UNISON presentation on TCS

1
Transforming Community Services What it means
and what we need to do
2

• Todays briefing should provide
• Outline of broad government agenda
• Timetable and overview of what PCTs are required
  to do
• Any questions?
• Options for service provision
• Implications for staff, UNISON and the NHS
• Focus on social enterprise (SE) right to
  request
• Any questions?
• Focus on workforce issues / consultation
  requirements
• Any questions?

3
TCS P9 / TU guide P4

• What is Transforming Community Services?
• Part of broader government agenda
• - Commissioning a Patient-Led NHS (2005)
• - Our Health, Our Care, Our Say (2006)
• - World Class Commissioning (2007)
• - Transforming Community Services Enabling New
  Patterns of Provision (2009)
• What has TU involvement been so far?
• - Twin-track approach

4
TCS P25-26

• Key dates for PCTs
• April 2009
• - Internal separation of PCT commissioner and
  provider arms
• - Contractual relationship Service-Level
  Agreement
• By Oct 2009
• - Decision on declaring interest in Social
  Enterprise or Community Foundation Trust (DH doc
  Social Enterprise Making a Difference a Guide
  to Right to Request)
• - Encouraging competition
• - Consider organisational form
• From Oct 2009
• - PCT commissioning arms should complete service
  reviews and market analysis and publish
  procurement (outsourcing) plan
• - PCTs to agree intentions for future of
  provider services with SHA
• - Decide which services subject to Any Willing
  PCT-accredited Provider (AWPP)
• During 2010 PCTs should develop implementation
  plan

5
TCS P27 - 31

• What will Strategic Health Authorities (SHAs) be
  doing?
• Provide support and guidance to PCTs
• Facilitate co-operation between PCTs on joint
  options
• Test proposals refer to Co-operation and
  Competition Panel
• Agree implementation plans with PCTs
• Approve applications for SE or CFT status

6
TCS P27 - 31

• Questions
• How was internal separation within your PCT
  managed and were you/staff side involved in the
  process?
• Any other questions so far?

7

• Possible models for service delivery
• Key issues on following slides
• What will its structure look like?
• What does it mean for staff?
• What about new starters?
• How viable is it?
• What does it mean for future of NHS?

8
TCS Pages 43 to 54, TU Guide Pages 6 to 8

• Possible models
• Arms-length provider organisation
• Polyclinics/GP-led health centres
• Community Foundation Trusts (CFT)
• Vertical Integration with acute trust
• Horizontal Integration with other PCTs
• Integrated Care with local authority/private
  sector
• Private / Independent providers
• Social Enterprise (SE)

9
TU Guide P6

• Arms-length Provider Organisation
• Separate commissioner and provider arm within PCT
• Staff and new starters NHS TCs/pension, A4C
  agreement
• Viability government/SHA pressure on PCT to
  divest further Co-operation Competition Panel
• NHS direct provision

10
TU Guide P6

• Polyclinics/GP-led health centres
• GP or private company-run
• Staff TUPE transfer no automatic link to A4C
  TU recognition? NHS pension in GP-run centres
  only
• New starters Cabinet Office Code applies
• Viability may be subject to takeover business
  failure
• If GP-run existing model
• If private company-run services fragmented
  services run for profit

11
TU Guide P7

• Community Foundation Trusts (CFT)
• Most likely established through merger of PCTs
• Staff and new starters NHS TCs/pension A4C
  agreement
• Viability must meet minimum requirements to
  become FT 3-year funding model
• NHS direct provision (subject to FT
  flexibilities)

12
TU Guide P7

• NHS Integration Vertical Integration
• PCT provider arm function integrated with local
  acute trust/FT
• Staff and new starters NHS TCs/pension, A4C
  agreement
• Viability Pressure from government about
  monopoly providers Co-operation Competition
  Panel
• NHS direct provision

13
TU Guide P7

• NHS Integration Horizontal Integration
• Merger of one or more PCT provider arms. May be
  first step to CFT
• Staff and new starters NHS TCs/pension, A4C
  agreement
• Sustainability challenges May be pressure to
  become CFT Co-operation Competition Panel
• NHS direct provision

14
TU Guide P7

• NHS Integration Integrated Care
• Joint health and social care services between NHS
  and Local Authority or private provider
• Staff
• - if NHS-run NHS TCs/pension, A4C agreement
• - if local authority-run TUPE applies
• - if private provider TUPE applies
• New starters either NHS or LA TCs/pension or
  Cabinet Office Code applies
• Viability possible disagreements over funding
• If NHS or LA - NHS remains in public sector
• If private provider fragmentation/run for profit

15
TU Guide P8

• Private / Independent providers
• Individual or bundled services transferred to
  private or voluntary sector organisations
• Staff TUPE transfer no NHS pension no
  automatic link to A4C potential loss of TUPE
  protection through E.T.O reason TU recognition?
• New starters Cabinet Office Code applies
• Viability dependent on profitability vulnerable
  to business failure
• NHS not publicly provided fragmented service
  private companies run for profit

16
TCS Pages 45 49, TU Guide Page 6

• Social Enterprise (SE)
• Individual or bundled services transferred to SE
  different structural models, including community
  interest companies and worker co-operatives
• Staff TUPE transfer no automatic link to A4C.
  NHS pension for existing staff undertaking only
  NHS work
• New starters Cabinet Office Code applies no NHS
  pension
• Viability if SHA approves right to request -
  SE gets 3-year contract vulnerable to takeover
  or business failure Co-operation Competition
  Panel
• NHS not publicly provided fragmented services

