John Swinney’s NHS Grampian crisis shows why scrutiny must lead to action

John Swinney has called for “dramatic action” after Healthcare Improvement Scotland found “major deficiencies” across NHS Grampian and reported that failures to learn from mistakes had caused “repeated and unavoidable harm” to patients.¹

The central failure was not an absence of rules. It was the inability—or unwillingness—of an institution to act on information it already had. Dr Gray’s Hospital continued operating on children despite an order to halt paediatric surgery, and the watchdog said it had lost confidence in management’s ability to provide reliable and consistent information.¹

That is how institutional failure becomes a system rather than an incident. A warning is issued, responsibility is assigned, assurances are given, and the machinery carries on until the next inspection exposes the same weakness in another form.

The report identified poor workforce planning, weak recruitment controls, serious problems in managing doctors, inadequate staffing and a failure by the board to address concerns about safety and quality.¹ These are not narrow technical defects. They are failures of oversight, leadership and accountability—the basic functions for which a health board exists.

Swinney called the failure to stop the surgery “reprehensible” and said immediate changes had been made to senior leadership.¹ That response is necessary, but it is not yet an answer. Replacing individuals can create the appearance of action while leaving decision-making, reporting and escalation systems untouched.

Healthcare Improvement Scotland made 6 recommendations covering safe services at Dr Gray’s, quality checks, medical staffing, information-sharing and board decision-making.¹ The test will be whether these recommendations acquire owners, deadlines and public progress reports, rather than becoming another document cited at the next moment of crisis.

The strongest defence is that complex reforms take years. Some do. But “in progress” cannot mean beyond scrutiny, and apologies cannot substitute for proof that dangerous practices have stopped.

Swinney and Health Secretary Angela Constance have demanded changes, while NHS Grampian’s leadership has accepted the findings and apologised to patients.¹ The public should not have to wait for another damning report to learn whether government oversight or institutional management has worked.