Fiddlers at the top

A few weeks back, the Cabinet Secretary for Health+ had to advise Parliament that one of the health boards she has responsibility for - NHS Lothian - had been fiddling [my word] the waiting list data for its patients so that Lothian's performance complied with targets set by Nicola.  As ever, inquiries are underway and promises have been made that things will change.  As ever, there is no sense that the executive team in charge of the public body will find their performance related pay reduced as a result.


Part of the problem Nicola has is in her excessive reliance on systems of self-assessment by health boards.  There is quite simply no adequate central resource available to her to conduct real spot-checks on the data from health boards in this and in other critical performance areas.


Intrigued by the potential consequences of the scale of the duplicity in this area of a board's performance, I asked the Cabinet Secretary : 

what systems are used by your staff to validate and audit progress and performance reports NHS Boards publish on meeting their general and specific equality duties?.

I also asked :

Can you please ensure that the quality assurance required and used in this context will be readily and easily accessible to Scotland’s citizens and community organisations representing the views and experiences of people with protected characteristics ?

You would have thought the Cabinet Secretary would seize the chance to plug the massive holes in her performance management capacity when it came to health boards.  You would have thought she would want to create a legacy where performance on waiting times, equalities, equal pay and much more improved when she was in office.  You would have thought.


Her response, drafted by her officials, was:

it is for each Health Board, as a named public body in equality legislation, to have in place the precise mechanisms they require to assure they are complaint with their legislative requirements. The Equality & Human Rights Commission is the regulatory body that ensures these requirements are met.

Nothing like not answering the question. Nothing like ignoring the reality that Westminster is slaughtering the EHRC and it will be unable to cross the road on its own to get change of a fiver, never mind check the performance of public bodies.


Self-assessment is not fit for purpose.  We have the stark evidence in from NHS Lothian.


If we are to make sure that the performance of our health boards is open, honest, transparent and eliminating the discrimination which exists, we need a tough, fit-for-purpose, independent and transparent performance monitoring regime.  Given the Cabinet Secretary's fondness for her concept of mutuality in the NHS, it is also critical that checking performance has to be done in partnership with the very people the whole effort is supposed to benefit - people from the equalities communities.


You might want to suggest to Nicola that she needs to get tough on equalities and tough on the performance of health boards in delivering equality. Feel free to use this tweet button to do just that.

Tweet to @NicolaSturgeon