OVER the last few weeks and months there has been a growing public interest in the decisions and accountability of health boards in Scotland, with one recently being taken “into hand” directly by the Scottish Government, and others – such as NHS Highland which covers the area I represent – being suggested as needing the same treatment as NHS Tayside.
The current system of health boards controlling and budgeting their own expenditure to meet the needs of the patients who use their services seems on the surface to be sensible, the premise being that they are aware of the needs of their area and are able to respond and provide for them. However, with 43 per cent of the entire Scottish Budget being spent on the NHS in Scotland in 2016/17, does this mean that 43 per cent of the entire Scottish Budget is being spent by groups of (essentially private) individuals who are not democratically accountable, nor have a public duty to manage their funds responsibly?
At present, strategy and policy is set – in the most part expertly in my opinion – by our Scottish Government in Holyrood, with the expectation that health boards will then meet those strategies and policies within their own areas. Worryingly, reports are coming in from throughout the country that whilst senior officials claim that their health boards are meeting objectives set by the Scottish Government, the practice on the ground can be very different.
Take, for example, mental health provision for children and young people. There is a strategy and guidance in place from the Scottish Government. An enormous amount of work and evidence-gathering happened to make this strategy as beneficial to young people as possible, and yet on an almost daily basis we are hearing that children throughout Scotland are not being treated, supported or diagnosed.
So who, then, is responsible for this failing? Is it the Scottish Government, which sets the policy and provides the budget to carry out the work to health boards? If it is, then parliament can, and does, scrutinise the government, but is this leading to improvements? No, because at the end of the day it is not the agency that is delivering the care, NHS boards are. So through local councils being involved with the NHS on Integrated Joint Boards, or the Lead Agency Model that we have in the Highlands, are NHS boards and management being held accountable for their failings and ensuring improvements? No, because there is no real democratic accountability for health boards and many councillors lack the confidence and skills to scrutinise outcomes.
I should note here that even when local councillors are excellent at scrutiny towards the NHS, they are treated with contempt, and there are very few examples of when scrutiny from an elected member at council level has led to improvements in outcomes for patients.
An almost revolutionary change is needed in relationships and culture, and soon. NHS boards must accept that they are spending enormous amounts of public money, which should mean enormous amounts of scrutiny and accountability. Councillors must be given the chance to affect real change and challenge outcomes, not for the sake of their own political career, but for the sake of their constituents who are the ones using, and paying for, their NHS services. NHS boards need to get a grip on their finances and manage their budgets responsibly. Both sides need to come together, supported and led by the Scottish Government, to produce real and meaningful change in our NHS and to ensure that this public money is being spent in a democratically accountable way.
Cllr Kirsteen Currie
Easter Ross
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