Health and Social Care Integration

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2017 National Delegate Conference
1 January 2017

Conference notes that across the UK there are a number of current initiatives seeking to bring about the integration or transformation of health and care services. The Welsh Government continues to recognise this agenda as being of national strategic importance.

These include, but are not limited to, the Five Year Forward View and Sustainability and Transformation Plans (STPs) in England, the ten year vision for health and social care based on the Bengoa report in Northern Ireland, and further moves towards more integrated health and social care in Scotland and Wales.

Conference remains deeply concerned that, as a direct result of the actions of the UK Conservative government, these plans are taking place at a time of prolonged austerity, with the NHS experiencing its poorest settlement for a generation and social care continuing to be run into the ground by years of chronic under-funding.

Conference condemns the government’s 2016 Autumn Statement that failed to provide any extra money for health and care services, with the subsequent local government financial settlement failing miserably to provide anything like the levels of funding that social care needs. Integration will not solve the funding crisis.

Conference notes that there are many challenges emanating from plans to transform or integrate services, including issues for staff in integrated workplaces, cuts to patient services, the threat of privatisation and the increasing use of shared services.

Conference notes that UNISON has always been open to discussing new ways of working and to consider change if this is demonstrably in the interests of patients. However, where change is just a smokescreen for cuts, privatisation or attacks on our members, UNISON must continue to respond decisively to defend services and jobs.

Conference asserts that the most effective and enduring innovations in our health and care services have come when workers and trade unions are properly involved and engaged, as well as the public. Conference therefore expresses its anger that too often this has not been the case, with the secrecy and lack of transparency around the development of STPs in England being a particularly worrying recent example.

Conference reaffirms its support for the principle of integration as a means of improving the seamless delivery of care to patients and service users, but with a number of important caveats around the need for integration not to be used as a cover for cuts, the need for full patient and staff engagement, and the need for integration not be used to level down pay and conditions.

Conference continues to have many concerns about the current funding environment in which these initiatives are taking place and notes that inadequate funding may result in integration and transformation agendas leading to local controversies about where the deepest cuts should take place – potentially pitting community against community.

Conference asserts that integration should never be seen as a way of delivering care on the cheap. After all, there is no evidence to back up claims that integration saves money; on the contrary, in the short term at least there should be an expectation that integrating services actually costs money, as additional funding may be required for double running costs and retraining or redeploying health and care staff. In fact, additional capital funding is often required in order to ensure current premises and physical services are fit for purpose – the Welsh Government allocated an additional £40m capital funding specifically targeted at the development of integrated health and social care.

Conference further recognises that the current largely privatised model of social care has undermined care standards for those reliant on it as well as undermining pay and conditions for the sector’s workforce.

Conference notes that there are often wider issues in integrated workplaces about merging two often quite different working cultures, and these challenges should not be underestimated.

Similarly, Conference has real concerns about the potential for integration, if handled poorly, to lead to two-tier workplaces and for equality issues to be insufficiently considered. Occupational therapists employed by Swansea Council recently received pay awards running into thousands of pounds in recognition they were being significantly underpaid in comparison to NHS peers, but this was only secured after a significant UNISON campaign work.

Conference agrees to affiliate to ‘Health Campaigns Together’ which organised the massive demo in defence of the NHS on 4 March 2017 and calls on the National Executive Council to initiate national action to protect the Health Service.

Conference believes that the huge size of the national demonstration in defence of the NHS in March this year that was mostly built by local campaigns and the number of local demonstrations around the country shows the potential for a serious fight to defend the NHS. We believe that the unions should be doing more to build that fight.

Conference therefore calls upon the National Executive Council to:

1) Campaign to highlight the government’s underfunding of the NHS and social care, and the impact on vulnerable service users and the predominantly low-paid female workforce;

2) Condemn in the strongest possible terms any attempts to use integration or transformation as a smokescreen for cuts, privatisation or attacks on staff;

3) Continue to support integration initiatives where these can be demonstrated to be in the interests of patients, service users and staff;

4) Condemn any attempts to use integration as a cover for cuts or as a means of levelling down pay and conditions;

5) Use every means at the union’s disposal including the 172,000 retired members of UNISON to challenge damaging job reduction plans – whether in the media, in councils, in Parliament, through protests, demonstrations and finally industrial action where there is a confirmed trade dispute;

6) Highlight in campaigning materials the abject failure of the privatised model of social care, and to popularise the case for the universal provision of social care on the basis of need, not profit, by a democratically accountable public sector;

7) Ensure that cross service group work takes place between health and local government branches to ensure a joined-up UNISON response where necessary;

8) Spread best practice from across the UK, both in terms of approaches to integration and tactics for challenging damaging plans;

9) Demand that patients, service users, the public and the workforce are properly involved from the start in the development and implementation of plans;

10) As appropriate, work with other trade unions, patient groups and campaigning organisations to build alliances;

11) Continue to produce guidance and provide campaigning support where branches are fighting damaging changes;

12) Oppose local service reductions or closures, and consistently highlight the root cause in the underfunding of services by the UK government;

13) Use the avenues available at combined authority level in England to promote greater investment and better employment standards in social care and health services;

14) Ask the TUC to call national demonstration in defence of the NHS.