Care and Wellbeing Board minutes: January 2023

Attendees and apologies

• Christine McLaughlin (Chair)
• Aidan Grisewood 
• Alan Gray
• David Martin
• Hugh McAloon
• John Burns 
• John Nicolson
• Karen Duffy
• Karen Reid
• Kim Walker 
• Linda Bauld 
• Linda Pollock 
• Liz Sadler
• Lorna Kelly
• Malcolm Summers
• Mary McAllan 
• Michael Chalmers 
• Niamh O’Connor
• Nick Morris 
• Ralph Roberts 
• Richard Foggo
• Stephen Lea-Ross
• Susan Webb

Apologies

• Alex McMahon
• Angela Leitch
• Donna Bell 
• Eddie Fraser 
• Gillian Russell 
• Gregor Smith
• Jason Leitch
• Judith Proctor
• Nicola Dickie 
• Richard McCallum
• Robbie Pearson
• Stephen Gallagher
• Tim McDonnell 

Items and actions

Welcome and apologies

The Chair opened the meeting, noted apologies and welcomed Susan Webb (Chair of Directors of Public Health) as a new member to the board. The Chair welcomed Karen Duffy to the board in her new role as Preventative and Proactive Care Senior Responsible Owner.  Lorna Kelly joined as deputy for Judith Proctor.

Meeting minutes from the last meeting held on 11 November 2022

Minutes of the Meeting on 11 November 2022 were agreed as an accurate record. No matters arising. 

Strategic overview – Kim Walker (KW), Niamh O’Connor (NO) 

Niamh O’Connor described the wider policy context and illustrated the connection between Portfolio activity across primary, secondary and tertiary prevention and how this maps to determinants of health, Marmot policy objectives and impact on the Portfolio mission. The gap in Portfolio coverage relates to population health initiatives including on major health harming behaviours such as alcohol and tobacco.  Proposal on how to fill that gap – likely as an extension to place and wellbeing – will come to Portfolio board. 

Niamh O’Connor reflected on significant progress being made across the Portfolio since the board was established in April 2022. As the Portfolio matures throughout 2023, the next phase will be to maximise the connections and dependencies between programmes and enablers. Examples of this are already happening, with the analysis and evidence enabler leading the preventative and proactive care (PPC) programme evaluation workshop on outcomes and the support the workforce enabler has provided to anchors work in the place and wellbeing programme. In addition, cross government policy coherence work is developing between health and economy, child poverty and place-based prevention. 

Kim Walker provided an update to the board on Portfolio progress, which is currently assessed as amber, based on the collective progress which has been made to date across programmes and enablers, balanced with ongoing challenge of resource implications and lack of progress on defining Portfolio benefits. KW pointed members towards the draft 2022 to 2024 Portfolio delivery plan, which will provide a visible path to green and an expected complete baseline of activity due by end of March 2023, and plan for scoping/engagement for NHS service reform work expected. KW highlighted the success of the first newsletter shared in December 2022 which has received over 2000 views.  

Christine McLaughlin asked the board to consider if the level of detail presented to the board and engagement between meetings on specific pieces of work is sufficient, or more needs to be done. 

Action board members to consider the level of detail shared in Portfolio board papers and engagement between meetings and provide feedback to Portfolio team

Programme progress – Karen Duffy (KD), Liz Sadler (LS), John Burns (JB) 

Executive sponsors/senior responsible owners (SRO) provided a brief update on their respective programmes. 

Karen Duffy highlighted PPC progress since the last board meeting. PPC are reporting amber, with a visible path to green. PPC are working with eleven pathfinders across health and social care partnerships on the getting it right for everyone (GIRFE) framework, with the first design school held last week and codesign process ongoing. Discussions have been taking place with NHS 24 and the Scottish Ambulance Service on primary care PPC and possible pilots for the preventative and proactive space. The waiting well workstream is progressing well, with a shadow group working on discovery ideas and the steering group commencing in February. KD highlighted two new objectives which have been included in the programme charter, focusing on digital PPC and living well. This will come for information to the board in March. 