17
TCS Page 37

• Department of Health says No blueprint
• But
• Pressure on staff to exercise Right to request
  for SE
• Preferable treatment for SE
• Potential threat of outsourcing if do not request
  SE
• Co-operation and competition panel

18
TCS Page 24
CFT
V E R T I C A L INT.
COMMERCIAL ORGANISATION
April 2010
October 2009
PCT Commissioners
Social Enterprise
PCT PS
April 2009
LA PARTNERSHIP
PCT Commissioners
HORIZONTAL INTEGRATION
PCT PS
ESTATE STRATEGY (April) SERVICE
LINE DIVERSITY (2010)
April 2008
PCT Commissioners
CONTRACTUAL/SLA RELATIONSHIP (April) IMPLEMENTATIO
N PLAN (October)
Provider Services
INTERNAL SEPARATION
PCT Commissioners
Provider Services
COMBINED ORGANISATION
19

• Questions
• Have you been approached about forming a SE?
• Have you been given information on your right to
  request?
• Are you aware of the pitfalls of SE?
• Any other questions?

20
TCS Appendix 2, Page 76

• TCS (Workforce) Appendix 2
• Issues for staff
• What it covers
• Sets out good practice on engaging staff TUs
• Equality requirements
• Sets out requirements if transferring staff
• Refers to NHS Constitution

21
TCS Appendix 2, Pages 76 and 77

• Staff Engagement
• PCTs required to work with TU reps on
• initial consideration and development of
  proposals for service delivery
• PCT Business and Workforce Plans must be shared
• Decisions on AWPP
• Legal requirements
• Good communications and consultation key
  proposals may be jeopardised if not

22
TU Guide Page 9

• Trade Union view
• PCTs and SHAs must ensure high level and early
  engagement and consultation
• Agree timetable and process for engagement at PCT
  and SHA level
• Seek views of members
• Discuss alternatives / mobilise opposition
• Extend timetables if necessary

23
TCS Appendix 2, Pages 76 77 TU Guide Page 9 10

• Mechanisms for early engagement
• and consultation
• PCT Level
• - Use Joint Consultative Committee and local PFs
  or new joint bodies
• - Engage with commissioning arm (FTO?)
• SHA Level oversight and review role. Use
  regional SPFs to consider PCT proposals
• Unions should use regional SPFs to ensure
  engagement and information sharing
• See key questions for TU Reps to ask PCTs/SHAs

24
CS Appendix 2, Pages 77 78 TU Guide Page 11 12

• Other Issues for Staff
• Equality to ensure no unlawful discrimination
  against employees
• Public Sector duty - PCTs must do Equality Impact
  Assessment. Ensure this is embedded in
  contractual relationships
• Must embed NHS Constitution and Handbook in
  provider contracts
• See key questions to ask PCT

25
TCS Appendix 2, Pages 78 to 90, TU Guide Page 12
to 13

• Protection - Pay TCs
• Where staff transfer TUPE applies. But ETO
  reason could negate TUPE protections
• Cabinet Office Statement of Practice Fair Deal
  for Staff Pensions (2000)
• Code of Practice on Workforce Matters (2005)
• Retention of Employment (RoE) model restricted
• See table summary (TCS pages 86 to 90)
• See key questions to ask the PCT

26
TCS App.2 Pages 83 to 85, TU Guide Pages 13 /14

• Human Resource issues
• Providers are expected to demonstrate
• - An HR Strategy
• - HR policies and workforce planning
• - Provision of access to Continuous
  Professional/Personal Development
• - Staff engagement through a staff survey, TU
  recognition, partnership working, consistent with
  NHS Constitution principles
• See key questions for new provider(s)

27

• Key tasks for UNISON branches
• Find out whats happening now
• Insist on early engagement/consultation
• Local staff side to agree timetable with PCT
• Build in timetable for reporting back to members
• Ensure staff informed about pitfalls of social
  enterprise and loss of rights/job security under
  privatisation
• Ensure NHS options considered/campaign for direct
  NHS provision
• Build in Cabinet Office Code and other
  protections to contract documents and procurement
  process
• Keep your regional office informed
  co-ordination and sharing experience helps us all
• Ensure all unions working together at all levels
• Recruit new members and organise workplaces

28

• What regions need to be doing
• Regional officials to agree timetable with SHA
• Contact Local Authority Health Overview and
  Scrutiny Committees (OSCs)
• Decide press strategy
• Keep national office informed co-ordination and
  sharing experience helps us all
• Ensure all unions working together at all levels

29

• Key Reference Documents (web links)
• Transforming Community Services
• /www.dh.gov.uk/en/Publicationsandstatistics/Public
  ations/PublicationsPolicyAndGuidance/DH_093197
• Next Stage Review
• /www.dh.gov.uk/en/Publicationsandstatistics/Public
  ations/PublicationsPolicyAndGuidance/DH_085825
• NHS Constitution
• /www.dh.gov.uk/en/Publicationsandstatistics/Public
  ations/PublicationsPolicyAndGuidance/DH_085814
• Social Enterprise - Making a Difference a guide
  to the Right to Request
• /www.dh.gov.uk/en/Publicationsandstatistics/Public
  ations/PublicationsPolicyAndGuidance/DH_090460
• Transfer of Undertakings (Protection of
  Employment) Regulations
• /www.berr.gov.uk/files/file20761.pdf
• Cabinet Office Code of Practice
• http//archive.cabinetoffice.gov.uk/opsr/workforce
  _reform/code_of_practice/index.asp

30

• Any other questions?