Scottish NHS – SWAG-ering Success?

Staff engagement as part of an innovative approach to industrial relations  is the key to improved patient care says a Nottingham Business School report on NHS Scotland. The authors claim that “Partnership in NHS Scotland has matured into probably the most ambitious and important contemporary innovation in British public sector industrial relations.” SWAG is the Scottish Workforce and Staff Governance Committee with its partners in acronym two other committees – one the forum dealing with strategic direction (SPF) and the other focusing on terms and conditions of employment (STAC). All this co-operative behaviour is in stark contrast to the market-driven approach adopted in England says the Business School in a rather combative press release which claims that the Scottish success has “cast doubt on the wisdom” of the English approach. Better patient care comes from better staff relationships committed to better patient care in partnership with employers. Some cynics will get a strong whiff of the smoke-filled rooms of the 70’s where behind closed doors, unions and government settled the fate of the nation over their tea and sandwiches. More hopeful voices will say that we are witnessing the application of Scottish communitarian approach described by commentators such as Neal Ascherson author of  ‘Stone Voices- the search for Scotland’ his account of Scottish nationalism – as a key distinguishing element of Scottish life. (Worth a read or re-read – it has a special resonance for fans of public engagement because Neal and friends actually got on a bus and went out to meet the Scottish public to spread the devolution word. The frustrations and joys of those encounters will be familiar to all of us who have hired the halls and wondered who if anyone will come and if they come, will they say anything? One school master/academic is quoted by Ascherson as saying that his great hope for devolution/ independence and a new Scotland was that at last the Scottish students would speak and not sit there mute letting the English do all the talking. Perhaps ten years later, such a student has found the power of speech and a seat on SWAG, STAC or the SPF?).

Where is the Patient Interest?

The MAC interest is of course the arrangements in place to make sure that the voice of the patient is heard in these co-operating councils. Patients/ users of health services do not appear to have any direct representation. In its conclusions 4 and 5, the report characterises the employers’ role which looks for co-operation on the delivery of improved healthcare within  a given budget while the staff side wants job security and involvement in policy setting. So the employers would appear to be the patient proxy. Is this enough? This is a question that needs an answer especially in the context of the final conclusion of the report. The research identifies the challenge of the future as the integration of health and social care which will bring together “two very different sets of industrial relations arrangements”. And a lot else besides, we would add. This is a challenge that is equally hard whatever the approach – market-led or SWAG-led. From the evidence so far, the English arrangements for this integration seem frozen in the starting traps and it would appear that the Scots have not even started.

Would the patient and the carer be the place to start, continue and finish? We only ask the question and note meantime that the other Scottish news in the NHIS newsletter is the apparent doubling in the cost of the Scottish NHS. The answer from Scottish Health Secretary Nicola Sturgeon is that the comparison is impossible from year to year because the counting is different and different things are counted.

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