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Your Money or Your Life

It’s not unusual for the people who run large organisations to occasionally set time aside to think about some fundamental aspects of the organisation and how it operates. It may be an ‘away day’ [or even two days], extended time   at an otherwise regular meeting or something similar.

Sometimes we might label it ‘blue sky thinking ‘or be told ‘nothing is off the table ‘or hear similar management cliches. But what we have seen in the past few days is that the one place you can’t do that without an almighty storm blowing up is in NHS Scotland.

The BBC reported that just such a discussion had taken place in September between some senior staff in various Scottish health boards, and that they had a copy of the draft minutes that reported discussion on possible charges for some [wealthier] patients, changes in the prescription regime, and faster turnaround of patients admitted to hospitals.

Cue for a storm of claims, counterclaims and the emphatic dismissal of any such idea by Scottish Government ministers including the Health Secretary and the First Minister. It appears the reaction on social media was so intense that the BBC issued a short statement defending their reporting of these events, and a few brave independence supporters also used Twitter to argue they were right to do so.

“Reporting on the NHS in Scotland is very important … [Our audience] have a right to know what those leading the NHS in Scotland are discussing – and that’s what we’ve been reporting today. “

If we ignore the furore surrounding the public release of this information, it’s important to think about some of the potential consequences and implications of what we have experienced over the past few days.

The first, and one that will have considerable impact on senior [appointed] health service leaders and those elected to government. Such a discussion only arises occasionally, and it’s usually prompted by a very senior person or people giving a brief to their senior strategic managers. The people in that meeting were either licenses, prompted – or perhaps even instructed – to think as widely as possible about future options that might tackle the ‘too much demand /too little money’ which is the health system conundrum that faces all 4 NHS systems in the UK. They took that brief, sat around a room for a good period of time and did just that, and recorded their discussion in minutes that will pass in front of at least 40 or 50 people.

Well, now they know; they won’t do that again will they.

Such events cause a major erosion of trust amongst staff in any organisation, and it will take a long time to rebuild – if it is rebuilt.

More broadly, across the whole range of public services in Scotland, it is clear that we have to think very hard about those public services are organised, delivered and financed. The Auditor General has reported earlier this month on behalf of Audit Scotland with a briefing paper on ‘Scotland’s Public Finances – Challenges and Risks .

In that document, it is observed that “…Both the Auditor General and the Accounts Commission have highlighted previously how difficult it is to reform public services…” and comments that ambitions have often not been matched by achievement.

So, there are explicit and implicit challenges for government – and indeed all of us – to think very hard about what those challenges and risks are. If we don’t, and if government doesn’t, then regardless of how we are located in constitutional terms, we will continue to drift along paring away at some budgets to temporarily boost others.

Both the Auditor General and the Accounts Commission have highlighted previously how difficult it is to reform public services,Wanting to achieve something is admirable but the ‘how ‘of doing that is the most critical aspect of any such discussion.

We can all agree that introducing charges for NHS services is not acceptable, but there are countless aspects of all our public services where such unconstrained thinking might help to chart a way forward.

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