'Outstanding' praise for bosses at struggling NHS boards

Bosses at struggling health boards are regularly being handed 'superior' and 'outstanding' performance appraisals, BBC Scotland can reveal.

The Scottish government has formal "oversight" of six NHS boards due to poor performance in areas such as finance and leadership.

But new data shows many NHS executives are being given top appraisal marks which are then linked to pay rises.

The Scottish government said executive appraisals are "robustly assessed".

A spokesman added that bosses in a struggling board can still deliver superior or outstanding performance given the range of individual responsibilities for executives in the NHS.

A recent review of senior management failings at NHS Forth Valley said it was "of concern" that these problems - and how they were being addressed by the board's chairperson and chief executive - were not reflected in the performance appraisal reports of the individuals.

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Appraisals of executives' performance are carried out by a board's remuneration committee and checked by a national performance management group.

The appraisal data was released to BBC Scotland under freedom of information laws but without revealing the individual scores of executives at the health boards.

Across all of the boards which responded to the request, the majority of executives got 'fully acceptable' scores and nobody's performance was ranked as 'unacceptable'.

The performance mark is linked to the potential pay increases of executives, which last year ranged from 0% for an unacceptable appraisal to 3% for an outstanding one.

The data covers a period when the NHS was under intense pressure as a result of the Covid pandemic.

Struggling health boards with formal Scottish government oversight are often referred to as being in "special measures" but this is a term used in England's health service.

In Scotland, health boards are subject to the "NHS Board Performance Escalation Framework" which ranks from one to five, with five being the worst, and it relates to specific problem areas.

Stage three and above is when the Scottish government formally puts in place support and oversight.

Appraisal scores for NHS boards with government oversight

• Ayrshire and Arran - Scottish ministers put in extra support in 2018 as result of concerns about financial management. At least one 'superior' and 'outstanding' award was handed out in 2020/21 and the following year.

• Borders - Has had oversight since 2018 for financial management issues. In 2022, five of its nine-strong executive team got 'superior' appraisals.

• Forth Valley - Has had government oversight of its "governance, leadership and culture" since 2022 due to problems with out-of-hours services and unscheduled care. The board's remuneration committee awarded nine executives in 2021/22 a 'superior' award, one the following year and one in 2022/23.

• NHS Highland - Oversight across different areas since 2018. A total of six 'superior' performances were recorded in 2020/21 and seven the following year.

An independent review last year raised concerns about executive appraisals at NHS Forth Valley but the board said work to "review and further strengthen" appraisal arrangements has been carried out

Appraisal scores for NHS boards currently without government oversight

• Greater Glasgow and Clyde - In 2020/21 four executives got either a 'superior' or 'outstanding' appraisal score. This came in a period when the board was in "special measures" relating to infection control procedures after the deaths of two children at the city's largest hospital.

• Lothian - At least one executive got a 'superior' score every year between 2020 and 2023, a period when the board did have Scottish government oversight due to delays in opening the new Sick Kids hospital and failings in paediatric audiology services.

• Fife - In 2021/22 and the following year, a total of six senior bosses got a ''superior' appraisal award. At least one executive got 'outstanding' in 2021/22.

• Lanarkshire - The board with the most 'superior' appraisal scores; a total of 11 in 2020/21, four the next year and five in 2022/23.

• Grampian - At least one 'superior' or 'outstanding' rating was dished out in 2020/21.

NHS Tayside, which has Scottish government oversight of its mental health performance, and NHS Dumfries and Galloway refused to release appraisal scores on the grounds it was personal information.

NHS Orkney - which has government oversight due to concern over its financial management - NHS Shetland and NHS Western Isles said they couldn't release the data because of issues with possibly identifying the individual executives.

A Scottish government spokesperson said: "We are assured, via the National Performance Management Committee, that executive appraisals and ratings are robustly assessed by board remuneration committees.

"Given the range of individual responsibilities of executives in the NHS, whilst a board may be addressing challenges in performance in a specific area, executives within that board can still be delivering superior or outstanding performance within the areas for which they are responsible."