Scotland’s NHS boards are suffering from an inability to attract and keep effective senior leaders, according to the seven different agencies overseeing the health and care sector.

Leadership challenges mostly relating to a high turnover in senior roles were identified in eleven of the eighteen national and regional patient-facing health boards in a new report.

Health and social care partnerships also faced problems at the top. In correspondence with Fife health board, the watchdogs cited the local health & social care partnership which has been through three chief officers and four finance heads in the four years since it launched in April 2016.

At the start of the year health secretary Jeane Freeman reshuffled senior leaders in Scotland’s NHS after the entire Greater Glasgow board was placed in special measures.

2020 saw further changes in Orkney and Highland, which appointed its third chief executive in less than a year in August.

The warning came from a group set up for Scotland in the wake of the 2013 Mid Staffs public inquiry that found evidence of widespread and serious failings in patient care at the Stafford hospital.

The Sharing Intelligence for Health & Care Group brings together the financial watchdog Audit Scotland, the Care Inspectorate, Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland, as well as NHS Education for Scotland, Public Health Scotland and the Scottish Public Services Ombudsman.

The report covers 2019 up to the start of the pandemic, though correspondence with NHS boards continued throughout 2020.

Looking at all 14 regional health boards and four patient-facing national boards, the group’s annual report highlights concerns in a number of areas, starting with a ‘mixed picture’ when it comes to the quality of care.

‘Some of the data we looked at also drew our attention to a health and care system that is highly pressured, eg increases in waiting times and staff vacancies,’ the document states.

It reiterates a warning from 2018-2019 that leaders are working amid conditions of “extreme pressure and great complexity”, stating there are leadership “challenges” in eleven of the eighteen board areas examined.

In a letter sent in May to retiring CEO Gerry O’Brien, regulators concluded that greater scrutiny of NHS Orkney was needed after warning of “ongoing flux” in senior leadership as well as some issues with finances, workforce and clinical engagement.

The next month Mr O’Brien’s planned successor Iain Stewart announced he would not be taking up the role at the last minute, following criticism over his trips to the mainland during lockdown, leaving the role to be covered on an interim basis by the head of NHS Shetland.

The former head of Audit Scotland, Caroline Gardner, characterised the problem last year as a ‘leadership merry-go-round of recent years, and the stop-start, short-term organisational culture that breeds.’

Ms Gardner suggested that a ‘blame culture’ that led to sackings or resignations as a ‘substitute for understanding the causes of the problem’ was shrinking an already small pool of potential leaders.

The report goes on to warn of an increasingly precarious financial situation across NHS Scotland in 2019-2020, flagging up concerns with ten of the eighteen boards looked at and warning:

‘Significant financial savings have been made by NHS boards, although there has been a heavy reliance on one-off (‘non-recurring’) savings.

‘This is unsustainable and, as we highlighted last year, there needs to be a greater level of transformational change and long-term financial planning.’

They add: ‘From our work in 2019–2020, we still believe that a greater scale and pace of change is required to ensure that people’s health and care needs are met in future.’

 

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