Healthcare Improvement Scotland and Scottish Government: operating framework

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

Annex 6: Detail/narrative and table to support Annex 5


To ensure an organisation-wide, consistent and transparent process for escalation of issues to Scottish Government. This would be undertaken when a lack of progress/response/input has been made by the service provider as a result of the usual HIS processes.


A quality assurance engagement by HIS has taken place (either through normal processes or as a referral from the Responding to Concerns process) and identified improvements to be made. These are agreed with the provider and there is a clear expectation with written agreement with the provider that these will be delivered upon.

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

  • No further engagement necessary
  • Recommendations made but will be followed up informally by link inspector
  • Recommendations made and 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 clear e.g. for a follow-up inspection or for the further reporting of progress by the 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.
Level Situation HIS Action SG contact and anticipated actions HIS Governance
Trigger Quality assurance activity has taken place by HIS (through normal processes such as inspection activity or as a referral from the responding to concerns process) and identified improvements to be made. This has been agreed with the provider and clear timescales identified for delivery of improvements. No, or limited, progress has been made by the provider within the agreed timescales. Escalate to improvement notice stage (Level 1). - -
Level 1 Improvement notice There is no, or limited, response from the service provider regarding lack of progress and/or lack of improvement poses a significant risk to patient care. Note: Criteria for each level of escalation will be developed. Should HIS have used its statutory powers to close a ward to further admissions then this would immediately lead to an improvement notice being issued. An improvement notice will be served from HIS's CE to the CE of the provider, copied to the Chair of the provider. This would clearly state what improvements are expected, by when and the consequences if no improvement has been made. The improvement notice will be published on the HIS website. HIS will publicly report progress against the improvement notice If joint engagement with another scrutiny body, the MoU with that body will clarify how respective escalation processes will be managed Sponsor division / policy lead (for information) SG will use this information to support routine monitoring of Boards' performance and to inform its own escalation framework. The information will feed into a rounded assessment by the Scottish Government of where a Board sits within the SG's own escalation framework. All below notified for information only at this stage: HIS Executive Team through weekly huddles and team meetings. HIS Chair HIS Board via HIS Chair Chair of provider
Level 2: Formally escalate to Scottish Government Sponsor Division and relevant policy lead Lack of engagement by the service and, or insufficient improvement has been made even after the improvement notice served. Note: Criteria for each level of escalation will be developed. A formal external escalation to Scottish Government Sponsor Division and relevant Policy Lead would commence. This would be signed off by the HIS CE (with the support from the Executive Team) and Chair and include a full account of action taken to date. Scottish Government Officials will take action in line with SG escalation processes and keep HIS informed of actions it intends to take. The HIS website will be updated to reflect this further escalation. Sponsor Division / Policy Lead DG Health SG will share this information internally in line with the processes set out in its own escalation framework and in support of Health and Social Care Management Board's role. In many cases, this will be an opportunity to identify, in conjunction with the Board, what improvement support is required. HIS CEO for approval HIS Chair for approval HIS Board via HIS Chair for information Chair of provider notified
Level 3: Escalate directly to Scottish Ministers Still no, or limited, evidence that actions have been taken forward, or continued concerns regarding the risk to patient care. Note: Criteria for each level of escalation will be developed. Our concern is now so significant that escalation is required directly to Scottish Ministers. HIS will provide the Sponsor Team a standard notice period of an intention to escalate along with an account of all action taken by HIS towards resolving the situation. When HIS initiates escalation to Scottish Ministers, this must be done through the Scottish Government sponsor team and policy lead who will ensure the process is coordinated with the Scottish Government's escalation framework. The HIS website will be updated to reflect this further escalation. Sponsor division notified. Scottish Ministers to determine appropriate action. Escalation discussed by ET and approved by the HIS Chair. HIS Board via HIS Chair for information



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