| Description | Interim Report: Review of NHS 24 |
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| ISBN | (Web Only) |
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| Official Print Publication Date | |
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| Website Publication Date | June 02, 2005 |
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THE ROLE OF THE NHS 24 BOARD
We have some sympathy with the NHS 24 Board, not least
with non-executive directors. This huge project had been
running for more than a year before most of them joined the
Board. The Chief Executive, the Finance Director and the
Medical Director had previously been members of the Project
Board executive team.
Moreover, even in February 2002, this Special Health
Board was overseeing a 'design-and-build' development of a
call centre network involving very modern technology and
with a very tight roll-out timetable. We readily pay
tribute to the Board for delivering the network of modern
contact centres that should bring significant benefits to
the people of Scotland for many years to come.
That said, we are concerned that on some important
issues, the vital governance "constructive challenge" role
of non-executive directors was not, according to their own
Board minutes, particularly evident.
The relevant minutes record no non-executive challenge
to the executive team's submission on remote and rural
areas described earlier. The paper was approved by the
Board.
At the June 2002 meeting, the Chief Executive reported,
only a few weeks after the North Centre opened, that call
volumes were higher than expected and "a simple and
effective call prioritisation process" had been developed
for times of peak demand - generally weekends. This was
the first introduction of call-back - soon to become an
integral part of the routine process - despite the extreme
limitations around the use of call-back set out in the
original design. Some obvious non-executive questions were
clearly called for - what were the implications? for how
long? what about the need for additional risk
management?
For at least the first 2 years of 'live' NHS 24 one of
the main risks identified was that of insufficient nurse
resources. The action plan response was invariably
"a robust recruitment/retention campaign." Throughout the
whole of that period that risk remained constant. Because
the whole range of this risk was never really properly
assessed, eg for its possible impact on the overall quality
of service delivered, it remains problematic to this day.
Had there been some non-executive "what if", "what if not"
questions along the way, and a little bit of subsequent
lateral thinking, things might now be different. Thought
might have been given to different ways of working.
And there are other examples. Sadly, over the last 2
years or so what was lacking was leadership. The major
challenges today are the same challenges identified at
least 2 years ago. They were just not tackled at the time.
It was as if, because NHS 24 had talked so much about all
the things it was bringing to the NHS - and to the public
at large - that it could not be open and frank when it
started to encounter problems. Even in the run-up to
December 2004 it was putting out very upbeat assurances yet
within weeks local Health Boards would struggle to
implement a very late contingency plan when NHS 24 finally
accepted that it might not be able to cope with the volumes
of incoming calls over the festive period. That does not
suggest for a moment that NHS 24 got it all wrong and
Health Boards did everything right. But had the
relationships allowed open and honest dialogue some better,
holistic solutions might have emerged to the benefit of
everyone - not least the eventual caller.
It may be that the whole Board was somehow intimidated
by its surroundings - by the glitter of high technology, by
huge amounts of innovation, by the excitement of creating a
chain of contact centres. That syndrome is not
unknown.
What is clear is that during the first 2 years or so of
NHS 24 the executive leadership was impressively strong and
decisive. From early 2003 through to the end of 2004, the
executive leadership appears to have been markedly less
impressive. That was unfortunate because of the
simultaneous transition from design and construction
through to integration and ultimate service delivery. In
those circumstances there was a clarion call for
non-executive leadership at the highest level. That did
not obviously materialise.
Whatever the reason, strong leadership should have
sorted things out and brought about a fresh focus, a focus
on the challenges of delivering an efficient, safe, high
quality and reliable service to the end user.