GMB Scotland is spread right across all industrial sectors which means when representing the members’ interest, our union has a vast amount of expertise and knowledge. Representation comes in various forms, whether it is supporting individual members, participating in consultation exercises or organising workplaces so that they have the ability to collectively bargain for themselves. We pride ourselves that at least someone within our broad church of an organisation will have some experience with any matter which may arise.
When it was mentioned to me by a local GMB workplace organiser (who has a considerable amount of responsibility within the care sector) that the forthcoming changes in relation to the integration of health and social care were the most significant since the creation of our NHS in 1948, it was then that I realised that for the safeguarding of our members’ working conditions and the patients which they care for, the GMB had to become involved.
There will always be an element of suspicion when large organisations come together to create, in essence, what will be a new service and that is what is happening here when NHS Scotland and local authorities come together to provide an integrated care plan.
At times, there can be further complications as the NHS areas can encompass several local authorities. For example, in Ayrshire where I am based, NHS Ayrshire & Arran has three local authorities within its boundaries (North, South and East). From my experience, it would seem that the three separate local authorities are working at different levels of speed to get their structures in place.
Not for one moment am I suggesting that these authorities should merge, but there are concerns from our members that there are many in-depth meetings and discussions taking place about the process and planning of how these new working arrangements are going to be put in place, while the actual job of working directly with the patient is not as big a priority as it should be.
Additionally, as the scope and amount of services which are being transferred from local authorities into this new working arrangement vary from authority to authority, it will be a very difficult balancing act to get the service exactly correct for that particular area.
While all this will be on the periphery of our priorities, nonetheless they are extremely important and there is a general concern from local authorities that they may become minor partners in this partnership in comparison to the vastly larger NHS organisations.
All that aside, where does this leave the workers who provide the actual care and what changes are they likely to see? One of the concerns that unions have is the move to ‘personalisation’ of care. These concerns are for our members and for the people that they provide care for and their families.
When speaking to our members on this, it’s clear they already provide a personal level of care for their patients and have a huge amount of trust in the wider community. We must remember carers have access to homes, medication and they have to have a wide knowledge of their patients’ needs and relate this in a personal manner when they are providing care to an individual.
This is true personalisation of care, which is having a dedicated carer or health care professional having the knowledge and expertise to deal with the needs of particular patients. At this moment, it is difficult to see where the move from transferring the financial responsibility of the personal budget to the individual, which will presumably mean that they have the purchasing power, in essence, to buy their care will be of benefit to the individual. In theory, it sounds extremely positive and it is being dressed up as the individual finally getting the opportunity to choose the care that they require.
However, given the many conditions that we as humans can suffer from and which need to be cared for, in particular those with long-term complex needs or near end of life conditions, how are individuals and/or their families expected to take on the responsibility of arranging care and with all the bureaucracy that goes with dealing with local authorities and NHS Scotland?
Our members are clear their employment lies with either the local authority or NHS Scotland and are experienced in dealing with their policies in what is already a heavily regulated profession, and by and large most workers are comfortable with this approach.
Our members will always provide the best quality of care despite the circumstances that might be placed before them, and personalisation can occur in many ways and not just through the financing of care packages (e.g., in residential care homes it could stretch to the operation and design of the building or for people in their own homes it may just be a regular trustworthy care worker who is there to provide a kind personal touch).
While the merits of ‘personalisation’ have yet to be tested fully, what is being presented appears to be positive in giving the individual to choose the care package that best suits their needs, union members will need to aware that they will be expected by local authorities and the NHS Scotland to make sure this transition goes smoothly.
While all the motives for this significant change seem to be good, there are views coming from a variety of sources that are questioning what will be the actual changes that patients will receive and what changes will workers have to incorporate into their duties to provide these services, and that this may just be large organisations coming together and moving accountability for care to the individual, who may already be struggling with day-to-day living.
Union officer, Paul Arkison, works for GMB Scotland, is based in Ayrshire and deal with all sectors of employment and industry.