IN the two years since Healthcare Improvement Scotland (HIS) was established to inspect hospitals and report on standards of care, there has been a concern that simply will not go away: is HIS truly independent of the health boards it is there to scrutinise?
The fallout from the Ninewells debacle - in which an HIS report on the Dundee hospital was redrafted after a meeting with the chief executive of NHS Tayside - led many to suspect the inspectors were indeed far too close to the boards. The new revelations that centre on the Royal Alexandra Hospital in Paisley will only underline those suspicions.
There is an excellent source for what we know about the report on RAH: a member of the hospital's staff who obtained copies of the inspectors' original feedback using freedom of information legislation. What those documents demonstrate is that, at the time of the inspection, considerable prominence was given to concerns about the spacing of beds in the day surgery unit. By the time the official report came to be published, these concerns were nowhere to be seen.
The response of HIS is that the question of bed spacing was left out of the final report because it was satisfied the hospital had plans in place to fix the problem quickly - and that is not an unreasonable position to take. Even so, in the aftermath of Ninewells, the RAH report raises more doubts over the relationship HIS has with the boards.
Clearly, some realism is needed about how HIS has to work - it already does a good job in escalating inspections to put pressure on health boards to act, but the sanctions it has at its disposal are limited which means that to some extent the body needs the co-operation of the boards day to day.
There is a danger in this co-operation, though, and it is that HIS gets too close to those it inspects. It is worth saying that HIS has carried out many excellent reports that have been critical of hospitals or particular departments and they deserve credit for those. But in what is still an evolving situation in the first years of a new public body, we need to ask what the purpose of this organisation really is.
The answer must surely be to serve the patient rather than the health boards and, if this is the case, can it be right that the boards can look at draft reports and are in a position to influence what is published? Can it be right that in some cases - Ninewells, and now Paisley - critical details appear to be glossed over to make wards look better than they really are? If patients are the focus of HIS - and they should be - the answer to both questions must be no.
What is required now from HIS and the Scottish Government is clear: a definitive statement on what HIS is for. The organisation may well have to tread a difficult line between reporting to the public and staying in touch with the health boards, but there should be a promise at the heart of what this body does, a promise to the public which says: HIS is not the voice of the NHS, it is the voice of the patient.
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