Letter from the Cabinet Secretary for Heath and Social care on an update of Health Boards currently in an escalated position within the NHS Scotland Board Performance Escalation Framework, 10 June 2021
I am writing to the Committee to update you on the position of the Health Boards currently in an escalated position within the NHS Scotland Board Performance Escalation Framework.
The Escalation Framework provides a clear and transparent basis for Scottish Government support and intervention where there are concerns about a Health Board’s ability to deliver standards or services. Its use is not limited to any particular performance measures and may be triggered by concerns about specific services or broader organisational issues. Our overriding priority is to ensure patients continue to receive first-class care, and we provide support to Boards to ensure there is no impact on patient services. More information about the five stages of escalation are set out on the Scottish Government website; NHS Scotland and Integration Authorities consolidated financial reporting: 2020-2021 - gov.scot (www.gov.scot)
The current Escalation Framework has five Stages of Escalation summarised in the attached appendix.
As at March 2020, there were six territorial Health Boards at Stage 3 or above within the Framework:
• NHS Greater Glasgow and Clyde at Stage 4 for specific issues relating to the Queen Elizabeth University Hospital and the Royal Hospital for Children Glasgow, and Stage 3 for issues relating to performance.
• NHS Tayside, NHS Highland, and NHS Borders at Stage 4 and NHS Ayrshire and Arran at Stage 3.
• NHS Lothian were placed at Stage 4 for specific issues relating to the Royal Hospital for Children and Young People, and at Stage 3 for specific issues relating to performance.
The Escalation Framework was paused at the end of March 2020 to enable all Boards to focus on ensuring an effective response to the pandemic. However, during March 2021, as part of the assessment of the latest Remobilisation Plans submitted by Boards, a review of Boards’ escalated positions was undertaken. This review drew upon information from Board Remobilisation Plans as well as other relevant data to assess Boards’ strength in the follows areas of performance as appropriate:- financial management; operational delivery; and governance and leadership. The review also considered any specific issues which were of particular concern at the time of escalation.
Following consideration of the outcome of that review, the following decisions were taken:
• NHS Ayrshire and Arran would remain at Stage 3. Escalation status applies to the Board’s financial position only.
• NHS Borders would be de-escalated to Stage 3 in relation to Finance and Stage 2 in relation to Governance and Leadership;
• NHS Greater Glasgow and Clyde would be de-escalated to Stage 2 in relation to performance and service delivery but remain at Stage 4 in relation to QEUH/RHC and strengthening management capability and capacity (which encompasses leadership and organisational culture);
• NHS Highland would be de-escalated to Stage 3. Escalation status continues to apply to finance, governance, leadership and culture, and mental health;
• NHS Lothian would remain at Stage 3 in relation to Mental Health performance, but de-escalated to Stage 2 in relation to remaining performance areas and Stage 1 in relation to the Royal Hospital for Children and Young People; and
• NHS Tayside would be de-escalated to Stage 3 in relation to Mental Health performance and Stage 2 in relation to financial position, governance and leadership, and performance.
Relevant Boards have been informed of the outcome of the review and the Scottish Government website has been updated.
The Escalation Framework plays a very important role in enabling and supporting Boards to address systemic performance issues and other issues in a supportive but effective manner. As such, my officials and I will continue to keep Boards’ escalation status under close scrutiny and regular review. I am, of course, happy to provide the Committee with further information should that be required.
Best wishes,