MSPs Tell Cabinet Secretary Of Their Concern Over The Monitoring Of Nhs Board Performance

2nd December 2019

Better monitoring of NHS board performance is needed to identify and address failings, according to a letter issued on 28th November 2019 by the Scottish Parliament's Health and Sport Committee. The Committee state that failure to monitor performance has had significant impacts on service delivery and the public purse.

The Health and Sport Committee have been scrutinising each of the territorial health boards over the past two years and their letter to Jeane Freeman MSP, Cabinet Secretary for Health and Sport, highlights common themes and failings from those evidence sessions.

In the letter, the Committee express concerns over the financial performance and sustainability of NHS Boards. It highlights NHS Ayrshire and Arran, NHS Borders and NHS Highland specifically, who have all received financial aid from the Scottish Government in recent years.

NHS Ayrshire and Arran confirmed that they received £23 million in brokerage from the Scottish Government in 2017 and will continue to need financial aid. While NHS Borders stated they would need between £15m and £20m from the Scottish Government in 2019/20 and NHS Highland confirmed that brokerage of £18 million was received from Scottish Government in 2018/19.

The letter also highlights that seven out of the ten health boards the Committee took evidence from had significant challenges relating to delayed discharge, where beds are occupied by patients ready to be discharged into the community.

The number of delayed discharges in Scotland has increased in the last year from 493,614 to 521,215, an increase of 6% overall and the letter calls for it to be tackled as an ‘utmost priority'.

Patient waiting times are another ongoing issue for the various boards. Cancer patients awaiting treatment was a recurring theme across all boards, while over half of the NHS boards scrutinised failed to meet the target of 90% of patients waiting no longer than 18 weeks from referral to treatment for Child and Adolescent Mental Health Services (CAMHS).

Lewis Macdonald MSP, Convener of the Health and Sport Committee, said: "Our evidence sessions with the various NHS Boards have revealed a number of concerning issues which must be addressed.

"We want to see better monitoring of NHS Board performance, identifying issues early and addressing those issues.

“All of our NHS Boards face financial pressures, but we know that several of them are repeatedly missing financial targets and needing to receive financial aid from the Scottish Government to provide services.

“Delayed discharge numbers continue to rise and this is clearly a concerning trend which needs to be tackled immediately. Patient waiting times, particularly around cancer treatment and access to mental health services, are also rising and we want to know the reasons for this."

The Committee also highlight the significant challenges NHS boards face around recruitment. NHS Dumfries and Galloway, as an example, had one of the highest consultant vacancy rates in the country at 20.9%, with all vacancies long term (six months or more).

High vacancy rates were said to directly impact morale and the mental health and well-being of existing medical staff, which can in turn increase absence and sickness levels. This also impacts on agency or locum spend. In 2018/19, NHS Highland spent £12.8million on medical agency staff which was an increase of 8.3% on the previous year.

Additionally, the letter illustrates the lack of progress in the integration of health and social care amongst NHS boards. The Committee say they haven’t seen any evidence that this is happening across all boards and that strong senior leadership is required to bring about this transformational change in health and social care services.