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

1. It would be useful to ensure that you have copies of the joint trade union guide (available from the UNISON website) and Appendix 2 of the Transforming Community Services: Enabling New Patterns of Provision guidance to hand when doing this presentation as the page references at the top of each slide refer to these documents and indicate where further information can be obtained. It would be useful to ensure that you have copies of the joint trade union guide (available from the UNISON website) and Appendix 2 of the Transforming Community Services: Enabling New Patterns of Provision guidance to hand when doing this presentation as the page references at the top of each slide refer to these documents and indicate where further information can be obtained.

2. Today�s 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? This slide sets out what will be covered in briefing. Highlights opportunity to ask questions at three points in briefingThis slide sets out what will be covered in briefing. Highlights opportunity to ask questions at three points in briefing

3. 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 Broad govt agenda: promoting choice / plurality of providers July 2005 � Commissioning a Patient-Led NHS stated that PCTs must divest. Govt climbed down after immense pressure from TUs/PCTs 2006 � Our Health Our Care Our Say: included more stakeholder engagement (narrow focus groups) � heavy promotion of choice 2007 � World Class Commissioning � based on idea that PCTs should focus less on provision and more on commissioning from a range of providers � encouraging market in NHS TCS: takes this agenda to a new level. PCTs must separate their provider and commissioning functions. Main document in the TCS programme is Enabling New Patterns of Provision, which sets out details of provider models available to PCTs UNISON / TU involvement so far: Twin track approach Campaigning against outsourcing of services, but need to ensure protections in place if staff do transfer All health TUs had input into Annex 2 of TCS document, to ensure protections in place and staff consultation paramount, but we do not support the changes taking place Broad govt agenda: promoting choice / plurality of providers July 2005 � Commissioning a Patient-Led NHS stated that PCTs must divest. Govt climbed down after immense pressure from TUs/PCTs 2006 � Our Health Our Care Our Say: included more stakeholder engagement (narrow focus groups) � heavy promotion of choice 2007 � World Class Commissioning � based on idea that PCTs should focus less on provision and more on commissioning from a range of providers � encouraging market in NHS TCS: takes this agenda to a new level. PCTs must separate their provider and commissioning functions. Main document in the TCS programme is Enabling New Patterns of Provision, which sets out details of provider models available to PCTs UNISON / TU involvement so far: Twin track approach Campaigning against outsourcing of services, but need to ensure protections in place if staff do transfer All health TUs had input into Annex 2 of TCS document, to ensure protections in place and staff consultation paramount, but we do not support the changes taking place

4. 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 These are the key dates as laid out by the DH in the TCS document. Some PCTs are ahead of or behind the timetable Whichever stage the PCT is at, there should have been full staff engagement along the way April 2009: by now PCTs should have separated into commissioner and provider arms: purchaser/provider split. They may have adopted different names e.g. Anytown Health and Anytown PCT, for the different arms but still remain part of the PCT. This focus on creating commissioning and contracting dynamic has been promoted by DH in the belief that more providers, and therefore competition, in the market will improve services. Separate governance arrangements, though PCT board ultimately accountable SLA introduced between commissioning arm and provider arm � based on NHS Standard contract By Oct 09: decisions on forming a social enterprise or CFT need to be made at this stage PCT as commissioner also needs to begin contacting local providers and removing anti-competitive obstacles into the �market� PCTs should be considering how to package services � with firm decisions to be made at a later date From Oct 09: Service reviews should be undertaken, where the PCT should consider whether services will be provided in same way or there is scope for improvement Market analysis: this should look at whether there were potential/alternative providers for services the PCT needs to provide Any Willing PCT-accredited Provider (AWPP). PCTs as commissioners will accredit willing providers � in line with the PCT�s commissioning strategy. Two-part process: 1) PCT needs to decide which services will be subject to procurement 2) Which providers will be accredited to bid for work During 2010: PCTs need to develop their implementation plan for the decision taken These are the key dates as laid out by the DH in the TCS document. Some PCTs are ahead of or behind the timetable Whichever stage the PCT is at, there should have been full staff engagement along the way April 2009: by now PCTs should have separated into commissioner and provider arms: purchaser/provider split. They may have adopted different names e.g. Anytown Health and Anytown PCT, for the different arms but still remain part of the PCT. This focus on creating commissioning and contracting dynamic has been promoted by DH in the belief that more providers, and therefore competition, in the market will improve services. Separate governance arrangements, though PCT board ultimately accountable SLA introduced between commissioning arm and provider arm � based on NHS Standard contract By Oct 09: decisions on forming a social enterprise or CFT need to be made at this stage PCT as commissioner also needs to begin contacting local providers and removing anti-competitive obstacles into the �market� PCTs should be considering how to package services � with firm decisions to be made at a later date From Oct 09: Service reviews should be undertaken, where the PCT should consider whether services will be provided in same way or there is scope for improvement Market analysis: this should look at whether there were potential/alternative providers for services the PCT needs to provide Any Willing PCT-accredited Provider (AWPP). PCTs as commissioners will accredit willing providers � in line with the PCT�s commissioning strategy. Two-part process: 1) PCT needs to decide which services will be subject to procurement 2) Which providers will be accredited to bid for work During 2010: PCTs need to develop their implementation plan for the decision taken

