The Scottish Government

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THE ROLE OF THE CENTRE (SEHD)

This was probably the biggest project ever launched by SEHD. It had potential implications for every household in Scotland. It would impact on 15 Health Boards, on the Scottish Ambulance Service, on Accident & Emergency, Primary Care and Secondary Care systems across the country. Again with hindsight, we are surprised that there was no-one at the centre (within SEHD) with a 'programme manager' type role-- to ensure that this large and complex project was proceeding as planned, to act as facilitator where necessary between Health Boards and NHS 24 where interests - and perhaps even local health delivery systems - were not identical; and not least to ensure that throughout the various stages of NHS 24 development the eye was never taken off the ultimate end product - a high quality service for the public at large. At several points along the way the absence of such a post, again with pure hindsight, meant that relative priorities were not always judged at arm's length.

SEHD did have a representative involved in the development of NHS 24 from the very beginning and who would subsequently, not frequently but regularly, attend Board meetings for more than a year after the new Board was set up. He would also receive copies of the minutes of all Board meetings up to the end of 2004. It seems he saw himself as "the link" between SEHD and the Board of NHS 24 - but not for matters which were within the direct responsibility and accountability of the Special Health Board. However, it might be that the NHS 24 Board assumed that he would keep SEHD updated and informed on any major challenges arising and the Board's response to those challenges. At least one former senior NHS 24 executive has told us that this would have been his assumption.

NHS 24, like every other Health Board and Special Health Board, is a statutory body accountable for its decisions to Ministers. But some of the decisions taken and judgments made by the Special Health Board were so significant - potentially impacting well beyond NHS 24 itself (eg remote and rural) - that one would have expected a formal message to go direct from the NHS 24 Board to the appropriate senior manager within SEHD.

Nevertheless that one example, if valid, possibly raises the question of the reason for and the purpose of an established 'link' representative in the first place. There are clear risks if Health Boards and SEHD do not have a common understanding of the limitations of this "link" role.

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