Annual review 2024: questions and answers 

Our annual review provides an opportunity for anyone to ask questions relating to our work.

Below are the questions which we ran out of time to answer during the session. 


How is access to medicines improving in Scotland? How are barriers such as patients’ travel time and cost affecting patient outcomes in their treatment?  

The Scottish Medicines Consortium (SMC) is part of Healthcare Improvement Scotland. Their role is to issue advice about the value of new medicines to Scottish NHS boards. To make sure issues such as travel time are considered, SMC committee has representation from health boards across Scotland. This includes remote and rural areas.  

In addition, SMC’s patient group partners attend committee meetings. They ensure patients’ voices are heard when decisions are being made. Patient groups will raise important equality issues, such as barriers to accessing current treatments and advantages of any new medicine. For example, a new medicine that can be given at home might replace current treatment that needs to be given in a hospital setting. For another medicine, there may be benefits in a longer time between hospital appointments.  

How does the annual review align with the future annual delivery plan of HIS’ work and what are the key priority areas for next year’s annual delivery plan? 

 Our annual review process allows time to pause and reflect on: 

  • what we’ve achieved 
  • how this aligns to our operating priorities 
  • how our key actions throughout the year sync to the broader goals of national healthcare objectives   

We are approaching the midpoint of our 5 year strategy – Leading Quality Health & Care for Scotland. We use the annual review to look forward to where we are going in the remaining trajectory of our plan. Keeping aligned to our strategy is crucial for maintaining a shared understanding of our work and what we can deliver.

Our priorities for next year remain the same. We have four strategic priorities that our Chair, Carole Wilkinson, highlighted in the annual review. We have begun our 2025-2026 planning cycle and by addressing these priority areas, we will support the ongoing improvement and sustainability of healthcare services in Scotland.  

Partnerships and horizon scanning are part of your work. How do you feel industry could become more involved?  

Our processes are designed to be inclusive and transparent. We are increasing our horizon scanning to help health and social care services prepare for new developments. We’re interested in hearing any suggestions on new ways to engage with industry and other stakeholders.   

Do you feel that the 1000 responses to the recent Citizen Panel report gives a true reflection of what Scotland expects from the NHS, given it’s less than 0.1% of the total population?  

Yes, we are confident the Citizens’ Panel gives a true reflection of the Scottish population’s view. Over 1000 Panel members were invited to provide feedback. We received 545 responses, which represents a 50% response rate. This is a robust response rate, indicating a good level of engagement from Citizens’ Panel members. The data for this survey is accurate to +/- 4.2% at the panel level providing confidence in the survey results.

The size of the panel is based on statistical research methods. This allows us to make a statistically robust analysis at a population level. Crucially, the membership is demographically balanced. This is so it reflects the Scottish population, for example, on age and deprivation. It includes people from across the country. 

We established the Citizens’ Panel to provide a snapshot of public opinion. However, it should be combined with further engagement both at a local level and using other methods that provide more detailed qualitative views. For example, via our Gathering Views work.   

Why are NHS Boards now designated as anchor institutions when the original research focused only on education institutions in the USA? This results in money, time and attention being diverted from core functions, resulting in an inferior delivery of services with all that implies.  

‘Anchor institution’ means an organisation that is unlikely to relocate. It is part of the local area and has a significant influence on health and wellbeing of communities. NHS Scotland is an anchor institution. Our role is to be at the heart of national efforts to understand and shape the quality of health and care. By working with partner we can embed quality management across health and care. Our Anchors Strategic Plan 2023-2026 details how we can make a difference to local communities. We don’t believe this diverts resources or is an intensive ask on the organisation. It aligns with our work to ensure people’s voices are at the heart of improvements to the safety and quality of care.  

Why when things go wrong in hospitals is the complaint system so difficult to navigate? This results in missed opportunities to improve the service, safety and quality of care. 

The complaints system at times can be difficult to navigate. Complaints can be complex in nature and need to be directed to the right place so they can be addressed in the right way.  

When something goes wrong, the first place to raise a complaint is with the board itself.  

If the complaint is from a member of staff and cannot be addressed through their board, or they don’t feel safe to do so, they can speak to the whistleblowing officer in their board, or the Independent National Whistleblowing Officer. Where appropriate, concerns raised through this route can be passed on to Healthcare Improvement Scotland if they fall within our remit.   

We deal with concerns raised by staff about the quality and safety of NHS services. This is a process known as responding to concerns.   

