One of Scotland’s top doctors has hit out at bureaucracy choking the health system after a “deeply disturbing” report from the country’s spending watchdog.
Health boards across the country set up community health partnerships (CHPs) seven years ago in an attempt to link up services across their area. That includes GP services, community health services, dentists, mental health and a range of other services.
However, a report published today by Audit Scotland states some of the CHPs don’t even know how many people they employ or how much they cost to run. The watchdog added it could only find “limited evidence” of any improvements having been made on the health care provided.
The 36 CHPs manage £3.2 billion in annual health and social work spending but, according to the report, some national health trends are worsening. More old people and those with long-term health problems are being admitted to hospital as emergencies.
While there has been a drop in “bed blocking” where patients are well enough to leave hospital but stay because there is no care for them outside that has remained a problem in parts of Fife.
Dr Dean Marshall, chairman of the British Medical Association’s Scottish general practitioners committee, said doctors recognised the report’s conclusions and criticised CHPs for high levels of bureaucracy.
“This is a highly critical report which confirms our experience of the management and performance of these organisations,” he said. “It is deeply disturbing that, with responsibility for such a significant sum of NHS funding and despite the many bureaucrats that work for these organisations, their financial management, strategy and governance is so poor.Beyond belief”That a CHP cannot say how many staff it has working within its structure, or how much it has spent on administration costs, is beyond belief.
“GPs have turned their back on CHPs because they have become bureaucratic monoliths caught up in their own internal processes rather than influencing the planning, funding and development of local services to meet patient needs. They have also spectacularly failed to bridge the gap between health and social care a challenge that must be met in order to care for our increasingly elderly population.
“We welcome the recommendation to involve GPs in planning services for the local population and in decisions about how resources are used. It is my view that in order to achieve real engagement, these GPs should be truly representative of their peers.
“This report signals a need for the Scottish Government to conduct a complete review of the structure and function of CHPs. In order to be successful at improving joint working between primary and secondary care, and between health and social care, these organisations must be clinically led and management supported. They cannot continue as they are.”
Auditor General for Scotland Robert Black said single bodies could not tackle Scotland’s health problems on their own.
“Stronger shared leadership is needed from all partners, with good engagement from GPs and other care professionals to ensure services meet the needs of local people and are efficiently delivered,” he said. “There should also be a fundamental review of the various partnership arrangements.”
Tory health spokesman Murdo Fraser described the report’s findings as worrying. The Mid Scotland and Fife MSP added, “Based on the findings of this report we support calls for the Scottish Government to conduct a complete review of the structure and function of CHPs as soon as possible.”