A story about the cosy club that runs Scotland

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By Kenneth Roy

Although she is still listed on official websites as chief executive of Healthcare Improvement Scotland (HIS), Dr Frances Elliot has been gone for some weeks. SR understands that she left with a haste unusual by civil service standards and that she has been re-assigned to other important duties in the Scottish Government.

The likeliest explanation for her abrupt departure from the so-called hospitals’ watchdog is that she incurred the displeasure of health secretary Alex Neil, who is fast developing a reputation as the angry man of St Andrew’s House.

Coincidentally, Dr Elliot’s removal from the post came a few days after our criticism of HIS’s report into the scandalous debacle at one of the regional boards monitored by her organisation. In Ayrshire and Arran, a patient died after being trapped in a faulty lift, another as the result of poor treatment to a leg wound, and there were disturbing cases of failure to diagnose cancers.

When a nurse requested access to a report into one such ‘adverse event’ in which he had been personally involved, the board refused to release the document and accused him of being ‘vexatious’. The nurse (Rab Wilson) pursued his case with the Scottish information commissioner, Kevin Dunion, who delivered a judgement withering in its indictment of NHS Ayrshire and Arran. Mr Dunion came close to accusing the management of lying.

The then health secretary, Nicola Sturgeon, promptly ordered Healthcare Improvement Scotland to conduct an inquiry into the board’s practices. Last month, we attacked the result – NIS’s report – as badly written, woolly in its conclusions, and intellectually poor, and added that by failing to damn the senior managers of NHS Ayrshire and Arran as they should have been damned, HIS had offered them an escape route. Far from heads rolling, those of the key players were left very much intact.

No sooner had SR exposed the shortcomings of HIS in relation to Ayrshire and Arran than Alex Neil delivered his own verdict on the handling of an HIS inspection of Ninewells Hospital in Dundee. He told MSPs he was ‘not impressed’ – code for ballistic – after hearing that a draft inspection report had been diluted.

The local newspaper, the Dundee Courier, was the first to reveal that elderly patients awaiting treatment were being left on trolleys and wheelchairs in corridors of ward 13 at Ninewells. HIS’s original report gave details of 35 such cases. NHS Tayside disputed the number and it was mysteriously changed in the final version from 35 to the rather less incriminating ‘some’.

Inevitably, the board was accused of attempting to play down the inhumane treatment of old people and HIS of failing in its duty of candour. But in both cases – Ayrshire and Arran as well as Tayside – there is a deeper problem connected to the complacent culture of governance in Scotland’s public bodies, repeatedly highlighted by this magazine in the last five years and just as repeatedly ignored.

Gerry Marr, the chief executive of NHS Tayside, was the officer of his board accountable for independent inspections carried out by Healthcare Improvement Scotland. At the time of HIS’s inquiry into the goings-on in ward 13, he was potentially compromised as a non-executive member of the board of HIS.

NHS Tayside has denied that there was any conflict of interest. Strictly speaking, this may be true. It seems that, when the ‘Ninewells Older People’s Report’ was being discussed by the board of HIS, Mr Marr left the room. The proprieties of the occasion were thus observed. But this fails to dispose of a familiar problem with Scottish public appointments – that poachers and gamekeepers are often one and the same. Perception is all, and in this case the perception was extremely poor – particularly when a report damaging to NHS Tayside’s reputation was changed at the last minute.

Another fact unpublicised until now is that, when HIS was conducting its inquiry into the affairs of NHS Ayrshire and Arran, the medical director of that board, Dr Robert Masterton, was also serving on the board of HIS. Again there is no suggestion of a direct conflict of interest, no suggestion that Dr Masterton influenced the content of this feeble report in any way. No doubt he left the room when it was being discussed, just as Mr Marr did. But there is the same issue of perception. To put it bluntly: how does it look?

Mr Marr’s term of office as a non-executive director of HIS came to an end last month. But HIS confirmed to us yesterday that Dr Masterton continues as a member of its board of directors despite Alex Neil’s stated unhappiness about senior staff of health boards also serving on the watchdog. We have established that the director of public health at NHS Grampian – another of the bodies liable to be inspected by HIS at some stage – likewise continues to double up as a member of the HIS board.

It seems that Dr Masterton and Grampian’s Sir Lewis Ritchie, unmoved by the health secretary’s protestations, intend to stick around until their part-time paid appointments with HIS expire in February 2015. If the Scottish Government is serious about avoiding potential conflicts of interest, and breaking up the cosy club which runs so much of Scottish public life, it should invite them to step down. Meanwhile, Healthcare Improvement Scotland is looking for a new fall guy. Sorry, chief executive.

Courtesy of Kenneth Roy and the Scottish Review