modern, consistent industrial relations practice delivered within the framework of a national strategy for human resources in the NHS in Scotland.

120. In developing such an approach, the Government will emphasise the balance between rights and responsibilities. Staff have the right to be involved and consulted in decisions which affect their job, how they work and the way service is delivered. Their responsibility is to work together to deliver a service which is effective and represents value for money.

121. Nurses, midwives, health visitors and the professions allied to medicine have long since taken the lead in providing effective and flexible solutions to changing patient needs, medical advances and shifts in the pattern of service delivery. They have expanded their scope for professional practice by developing in-depth specialist knowledge and skills in, for example, caring for patients with diabetes, glaucoma and mental illness. In primary care, the development of the nurse practitioner role has been key to changes in how patients with chronic problems are managed and cared for.

122. The Government value this commitment and wish to support and encourage future initiatives which will make the most of the contribution of nurses, midwives and health visitors to the provision of clinical services and will support the establishment in Scotland as soon as possible of a Nursing and Midwifery Practice Development Unit. The Unit will concentrate on the development and promotion of clinical excellence, and encourage networking and the sharing of good practice throughout the NHS in Scotland. The Unit will complement the Nursing Research Initiative already established in Scotland.

123. As the central theme of a human resources strategy, the Government intend to continue to invest in education, training and development. This will ensure that NHS staff are appropriately trained and well qualified both in the interests of the NHS and for their personal development in acquiring lifelong skills. A comprehensive training and development strategy will be produced which underpins the key strategic objectives of the NHS in Scotland. It will tackle a range of issues including:

• recognition of the value of lifelong learning and Government's wider policies for education and training;
• equal and easy access to training and development opportunities for all staff;
• promotion of a competency approach underpinned by national occupational standards and support of Government training programmes such as modern apprenticeships;
• commitment and support to the developments in undergraduate and Postgraduate education in medicine. The Government will examine the opportunities to further develop the role of the Scottish Council for Postgraduate Medical and Dental Education; and
• a commitment to the framework of Continuing Medical Education and Professional Development, a vital component in the maintenance of standards and competency of all clinical staff.

124. The relationship between employer and employee is vital to our success. The removal of gagging clauses from contracts of employment is a clear signal of the new culture the Government are determined to create in the work place. To do so, the Government have a number of priorities:

• The Government are committed to working closely with the medical profession on further improvement in the hours, conditions and quality of training for all grades of junior doctors. In addition, there will be closer working with the professions in solving complex and difficult manpower issues. Greater emphasis will be placed on the support of research and practice in the development of a flexible workforce, in a rapidly changing clinical environment.
• Since the NHS is one of the largest employers in Scotland, with a workforce in which over 70% are women, we are conscious of our responsibility to support and develop working conditions that recognise the needs of the modern family. We will work with NHS staff to develop effective employment practices. We will seek to reduce the barriers between staff groups and enhance personal responsibility and leadership. The Management Executive will promote equal opportunities in their widest sense as part of the human resources strategy for the NHS in Scotland to ensure that managers recognise and incorporate best practice with the aim of promoting the development of all staff and eliminating discrimination.
• The NHS in Scotland provides employment for over 130,000 people who work in hospitals, health centres and patients' homes. The Government will require all NHS employers to develop specific proposals to enhance the health, safety and security of staff. This will include the provision of access to an effective and comprehensive Occupational Health Service.
• Staff also should be given access to health promoting activities in the workplace, consistent with the Government's aim of improving the health of Scotland. The Government will therefore support the development of health promoting programmes for staff in their place of work.
• Exploratory talks have already commenced on the future of pay and conditions of NHS staff. Any system will need to balance the need to be flexible with a requirement to maintain a system of core pay and conditions of service across the NHS. Any system must have the confidence of staff and be seen to be fair.
• The Government are aware that the changes proposed in this document will have significant impact. It will affect not only the number of senior managers in the system but also the skills required of them. With this in mind, the Development Group in Scotland is under review and the report of this review will be available in April 1998, dealing with the way forward in management development and succession planning for the NHS. In addition, and following consultation with interested parties, the Management Executive will take the lead in developing clear plans to support the managerial workforce through this period of transition.

125. Many people work in the NHS who are not directly engaged in clinical care but who nevertheless make an important contribution to the quality of patient care. They are generally referred to as working in Ôsupport services'. The Government believe that these members of staff need to be regarded as an integral part of the patient care team. Trusts will be required to assess systematically the value and quality of their support services, and to explore innovative ways of developing them, in consultation with staff and their representatives. The options which emerge must demonstrate a clear commitment to investment in the people who work in the NHS in Scotland. The Government will establish a steering group to support, identify and disseminate best practice in the management of support services and pilot a variety of partnerships for their development.

The Way Ahead

126. All NHS staff will continue to face enormous challenges as we constantly find new and better ways of delivering services to the population. The pace of change means that staff need to be given the support, skills and reward in order to sustain and build on their existing commitment. A practical human resources strategy is intended to assist in the more effective use of the existing resources we commit to manpower, training and education. It is also intended to give staff confidence that they are valued in ways which are meaningful, practical and realistic.