Committee
Audit Committee, 02 Apr 2001
02 Apr 2001 · S1 · Audit Committee
Item of business
National Health Service (Tayside)
Mr Jones:
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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 Health: A plan for action, a plan for change" in December; it might be worth spending a couple of moments describing the service's new accountability and performance management arrangements.We are creating 15 new NHS boards, which will be responsible for setting the strategy for an area, for allocating resources to all the NHS organisations within the area and for managing performance. The composition of those boards will include the chairmen and chief executives of all the NHS organisations in the area. As a result, a single boardroom will be responsible for the corporate management of the NHS in an area. That important change will ensure a single agenda, with resources managed to best effect for a particular population.We are in the process of appointing new chairmen to those NHS boards; we have already appointed two—one to Fife, and Peter Bates to Tayside—and the other 13 are being appointed. We want strong leaders to manage the corporate business within an area.We are also moving away from having separate lines of accountability between NHS trusts and health boards and the Scottish Executive. Under the new arrangements, there will be a single local health plan for an area, which will demonstrate not only that national priorities and local issues are being addressed but that all plans are affordable and that resources are being used to best effect in an area.Furthermore, we are introducing a new performance assessment framework for the service, which will address the whole business of an NHS board. As well as addressing financial and efficiency issues, the framework will address how a health board is implementing the health improvement agenda for its population, how it is tackling issues of clinical quality and governance, how it involves the public, how it works with its key partners in the area, principally the local authorities, and how the NHS board manages its staff. That last point is important; as 136,000 people are employed in the NHS, we must send strong messages about how staff should be governed.We will set targets and performance measures in each of the areas that I have described and annually publish every health board's performance against those targets to ensure a public demonstration of the overall performance of a health system.We are also introducing a new, simplified finance regime that will move away from one or two of the remnants of the internal market in the existing finance regime and allow us to take a whole-system approach to managing health service resources within an area. We want to move away from the current situation in which, in some health board areas, one organisation might be in deficit and another in surplus. We want the resources to be managed to best effect for the population through the finance regime.
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...