5. 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 As part of TCS, Strategic Health Authorities (mention your regional one) appear to have been given a greater implementation role. Govt is obviously concerned that PCTs may be resistant to TCS changes. SHAs will encourage competition. SHAs will facilitate co-operation between PCTs looking at joint options e.g. London SHA � encouraging PCTs to work together on joint options such as mergers. The number of direct provider organisations in London has reduced over the past year from 37 to 21 and is likely to fall further through mergers or management arrangements. SHAs will test whether PCT proposals meet govt competition criteria. If proposals do not meet criteria, PCT will be asked to amend them. However, if still disagreement, SHA may seek input from Co-operation and Competition Panel (CCP) � new govt appointed body. CCP also set to adjudicate where private companies complain about anti-competitive behaviour e.g. if PCT awards a contract without tendering for bids. CCP, tellingly, is sometimes referred to simply as Competition Panel. SHA will agree Implementation plans with PCT. If PCT is not engaging with staff/TUs, SHA should intervene (this will be dealt with in final section) SHA must approve plans for social enterprise and CFT.As part of TCS, Strategic Health Authorities (mention your regional one) appear to have been given a greater implementation role. Govt is obviously concerned that PCTs may be resistant to TCS changes. SHAs will encourage competition. SHAs will facilitate co-operation between PCTs looking at joint options e.g. London SHA � encouraging PCTs to work together on joint options such as mergers. The number of direct provider organisations in London has reduced over the past year from 37 to 21 and is likely to fall further through mergers or management arrangements. SHAs will test whether PCT proposals meet govt competition criteria. If proposals do not meet criteria, PCT will be asked to amend them. However, if still disagreement, SHA may seek input from Co-operation and Competition Panel (CCP) � new govt appointed body. CCP also set to adjudicate where private companies complain about anti-competitive behaviour e.g. if PCT awards a contract without tendering for bids. CCP, tellingly, is sometimes referred to simply as Competition Panel. SHA will agree Implementation plans with PCT. If PCT is not engaging with staff/TUs, SHA should intervene (this will be dealt with in final section) SHA must approve plans for social enterprise and CFT.

6. Questions How was internal separation within your PCT managed and were you/staff side involved in the process? Any other questions so far? Useful here to get feedback on local situationsUseful here to get feedback on local situations

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? In next few slides we�ll look at all the models as set out in TCS document and consider what they will look like and what they mean for staff and new startersIn next few slides we�ll look at all the models as set out in TCS document and consider what they will look like and what they mean for staff and new starters

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) These are the options that will be covered in turn over the next few slides. The information provided is UNISON�s interpretation of the information provided in the TCS document, but there are likely to be local variations on many of the modelsThese are the options that will be covered in turn over the next few slides. The information provided is UNISON�s interpretation of the information provided in the TCS document, but there are likely to be local variations on many of the models

9. Arms-length Provider Organisation Separate commissioner and provider arm within PCT Staff and new starters: NHS T&Cs/pension, A4C agreement Viability: government/SHA pressure on PCT to divest further; Co-operation & Competition Panel NHS direct provision Known as ALPOs. Also sometimes referred to as direct provider organisations (DPOs) or autonomous provider organisations. STRUCTURE: PCT maintains services as provider unit within organisation PCT board ultimately accountable STAFF AND NEW STARTERS Best for staff and new starters Keep NHS T&C and pension Come under future A4C negotiations VIABILITY Govt says �still an option� but there is likely to be heavy pressure from SHA and Co-op and Comp Panel (referred to in earlier slide) PCT would need to provide robust justification to keep provider unit in-house WHAT IT MEANS FOR FUTURE OF NHS Directly provided NHS services Known as ALPOs. Also sometimes referred to as direct provider organisations (DPOs) or autonomous provider organisations. STRUCTURE: PCT maintains services as provider unit within organisation PCT board ultimately accountable STAFF AND NEW STARTERS Best for staff and new starters Keep NHS T&C and pension Come under future A4C negotiations VIABILITY Govt says �still an option� but there is likely to be heavy pressure from SHA and Co-op and Comp Panel (referred to in earlier slide) PCT would need to provide robust justification to keep provider unit in-house WHAT IT MEANS FOR FUTURE OF NHS Directly provided NHS services

