Health Secretary in last chance saloon

Health Secretary in last chance saloon

by Elizabeth Smith
article from Monday 23, April, 2018

THE CREATION of the NHS seventy years ago was one of this country’s greatest achievements, mainly because it was a universal service based on clinical need rather than on patients’ income. With the passage of time however, these needs have changed, and with them, the ability of the NHS to deliver on its founding principles. 

In this respect, it is not a matter of party politics. Demographic changes are largely the issue but so too, ironically, is the success of the NHS. With many more people living so much longer as a result of vastly improved treatments, the challenge of delivering universal care will always be one of the most difficult issues confronting any government. There are also many more people living longer with chronic ill health and that includes mental health. 

Many experts and health professionals believe this makes the case for integrated health and social care incontrovertible. In particular, we need to find ways to ensure older people do not overstay their time in hospital if they can be looked after at home and in their communities. It is hard to argue against this, which is why no political party is standing in the way of the integrated service approach.

The debate is raging however, about how that integrated approach should be managed and, in this context, last week could hardly have been worse for the SNP.

I suspect the very serious problems that have been exposed within NHS Tayside and NHS Highland in recent days will have a long way to run until all the detail is uncovered about who authorised some really bad decisions, including the misuse of charitable endowment funds  – something that has rightly appalled the public. Both the official enquiries and the spotlight from the media will eventually spill the beans on who knew what, when, and who made the mistakes.

In the meantime, however, the current controversy has thrown up other issues about the running of NHS boards. How can it be right that those trustees who sit on the boards are responsible for overseeing the spending of taxpayer’s money and also being responsible for overseeing the spending of charitable donations, often given by patients and their families?  This surely presents NHS board trustees with a conflict of interest – a point raised by Scotland’s Auditor General, Caroline Gardner, when she gave evidence to Holyrood’s Public Audit Committee last week.

She made the further point that, such are the financial pressures on the NHS, there are temptations amongst trustees to find ways to “borrow” money from other sources to supplement public money and try to deal with spending shortfalls – hence the conflict of interest is potentially heightened. It is to be hoped that when the Office of the Scottish Charity Regulator (OSCR) makes its report on NHS Tayside by the end of May, it will address this issue as a matter of urgency.

OSCR and the Scottish Government have, of course, questions of their own to address too. How was it that, despite concerns from both internal and external auditors highlighting issues relating to the spending of charitable endowments, a period of four years elapsed before any real action was taken? In a letter to one of my constituents, OSCR confirmed that it did not know about the NHS Tayside scandal until 4th April. It looks as though the Scottish Government wasn’t aware of the issue either until around the same time. This begs the question why public bodies were asleep at the wheel for four long years - something that is inexcusable.

The recent issues also raise concerns about whether the current structure of integrated joint boards is the right way forward. I don’t think there is any secret that all political parties have concerns. Indeed, whilst campaigning in the recent Highland Perthshire by-election, I heard that some SNP councillors want the Health Secretary to address this issue as a matter of urgency such is the volume of complaints they are receiving on the ground. 

Integrated joint boards do not currently have clear lines of responsibility, there appears to be inequity in the balance between health and social services expertise, and the tendering process which allows third sector organisations to play their part in assisting with the provision of services is not working well. This puts councillors in impossible situations when they serve on these boards and it undermines the accountability which all our constituents should expect from their local health boards. 

As was mentioned before, the running of the health service will never be easy but surely it would be given a better chance if ministers could get a grip of what is really wrong with the management process.  Shona Robison, the Health Secretary (pictured), is in the last chance saloon

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