Care and Wellbeing Portfolio Board minutes: April 2022

Attendees and apologies

• Richard Foggo (Chair)
• Christine McLaughlin (Chair)
• Linda Pollock
• John Burns
• Jonathan Cameron
• Michael Kellet
• Anita Morrison
• Eddie Follan
• Richard McCallum
• Tim McDonnell
• Donna Bell
• Michael Chalmers

Apologies:

• Eddie Fraser
• Gillian Russell
• Gregor Smith
• Mary McAllan
• Robbie Pearson
• Ralph Roberts
• Aidan Grisewood
• Linda Bauld

Items and actions

Introduction

Christine McLaughlin (CMc) welcomed attendees to the first Care and Wellbeing Portfolio Board (CWPB) and introduced the Care and Wellbeing Portfolio (CWP).

The purpose of the meeting was set out:

• for CWPB to learn as we go, developing iteratively and building trust and positive relationships
• agree scope and approach of CWP
• to reflect on the Terms of Reference, to understand what the collective responsibilities are, recognising that we are not starting the portfolio from zero as a lot of substantial work has already been achieved

CMc provided thanks to all who have been involved so far and acknowledged colleagues who have been invited to join Board: 

• Linda Bauld - Chief Social Policy Adviser, SG
• Aidan Grisewood – Director, Economic Transformation Strategy
• David Martin – SG Non-Executive Director
• Eddie Follan – COSLA Advisor

Board members and attendees were invited to introduce themselves. Please refer to Appendix 1 for attendee details.  

Care and wellbeing portfolio – Richard Foggo (RF)

RF presented an overview of CWP (slides presented) and highlighted the following key points: 

• Scotland has the lowest life expectancy in western Europe
• problem statement - ‘we work in a system that is unsustainable, lacks coherence isn’t delivering the outcomes we need’
• the importance of learning from previous strategies that have not been delivered. That includes lack of coherence, too many priorities, failure to consider enablers. The CWP would have to take different approach
• cross government working would be essential, given wider contribution to outcomes, and that meant a wider set of Portfolio priorities including climate, children and young people, and communities
• the “three horizons” model is the basis for ensuring that our strategic approach balanced managing the current system (H1), innovating to sustain the current system and bridge to a new world (H2), and creating the conditions for the new world (H3). This must be done in parallel from now, and not in a linear, sequential way

RF set out emerging priorities under the three horizons including digitally enabled community MDT and digital front door in H2 and enhancing citizen empowerment in H3. In discussion the following points were made:

• the focus for CWP needs to be wider than traditional health and so we will need to work with other SG portfolios and other public sector partners
• we need to ensure that the three horizons model is understood and used consistently not just within CWP but also in NHS planning. That means ensuring that H1 concerns inc NHS delivery are related clearly to H2 innovations and H3 issues
• broad agreement on diagnosis of basic issues CWP has to address (sustainability and health inequalities)
• workforce was recognised as a significant enabler. This is critical with NHS as biggest employer in Scotland

CWP strategic framework – Kim Walker (KW)

KW presented the methodology for the Portfolio Framework for CWP. The key points included:

• adopting methodology to design and define the framework using best practice  
• portfolio Definition (cycle 1) outlines what will be delivered, including priorities and products 
• the Portfolio Delivery (cycle 2) includes dependency management, consistency and ways of working 
• currently in cycle 1 within the definition phase - creation of charters for programmes and enablers to understand Portfolio scope that will help deliver the mission
• framework will provide infrastructure to support delivery 

Care and wellbeing programme charters

Integrated Urgent and Unscheduled Care (IUUC) Programme Charter– John Burns (JB). JB provided a verbal account of IUUC Charter. Key points included:

• IUUC charter is in a dynamic place which will further evolve over time with the establishment of the national collaborative and re-design of the care pathway
• draft charter has been considered by the IUUC Programme Board, it is an iterative process with clearer connections to the portfolio mission, priorities and longer term reform ambition to be identified
• significant connections across the 3 other Care and Wellbeing Programmes as well as Enablers, for example, digital front door

Integrated Planned Care (IPC) Programme Charter – JB

JB provided a verbal account of the IPC Charter. Key points included:

• strong connection between IUUC and IPC over the last two years that needs to continue
• the charter has been built around the planned care delivery framework
• there is a need to think differently in terms of planned care – manage current challenges while planning for future
• need to be agile, similar to IUUC in making stronger connection to mission and priorities, and acknowledge that we are working in a challenging environment as we reform services

Preventative and Proactive Care (PPC) Programme Charter – Donna Bell (DB)

DB presented the PPC Charter. Key points included:

• acknowledged importance of links between IUUC and PPC
• positive discussions have taken place at PPC Steering Group, focusing on multi-disciplinary working, changing how people think about health, and getting leadership and front-line staff buy-in will be crucial
• PPC will use the Getting it Right Together practice model, using a holistic approach, with and for the people and involve primarily community-based set of support and interventions
• positive response and commitment to pathfinders, building on existing locality working and linking with other programmes
• dependencies and opportunities to be worked through between PPC and IUUC and P and WB in particular 
• digital will be an important enabler for PPC (e.g. predictive analytics on LTCs)
• emphasis to understand the role of multi-disciplinary teams (MDTs) and how they are used as the centre piece of the programme
• need to make sure workforce is used in the best possible way within a local, regional, and national basis