10. 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 STRUCTURE Health centres providing GPs, nurses, AHPs, minor surgery etc Can be GP-run or private company-run Polyclinics initially suggested in review of NHS services in London � where GP services would be brought together into polyclinics (with some GPs forced to closed) and some diagnostic functions moved away from acute hospitals and into polyclinics Govt has said that outside London, any GP-led health centres will provide extra capacity only and will mean the closure of any GP surgeries STAFF: If GP-run: Staff would be TUPE�d to GP practice as practice staff. Entitled to NHS Pension scheme If private co.-run: TUPE applies but no entitlement to NHSPS NEW STARTERS: If GP-run: NHSPS; Cabinet office code of practice on workforce matters applies (as part of NHS standard contract): gives new joiners working on NHS contract - overall T&Cs no less favourable If private co.-run: Cabinet office code applies and �reasonable pension� must be provided VIABILITY: As with any private company - vulnerable to business failure or takeover by another co. WHAT IT MEANS FOR FUTURE OF NHS: GP practice � existing model in NHS; private co. run: fragmentation/privatisation; poorer T&C in long term and TU recognition may be problematic STRUCTURE Health centres providing GPs, nurses, AHPs, minor surgery etc Can be GP-run or private company-run Polyclinics initially suggested in review of NHS services in London � where GP services would be brought together into polyclinics (with some GPs forced to closed) and some diagnostic functions moved away from acute hospitals and into polyclinics Govt has said that outside London, any GP-led health centres will provide extra capacity only and will mean the closure of any GP surgeries STAFF: If GP-run: Staff would be TUPE�d to GP practice as practice staff. Entitled to NHS Pension scheme If private co.-run: TUPE applies but no entitlement to NHSPS NEW STARTERS: If GP-run: NHSPS; Cabinet office code of practice on workforce matters applies (as part of NHS standard contract): gives new joiners working on NHS contract - overall T&Cs no less favourable If private co.-run: Cabinet office code applies and �reasonable pension� must be provided VIABILITY: As with any private company - vulnerable to business failure or takeover by another co. WHAT IT MEANS FOR FUTURE OF NHS: GP practice � existing model in NHS; private co. run: fragmentation/privatisation; poorer T&C in long term and TU recognition may be problematic

11. Community Foundation Trusts (CFT) Most likely established through merger of PCTs Staff and new starters: NHS T&Cs/pension; A4C agreement Viability: must meet minimum requirements to become FT; 3-year funding model NHS direct provision (subject to FT flexibilities) STRUCTURE : Likely to be formed through merger of PCTs as have to meet income threshold of Monitor (FT regulator) Approx 1/3 of PCTs don�t meet minimum income threshold Required to exist as APO for one year before becoming FT Currently lack of clarity from DH about how many CFTs will be allowed to be created. STAFF AND NEW STARTERS: Retain NHS T&Cs/pension; continue to come under NHS AfC negotiations VIABILITY: Potential CFTs have to undergo robust financial viability assessment by Monitor which includes 5-year business plan Will received 3-year contract from PCT WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision � though FTs have greater freedom from DH and SHA control STRUCTURE : Likely to be formed through merger of PCTs as have to meet income threshold of Monitor (FT regulator) Approx 1/3 of PCTs don�t meet minimum income threshold Required to exist as APO for one year before becoming FT Currently lack of clarity from DH about how many CFTs will be allowed to be created. STAFF AND NEW STARTERS: Retain NHS T&Cs/pension; continue to come under NHS AfC negotiations VIABILITY: Potential CFTs have to undergo robust financial viability assessment by Monitor which includes 5-year business plan Will received 3-year contract from PCT WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision � though FTs have greater freedom from DH and SHA control

12. NHS Integration � Vertical Integration PCT provider arm function integrated with local acute trust/FT Staff and new starters: NHS T&Cs/pension, A4C agreement Viability: Pressure from government about monopoly providers; Co-operation & Competition Panel NHS direct provision The next three slides cover various forms of NHS integration STRUCTURE: Provider arm integrated with acute trust either through merger or joint management arrangement Existing FTs keen to take on primary care services Some PCTs appear to be using this model as a holding arrangements until they have decided on their long-term plan. STAFF AND NEW STARTERS : Remain part of NHS retaining all T&Cs VIABILITY: Sustainable as business but primary care services may be sidelined Contradicts govt�s stated direction of travel i.e. bringing community services closer to patients, as it gives power back to acute sector and creates monopoly providers May be pressure from govt, SHA, co-op and comp panel to separate WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision The next three slides cover various forms of NHS integration STRUCTURE: Provider arm integrated with acute trust either through merger or joint management arrangement Existing FTs keen to take on primary care services Some PCTs appear to be using this model as a holding arrangements until they have decided on their long-term plan. STAFF AND NEW STARTERS : Remain part of NHS retaining all T&Cs VIABILITY: Sustainable as business but primary care services may be sidelined Contradicts govt�s stated direction of travel i.e. bringing community services closer to patients, as it gives power back to acute sector and creates monopoly providers May be pressure from govt, SHA, co-op and comp panel to separate WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision

