Letter to the Convener from Stephen Boyle, the Auditor General for Scotland, 20 December 2021
Dear Convener
The 2020/21 audit of NHS Tayside has concluded and the auditor’s opinions on the annual report and accounts are unmodified.
I am writing to advise the Public Audit Committee that I have decided not to produce a Section 22 report on NHS Tayside this year.
There has been ongoing Parliamentary attention given to NHS Tayside in recent years. In December 2020, a sixth consecutive Section 22 report was presented to Parliament on NHS Tayside. This reported that NHS Tayside is making progress under its new Executive Leadership Team and financial management had strengthened alongside some improvements in service performance. However, there were still matters to be addressed.
The 2020/21 audit found that NHS Tayside continued to make progress. The board operated within its revised Revenue Resource Limit for 2020/21 and achieved all of its planned efficiency savings of £28.1 million. This was after making a £3 million repayment to the Scottish Government of its outstanding £7 million funding flexibility and returning £7 million of Revenue Resource Limit funding to the Scottish Government for re-allocation in 2021/22.
In common with all NHS bodies, the Covid-19 pandemic has had a significant impact on the focus and priorities of NHS Tayside, and the effect of this on the board’s longer-term financial position and savings targets is still uncertain.
The 2020/21 annual audit report states that improvements are being made in mental health services in Tayside although significant work is still required. The board is considering its response to the recent independent Inquiry into Mental Health services in Tayside, Trust and Respect, Progress Report 2021. The Minister for Mental Wellbeing and Social Care has recently appointed an independent group who will provide oversight and assurance and support progress in improving Tayside’s mental health services and ensure that the recommendations from the independent inquiry are fully implemented. The auditor will monitor the board’s progress in this area in 2021/22.
In April 2018, NHS Tayside was moved to escalation level 5, the highest level of the Scottish Government’s NHS performance escalation framework. This was in response to concerns over NHS Tayside’s financial sustainability and weaknesses in its governance arrangements.
As a result of improvements in corporate governance arrangements put in place during 2018/19, the board's level of escalation was reduced to level 4 in February 2019. Level 4 escalation indicates significant risks to delivery, quality, financial performance or safety.
During March 2021, the Scottish Government undertook a review of NHS boards’ escalated positions. This review drew upon information from Remobilisation Plans as well as other relevant data to assess boards’ strength in the following areas of performance: financial management; operational delivery; and governance and leadership. The review also considered any specific issues which were of particular concern at the time of escalation.
Following consideration of the outcome of that review, in June 2021, the Scottish Government de-escalated NHS Tayside to Stage 2 in relation to financial position, governance and leadership, and performance; and to Stage 3 in relation to Mental Health performance. This is a further reflection of the improvements made by the board.
I will provide a further update on NHS Tayside in my NHS in Scotland 2021 report, due for publication in February 2022.
With best wishes
Stephen Boyle
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