THE ROLE OF THE SCOTTISH EXECUTIVE HEALTH DEPARTMENT
There is an important ongoing role for SEHD in all of this. That role will range from facilitating to monitoring to ensuring quality delivery on the ground. We are encouraged by the fact that distinct messages around these issues are already coming from the highest executive level within NHSScotland. Board Chief Executives across Scotland are already getting a clear message that they will be held personally accountable for the successful delivery of health care within the community and, of course, NHS Boards will continue to be accountable to Ministers.
This may also be an appropriate opportunity for SEHD to review the basis of the performance management reports that come in weekly from NHS 24. These appear to have remained substantially unchanged since the early days of NHS 24 although the operational and management issues have changed considerably. We say elsewhere that NHS 24 management ought to be reviewing its performance on a day-by-day basis or at least on a 2-part week (Monday to Thursday and Friday to Sunday) and it might be more relevant to have performance reports to SEHD framed in that manner.
This report on NHS 24 may, in wider terms, lead to consideration of whether there are lessons for SEHD in the future. Should SEHD take a more active interest in the performance of a fledgling organisation than it would in other circumstances? In our interim report we were critical of the way the Board of NHS 24 did not at times fully consider the implications of some operational issues. But SEHD would generally receive all the same papers that were available to non-executive Board members. We appreciate that normally SEHD is reluctant to interfere in affairs that are the responsibility of Boards but perhaps with fairly new Boards it is necessary to retain a little more control. We also appreciate that every Health Board has an annual accountability review but, again, SEHD might wonder whether that is sufficient in the case of a fairly new organisation. It can be more difficult for SEHD if it is receiving wholly positive messages from the new organisation. Perhaps that points to the need for more robust monitoring, particularly in ensuring that performance reports received by SEHD contain all the factual information necessary to allow a proper assessment.
We wonder also whether SEHD ought to be actively involved in putting out the public message about calls to NHS 24 in out of hours periods - either directly or jointly with Health Boards and NHS 24.