Chamber and committees

Agenda for Change represents a ground breaking package of pay reform for over 90% of NHS Scotland staff. Not only will it deliver equal pay for work of equal value for staff, but will also improve personal development though wider access to training and career progression opportunities.

Agenda for Change is currently in its implementation phase, so it is as yet too early to establish what the full effects of implementation on patient services are. However, when it is fully embedded it is anticipated that the new system will support the delivery of improved and modernised services to patients, with higher quality care provided to more patients, more quickly.

The Scottish Executive has recently written to all health boards in NHS Scotland asking for the submission of delivery plans which outline how pay modernisation is being used and will be used to deliver benefits realisation. Health boards have been asked to submit their initial plans by 30 September 2005, with a further six months progress report to be submitted by 31 March 2006.

At the end of August 2005 NHS Scotland had matched 45% of its staff to national job profiles. While progress has been steady, NHS Scotland acknowledge that, in common with the other UK Health Services, not all staff will be assimilated to new pay bands by the original UK target date of end September.

Partnership discussions have taken place with a view to establishing a framework which will achieve assimilation of staff to new Agenda for Change pay bands as soon as possible, while retaining the quality assurance and consistency checking which is carried out at local and national levels. In this respect, the Scottish Executive Health Department has asked all health boards to submit tightly timetabled progress plans. Progress plans, both at health board level and across NHS Scotland, will be performance managed by the Scottish Executive.

The Scottish Pay Reference and Implementation Group have made a number of recommendations to health boards with a view to improving progress towards implementation. These are:

Concentrating efforts, in the first instance, on the large job families and those posts which will match straightforwardly;

Developing a separate timetable for Special Health Boards, and

Establishing regional or national job evaluation panels for common posts requiring local evaluation.

An electronic tool which will assimilate staff to the new Agenda for Change pay bands has been designed, and will be rolled out to the service in the week commencing the 26 September.

NHS Scotland remains committed to implementing Agenda for Change as quickly and effectively as possible, while ensuring that the process of implementation and its outcomes are fair, balanced and consistent.

The Invitation to Tender for the next Northern Isles ferry service contract invites tenderers to bid on the basis that the Transfer of Undertakings (Protection of Employment) Regulations (TUPE) apply as set out in answer S2W-19203. There would not, therefore, appear to be any need for redundancy in these circumstances. However, if it were concluded that TUPE did not apply, responsibility for any redundancy payments would rest with the current operator. If any redundancy payment arose in the course of the next contract period, it would be a matter for the contractor in the light of the terms of the staff contracts involved. Under the draft grant agreement, the grant available would be reduced if subsequently the support required fell because of consequential staff cost savings.

The Invitation to Tender for the next Northern Isles ferry service contract recognises the importance of the process for the existing marine staff, shore staff and management. Tenderers are required to provide details of their proposals on staffing in their tender documents. The Invitation to Tender also refers to the importance of the Transfer of Undertakings (Protection of Employment) Regulations (TUPE), and advises that, while the issue remains a matter for interpretation of law, tenderers are invited to bid on the basis that TUPE applies.

The contract between NorthLink and the Scottish ministers for the delivery of lifeline ferry services to the Northern Isles does not cover relations between NorthLink and its staff. Accordingly, while we do receive occasional information on matters relating to the management of staff, we do not routinely monitor all matters affecting the terms and conditions of employment of NorthLink staff. Despite their offshore status, NorthLink’s staff are still protected by UK employment law.

There are several reasons. The grant agreement of December 2000 between the Scottish ministers and NorthLink provided that NorthLink would receive a Base Annual Grant for each year of the contract towards the provision of the approved services. Those Base Annual Grant figures were expressed in April 2000 prices and the grant agreement provided that they would be re-valued annually to reflect inflation, using the Retail Price Index. The figure of £29.7 million quoted in the question is simply an addition of the first three Base Annual Grant figures at April 2000 prices and so takes no account of inflation since then.