Board members raised the risk that this programme relies on an overly medicalised model of care and commented that it is critical that it connect to wider placed based prevention work, in partnership with initiatives in economy and covid recovery including the Glasgow and Dundee pathfinders. The board highlighted the need to consider PPC focusing on the cost of getting to an appointment and the wider determinants for access to healthcare. KD welcomed suggestions from the board to explore other areas PPC can work in. The board asked for further information on how PPC programme works together, to get a better sense of scope and impact and allow other areas to engage appropriately and consider wider impacts. It was suggested that presenting connections to other strategies (e.g. covid recovery strategy) visually, would help communicate a common agenda. 

Actions

• PPC colleagues to share updated programme charter at the next board meeting in March
• KD to share driver diagrams for PPC with board members
• NO to follow up with KD on how Glasgow and Dundee pathfinders can support and benefit from work in PPC

John Burns provided an update on the NHS Recovery, Renewal and Transformation (RRT) programme (previously NHS service reform). Since the last board, work has progressed on definition and scope. JB highlighted the importance of being agile in this work, having flexibility but clearly defined objectives. Initial advice to Ministers is being drafted to set out an approach to the work which will demonstrate connection across Portfolio and understanding of the importance of delivery improvement, looking at the complex and challenging transformation that be required over the next decades in health provision. This will include proposals for co-production with stakeholders and the public. It will be crucial not to duplicate or create additional work and demonstrate this is truly a whole system single approach to change, keeping the coherence between the Portfolio, programmes and enablers and other work such as the national care service. A charter will then be developed to bring back to the board for consideration. 

Summary of the board discussion on this item:

• community empowerment and ensuring the public’s role will be an essential part of this work and colleagues were keen to engage in discussions on this
• recognition that health and social care targets and standards need re-designed including explicit reference to the CWP population health measures
• the board agreed to dedicate significant time to a discussion on this work at the next board meeting

LS provided an update on the place and wellbeing (PAW) programme. The anchors workstream is moving forward, with a finalised workplan for 2023 to 2024 due at the next steering group. An updated charter was presented to the board, with a renewed scope of the enabling local change workstream (previously whole system alignment), and revised objectives to the anchors workstream, reflecting the workstream’s priority areas, workforce, procurement and land and assets. The enabling local change objectives have been streamlined due to available resources and time limited opportunities. These objectives will focus on improving local access to population health data and intelligence, effectively deploying Public Health Scotland (PHS) resources to better support local public health planning, and ensuring health is engaging proactively and consistently in Community Planning Partnerships (CPPs) across Scotland. 

Board members suggested further connecting with partners across community planning to gather a sense of what they feel their focus and priorities should be. Engagement with the national community planning improvement board was recommended.  The board noted that Susan Webb was a member of that Group. 

Action LS to engage with the national community planning improvement board to gather a sense of their views on what their focus and priorities should be.

Decision the board approved the updated place and wellbeing charter. 

Workforce – Steven Lea Ross (SLR)

Steven Lea Ross, enabler lead for workforce, presented the workforce enabler charter to the board for discussion and approval which sets out the strategic objectives and priorities in the CWP, and links to programmes and enablers.

The charter sets out the contribution of the workforce enabler to the Portfolio, outlining the ambition to support recovery, transformation and growth predicated on a long-term objective of achieving workforce sustainability. It is predicated on the five pillars set out in the national health and social care workforce strategy: plan, attract, train, employ and nurture. 

The high-level deliverables that will support the delivery of the workforce enabler vision over the next 24 months focus on 3 key areas:

1. improving existing planning, and workforce data approaches at local and national level, linking planning to anticipated population health and care demands
2. developing and embedding training approaches that will support the health and social care workforce reform
3. maximising opportunities for new recruitment, diversification and career length, to minimise the ongoing risks presented by the workforce undersupply

The activity being delivered by the workforce enabler is actively supporting several strategic priorities of the Portfolio and programmes. The enabler is providing strategic support and challenge to health boards developing their role as anchors, through increasing opportunities for apprenticeships and early career entry into stable employment, as well as alternative entry routes for roles to allow parents to sustain and progress in work. Through developing new and bespoke training environments this will reskill and upskills areas of shortage across both acute and community settings.