13. NHS Integration � Horizontal Integration Merger of one or more PCT provider arms. May be first step to CFT Staff and new starters: NHS T&Cs/pension, A4C agreement Sustainability challenges: May be pressure to become CFT; Co-operation & Competition Panel NHS direct provision STRUCTURE Merger of one or more PCT provider arms (can also refer to local authority/PCT mergers � but we will deal with that under the integrated care slide. Sometimes refers to integration with mental health trust, though this is also known as diagonal integration) Likely to be first step to CFT Structure will be down to local circumstances STAFF AND NEW STARTERS Remain part of NHS retaining all T&Cs VIABILITY Merged bodies likely to be pressured to become CFT by SHA / govt. TCS document states it would be �inappropriate� to create new NHS trusts which aren�t FTs. WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision STRUCTURE Merger of one or more PCT provider arms (can also refer to local authority/PCT mergers � but we will deal with that under the integrated care slide. Sometimes refers to integration with mental health trust, though this is also known as diagonal integration) Likely to be first step to CFT Structure will be down to local circumstances STAFF AND NEW STARTERS Remain part of NHS retaining all T&Cs VIABILITY Merged bodies likely to be pressured to become CFT by SHA / govt. TCS document states it would be �inappropriate� to create new NHS trusts which aren�t FTs. WHAT IT MEANS FOR FUTURE OF NHS: NHS direct provision

14. NHS Integration � Integrated Care Joint health and social care services between NHS and Local Authority or private provider Staff: - if NHS-run: NHS T&Cs/pension, A4C agreement - if local authority-run: TUPE applies - if private provider: TUPE applies New starters: either NHS or LA T&Cs/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 STRUCTURE: Joining up of health and social care either through joint management, Section 75 partnerships or possible creation of new organisations such as care trusts. Structure dependent on local circumstances. DH announced 16 Integrated Care Organisation pilot sites in April 2009 chosen from 100 applicant sites � aim is to evaluate a range of models of integrated care. Pilot sites include a mixture of PCTs, GP-led initiatives, social care, CVS and private organisations STAFF: If NHS: Remain part of NHS retaining all T&Cs If LA: TUPE / LG pension If private/CVS: TUPE applies NEW STARTERS: Either NHS or LA T&C and pension OR Cabinet office code applies VIABILITY: Business failure possible / Disagreement over pooled budgets WHAT IT MEANS FOR FUTURE OF NHS: If NHS/LA-run: NHS remains in public sector If private/CVS: fragmentation/privatisation STRUCTURE: Joining up of health and social care either through joint management, Section 75 partnerships or possible creation of new organisations such as care trusts. Structure dependent on local circumstances. DH announced 16 Integrated Care Organisation pilot sites in April 2009 chosen from 100 applicant sites � aim is to evaluate a range of models of integrated care. Pilot sites include a mixture of PCTs, GP-led initiatives, social care, CVS and private organisations STAFF: If NHS: Remain part of NHS retaining all T&Cs If LA: TUPE / LG pension If private/CVS: TUPE applies NEW STARTERS: Either NHS or LA T&C and pension OR Cabinet office code applies VIABILITY: Business failure possible / Disagreement over pooled budgets WHAT IT MEANS FOR FUTURE OF NHS: If NHS/LA-run: NHS remains in public sector If private/CVS: fragmentation/privatisation

15. 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 STRUCTURE: PCTs likely to hive off individual bundles of services to put out to tender. They may choose just to sell off a few services. However, already seeing some PCTs where they intend to carve up their entire provider arm into individual bundles to be put out to tender. Private sector likely to cherry-pick profitable services STAFF: Staff TUPE transferred across; no NHS Pension; no automatic link to future AfC negotiations Some employers may try to claim economic, technical or organisational (ETO) reasons for getting round TUPE protections. Legal advice should be sought if this is tried. TU recognition likely to be more difficult NEW STARTERS: Cabinet office code applies VIABILITY: Vulnerability to business failure will depend on how profitable service is WHAT IT MEANS FOR FUTURE OF NHS: NHS services not directly provided and run for profit; fragmentation of NHS; NHS may have to foot the bill if companies fail STRUCTURE: PCTs likely to hive off individual bundles of services to put out to tender. They may choose just to sell off a few services. However, already seeing some PCTs where they intend to carve up their entire provider arm into individual bundles to be put out to tender. Private sector likely to cherry-pick profitable services STAFF: Staff TUPE transferred across; no NHS Pension; no automatic link to future AfC negotiations Some employers may try to claim economic, technical or organisational (ETO) reasons for getting round TUPE protections. Legal advice should be sought if this is tried. TU recognition likely to be more difficult NEW STARTERS: Cabinet office code applies VIABILITY: Vulnerability to business failure will depend on how profitable service is WHAT IT MEANS FOR FUTURE OF NHS: NHS services not directly provided and run for profit; fragmentation of NHS; NHS may have to foot the bill if companies fail

