6. Options for hosting the INO role
The Scottish Government considers that where the INO is hosted is fundamental to the credibility and ultimately the success of the role. The independence and impartial nature of the role are viewed as vitally important. The Scottish Government has considered various options for hosting the role bearing in mind factors such as costs, likely volume of cases, staffing considerations, legislative requirements and access to specialist advice.
Three key options emerged:
- Option 1: INO hosted within NHSScotland - Healthcare Improvement Scotland ( HIS)
- Option 2: INO hosted within existing external organisation - Scottish Public Services Ombudsman ( SPSO)
- Option 3: INO created as a new Public Body
Question 4: Where should the INO role be hosted?
Of the 47 respondents who provided a clear preference, a majority of 36 respondents considered that the INO should be hosted within the SPSO. 11 recommended hosting the INO within HIS, eight of these being individual respondents, the remaining three being professional or other public bodies. None suggested creating the INO as a new public body which was viewed as a costly and unnecessary option.
Only one further option, Audit Scotland, was proposed by one individual as being an independent organisation appropriate for hosting the INO role.
Views for and against Option 1: INO role hosted within HIS
Amongst the minority of respondents who supported the INO role being hosted within HIS the following benefits were identified:
- HIS role fits with the INO role regarding service improvement and scrutiny functions.
- HIS already deals with whistleblowing complaints and therefore taking on the wider INO role will be more straightforward than if another body takes this on.
- HIS is already well known to NHS staff.
The most common argument against hosting the INO role within HIS was that HIS is not viewed as independent by NHSScotland staff and conflicts of interest may arise or be seen to arise.
Another recurring argument against the HIS as host to the INO role was that HIS focuses on healthcare issues but the Integration Joint Board arrangements would require it to broaden its focus to wider care issues which may compromise its core functions.
Views for and against Option 2: INO role hosted within SPSO
This was the more popular option amongst those who responded, with the primary argument in favour being the independence of the SPSO from health and social care bodies and also the perception and impression of impartiality (from care bodies and from the Scottish Government) which it generates:
"Whilst there are arguments that could be made for hosting the INO within HIS, we think that it would be better placed within the SPSO as it then is visibly independent of the NHS and Scottish Government. This independence could be important in avoiding allegations of NHS or government interference which might be raised if there was a contentious judgement and it was hosted within HIS" (Guild of Healthcare Pharmacists).
A few respondents highlighted the advantage of the SPSO already spanning the entire public sector, including both health and social care sectors. The Scottish Social Services Council commented:
"We note that the SPSO currently has a role as the final stage in investigating complaints from service users and note that their remit extends beyond health boards to include some care providers who provide services on behalf of the NHS and also to local authorities who provide and commission social care services."
Other arguments in favour of hosting the INO role within the SPSO were that the SPSO already has relevant expertise and experience; this will be the most cost-effective option; and this is the option which will reduce risk of duplication the most.