Place and Wellbeing (P and W) Programme Charter - Michael Kellet (MK)

MK provided an overview of the P and W Charter. Key points included: 

• P and W is not just about care but about how to get people to stay well without requiring care from the system
• focus on communities which includes all sectors, third parties, private and public working. It aims to reduce inequalities in healthcare with local focus being at the heart of the programme
• there are three workstreams under the focus of P and W: Whole system alignment; Anchor institutions; and Community led improvement in local communities
• good progress is being made and now have an established steering group whose members include individuals across the HASC system, COSLA, and critical friends

General feedback on charters

Key points included:

• board members were content with how the work within the four programmes is coming together as in initial package of reform
• further connections needed between PPC and P and W on prevention and public health. E.g. the links between system, citizens and community led groups to help reduce unhealthy life expectancy
• portfolio priorities framed by 3H will be brought to the next meeting
• government programmes and priorities sitting alongside CWP (e.g. the child poverty plan, The Promise, net zero, etc.) need to be considered as we build portfolio
• suggestion to look at the milestones for each of the programmes to help look at the synergies
• would be useful to know which MDTs CWP are focussing on and highlight the need for more emphasis on the definition of communities
• work is underway around the development of pathfinders looking at locality-based work with an interest to understand what people want in terms of services
• COSLA are cited on CWP and are keen to seek opportunities to get buy-in from the new Execs, who are due to start their new posts and through discussion during Board

Actions: 

• CMc, RF, MS to bring an updated visual on Portfolio priorities at the next Portfolio Board
• CMc and RF to look at ways to incorporate the government programmes into CWP
• PMO to review milestones of each of the programmes and identify synergies

Enabler charters 

Analytical Insights Charter – Anita Morrison (AM)

AM introduced the Analytical Insights charter. The following points were made in discussion: 

• looking at the evidence base for health inequalities and healthy life expectancy over the COVID-19 pandemic, what’s currently available and working with across Scot Gov, PHS and local authorities
• HSCA will produce a core evidence pack and are in the process of developing version 1. Includes focus on Health economics to identify the inequality impacts that we are seeing. 
• currently working with P and W by looking at evaluation plan and developing theory of change
• making sure that any analysis conducted is clearly understood by the Board and is coherent approach across CWP

Digital, Data and Innovation (DDI) Charter – Jonathon Cameron (JC)

JC introduced the DDI charter. Key points included: 

• the new data delivery plan is going out for public consultation shortly providing opportunity engage with the broader public in how we are using data
• digital front door critical to CWP work – support citizens with access to digital services and have ownership of their care and wellbeing
• risk of increasing interest from HARA on clinical safety which is impacting the timelines on the work being done

Action:

• JC to circulate the updated Digital Charter to the Board

Service Design and Quality Improvement Charter – Linda Pollock (LP) 

LP introduced the charters. The following key points were discussed: 

• there is a network of QI resources that the CWP can engage with to support improvement, project support and evaluation
• service Design team is working across the Portfolio to develop approach to involving people who use and provide services in design and planning
• there is a requirement within Service Design to think about the wider engagement plan
• QI and service design team is small and prioritisation within CWP will be necessary
• IUUC Programme Board are thinking about level of engagement and there is a risk of each Programme working in silo. Need to think about wider participation of users of services across all programmes in a coherent way

Action:

• consider how CWP Programmes are tied into wider engagement with service users to ensure approached in a structured and coherent way. LP to lead on discussions

Value and Sustainability Charter – Richard McCallum (RM) 

RM provided an overview of the sustainability and value enabler. Key points from discussion included: 

• it is important to ensure funding decisions are made in a coherent way, framed in relation to reducing health inequalities and increasing healthy life expectancy whilst expecting the financial challenges we will be facing within the next couple of years
• programme plans need to be coherent in any funding propositions and account for financial context linked to improved outcomes
• we need to have flexibility to think differently in terms of infrastructure, and how that can support portfolio mission and priorities

Workforce charter - Steven Lea-Ross (SLR)

SLR provided the Board with a summary of workforce. The key discussion points included: 

• the Workforce strategy sets out ambition around growth and transformation, which will also include a sustainable workforce that is value for money. This is a revision on the current workforce plan and approach
• lifecycle action plan which includes recruitment, training staff, and clinical responsibility – changing behaviours
• workforce is focussed around H2 and H3 
• the focus is around the skills that the workforce can do rather than who they are

CMc thanked presenters and highlighted the importance of enablers within CWP.

CMc asked for feedback on the Terms of Reference for the CWPB. Thoughts were invited with regards to meeting monthly, and additional external board members. The Group did not have any immediate comment but agreed to get in touch in advance of the next board if any amendments need made.

Decision – The group agreed on the Terms of Reference provided no comments come back before the next Portfolio Board. 

CMc thanked everyone for their contributions and encouraged the Board to get in touch if they have any questions. 

Date of the next meeting

Thursday 26th May 2022.