16. 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 STRUCTURE: Various business structures that SEs can adopt including community interest company, charity and industrial and provident society Govt � keen to promote social enterprise as acceptable face of competition and marketisation Given staff �right to request� forming a SE where any willing staff can put together business plan for their service to become SE In practice - very little interest from staff. Most proposals on SEs have been management-led Some PCTs looking to transfer whole provider arm over to SE. Other PCTs may encourage particular groups of staff to exercise their right to request. SEs existed for long-time providing niche role, organically grown to fill gaps within NHS provision. Push from govt is for SEs to become mainstream health care providers and take over role of NHS, rather than just complement it. STAFF: Staff will be TUPE transferred; no automatic link to future A4C negotiations; NHSPS only for transferred staff undertaking solely NHS work. So if a member of staff begins work on non-NHS work � they will no longer be entitled to membership of NHSPS Q&A is available in DH document: Making a Difference � a guide to Right to Request NEW STARTERS: Cabinet office code applies; no entitlement to NHSPS VIABILITY: Dependent on length of contract with PCT � may be offered 3-yr uncontested contract or 5-year contract with conditions or may be contracted under AWPP model where it will keep the contract as long as it meets agreed standards and prices Study by Global Entrepreneurship Monitor in 2008 said social enterprise companies are twice as likely to fail as conventional for-profit companies. Given current economic climate this may be even greater. No guarantee staff will be transferred back into NHS if business fails. Central Surrey Health � first social enterprise pathfinder. Held up as example of effective social enterprise. However, DH was keen for it not to fail so trade unions were offered many guarantees. This won�t be replicated in other SEs Private sector already complaining about uncontested contracts for social enterprises and may see these challenged by the CPP. WHAT IT MEANS FOR FUTURE OF NHS: Fragmentation of NHS, not publicly provided, service providers competing against.STRUCTURE: Various business structures that SEs can adopt including community interest company, charity and industrial and provident society Govt � keen to promote social enterprise as acceptable face of competition and marketisation Given staff �right to request� forming a SE where any willing staff can put together business plan for their service to become SE In practice - very little interest from staff. Most proposals on SEs have been management-led Some PCTs looking to transfer whole provider arm over to SE. Other PCTs may encourage particular groups of staff to exercise their right to request. SEs existed for long-time providing niche role, organically grown to fill gaps within NHS provision. Push from govt is for SEs to become mainstream health care providers and take over role of NHS, rather than just complement it. STAFF: Staff will be TUPE transferred; no automatic link to future A4C negotiations; NHSPS only for transferred staff undertaking solely NHS work. So if a member of staff begins work on non-NHS work � they will no longer be entitled to membership of NHSPS Q&A is available in DH document: Making a Difference � a guide to Right to Request NEW STARTERS: Cabinet office code applies; no entitlement to NHSPS VIABILITY: Dependent on length of contract with PCT � may be offered 3-yr uncontested contract or 5-year contract with conditions or may be contracted under AWPP model where it will keep the contract as long as it meets agreed standards and prices Study by Global Entrepreneurship Monitor in 2008 said social enterprise companies are twice as likely to fail as conventional for-profit companies. Given current economic climate this may be even greater. No guarantee staff will be transferred back into NHS if business fails. Central Surrey Health � first social enterprise pathfinder. Held up as example of effective social enterprise. However, DH was keen for it not to fail so trade unions were offered many guarantees. This won�t be replicated in other SEs Private sector already complaining about uncontested contracts for social enterprises and may see these challenged by the CPP. WHAT IT MEANS FOR FUTURE OF NHS: Fragmentation of NHS, not publicly provided, service providers competing against.

17. 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 The DH has said they are not prescribing a model for PCT provider arms. However it is clear that PCTs keeping their provider units in-house will come under heavy pressure to use a different organisational model. There has also been heavy promotion of the �right to request�. SEs have been offered 3-year uncontested contracts and the govt is promoting them heavily. The govt has also set up the CCP, the aim of which is to promote competition and new providers in primary care.The DH has said they are not prescribing a model for PCT provider arms. However it is clear that PCTs keeping their provider units in-house will come under heavy pressure to use a different organisational model. There has also been heavy promotion of the �right to request�. SEs have been offered 3-year uncontested contracts and the govt is promoting them heavily. The govt has also set up the CCP, the aim of which is to promote competition and new providers in primary care.

18. This slide shows the key dates in diagrammatical form and what the primary care market will look like by 2010.This slide shows the key dates in diagrammatical form and what the primary care market will look like by 2010.

