The Courier & Advertiser (Angus and Dundee)
Keep politics out of health care, says former NHS Tayside chief.
In the final part of our NHS series, Michael Alexander speaks to former Tayside health board chairman Professor John Connell
Devolution is essential for the accountability of the NHS, however, NHS Scotland needs to “stop being so insular” and to look outside its borders to see how things might be done better or differently in future.
That’s the view of former NHS Tayside chairman Professor John Connell who said a “good honest debate” about health care has become “almost impossible” in Scotland because of the politicisation of the NHS.
He is calling for a review of NHS governance in Scotland – more akin to the English model which keeps the service at arms-length from politics.
He also believes the governance of the flagship health and social care policy, while essential to tackle the challenge of Scotland’s ageing population, has “not been thought through”.
Professor Connell tendered his resignation as NHS Tayside chairman in early April, less than a day after Health Secretary Shona Robison called on him to quit the crisis-hit health board.
His resignation came just days after it emerged NHS Tayside had used money from charitable donations to pay for computer equipment in 2014, before Professor Connell was appointed chairman.
It followed on from the revelation that the health board has been using money intended for digital health programmes to meet other costs.
Auditors said the health board has been “misrepresenting” its finances since 2012, while an independent report, published last week, highlighted a “number of weaknesses” in the board’s financial management arrangements.
In an exclusive interview with The Courier, Professor Connell called on the Scottish Government to consider a new structure whereby there was “more distance” between politicians and NHS management.
“One of the things going forward is the need to look at the governance of the NHS,” he said.
“Accountability is important. But at the moment the governance has become wrapped up in this politicisation, which makes life hard. In NHS England, for example, it’s actually an arms-length body through the Department of Health.”
While the Secretary of State for Health, Jeremy Hunt, is accountable to Westminster for the way the NHS performs, the NHS chief executive does not report directly to politicians. That, Professor Connell believes, changes the nature of the NHS.
“I think in Scotland we should be asking ‘is there a way we can take the NHS governance and make it less politically accountable all of the time?’ ”
Given the vast sums of money being allocated through the Scottish Parliament, Professor Connell said scrutiny of the NHS by politicians needs to happen.
But because the chief executive of NHS Scotland is directly responsible to the cabinet secretary, he said it’s “almost as if the cabinet secretary is acting as the chief executive of the NHS in Scotland.”
This left her in a difficult political position, he said, because it “exposes her” and resulted in her being blamed for “every single minor error that happens” which, he added, “isn’t right”.
He continued: “I would say it’s much healthier to have the cabinet secretary responsible for strategy, policy and the budget, and then having an arms-length body that manages the system on a dayto-day basis.
“I think that would actually free up the NHS in Scotland to be more flexible, more innovative and maybe actually more efficient.”
It’s two years since Scotland introduced health and social care legislation which established joint boards for integrated health and social care. However, Professor Connell said it’s often difficult to know who is responsible or accountable for decisions.
“We’ve seen this locally – the out-of-hours service in Fife has been radically changed, with St Andrews Hospital no longer providing care overnight,” he said.
“Was that decision made by the new board, the health board, or was it a joint decision? It’s not really clear. At the end of the day the chief executive of NHS Fife is the accountable officer, but he is not seen as responsible.”
Professor Connell said there also has to be clearer governance on regional solutions for health.
“We need quite a careful think about how the NHS should be best managed collectively by society,” he added. “I think it’s unlikely to happen – a pious hope – but it would be nice to think our politicians had the maturity to actually have a discussion how, as a society, we do this for everyone’s benefit.”