Serious failures in the running of NHS Western Isles and a failure year after year to have in place adequate financial controls are cited amongst key findings in a report published today by the Scottish Parliament’s Audit Committee.
The Committee also describes the current situation whereby Western Isles Health Board has three chief executives - one suspended, one on secondment and one acting - as unacceptable and calls on the Scottish Government to work with the board to resolve the situation urgently.
Over all, the report finds that a number of factors contributed to the financial failings at the board, which had a cumulative deficit of £3.36 million at the end of the financial year 2006/07. These factors included external cost pressures from changes in the wider NHS and issues stemming from the design of health services in the Western Isles.
However, the report finds that the situation was exacerbated by inadequate internal control systems and weak financial management at the board.
The committee goes on to express concern over appointment processes used in the NHS, and considers there to be a lack of transparency in the way people were appointed to temporary posts and secondments. As such, the committee recommends that the Government reviews its appointment processes and procedures for dealing with incompetence, inefficiency and failures in performance.
Committee Convener Hugh Henry MSP said:
“It is clear that there is considerable anger and dismay, especially in the local community, regarding the failures in systems and management that have taken place within Western Isles Health Board over a number of years. It is not acceptable for the same failures to keep occurring year after year, as happened within NHS Western Isles.
“ This committee is deeply concerned by the fact that the board has three chief executives. This must be resolved urgently. We also believe that the Government must review its arrangements for appointing staff to temporary posts and secondments to ensure proper transparency.
“Where failure occurs, it is simply not good enough to keep moving staff on, often to senior positions. There is a worry that this occurrence might reflect a wider culture in the health service of failing to address performance issues and we would be concerned if this also happens in the wider civil service.
“The Permanent Secretary at the Scottish Government should review the procedures for dealing with incompetence and report back to our committee.
“The Committee believes that the Health Directorates must bear part of the responsibility for failures at the board, as they should have ensured that the clinical strategy being pursued by the board was sustainable. The Health Directorates should also have identified the management failures at the board much earlier and taken more decisive action.”
Mr Henry concluded that:
“The committee is, however, impressed by the achievements of the current management team in bringing the board into financial balance. We are concerned, though, that momentum will be lost unless there is consistency of leadership at the board and unless a sustainable and financially affordable clinical strategy is developed”
The committee’s findings include that:
The difficulties within the board occurred over a number of years, despite being brought to the board’s and the Government’s attention in successive audit reports. The committee is concerned that a lack of financial expertise by board members prevented the board from effectively scrutinising the proposals put before them, and the committee recommends that the Government should review the training and development that is provided for health board members across Scotland.
The committee also criticises the former Health Department for failing to ensure that the board developed a model of service delivery which was sustainable and for failing to act quickly enough to address the problems that occurred at the board.
The report concludes that significant progress has been made by the current management team and arrangements for the repayment of the board’s accumulated deficit should therefore be agreed at the earliest opportunity.
The Audit Committee’s recommendations include that:
- The clinical strategy currently being developed by the board must be financially sustainable under the agreed funding formula.
- The Scottish Government Health directorates should review the arrangements for the recruitment, training and support provided to health board members.
- The board must work with the Scottish Government Health Directorates to identify recurrent savings which can be made at the board.
- The Permanent Secretary (Accountable Officer for the Scottish Government ) should review the practice of transfers and secondments across the whole of the public sector, along with the arrangements for dealing with poor performance.
- The Health Directorates should have intervened earlier and the way the Health Directorates interact with health boards should be reviewed.
- There should be a more robust mechanism to ensure health boards’ compliance both with recommendations made by external auditors and with directions provided by the Scottish Government through the annual review process.
This report has been published following the Committee’s inquiry into the Auditor General for Scotland’s report on the 2006/07 Audit of Western Isles Health Board.