The week began with a Daily Briefing about a serious concern about the failure of a health board in Scotland, with the government arguing that the health board was the solution to its own problem. The week ends with a Daily Briefing about a serious concern about the failure of a health board and the government arguing that the health board is the solution.
It isn't the same health board, though. This time it is NHS Grampian. And this time it isn't an unprecedented 'plea for help' from the entire accident and emergency unit but instead a scandal about potentially dangerous operations being carried out on children.
Healthcare Improvement Scotland has issued a report which is utterly damning. Among the aspects of the Health Board's performance it raises serious concerns about are leadership and accountability, governance, assurance and board oversight, ability to effectively resolve problems and implement improvements, culture, service sustainability and candour and transparency. It is hard to know what to make of such a comprehensive condemnation.
Yesterday the First Minister responded by discussing how some executive positions have turned over and expressed 'utmost confidence' in the new Chair. This is hardly reassuring; NHS Grampian was caught in a series of scandals over a decade ago and rather than fire the Board, the Scottish Government shuffled some executive positions and expressed 'confidence' that the Board would turn things around.
That was in 2014, but the report published yesterday makes clear that there were subsequent substantial warnings of problems in 2016 and 2023. The Scottish Government appears not to have 'utter confidence' in its quangos, and repeated and disturbing failures in the same health board do not seem to do anything to dent that confidence.
In 2014, the only real action taken was to gradually shuffle out some of the people responsible. Five people left, but four of them simply retired. They were replaced with the people who this report has now condemned and whom the First Minister assures us have been replaced again.
Last time there was one resignation; this time there does not seem to be any. Yet again a ruling class has presided over massive, shocking failures, has stonewalled the public and then quietly saved their own skins with the help of the government, which has assumed the same position throughout – it has at no point ever not had full confidence in the Health Board.
It cannot be clearer that Scotland is run by a group of unaccountable people, will not face any accountability no matter what they do or don't do, will be protected and parachuted out and replaced with other members of the same ruling class. They can then repeat the process, and at the end, when they are found to have also failed, they will be protected by the government too.
Yet medicine is a scientific subject, and PR does not make an illness go away. In medicine, if the same remedy is tried over and over and the same failed outcome results, the medics would not repeat it again. In public sector governance, the opposite is true. It is immune to facts, precedent and history and will always be met with a reshuffle and a statement of confidence.
There is a fundamental problem with the culture of governance in Scotland, and there is a fundamental problem in the political culture of how to respond to the failure of governance. The former believes they are there to cover their own backs and suppress bad news about their performance. The political culture sees its role as to intervene when failures become too big, but only to ensure the continuation both of the failed structure and the failing culture.
And so it repeats again and again, quango after quango. This is met with an utterly remarkable degree of tolerance by the political classes, and that in turn solidifies and makes permanent the problem. It does not seem that there is anything shocking enough to disrupt the comfortable existence of a health board, and there is no problem that hasn't already been fixed by a reshuffle that has already taken place.
People in Scotland have been poisoned with infected water while in hospital, have been operated on fraudulently, leaving them disabled, had their children subjected to unnecessary and dangerous operations, had their tax money fraudulently misappropriated by an NHS official in a bribery scandal (he and four others are now in prison, though their sentence has just been cut).
They have manipulated waiting list data, been caught in major bullying allegations, have been responsible for systematic breaches in data protection laws, appear to have pressured a hospital to open before it was safe, lost in court over discrimination, covered up an unsafe ventilation system in a children's hospital and harmed babies because of a toxic culture in a maternity unit.
Every one of these was covered up by its respective Board. There is a clear, systemic failure of governance in the NHS, and neither another shuffling of the deckchairs nor yet another offer of 'confidence' from the First Minister is an appropriate response.