NHS 24 'dysfunctional', Scotland's top health official Paul Gray tells Scottish Parliament committee

Scotland’s most senior health official labelled medical helpline NHS 24 a “dysfunctional organisation” after costly contractual flaws with its new call handling and IT system were not escalated for almost two years.

NHS 24 withdrew its Future Programme from service last November and moved back to its legacy system amid concerns for patient safety.

It came after Audit Scotland raised concerns over delivery of the new system – which had already been pushed back from October 2013 – amid an estimated cost of £117.4m, 55 per cent higher than the original estimate of £75.8m.

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NHS Scotland chief executive Paul Gray yesterday acknowledged that the overspend could potentially rise to £49.2m "depending on what the ultimate implementation is" as he appeared before Holyrood’s Public Audit Committee.

"As the accountable officer for the health budget, I both understand and accept the committee's expressed anger and frustration at the very substantial delays and cost increases associated with the NHS 24 Future Programme, and I am very sorry indeed about this," he said.

MSPs previously heard that NHS 24 staff identified gaps in the IT contract in April 2012 – a month after it was signed – though the then chief executive was not informed until 22 months later. 

Gray said: "I'm aware that the knowledge of the deficiencies in the contract was with staff in NHS 24 sometime before the chief executive and the chair were told… The chair and the chief executive did not know until January 2014."

Conservative MSP Mary Scanlon said: "Are you not concerned that not only did you not know that they were running towards a £50m overspend, the director of finance did not know, the chief executive did not know, and a member of staff employed a leading legal company to try and negotiate this contract that you were unaware of, the officers, director of finance and chief executive, were unaware of?"

Gray said: "It causes me grave concern… An organisation in which a member of staff knows something of that significance and does not escalate it immediately to the board is a dysfunctional organisation.

"It would be my concern, therefore, to ensure that no organisation for which I am responsible behaves in such a way that a member of staff feels they cannot escalate an issue of that significance to the board."

On the issue of performance, Gray told MSPs that the scheduled care element of the system – which became operational on October 28 – worked, however the organisation “had not invested enough in the training of the staff” in preparation for the out-of-hours element being switched on. 

“The staff were not sufficiently familiar with the system for it to operate at the speed that was required to give the turn-round to the patients who were calling in,” the NHS chief executive said. Gray personally saw staff “struggling to operate the system at the rate at which it should be operated” during a visit, MSPs were told.

The initial contract was “optimistic in its prediction of how complicated it would be and how much it would cost”, he said, citing failure to include an allowance for inflation and any contingency. “Again I believe both of these decisions to be wrong,” Gray added.

It was also tested with more experienced staff and one-to-one support, which presented an inaccurate picture. “That was a misjudgment by NHS24 of the amount of training that would be needed and they took too much confidence from the effective running and testing,” he said.

Committee convener Paul Martin asked Gray if he felt he had "let down the Scottish Government in terms of the information that you provided to them to allow this overspend to take place over the last three years”.

Gray, who also serves as director general for health and social care,​ said: "I've been the accountable officer for two years and two months, but that doesn't alter the fact that ultimately I am responsible for the total sum.

"The decisions that were taken in relation to what got us here were taken before I was the accountable officer, but nevertheless I am the accountable officer now and I am accepting responsibility."