The grant agreement also provided that NorthLink would be entitled to claim additional grant reflecting material changes in certain costs such as harbour dues, staff costs and fuel prices which could not be accurately calculated at the time the contract was signed. The £29.7 million figure, again, makes no provision for these factors.

NorthLink also advised the Scottish Executive that its business plans had been affected by a variety of other factors for which there was no recourse through the material change provisions in the grant agreement. These included: the commencement of a new, competing ferry service across the Pentland Firth in the period between the signing of the grant agreement and the start of the NorthLink service; the loss of Shetland freight business to a competing operator during 2002-03; delays to the completion of Scrabster Harbour which meant that the MV Hamnavoe had to be laid up for six months, and a number of additional cost factors which became apparent when the service came into operation.

In order to keep the essential lifeline services operating, the Executive agreed to pay additional subsidy to NorthLink, over and above the contracted sums, but this was on the basis of an early re-tendering of the contract and the provision of the minimum support necessary to secure the continuity of the services.

The continuation of high-level achievement in meeting the Quality and Outcomes Framework standards and providing additional services through the nGMS Contract provides positive benefits for the quality of the lives of many people across Scotland.

For Example:

Practices are rewarded for developing registers for patients with each of 10 chronic diseases and to show evidence of high-quality care of these conditions. Systematic call and recall of these patients is integral to this process, so that patients can be monitored and treated in accordance with expert guidance to optimise their care and prevent complications, minimising the need for referral to secondary care. Good chronic disease management is likely to reduce un-scheduled admissions to hospital.

The QOF improves and encourages screening for all patients by incentivising up to date information about blood pressure, smoking status and past medical history so that patients in need of interventions can be targeted. It continues to incentivises  practices to conduct cervical screening (smear tests) and to screen children in accordance with guidance.

Enhanced services for flu and pneumococcal immunisation and for childhood immunisations, as well as the QOF, encourage practices to invite those eligible for these programmes for the appropriate intervention.

There are a number of mechanisms already in place and being developed to measure the public benefit of the new General Medical Services (GMS) contract.

1. The national Pay Modernisation Team has developed an NHS Scotland-wide nGMS Implementation Tool to measure NHS boards’ progress in delivering the GMS contract. The information from this process is fed into the NHS board annual review process and action plans at both local and national level are being developed to address any issues from this which will improve delivery of services under the GMS contract to the public.

2. Pay Modernisation Delivery Plans being submitted by NHS boards provide an opportunity to assess benefits and to ensure key issues are addressed both locally and nationally.

3. The Quality and Outcomes Framework provides a comprehensive set of quality indicators that measure standard of quality care provided to patients and organisational achievements.

4. NHS QIS has produced standards for the provision of safe and effective out-of-hours primary medical services to the public and these are evaluated to ensure they meet the required levels .

5. Service specifications of enhanced services require providers to submit information to their NHS boards to support clinical and financial governance frameworks.

6. NHS boards continue to develop systems to identify the impact of provision of enhanced services to patients and the general public.

7. The performance of the GMS contract, including the delivery of patient benefits, is also discussed as part of the annual review for each NHS board.

The Scottish Executive has no current plans to provide revenue or capital support to the Aberdeen Exhibition and Conference Centre.

The Scottish Executive issued a Health Department Letter (HDL(2005)28) on delivering the benefits of Pay Modernisation in July 2005. The HDL asked boards to submit Pay Modernisation Benefits Delivery Plans by 30 September 2005. This will allow the department to measure the effective delivery of the three strands of pay modernisation (Consultant Contract, Agenda for change and General Medical Services contract).

The Pay Modernisation Team are working with Audit Scotland who are currently undertaking an audit of the implementation of the consultant contract and a full report is expected to be published early in 2006.

The Executive hold an annual review with each health board. These reviews are held in public and are this year conducted by the Minister for Health and Community Care. Due to its high priority, Pay Modernisation is one of the items which boards are specifically asked to cover in their review.