Support for patients who have complaints is available from the Patient Advice and Support Service (PASS). PASS is an independent service that provides free, accessible and confidential advice and support about NHS healthcare to patients, their carers and their families. Their trained advisors can support anyone who uses NHS Scotland to understand their rights and responsibilities as a patient, raise concerns, give feedback, or make a complaint. The service is provided by Citizens Advice Scotland. It can be accessed from any Citizens Advice Bureau in Scotland, or via PASS | Patient Advice and Support Service Scotland (pass-scotland.org.uk).    

The introduction of  a Patient Safety Commissioner for Scotland will provide a voice for the people of Scotland in relation to the safety of health care.  

What are the benefits and challenges of the organisational restructure experienced in HIS over the last year?  

Restructuring gives us the opportunity to review and bring our services into natural structures and groupings which compliment how we work. It also increases opportunities for cross organisational working. This will help us deliver our work more effectively. 

The challenge has been a period of change which has been unsettling for many staff. We recognise this. We are working with staff in partnership to support and continue to embed our new structures and directorate arrangements. 

Home working provides an opportunity to recruit across the whole of Scotland on an equal basis. How is HIS taking advantage of this and ensuring there is not a bias in recruiting to two traditional offices? 

Our current hybrid way of working has shown that our work can be done from anywhere in the UK, with exceptions for specific staff groups whose roles need to be carried out on site.  

A recent postcode analysis of our workforce showed we employ several staff who live in remote and rural areas. We also monitor the use of available desks within our office bases. It is important that we employ the right person rather than employ someone based on their home address. This is why we have a flexible working policy.  

How does HIS listen to staff suggestions for improvement?  

We have a range of ways of doing this. We have received our iMatter reports at both directorate and team level and developed action plans to address matters raised.  

We are also beginning to run pulse surveys in our directorates. Colleagues can also raise matters that concern them at our regular All Staff Huddles. Our regular ‘Coffee with Carole and Robbie’ (our Chair and Chief Executive) sessions are also open to all staff to attend. 

The lowest scoring question on the organisation’s iMatter survey this year was “I am confident performance is managed well within my organisation”. The iMatter results also show that staff are disconnected from the board. What action is HIS taking to monitor performance? What action has been taken since the results were published?  How does the board plan to address this and support staff in understanding their role and impact?  

An overarching ‘Shaping Staff Experience’ action plan has been developed for the organisation. This has been shared with our Partnership Forum and staff governance committee. 

The plan outlines a range of commitments including: 

  • a strategic review of imatter results 
  • work to better understand what the questions ‘mean’ within HIS (such as the performance management question) 
  • expanding the use of the pulse survey model currently already in place within the Community Engagement and Transformational Change and the Evidence & Digital Directorates 

Directorates have also been asked to compile directorate action plans. These will build on individual team plans. We will also use pulse surveys to enable local discussion.  

Our board take an active interest in our iMatter results and our board members attend all staff events, staff inductions and encourage staff to attend public board meetings. Our Chair welcomes approaches from staff, both online and in person, to share feedback and ideas. We want to ensure updates and information are shared effectively across our organisation. 

How are HIS monitoring the implementation of action plans created from iMatter? How are staff involved in developing action plans? 

An overarching ‘Shaping Staff Experience’ Action plan for the organisation has been developed following the iMatter results. We have shared it with our Partnership Forum and staff governance committee. 

IMatter processes require individual teams to be involved in developing and ‘owning’ team action plans. Teams get a regular opportunity to check in and look at progress against the two or three commitments that have been developed. If a team has not been involved in development of their plan they should raise it with their director or appropriate line manager. This will ensure they are aware of the team concerns. It will also provide an opportunity to discuss how best to remedy this going forward. The Board and Executive Team are committed to looking at all opportunities to improve on staff experience. It is important to get the chance to raise this matter locally.  

How is HIS monitoring the implementation of all the supports it provides to staff that have been discussed?  

Any individual who experiences well-being or health issues can access support in a timely way from: 

  • their manager 
  • Human Resources (HR) 
  • our Occupational health team 

Our employee assistance programme, provided by Spectrum Health also includes the opportunities for individuals to contact them directly for support. This can be done without going to a line manager if there is a need for urgent support.   

We ensure the support available to staff is shared in detail with our Health and Safety Committee. It is also shared with our Board Staff Governance Committee. There is also a health and wellbeing page, offering a range of support, on our intranet. This page details the range of support, both formal and informal, that staff can access. We also receive regular monitoring reports from Spectrum Health and our occupational health service (provided by NSS). These reports show the range of appointments and activity they have been involved in supporting.