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? These questions are a chance to gauge what level of pressure there has been on PCT staff to consider social enterprise.These questions are a chance to gauge what level of pressure there has been on PCT staff to consider social enterprise.

20. 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 Point out page references at the top of each slide. This slide outlines Appendix 2 of DH TCS document. Appendix 2 was only included following TU intervention through the national Social Partnership Forum. Point out page references at the top of each slide. This slide outlines Appendix 2 of DH TCS document. Appendix 2 was only included following TU intervention through the national Social Partnership Forum.

21. 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 The requirements on PCTs laid out here are taken from Appendix 2 of the DH TCS guidance. The guidance is very strong on TU engagement and PCTs are expected to follow this. Legal requirements for consultation are set out on p.76 of TCS which states that early engagement must be part of the process Your rights are written into the guidance, which should be quoted at employers if they fail to engage with staff. If PCTs still not engaging with staff, you should consider raising your concerns with your RO and the SHA.The requirements on PCTs laid out here are taken from Appendix 2 of the DH TCS guidance. The guidance is very strong on TU engagement and PCTs are expected to follow this. Legal requirements for consultation are set out on p.76 of TCS which states that early engagement must be part of the process Your rights are written into the guidance, which should be quoted at employers if they fail to engage with staff. If PCTs still not engaging with staff, you should consider raising your concerns with your RO and the SHA.

22. 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 This slide sets out the TU view on what we expect should happen during the TCS process. PCTs and SHAs must ensure that staff and TUs are engaged with at an early stage in the process. Staff must be integral to decision making process and proposals should not be presented to staff as a fait accompli. PCTs and SHA should agree a full timetable with TUs, setting out key points at which staff are able to input into proposals. Branches need to ensure that views of members are sought and that members are fully briefed on proposals If PCTs or SHAs are refusing to engage with staff or not listening to their concerns, then we need to mobilise opposition to this through local campaigning. If, as is the case in some PCTs, the employers are pushing ahead with an unrealistic timetable which does not allow adequate time for proper staff and TU involvement, we need to push for an extension of the deadlines.This slide sets out the TU view on what we expect should happen during the TCS process. PCTs and SHAs must ensure that staff and TUs are engaged with at an early stage in the process. Staff must be integral to decision making process and proposals should not be presented to staff as a fait accompli. PCTs and SHA should agree a full timetable with TUs, setting out key points at which staff are able to input into proposals. Branches need to ensure that views of members are sought and that members are fully briefed on proposals If PCTs or SHAs are refusing to engage with staff or not listening to their concerns, then we need to mobilise opposition to this through local campaigning. If, as is the case in some PCTs, the employers are pushing ahead with an unrealistic timetable which does not allow adequate time for proper staff and TU involvement, we need to push for an extension of the deadlines.

23. 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 TCS Appendix 2, Pages 76 &77 TU Guide Page 9 & 10 There are a number of mechanisms available to branches to ensure that early engagement and consultation takes place: At PCT level: existing bodies such as JCCs or local partnership forums could be used or where appropriate or necessary a specific consultative body on TCS should be set up. Some PCT commissioning arms are refusing to engage with branches representing members in provider units, claiming that the provider arm is just one of a number of bidders and that it would be seen as unfair to speak to one bidder and not to another. It is essential that staff views are considered and taken into account as part of any tendering process. It may be necessary to ask a full-time officer to intervene as a �neutral� representative if the commissioner refuses branch engagement. It may also be useful to tap into members in the commissioning arm and an MiP members too. SHA level: SHAs are expected to have an oversight and review role. Regional social partnership forums are a useful channel through which to consider and engage with PCT proposals On P.10 of the joint union guide, we have included a list of key questions that you may want to ask your employer if you have not been included in the decision making process so far. The questions are by no means exhaustive and should be used in conjunction with any questions that may be relevant to your particular workplace. There are a number of mechanisms available to branches to ensure that early engagement and consultation takes place: At PCT level: existing bodies such as JCCs or local partnership forums could be used or where appropriate or necessary a specific consultative body on TCS should be set up. Some PCT commissioning arms are refusing to engage with branches representing members in provider units, claiming that the provider arm is just one of a number of bidders and that it would be seen as unfair to speak to one bidder and not to another. It is essential that staff views are considered and taken into account as part of any tendering process. It may be necessary to ask a full-time officer to intervene as a �neutral� representative if the commissioner refuses branch engagement. It may also be useful to tap into members in the commissioning arm and an MiP members too. SHA level: SHAs are expected to have an oversight and review role. Regional social partnership forums are a useful channel through which to consider and engage with PCT proposals On P.10 of the joint union guide, we have included a list of key questions that you may want to ask your employer if you have not been included in the decision making process so far. The questions are by no means exhaustive and should be used in conjunction with any questions that may be relevant to your particular workplace.

