RECENT events within NHS Greater Glasgow & Clyde Health Board indicate to me that there has been loss of any semblance of control over operational matters. In November 2019, the health board was put in limited level 4 special measures. These were extended in January 2020. Level 4 special measures indicate “significant risks to delivery, quality, financial performance or safety” and senior level external support is required. Focus was placed on finance, culture and leadership, and deficiencies in provision of scheduled care, unscheduled care and primary out-of-hours care.

At the time of writing, the NHSGG&C region has witnessed 633 deaths/million population related to Covid-19 compared with the Scottish average of 468/million. Following the first wave earlier this year there has been little evidence of effective planning for the second wave. As Glasgow hospitals fill again, the decision to cancel elective, non-Covid-19 admissions at Glasgow Royal Infirmary and Queen Elizabeth University Hospital was the first response. Dozens of patients who were self-isolating in preparation for surgery were cancelled with little or no notice. The public outcry forced the senior management team, pressured by politicians, to reverse this decision. It became apparent there was a total breakdown of internal communication and planning between NHSGG&C management and front-line service providers.

Worse yet was the fiasco surrounding the unplanned closure of the Intensive Care Unit at Inverclyde Royal Hospital the week before. It begs the question as to the level of awareness or involvement of the chief executive in the lead-up to declaring the ICU unsafe to stay open. By focusing on political and financial targets, the health board has lost sight of the needs of patients and its employees. The advice of nurses and doctors is being disregarded. Frequently, implementation of management policy requires schoolyard bullying tactics. Consequently, when huge additional demands are being placed on a fatigued workforce, there is the real possibility that their support will be alienated. Negotiations with nurses and intensive care doctors are close to breaking point as a result.

These shortcomings demonstrate that the health board is now impeding effective delivery of care, and are only the tip of the iceberg. Many other examples of NHSGG&C delivering unsafe care have simply come and gone without accountability being imposed. Next in the pipeline is the proposed stripping of all urology services from the Clyde sector of the health board.

Stage 5 special measures means that the “organisational structure in a health board is prohibiting effective care”. Surely the time has come for the chief executive and chairman to be stood down. The entire NHSGG&C Health Board should be placed in stage 5 special measures. The time has come to stop this disaster unfolding further. Winter is not the time to be expecting an already failing NHS GG&C to have to cope with the combination of Covid-19, additional seasonal workload, the backlog of the non-Covid-19 first wave, and the continuance of all elective, non-urgent non-Covid-19 healthcare.

Robert Stuart, FRCPSG (Gen Surg), Rhu.