NHS Scotland’s governance arrangements need to be strengthened to deliver the scale of reform needed across the health service.
NHS Scotland comprises 22 NHS boards, with oversight provided by the Scottish Government. A range of governance groups are in place across NHS Scotland but there are weaknesses within the scrutiny and assurance processes at the Scottish Government level. This risk could be reduced by making greater use of non-executive directors to provide more challenge.
The planning and governance of healthcare in Scotland is becoming more complex, and this limits NHS boards’ ability to drive reform. The mix of local, regional, and national partners makes decision making and accountability difficult.
A new planning framework has been introduced by the Scottish Government and new national strategies for reform are due in 2025. Dealing with this change will be challenging for boards, but it should give them more clarity and help them to work more collaboratively to deliver reform.
NHS boards use a blueprint for good governance that was produced in partnership with the Scottish Government. The blueprint has been well received but there is scope for it to be strengthened to more clearly set out how board governance should be adapted to deliver reform.
Stephen Boyle, Auditor General for Scotland, said: “The delivery of NHS services must be reformed for Scotland’s health service to remain affordable and sustainable.
“NHS Scotland’s governance arrangements are key to delivering that reform, but they need to be strengthened.
“The planning of healthcare in Scotland is becoming more complex and the Scottish
Government needs to ensure lines of accountability and decision-making are clear.”