24. 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 CS Appendix 2, Pages 77 &78 TU Guide Page 11 & 12 This slide sets out some other issues that you may need to consider during consultation P. 77 in the TCS guidance, paragraph A63 states that �no employees should receive less favourable treatment on the grounds age, gender, marital status, race, religion etc�� The PCT has a public sector duty to undertake an assessment of the impact on equality of any change and the impact on the workforce. Many employers may be less familiar with Equality Impact Assessments than branches and so it is important to ensure that this duty is flagged up with the employer and that the branch is satisfied with the scope and depth of the assessment. If the Equality Impact Assessment can show that one particular group appears to be adversely or disproportionately affected by any changes then there may be grounds for the assessment to be used as a block to the changes. The TCS guidance states that the NHS Constitution should be embedded in provider contracts. PCTs should be using the NHS Standard Contract as a template which already has this provision included. There are some suggested key questions that you may want to ask your employer regarding equality and equality impact assessments on P11 of the joint guidance.This slide sets out some other issues that you may need to consider during consultation P. 77 in the TCS guidance, paragraph A63 states that �no employees should receive less favourable treatment on the grounds age, gender, marital status, race, religion etc�� The PCT has a public sector duty to undertake an assessment of the impact on equality of any change and the impact on the workforce. Many employers may be less familiar with Equality Impact Assessments than branches and so it is important to ensure that this duty is flagged up with the employer and that the branch is satisfied with the scope and depth of the assessment. If the Equality Impact Assessment can show that one particular group appears to be adversely or disproportionately affected by any changes then there may be grounds for the assessment to be used as a block to the changes. The TCS guidance states that the NHS Constitution should be embedded in provider contracts. PCTs should be using the NHS Standard Contract as a template which already has this provision included. There are some suggested key questions that you may want to ask your employer regarding equality and equality impact assessments on P11 of the joint guidance.

25. Protection - Pay T&Cs 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 This slide lays out what protections there are for staff T&Cs Where staff transfer TUPE applies, but as stated earlier in the presentation some employers are using the current economic climate to try to vary the conditions of transfer. There are situations where dismissals of staff to be transferred or changes to terms and conditions are allowed. These are for economic, technical or organisational reasons, sometimes referred to as ETO reasons. You should contact your branch or regional office if your employer is claiming that these reasons are relevant to your transfer. Fair pension: If NHS Pension Scheme Members are transferred to a private sector contractor under TUPE then under mandatory guidance from the Treasury called 'Fair Deal for Staff Pensions' the transferred members must be offered a �broadly comparable pension scheme� certified as such by the Government Actuary's Department. It also applies to subsequent transfers between contractors. It means that if on transfer you belong to a ' final salary' scheme like the NHS Pension Scheme you must be offered a comparable but not necessarily identical scheme which must also be 'final salary' with the new employer. The Cabinet Office Code of Practice on Workforce Matters in public sector contracts states that where staff have been transferred, new starters working on that contract will be on terms and conditions, which should be overall no less favourable than the terms and conditions of transferred employees. The Code is designed to prevent the emergence of a 'two-tier workforce', dividing transferees and new joiners working beside each other on the same contracts. The use of the RoE model, whereby staff were seconded to the new organisation to work on the contract, retaining their employment by the NHS organisation has been restricted. Trusts have been advised that currently this is only available for use in ISTC and PFI schemes. P.86-90 of the TCS guide sets out in a table what will happen to T&Cs and pensions for staff and new starters in the various provider models. P.13 of the TU guide sets out some questions regarding TUPE This slide lays out what protections there are for staff T&Cs Where staff transfer TUPE applies, but as stated earlier in the presentation some employers are using the current economic climate to try to vary the conditions of transfer. There are situations where dismissals of staff to be transferred or changes to terms and conditions are allowed. These are for economic, technical or organisational reasons, sometimes referred to as ETO reasons. You should contact your branch or regional office if your employer is claiming that these reasons are relevant to your transfer. Fair pension: If NHS Pension Scheme Members are transferred to a private sector contractor under TUPE then under mandatory guidance from the Treasury called 'Fair Deal for Staff Pensions' the transferred members must be offered a �broadly comparable pension scheme� certified as such by the Government Actuary's Department. It also applies to subsequent transfers between contractors. It means that if on transfer you belong to a ' final salary' scheme like the NHS Pension Scheme you must be offered a comparable but not necessarily identical scheme which must also be 'final salary' with the new employer. The Cabinet Office Code of Practice on Workforce Matters in public sector contracts states that where staff have been transferred, new starters working on that contract will be on terms and conditions, which should be overall no less favourable than the terms and conditions of transferred employees. The Code is designed to prevent the emergence of a 'two-tier workforce', dividing transferees and new joiners working beside each other on the same contracts. The use of the RoE model, whereby staff were seconded to the new organisation to work on the contract, retaining their employment by the NHS organisation has been restricted. Trusts have been advised that currently this is only available for use in ISTC and PFI schemes. P.86-90 of the TCS guide sets out in a table what will happen to T&Cs and pensions for staff and new starters in the various provider models. P.13 of the TU guide sets out some questions regarding TUPE

