28. The Role of Scottish Government
Tension and Balance
28.1. I acknowledge that it must be hard to be an official in the Scottish Government trying to deliver all of the policies and targets of the government of the day and knowing, by implication or explicitly, that there are all sorts of issues at local as well as regional and national levels which are difficult to manage.
28.2. The tension of balancing possibly competing political, policy, financial and human needs must seem acute on a daily basis. The need to achieve particular goals must place real pressure on all concerned. The same, I suspect, will apply to a minister or a Cabinet Secretary.
28.3. There is also the tension between intervening and encouraging organisations and individuals to deal with issues themselves. Government is often accused of over-involvement. Yet, when things go wrong, it is held responsible. Judging when and how to intervene is not easy. I mention this as it may help to explain the Scottish Government's response to its own knowledge about events in NHSH.
Awareness of Situation in NHSH
28.4. Officials were made aware in autumn 2017 about concerns expressed by NHSH non-executive directors. It seems likely that more active intervention at that time would have avoided such a public and arguably more damaging process now. Indeed, I am satisfied that senior people in Scottish Government were aware of the dysfunctioning situation with the Board and at senior leadership level for a considerable period of time prior to matters becoming more public in the autumn of 2017.
28.5. In particular, the resignation of a number of non-executive directors and other events and information provided to the Government over a period of time ought to have signalled the seriousness of matters and could have prompted more decisive action at an earlier stage. The question of whether the Scottish Government could and should have acted is for others to consider.
28.6. A few observations from senior people in NHSH sum up what I have heard in this connection:
"The main point there, SG have known that there are things going on."
"We were told that "we're trying to deal with this internally" which gave me the clue that the Cab Sec wouldn't know".
"I can't feel the government in any of this. I don't know where they were, what role they were playing. They've almost been watching the board self-destruct. Watching to see whether we succeeded."
"I expected an exit-interview with government in which I could voice my concerns but this never happened. I subsequently attempted to raise my concerns with [a very senior official] on several occasions soon after leaving, prompted usually by another confidential call from a senior member of staff asking for my advice. I also offered to participate in the governance review conducted approx a year ago now…. but although given assurances by the civil servants that I would be contacted, I never was."
"Scottish Government was made aware of a number of the above issues and its action was to instigate a quiet 6 month review of Board governance rather than to take a more direct or more visible action."
"The overall message, yes I believe there was a serious problem. It related directly to the CEO. I believe that, for whatever reason, Chairs were afraid to do anything about it. There was also the dynamic of government civil service and politicians. I've had conversations with everyone including [senior civil servant] about it. The reaction from civil servants are "don't put it in an email please".
"I told him [senior Scottish Government official] my story and about the whistleblowing line being a waste of time. I told him there was a list of people to speak to them. I said if they can't speak to you, what should I tell them? He said, "tell them message received, loud and clear". But then nothing happened. So, SG was of no use."
28.7. I have gained an impression that the Scottish Government is sometimes viewed as being less respectful and less coherent in its engagement with boards and their leaders than it may perceive from its perspective. Certainly, the same points about a collective and enabling approach to leadership which I mention in later chapters should also apply at the top of NHS Scotland.
28.8. There are no doubt lessons to be learned about when and how to act. Perhaps what is needed is the setting of clear benchmarks against which to assess whether, how and when to intervene. The Scottish Government is an essential part of the system. How it acts and reacts also impacts on those in NHS boards and executive positions in local areas. Now seems like a good time to review this relationship.