Telehealth – the delivery of health services through new technology - is an exciting and promising area of healthcare – it has already led to equipment that allows patients' health to be better monitored at home and at a time when NHS resources are under increasing pressure, it has the potential to save public money. It is worth pursuing further.
However, the record of the Scottish Centre for Telehealth and Telecare (SCTT) and its management by NHS 24 is an increasingly troubling one. Earlier this year, The Herald revealed that £58,000 was spent on corporate credit cards in the last three financial years by NHS 24 and that the service funded 87 staff trips abroad between April 2014 and the end of February this year. All together, NHS 24 has spent almost £200,000 on European travel and much of it has gone on investigating and developing telehealth services. While significant funding from Europe has been won, given (With) some of the spending was unsupported by receipts, the figures raised legitimate questions over how rigorous the financial culture has been at NHS 24.
Now the questions have become even louder with the news that NHS 24's management of SCTT has been severely criticised in an independent review by auditors PricewaterhouseCoopers, who have not held back in their assessment. According to the report, which has been leaked to The Herald, no governance process has been exercised over the growth in the number of staff at SCTT (it has risen from 14 to 30) and there are questions about whether the seniority, and therefore cost, of certain staff is justified. The conclusion is damning: "NHS 24 governance of SCTT direction and performance has been largely absent in an effective manner since 2012."
The report's conclusions will add further to the aura of concern around NHS 24's financial performance. The day-to-day work of the service is handling calls to GP surgeries outwith normal hours and after a shaky start it is going reasonably well. However, it is now two years since the service was due to start using a new IT system that was designed to help staff deal with calls more effectively and, while it is now, finally, expected to get underway this October, the long delays, and the budget over-run of more than £20million, have done nothing for NHS 24's reputation for careful stewardship of public funds.
In the wake of all these incidents – the delay in the IT system, the questions over credit card spending and now PricewaterhouseCoopers's report – the Scottish Government and NHS 24 must demonstrate that robust internal and external procedures are in place to ensure that money is being well spent. Every public organisation has to be rigorous in how it spends taxpayers' money and after a succession of problems, NHS 24 needs to reassure taxpayers that its financial systems are strong and fit for purpose. NHS 24 says it continuously reviews the robustness of its financial arrangements and updates them where appropriate, but there are questions over whether the scrutiny of the service is strong enough. NHS 24 has to be good financial health, but the diagnosis currently is: cause for concern.
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