Call for NHS shake-up to cut bureaucracy, increase scrutiny

NHS Lothian has recorded persistently poor performances on discharges and waiting times. Picture: Ian Georgeson
NHS Lothian has recorded persistently poor performances on discharges and waiting times. Picture: Ian Georgeson
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TWO former SNP cabinet ministers have called for a shake-up of the NHS in Scotland to cut bureaucracy and increase accountability.

Ex-Health Secretary Alex Neil and former Justice Secretary Kenny MacAskill, former MSP for Edinburgh Eastern, argued separately for a slimmed-down structure and a more local focus.

Their comments came amid the crisis at NHS Tayside, where bosses used over £2 million of charity money raised from public donations and bequests to cover running costs.

But they said there were problems across the NHS in Scotland which demanded action.

NHS Lothian has recorded persistently poor performances on both delayed discharges and waiting times.

And at the end of last year Health Secretary Shona Robison ordered an independent external inquiry into the under-reporting of the number of patients waiting longer than the four-hour target in all four Lothian emergency departments – 
at the Royal Infirmary, the Western General, the Royal Hospital for Sick Children and St John’s Hospital, Livingston.

Mr Neil said part of the problem was lack of accountability and scrutiny. “The more accountable a public service is, the more efficient it tends to be.

“We now have a total of 22 health boards, including the local ones, plus 31 health and social care partnership boards, so we have 53 different boards running the health service in Scotland.

“We need to streamline the whole thing, cut out bureaucracy, remove duplication, and put the savings into frontline services. I’m suggesting we have three strategic health and social care authorities, who would not deliver services but set budgets and make sure there were centres of excellence.”

Lothian would be linked with Fife, Forth Valley and Borders in a new East of 
Scotland strategic authority, while others covered North and West. “We need then to have a local organisation in each area. At the moment there’s the council, the health board and the integration board. We should have one organisation in each area running the whole thing and make it much more local.”

Mr MacAskill said he was not advocating any particular new structure, but wanted less bureaucracy and more democratic accountability.

“It won’t be quick or easy but what we’ve got ain’t working so we need to look at alternatives.

“There are obviously structural issues when so many health boards are running into problems.”

Tory health spokesman and Lothian MSP Miles Briggs said Mr Neil was a gamekeeper turned poacher. “On his watch Scotland built up more bureaucracy than any other country in health.”

But he agreed structures had to be reformed, with financial accountability and decision-making streamlined.

“We as Scottish Conservatives are looking at this and will set out our plans before the 2021 elections.”