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.