Workforce have a strong strategic link to the sustainability and value workstream sitting in the finance enabler. Current workstreams are looking at approaches to supplementary staffing and reinvesting release of income and looking at supply and demand. The tension between availability of workforce and finance will influence the rate at which objectives can be achieved. 

Summary of board discussion on this item: 

• need to expand focus on more than NHS, including social care and other services done with community planning partner
• stronger focus is needed on retention, given the length of careers now envisaged, and the culture and behaviour which enables retention
• digital skills and capabilities will be required to achieve these objectives
• further clarity required on what we mean by “growing workforce"
• consider the difference in directly managed versus contracted workforce where there are varying levels of influence
• improving outcomes and taking a preventative approach will reshape the balance and scale of workforce as well as improving financial sustainability. It is important efficiency can be developed through the reduction in gatekeeping activity and the over specialisation of job roles. 

The board approved the workforce charter in principle, with the expectation feedback provided by the board is reflected in the charter. 

Action SLR to update the workforce charter to reflect the feedback from board members. 

Decision the board approved the workforce charter, with the expectation feedback was reflected. 

Analysis and Evidence – Anita Morrison (AM), Scott Heald (SH)

Anita Morrison, enabler lead for analysis and evidence, and Scott Heald, director for data and digital innovation and head of statistics at Public Health Scotland (PHS) provided an update on the Portfolio outcomes, indicators, and dashboard, as well as the health economics workstream.   

The marmot framework is the foundation of the Portfolio. Analysis and evidence have been progressing work in partnership with PHS to develop a dashboard which will track progress against the eight marmot policy objectives using a set of proposed indicators. The indicators drawn from several existing sources including national performance data and the Covid recovery dashboard as well as additional CWP indicators will provide the underpinning rationale and logic, setting out the determinants of health and inequalities which require action across government. Data will be disaggregated by Health Board and local authority level, and by equalities group where possible. 

The dashboard will provide access to the latest data to:

• understand progress against each indicator at a national and local level and assess if outcomes are improving
• support improvement and drive local change by delivery partners
• highlight where further action may be needed 

The current dashboard is a minimum viable product which will be developed over time, evolving with feedback from users. Work is planned to develop case studies with examples of how data is being used to support improvement and drive change, showing successful prevention action. In addition, as the National Care Service (NCS) Programme develops, it is likely more outcomes and indicators will be included. 

AM provided an update on the health economics workplan for 2023. Health economists in Scottish Government and PHS have been working collaboratively on this. The plan uses national and international evidence including the scottish burden of disease study. The long-term aim is to offer a framework for assessing and prioritising resource allocation to have maximum impact in addressing health inequalities.  AM also noted that PHS and Gerry McCartney at the University of Glasgow had completed a rapid health impact assessment which identified and assessed pathways through which the rising cost of living is likely to affect health. They had also undertaken further work on the mitigated and unmitigated impact of the cost of living crisis on mortality, this was published in December 2022. 

Summary of board discussion on this item: 

• consider how the dashboard and associated data is used both locally and nationally
• need to make the dashboard manageable without relying on manual collection of data
• the health economics work can help to inform and challenge decision making especially on need for long term transformation
• this work is a foundational component of the Portfolio 
• suggested SH attends the directors of public health group to discuss how they can support translation into actionable insights
• consider how health economics work can be brought into programmes

Any other business

There were no other items of business, and the Chair closed the meeting. 

The next Care and Wellbeing Portfolio Board was confirmed at the meeting being scheduled for 2 March at 2pm. 

Following this meeting an update was emailed to the board.  This noted that due to diary issues the Care and Wellbeing Portfolio board on 2 March had been cancelled. The next meeting was held on 30 May 2023.