Healthcare Improvement Scotland and Scottish Government: operating framework

Sets out how we will work with Healthcare Improvement Scotland, including roles and responsibilities.

Annex 5 HIS Escalation – Introduction

The purpose of this escalation framework is to ensure that HIS have a clear, consistent, and transparent process for escalation of issues to Scottish Government, and where required, direct to Scottish Ministers via the Sponsor Function.

Where Quality Assurance activity undertaken by HIS has identified improvements to be made, these are agreed with the service provider with a clear expectation through written agreement that these improvements will be delivered upon.

The improvements at this stage are agreed between HIS and the service provider in question and are based on the level of risk of harm to the patients, the public, and/or staff. These will follow a standard typology, such as:

  • no further engagement necessary;
  • recommendations made, but will be followed up informally by relevant inspection/review team leads;
  • recommendations made, and service provider will be asked for an update on progress by a stated date;
  • significant recommendations made requiring a follow-up inspection within a clear timescale;
  • significant issues identified requiring immediate escalation.

In all cases, the timescales will be clearly defined e.g. for a follow-up inspection as detailed in the published inspection methodology or for the further reporting of progress by the service provider. Further engagement may be required if not all improvements have been made or we are not fully assured. However, any extension to the original timescales will be clearly recorded and new expectations clearly set.

In some instances HIS may choose to escalate concerns to the Scottish Government. This escalation would be undertaken in the following situations:

  • a lack of progress/response has been made by the service provider, as a result of the usual HIS processes aimed at ensuring improvement;
  • HIS become aware of serious safety concerns through its activity, which require immediate action by the service provider

This process does not preclude the use of the existing process within the Quality Assurance Directorate for issues identified during hospital inspections. Should HIS use its statutory powers to close a ward to further admissions, then the escalation process would immediately trigger.

The levels of escalation are set out below. Escalation of concerns to Scottish Government and/or Scottish Ministers will be taken in to consideration as part of the wider consideration of board performance undertaken by the SG National Planning & Performance Oversight Group (NPPOG).



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