it allows its staff to talk honestly and publicly about any shortcomings without fear of reprisals, it is honest to the public about its failings and financial shortfalls, and above all it encourages and participates in a wider debate in Scottish society about how to run, and fund, the country's most important and valued public service.
Sadly, the evidence is that the NHS in Scotland is not living up to this ideal. There have been recent improvements, such as the whistleblowers' phoneline, and there has been government action to stop health boards inserting gagging clauses in their staff contracts, but the concern remains that health boards and politicians are projecting an unduly positive image of how the NHS is working and suppressing any evidence of problems.
The secrecy around the investigation by NHS Healthcare Improvement Scotland (HIS) into care at Aberdeen Royal Infirmary adds to the concern. As long ago as March, a consultant at the hospital spoke to the Health Secretary Alex Neil, which led to NHS HIS interviewing 30 members of staff, which in turn led to a meeting to discuss the issues raised involving senior NHS staff. However, it is only now that some of the details of the investigation have emerged, and that is thanks not to the openness of NHS Grampian but to a freedom of information request by The Herald.
In defending its position, NHS Grampian says it was open in a statement on its website about the terms and scope of the review, but the statement was only in the broadest terms, which would make it hard for patients to know what was really going on. NHS HIS also says it does not want to prejudice its final report and is concerned that openness could discourage other staff from talking openly.
However, provided the names of individual patients or staff are withheld, there is no reason why NHS HIS should not have been more open - indeed, if a complaint is so serious that it triggers interviews with 30 staff, a large degree of openness is needed.
The investigation by NHS HIS is focusing on underlying issues that could impact on the quality and safety of care. It also points to concerns about staffing in accident and emergency and includes an allegation of sub-standard care in wards for the elderly. Given a greater degree of honesty on these issues and others, patients might have been more vigilant or even chosen treatment elsewhere. The point is that patients should have the information and it should not be in the public domain only because of an FOI request.
NHS HIS must consider now its responsibilities in the matter and remember that patients know the difference between an ongoing review and a final report.
The report will be made public but not until the end of the year, which means that for at least eight months the public have been largely in the dark. The issues covered by the review are too important for that to be allowed to continue.