In November 2022, NHS Forth Valley was placed under Scottish Government control after “significant risks” were found within the health board.
The move came after issues were raised by a Healthcare Improvement Scotland report, as well as other concerns over performance and leadership.
The measures were recently lifted after nearly two years, in October 2024.
A taskforce dedicated to helping NHS Forth Valley has implemented several changes.
The health board is now under new leadership, running new culture programmes and most areas of concern have drastically improved.
Here’s everything you need to know about why drastic action was taken and what has been done to improve the situation.
Why was NHS Forth Valley placed under special measures?
The Scottish Government escalated NHS Forth Valley to Stage 4 on November 23, 2022, due to concerns over leadership, culture and governance.
Stage 4 indicates that an NHS board has “significant risks to delivery and tailored support is not producing the required improvements”, therefore requiring senior support.
NHS Greater Glasgow and Clyde was escalated to Stage 4 in 2019, but it is rare for this level of oversight to be required.
Under the Support and Intervention Framework, it prompted a need for an Assurance Board chaired by the Scottish Government to support the health board while it delivered improvements.
At the time, then health secretary Humza Yousaf said there were a range of performance-related issues within NHS Forth Valley, including concerns around GP out-of-hours services and unscheduled care.
The board determined the necessary steps to fix problems.
This included supporting performance improvements in out-of-hours, unscheduled care, mental health, and integration.
What changed at NHS Forth Valley?
NHS Forth Valley moved to Stage 3 of the NHS Scotland Support and Intervention Framework on October 1, 2024.
This meant the health board no longer required oversight from the Assurance Board.
Out of Scotland’s 14 health boards, six are currently at Stage 3.
In a letter to MSPs, the chair of the NHS Forth Valley Assurance Board, Christine McLaughlin, outlined the improvements made.
In terms of leadership and culture, she highlighted “increased stability” due to recent appointments, such as new chief executive Ross McGuffie.
A Culture Change and Compassionate Leadership programme was also implemented.
This involved “extensive listening and learning at all levels of the organisation”, as well as improvements in leadership and ensuring employees have the opportunity to have their concerns heard.
Governance issues were seen to be resolved, as the Assurance and Improvement Plan was being met.
While performance was not the reason NHS Forth Valley moved to Stage 4, improvements in out-of-hours, child and adolescent mental health (CAMHS), psychological therapies and integration were reported.
Ms McLaughlin said the board was “doing everything possible” to reach improvements in unscheduled care.
What does the data say?
Pressure on NHS Forth Valley is rising in some areas, with 6,189 presentations to the GP out-of-hours service in March 2024, compared to 4,454 in March 2023.
In terms of unscheduled care, such as A&E, NHS Forth Valley continues to have patients waiting more than four hours, as per the standard across Scotland.
The standard for mental health care is for 90% of patients to start treatment within 18 weeks of referral.
NHS Forth Valley falls below this mark. In the quarter ending March 2024, 68.9% of patients were seen on time by the health board, compared to 71.1% in March 2023.
The figure was sitting at 71.6% in the quarter ending June 2024.
CAMHS is held to the same standard as adult mental health care, and great improvements have been seen here.
For the quarter ending March 2024, 92.8% of CAMHS patients were seen within the timeframe, whereas in March 2023 it was sitting at 42.5%.
By June 2024, this had increased to 97.9%.
What does NHS Forth Valley say?
NHS Forth Valley told The Courier that a wide range of work has strengthened and improved leadership, culture, and governance across the organisation.
A spokesperson said: “Changes have also been made to improve performance in a number of service areas including Child and Adolescent Mental Health Services and GP out-of-hours services.
“As a result, NHS Forth Valley is currently one of the best performing NHS Boards in relation to mental health support for child and young people and waiting times for outpatient and planned surgery.
“We have also invested heavily in the development of advanced practice training for nurses and AHPs to help increase capacity and reduce waiting times across local services.
“This approach is seen as a model of good practice and many other NHS Boards are keen to adopt a similar approach to staff training and service redesign.
“We recognise, however, there is more to do to ensure we maintain and build on the progress made over the last two years and we will continue to work closely with Scottish Government colleagues, partner organisations and local staff to take forward a wide range of changes and improvements.
“This includes ongoing work to take forward a significant culture change programme, plans to develop and deliver an ambitious new healthcare strategy to improve the health of local people and further work to strengthen our approach to active governance to help ensure we are able to anticipate and respond to future risks and opportunities.”
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