Healthcare Improvement Scotland and Scottish Government: operating framework

Annex 7 HIS Escalation – Process Table

HIS Level

Level 1:

Formal

letter of non-compliance issued to the service provider

Situation

There is no, or limited, response from the service provider regarding lack of progress and/or lack of improvement poses a significant risk to patient care.

And/Or:

Serious patient safety concerns have been identified that require immediate action by the service provider.

Note: Criteria for each level of escalation will be developed.

HIS Action

A letter of non-compliance will be served by HIS’ CEO to the CEO of the service provider, copied to the Board Chair of the service provider.

This will clearly state what improvements or assurances are expected, by when and the subsequent stage in the process if no improvement has been made.

The letter will be published on the HIS website. HIS will publicly report progress made in response.

If joint engagement with another scrutiny body, the MoU with that body will clarify how respective escalation processes will be managed.

SG contact and anticipated actions

SG Sponsor Function and relevant policy lead / budget holder will be informed.

SG may use this information to support routine monitoring of Boards’ performance and to inform its own escalation framework. The information will feed into a rounded assessment by the SG of where a service provider (e.g. Health Board) sits within SG’s own escalation framework.

SG NPPOG may be informed for information only at this stage.

HIS Governance

The below will be notified for information only at this stage:

• HIS Executive Team
• HIS Chair
• HIS Board via HIS Chair
• Chair and CEO of provider

HIS Level

Level 2:

Formally escalate to SG Sponsor Function and relevant policy lead

Situation

Lack of engagement by the service provider and, or insufficient improvement has been made even after the improvement letter issued.

Note: Criteria for each level of escalation will be developed.

HIS Action

A formal external escalation letter is issued to the SG Sponsor Function and relevant policy lead / budget holder.

This would be signed off by the HIS CEO (with the support from the HIS Executive Team) and Board Chair and include a full account of action taken to date.

The HIS website will be updated to reflect this further escalation.

SG contact and anticipated actions

Sponsor Function / policy lead / budget holder / DG Health

SG will share this information internally in line with the processes set out in its own escalation framework and in support of the Health and Social Care Management Board’s role. In many cases, this will be an opportunity to identify, in conjunction with the Board, what improvement support is required.

SG Sponsor Function may escalate to NPPOG for consideration and agreement of required action in line with SG escalation processes.

SG will keep HIS informed of any actions it intends to take.

HIS Governance

• HIS CEO for approval
• HIS Board Chair for approval
• HIS Board via HIS Board Chair for information
• Board Chair and CEO of provider notified

HIS Level

Level 3:

Escalate directly to Scottish Ministers

Situation

Still no, or limited, evidence that actions have been taken forward, or continued concerns regarding the risk to patient care.

Note: Criteria for each level of escalation will be developed.

HIS Action

HIS concern is now so significant that escalation is required directly to Scottish Ministers.

HIS will provide the SG Sponsor Function with a standard notice period of an intention to escalate along with an account of all action taken by HIS towards resolving the situation.

When HIS initiates escalation to Scottish Ministers, this must be done through the SG Sponsor Function, copying in the relevant policy lead / budget holder.

The HIS website will be updated to reflect this further escalation.

SG contact and anticipated actions

Sponsor Function will work with Sponsor Lead and notify

Scottish Ministers to determine appropriate action.

SG Sponsor Function will also escalate to NPPOG for consideration and agreement of required action in line with SG escalation processes.

SG will keep HIS informed of any actions Ministers intend to take.

HIS Governance

• Escalation discussed by ET and approved by the HIS CEO and Board Chair.
• HIS Board via HIS Board Chair for information
• Board Chair and CEO of provider notified