26. 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) TCS guidance is clear that where staff are transferred the contracts should set out expectations re. training and all statutory requirements such as health and safety and equal ops. These should be enshrined in the contracts. New provider organisations are expected to demonstrate an �appropriate HR strategy� � which will include plans for recruiting and retaining staff, a development and training programme, constructive plan for staff engagement and partnership and disciplinary, grievance and equal opportunity policies equivalent to the NHS. They should also be able to demonstrate a commitment to promote equality of access to Continuous Professional/Personal development. Providers are also expected to carry out annual staff surveys, clarify their approach to continuing recognition of existing TUs as per the NHS Constitution and the 2007 NHS Partnership agremeent These requirements are likely to be off-putting to some organisations and it is important that these are enshrined in any contracts, as stated in the DH guidance. However, it�s important to note that the Govt won�t enforce TU recognition as they have said that it�s the responsibility of the TUs. But the do say that employers should encourage partnership working. TCS guidance is clear that where staff are transferred the contracts should set out expectations re. training and all statutory requirements such as health and safety and equal ops. These should be enshrined in the contracts. New provider organisations are expected to demonstrate an �appropriate HR strategy� � which will include plans for recruiting and retaining staff, a development and training programme, constructive plan for staff engagement and partnership and disciplinary, grievance and equal opportunity policies equivalent to the NHS. They should also be able to demonstrate a commitment to promote equality of access to Continuous Professional/Personal development. Providers are also expected to carry out annual staff surveys, clarify their approach to continuing recognition of existing TUs as per the NHS Constitution and the 2007 NHS Partnership agremeent These requirements are likely to be off-putting to some organisations and it is important that these are enshrined in any contracts, as stated in the DH guidance. However, it�s important to note that the Govt won�t enforce TU recognition as they have said that it�s the responsibility of the TUs. But the do say that employers should encourage partnership working.

27. Key tasks for UNISON branches Find out what�s 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 This slide outlines some suggestions for the key tasks that branches may want to undertake as part of the TCS process.This slide outlines some suggestions for the key tasks that branches may want to undertake as part of the TCS process.

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 This slide outlines what regional officers should be doing along side the branches. Regions should be engaging at Strategic Health Authority level to agree the timetable for any of these changes. Since January 2003, every local authority with social services responsibilities has had the power to scrutinise local health services. Local Authority Health Overview and Scrutiny Committees (OSCs) take on the role of scrutiny of the NHS � not just major changes but the ongoing operation and planning of services. They are the �official consultee� on substantial variations to services and have powers to request information and attendance of PCT officers. If they decide that consultation at local level has been inadequate or they believe the proposals are not in the best interests of the community they can refer matters to the Secretary of State for Health. It�s important to ensure that the public are made aware of any changes through using local media. It�s also important to inform national office so that a clearer picture of what�s happening across England can be seen. As part of the production of the joint guidance, all the NHS trade unions and the TUC expressed strong reservations that the TCS process may lead to fragmentation of NHS services and increased use of the private sector to deliver public services for private profit. They, along with UNISON, believe that this poses a real threat to NHS job security and of potential job losses. This slide outlines what regional officers should be doing along side the branches. Regions should be engaging at Strategic Health Authority level to agree the timetable for any of these changes. Since January 2003, every local authority with social services responsibilities has had the power to scrutinise local health services. Local Authority Health Overview and Scrutiny Committees (OSCs) take on the role of scrutiny of the NHS � not just major changes but the ongoing operation and planning of services. They are the �official consultee� on substantial variations to services and have powers to request information and attendance of PCT officers. If they decide that consultation at local level has been inadequate or they believe the proposals are not in the best interests of the community they can refer matters to the Secretary of State for Health. It�s important to ensure that the public are made aware of any changes through using local media. It�s also important to inform national office so that a clearer picture of what�s happening across England can be seen. As part of the production of the joint guidance, all the NHS trade unions and the TUC expressed strong reservations that the TCS process may lead to fragmentation of NHS services and increased use of the private sector to deliver public services for private profit. They, along with UNISON, believe that this poses a real threat to NHS job security and of potential job losses.

29. Key Reference Documents (web links) Transforming Community Services /www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093197 Next Stage Review /www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 NHS Constitution /www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085814 Social Enterprise - Making a Difference: a guide to the Right to Request /www.dh.gov.uk/en/Publicationsandstatistics/Publications/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 NHS Standard Contracts www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451 This slide provides links to some of the key documents that we�ve mentioned in the presentation.This slide provides links to some of the key documents that we�ve mentioned in the presentation.

30. Any other questions?