Committee
Audit Committee, 02 Apr 2001
02 Apr 2001 · S1 · Audit Committee
Item of business
National Health Service (Tayside)
Mr Peter Bates (NHS Tayside):
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Convener, thank you for giving me the opportunity to make a brief statement. As you have said, there has been concern about the health service in Tayside for many years. Indeed, the service's history may be described as turbulent, with many consequences, including, sadly, a loss of trust, particularly in the health board and some constituent parts of our health service. However, in approaching this agenda, we must remember that we have an outstandingly good health service here and a dedicated and committed work force. It is important that we learn from the past so that we can focus on the future.I have spent the past 10 weeks with a number of our consultants, nurses, doctors and general practitioners, with representatives of community groups, patients and local government, and with many others. If I have found one common thread, apart from huge dedication and commitment, it is that there is concern and—I must advise the Audit Committee—loss of morale about the fact that Tayside health service is continually presented as failing. We have to reverse that. I feel strongly that that is a key challenge that I have been set.On behalf of NHS Tayside, I welcome the Auditor General's report, which is fair, measured and accurate. I wish to record formally my appreciation for the way in which the Auditor General and his staff went about preparing the report. Given the nature of some of our difficulties in Tayside, that process could have been damaging, but it was not.As a very newly appointed chairperson on a very steep learning curve, I am determined to lead a process of continuing recovery. Although change has started and will continue—as it needs to do—we face many challenging decisions, as the Auditor General's report covers very well. Indeed, those decisions probably needed to be taken a long time ago.Tayside Health Board needs the support of MSPs, the media, the Executive, the Auditor General and many others to continue the process of recovery. We have made the first steps in a long and complex journey, which must continue in the right direction. That journey is built on the two key principles of far greater honesty and far greater transparency, which is the spirit in which we will approach answering questions and entering into dialogue today.
In the same item of business
The Convener (Mr Andrew Welsh):
SNP
I formally open the meeting in public. I say a big thank you to the staff of Dundee City Council. Even though today is, I believe, a Dundee public holiday, t...
The Convener:
SNP
We now come to the evidence-taking session. This is the first occasion on which the committee has taken evidence on the NHS in Tayside, based on the Auditor ...
Mr Peter Bates (NHS Tayside):
Convener, thank you for giving me the opportunity to make a brief statement. As you have said, there has been concern about the health service in Tayside for...
The Convener:
SNP
The committee expects—and will appreciate—honesty and transparency. Committee members and the general public well understand your comments about the dedicati...
Mr Trevor Jones (Scottish Executive Health Department/Chief Executive of the National Health Service in Scotland):
First, I should point out that those relationships are changing, so if I describe the history, it might also be useful to describe how the new world will loo...
The Convener:
SNP
Who is in charge? Clearly Tayside health services are in a mess, and have been in one for many years. Tayside is the worst-case financial scenario in Scotlan...
Mr Jones:
Ultimately, the minister is responsible for the overall direction of the NHS. As principal accountable officer, I am responsible for the £5 billion health se...
The Convener:
SNP
However, we are still talking about £11.1 million and the worst record with regard to return on capital.
Mr Jones:
Yes, indeed.
The Convener:
SNP
The health department gives £400 million to Tayside authorities. What is to prevent the situation from recurring?
Mr Jones:
We are now putting in much stronger lines of performance management and accountability to the NHS. The committee will be aware that we issued "Our National H...
The Convener:
SNP
You are in full flow; however, the answers are getting rather long. As I do not want to pre-empt future questions, I would like answers to be as clear and as...
Mr Jones:
We have a series of escalating interventions. For all health boards, there is a routine monitoring process to demonstrate how a health system is performing. ...
The Convener:
SNP
Sending in a task force, or replacing a board or a chairman, is closing the stable door after the horse has bolted. It is the disaster scenario.To quote from...
Mr Jones:
With respect, convener, I do not agree that the health department has failed to fulfil its role. As problems have been identified, action has been taken. In ...
The Convener:
SNP
There were continuing problems over many years. I am trying to find out what mechanism exists centrally to do something about problems. I quote from the Audi...
Mr Jones:
I will not repeat the new performance assessment framework because I ran through it in some detail. That new framework will prevent some of the problems that...
Kate MacLean (Dundee West) (Lab):
Lab
I welcome what you have said about the new performance assessment framework, which will be much more robust.I would like you to clarify your answer to the co...
Mr Jones:
Let me repeat that NHS organisations are separate corporate bodies. Their officers are directly accountable to the Parliament for the funds allocated to them...
The Convener:
SNP
The Auditor General's report says that the central mechanism used by the department to hold health boards and trusts to account is the accountability review ...
Mr Jones:
There is a formal accountability review meeting once each year, which reviews the performance of an NHS organisation over the previous 12 months and agrees a...
The Convener:
SNP
Are performance and financial management issues considered in detail and are full records kept?
Mr Jones:
Following the meeting, a formal letter is issued from the chief executive of the NHS to the chairman and the chief executive of the health board. The letter ...
The Convener:
SNP
Let me see whether I have got this right. You have an annual accountability review meeting—one per board area—at which general issues are talked about, but n...
Mr Jones:
I cannot comment on those accountability meetings. I was not there, so I cannot comment on the detail of the discussions. The letter that confirms the agreem...
The Convener:
SNP
It is not very satisfactory to be told in February that all is well and then in July that all is wrong. Do the accountability review meetings highlight perfo...
Mr Jones:
They do—if significant problems are identified. We have a monthly monitoring arrangement with each NHS organisation. John Aldridge will perhaps describe that...
The Convener:
SNP
But it did not. The approach is rather hands-off. Given the problems that have occurred, and given previous management difficulties, I would have thought tha...
Mr Jones:
There is a monthly monitoring process. Mr Aldridge will describe how the problem was identified. As I said, that ran through from May 1999 to the July monito...
Mr John Aldridge (Scottish Executive Health Department):
In addition to the annual accountability review, there are regular meetings—both on the wider performance management agenda and on specific financial perform...