Scottish Government steps up scrutiny of NHS health board amid financial crisis

The Scottish Government has stepped up its scrutiny of an NHS health board amid a deepening financial crisis.

Health secretary Neil Gray announced on Monday that NHS Grampian had been escalated to Stage 4 of the national NHS performance framework.

It’s the highest level of intervention possible before the Scottish Government calls in its statutory powers.

The framework is Scotland’s way of monitoring health board performance and managing risk across NHS Scotland.

Stage 1 indicates a “steady state”, stage 2 is for informal intervention, stage 3 is for enhanced monitoring and support, stage 4 indicates “significant risks” for delivery, and stage 5 is reserved for cases where the level of risk is “so significant” that boards require direct intervention using the government’s statutory powers of direction.

Following careful consideration, NHS Grampian has today been moved from stage 3 to 4.

“Staff in NHS Grampian continue to work tirelessly to deliver the high quality care we expect. However there are continuing concerns about financial management and associated operational pressures,” health secretary Neil Gray said.

“Escalation to Stage 4 will bring enhanced scrutiny and support from the Scottish Government and we will work with Grampian to ensure sustained improvement. This will include a whole system diagnostic to be carried out by an external consultancy to help inform a tailored package of support.

“I am confident that, through these actions, we will soon have a clear plan to stabilise the system and set the right conditions for the necessary, longer term transformational work – with the key aim being to ensure the sustainable delivery of high quality healthcare services for the benefit of local people.”

The Scottish Government felt the formal escalation is “necessary” to combat the “significant risks” to both the local health board and to the overall NHS Scotland system.

It comes just months after the Government placed NHS Grampian at the first formal stage of escalation – stage 3 – for its financial management in January.

The move is expected to halt the rate of over-spending in NHS Grampian and address the immediate financial and operational pressures “to stabilise the system”.

Last month, STV News revealed that the health board owes the Scottish Government £92.2m after it had to borrow millions to plug a financial black hole.

The Scottish Government bailed NHS Grampian out for the second year in a row after it racked up a £67.5m financial blackhole – the largest overspend of any NHS health board across Scotland.

In light of these figures, the health board was ordered to make £39m worth of savings in the coming year.

NHS Grampian performance has also been poor with the health board previously admitting that the “time patients spend in our emergency departments, the time ambulances have to wait outside our hospitals and the time spent waiting for outpatient appointments” are areas where performance is “not where we would like it to be”.

“NHS Grampian has too few acute hospital beds and too few staff in some key service areas to cope with demand, which continues to rise,” the health board said in April.

“Likewise, our local Healthcare Partnerships do not have enough capacity in the community to support patients to leave hospital – meaning we are unable to free-up beds for new patients to be admitted.

“In Grampian, there is not enough funding or physical space to make any significant improvement in these areas imminently – meaning, whilst we know what the issues are, there is no silver bullet solution to overcome them.”

The Government said on Monday that the current stage 3 recovery plan and tailored government support is “not producing the required improvements”.

At stage 4, senior level external support is required, and NHS Grampian will report to an Assurance Board chaired by the Scottish Government and to the director general for Health and Social Care.

The National Planning and Performance Oversight Group (NPPOG) will also be informed of progress on a regular basis.

Although the onus remains on the NHS Board to deliver the required improvements, a “whole system diagnostic” package will also be carried out by an external consultancy, which is expected to wrap up in June.

That assessment will inform any support or decisions that may follow. The board will also come under new leadership this year, with interviews for the chief executive post also expected to take place in early June.