Former NHS Lothian chair says board were told to 'shut up' when asking Scottish Government for fairer funding

Departed NHS Lothian chair Brian Houston says the health board has been pressing the Scottish Government for fairer funding for the region for the past seven years – but were told to shut up.

Figures last year revealed Lothian had been underfunded by £365m in the past 11 years.

Mr Houston said: “Almost ever since I arrived on the board, we have been making the case to government that the NRAC formula significantly disadvantages Lothian.

”The government will say they have just made a budget announcement that seeks to correct that. It corrects it by about a farthing in the pound whereas the gulf is about 20p in the pound.

“If you consider what that amount of money represents and calibrate it in terms of waiting times or missed operations, it’s massive.

“And if you go back over recovery plans submitted by NHS Lothian over the last three or four years, the additional resourcing required in these plans to get us back on track just about equates with the level of these gaps.”

He said NHS Lothian had put forward business cases on what was required to tackle shortfalls in performance on issues like four-hour waits at A&E, mental health access, cancer waiting times, but the response from government had been “minimal”.

“The response has come back ‘It’s your job, you’ve got a budget, we’re spending more than we ever have before, so don’t complain’.

“Tim Davison [chief executive], myself and the director of finance have on different occasions effectively been told to shut up.”

The NHS Scotland Resource Allocation Committee (NRAC) formula was introduced in 2009/10 and allocates money to health boards based on the age and sex distribution of the population in each area, geographic factors and other health indicators.

But because of large differences between the new allocations and the previous amounts boards had received the NRAC formula is still being phased in.

The gap between the amount NHS Lothian should receive and its actual allocation added up over the years to a total of £365.7m, according to statistics from the Scottish Parliament Information Centre (Spice).

Mr Houston said the funding shortfall came despite the fact Lothian’s population was the fastest growing in Scotland and was projected to continue as such.

“That funding gap is in danger of widening all the time unless it is corrected.”

And he said other factors also made NHS Lothian’s financial position worse.

“The decision to build the Royal Infirmary using PFI has resulted in an ongoing annual revenue cost disadvantage to NHS Lothian of many millions of pounds.

“It means every year we are that much money worse off in terms of what we can spend on services because of the

government decision all these years ago to go for PFI.”

He said the new Sick Kids would add to that burden.

“Other factors which also bear on it include social care capacity in Edinburgh and the fact we have bed-blocking to a much greater extent than any other part of Scotland.

“There are two issues creating this limitation on social care capacity – the labour market, because you can’t hire people to work in social care when they can earn more stacking shelves in Tesco; and secondly the property market – you can’t get social care homes because of the property prices or if you can the cost is so huge the city can’t afford to fund it.”

Mr Houston said he felt bad that he and his colleagues had failed to win the extra funding from government which Lothian needed.

“I have a guilty conscience that we have not been able to make this argument stick.

“The people who suffer are the communities of Lothian. They are the people who are receiving a lot less in terms of healthcare than they are entitled to.

“It’s not about NHS Lothian as a board squealing we are badly dealt with. We are concerned because we are under delivering on what our community is entitled to be receiving.”But he argued the board being put into special measures following the Sick Kids debacle should be used by the government as an opportunity to make the investment needed to put NHS Lothian on a fairer footing.

He said last autumn he had been speaking to two senior civil servants who listed what the board should do to get out of special measures by January.

“But I said: ‘I don’t want to be out by January. If you’re telling me that through special measures we’re going to get extra support and money to fix the problems, bring it on’.

“If special measures are meaningful, let’s make them meaningful and use them to recognise we’ve got a problem, we have a crisis here and it needs special measures – not special measures saying you need to report against these things every five

minutes, but sitting down and having a fundamental review of how we deliver things, designing new solutions and investing the money to make that happen.”

Health secretary Jeane Freeman must appear before Holyrood this week to answer accusations from one of Scotland’s top public officials that she lied, the Scottish Conservatives have said.Mr Houston said Ms Freeman wasn’t telling the truth when she claimed she personally halted the opening of Edinburgh’s new Sick Kids hospital, over-ruling the health board in the process.

In an explosive interview in yesterday’s Edinburgh Evening News, he also said Ms Freeman told him to resign or she would sack him over the fiasco.

The showdown came when the health secretary was under intense pressure for other failings across Scotland’s health service, not least the significant delays to the flagship children’s hospital, which was supposed to open in 2012.

Shadow health secretary Miles Briggs said: “Scotland’s health secretary has been called a liar by one of the most senior public officials in the land.

“That’s an incredible situation, and one which she must address immediately. We’re demanding she makes a statement to Holyrood this week on the fiasco. It seems from Mr Houston’s account that Ms Freeman – who was already under intense pressure because of other health failings across Scotland – used the Sick Kids crisis to show who was boss.

“That would be playing politics with one of the worst NHS scandals since devolution.”

A spokesman for the Scottish Government said: “We totally refute the claims made by Mr Houston.”