Concerns over NHS Highland's ability to make 'urgent and major changes'

Scotland’s Auditor General is concerned about NHS Highland’s capacity to make “urgent and major changes” given the health board’s “significant and long-standing problems”, an Audit Scotland report reveals.

In another report, on NHS Tayside, Auditor General Caroline Gardner has said that board “still faces substantial long-term financial and operational challenges”.

The reports come after the two health boards have been plagued with financial, leadership and operational issues in recent years.

On NHS Highland, this was the Auditor General’s second consecutive report on financial sustainability at the board, and the fourth in six years.

“There are concerns over the wider governance and culture at NHS Highland. The action plan which resulted from the governance review has lacked progress in certain areas,” the report said.

“Scrutiny and challenge by the audit committee has not been effective in addressing areas of risk, and overall risk management arrangements need to be strengthened.”

It found NHS Highland continued to face “serious financial challenges in 2018/19”, and while the board’s financial targets were achieved, it was only through brokerage from the Scottish Government to the tune of £18m.

“If brokerage had not been provided, the board would have reported an overall deficit position of £17.86 million,” the report said.

The report also found “there are high levels of unfilled vacancies in NHS Highland” particularly in primary and secondary care clinical posts, which it concluded could “affect services and creates a reliance on locum staff”.

On leadership, the report said there had been recruitment difficulties in some “key posts”, which had “left gaps in leadership capacity to deliver the financial recovery programme and a lack of clarity in lines of responsibility and accountability within the organisation”.

“Given the board’s past record in addressing problems, and the current leadership and organisational difficulties it faces, I have concerns about the board’s capacity to bring about the necessary change. The board will continue to need extra support in 2019/20, to develop and implement a clear plan to achieve a financially sustainable position and to address the organisational issues it faces. The focus now must be on longer-term sustainable reforms, rather than short-term, reactive changes,” the report found.

Regarding NHS Tayside, this was the fifth consecutive report the Auditor General had provided on the health board, over a “series of significant concerns, covering financial, performance and governance issues”.

The report found NHS Tayside “continues to have an expensive operating model”, but that the board was reduced from “level five escalation – the highest level” to a level four in February this year “after improvements were noted under the new executive leadership team”.

It recommended more work was “required to develop the detail behind the high-level savings and transformation plans”.

Alongside the development of detailed plans, the report said there was “the need for the alignment of appropriate organisational capacity and resources to ensure transformation plans are realised”.

Additionally: “The board needs effective leadership to drive forward its plans for transformation and appointments to key senior management posts are now critical. Transforming the board’s services and costs remains crucial for the board’s future sustainability.”

Gardner said: “It is a positive forward step that NHS Tayside now has a transformation plan, but moving away from the current ways of working will be difficult without well-developed and detailed implementation plans. So far there is little evidence of the sustainable service redesign and transformation that is critical to reducing costs while maintaining or improving services.

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“The future is challenging for NHS Tayside. Effective and stable leadership will be critical in bringing about long-term service transformation.”

In response to the Highlands report, Highlands and Islands Greens MSP John Finnie said he was concerned the Auditor General “does not believe NHS Highland has capacity to bring about the necessary changes”.

“My constituents deserve a quality service, but there is a real risk that, without change, they won’t receive this in the face of ‘complex and ongoing problems’,” Finnie said.

“The Scottish Government must commit to supporting the board as it engages in a process of redesigning services, ensuring that local communities and committed staff are at the heart of discussions on any proposed service changes.”

And on NHS Tayside, Mid Scotland and Fife Greens MSP Mark Ruskell said the report confirmed the health board “faces a challenging future”.

“The Scottish Government must ensure that the health board adequately engages with communities and its committed workforce as it seeks to redesign services,” he said.

“Too often, as with removing emergency surgery from the Perth Royal Infirmary, communication has not been good enough. My constituents expect and deserve a top quality health service and I’ll continue to Press the Health Secretary to ensure that this is delivered.”

Post-Legislative Scrutiny Committee Convener, and Scottish Labour MSP, Jenny Marra said Highland report would “ring alarm bells for the committee”.

“Yet again we hear of issues of financial sustainability, overspending on drugs and adult social care, and unfilled vacancies,” Marra said. “As ever, clear leadership is crucial. The committee will want to explore, with the Auditor General, the level of support being put in place by the Scottish Government to help combat these issues for the long term.”

Marra said the Tayside report showed there was “still a long way to go to secure the future” of the health board, and the committee would explore the issues of “leadership, long term service transformation and the timescale for delivery” raised in the report.

A Scottish Government spokesperson said: “As recognised by Audit Scotland, investment in our health services has grown by six per cent above inflation over the last ten years, and now exceeds £14 billion this year. 

“The 2019/20 baseline resource budget for both NHS Tayside and NHS Highland has increased by 2.9% - to £762.9 million for Tayside and £627.5 million for Highland. We have also increased financial flexibilities for NHS Boards so they can work towards a balanced and sustainable financial position. 

“All Boards have now considered the findings of the Sturrock review and have provided details of the actions they have taken in light of the recommendations. We will ensure staff across our NHS are treated with dignity and respect and that they feel able to raise any concerns.”