Care and Wellbeing Portfolio Board minutes: April 2024

Attendees and apologies

• Christine McLaughlin,  Co-Director Care and Wellbeing Portfolio, Scottish Government – Chair 
• Anne Armstrong, Chief Nursing Officer, Scottish Government (Deputy Alex McMahon)
• Linda Bauld, Senior Reporting Officer, Place and Wellbeing Programme, Scottish Government
• Donna Bell, Executive Sponsor Preventative and Proactive Care Programme, Scottish Government
• Steven Carter, Strategic Reform Lead, Scottish Government
• Katie Clayton, Preventative and Proactive Programme Manager, NHS NSS
• Ellie Crawford, Delivery Lead, Preventative and Proactive Care Programme, Scottish Government
• Nicola Dickie, Director for People Policy, CoSLA
• Anna Dominiczak, Portfolio Lead for Innovation, Scottish Government 
• Karen Duffy, Senior Reporting Officer, Preventative and Proactive Care Programme, Scottish Government
• Nicola Edge, Portfolio Lead for Analysis and Evidence, Scottish Government 
• Eddie Fraser, Chief Executive, SOLACE
• Alan Gray, Portfolio Lead for Finance, Scottish Government
• Aidan Grisewood, Director for Economic Transformation Strategy, Scottish Government
• Nichola Hattie, Portfolio Lead for Workforce, Scottish Government (Deputy Stephen Lea-Ross) 
• Caroline Hiscox, Vice Chair of NHS Chief Executives Group, NHS Grampian 
• Callum Irving, Covid Recovery Strategy, Scottish Government (Deputy Mary McAllan)
• Christine Jack, Health and Social Care Scotland representative, (Deputy Julie Whyte)
• Roa Johnstone, Care and Wellbeing Programme Manager, NHS NSS
• Grant Laidlaw, Presenter for Preventative and Proactive Programme, Scottish Government
• David Martin, Non-Executive Director, Scottish Government
• Carolyn McDonald, Presenter for Preventative and Proactive Programme, Scottish Government
• Katie Morris, Presenter for Preventative and Proactive Programme, Scottish Government
• Nick Morris, Chair of NHS Chairs, NHS Dumfries and Galloway
• John Nicholson, Deputy Director, Population Health Strategy and Improvement, Scottish Government
• Niamh O’Connor, Deputy Director, Population Health Strategy and Improvement, Scottish Government
• Gordon Paterson, NES representative, (Deputy Karen Reid), NHS NES
• David Plews, Long Term Planning Lead, Scottish Government
• Paula Speirs, Senior Reporting Officer, Long-Term Planning Programme, Scottish Government
• Chris Stothart, Strategic Reform Lead, Scottish Government
• Malcolm Summers, Strategic Reform Lead, Population Health Strategy and Improvement, Scottish Government
• Ian Tervit, Place and Wellbeing Project Manager, NHS NSS
• Amanda Trolland, Long Term Planning Programme Manager, NHS NSS
• Kim Walker, National Programme Director, NHS NSS
• Susan Webb, Directors of Public Health Representative, NHS Public Health Scotland
• Emma Wylie, Place and Wellbeing Programme Manager, NHS NSS

Items and actions

Welcome and Apologies

The Chair opened the meeting, noted apologies, and welcomed new member Anne Armstrong, interim Chief Nursing Officer (CNO).

Meeting minutes from the last meeting held on 24 January 2024

Minutes and Actions from the last meeting held on 24 January were agreed as an accurate record.

Strategic Overview – Niamh O’Connor (NO), Kim Walker (KW), Christine McLaughlin (CM)

Niamh O’Connor provided an update on key areas of the Care and Wellbeing Portfolio (CWP) engagement and progress since the January meeting and strategic insights relevant to the portfolio. New data has been published by the ONS that highlights Scotland we are no longer seeing sustained excess mortality in Scotland, with the number of deaths in 2023 in line with expected deaths. This is based on a new method for estimating excess deaths across the UK, recommended by the ONS and NRS, that improves the analysis by taking account of the underlying size and age of the population. In addition the Global Burden of Disease study has been published in the Lancet in March 2024 on the global impact of the pandemic on life expectancy.

The Population Health Framework continues to develop and it was agreed in February that it would be co-produced with COSLA. We are not waiting for the framework to be developed though, with significant milestones achieved for primary prevention policies in recent weeks with parliament agreeing to continue and uprate minimum unit pricing and Westminster voting to support the UK wide Tobacco and Vapes Bill that will, if passed, essentially phase out the legal sale of cigarettes, on its second reading last Wednesday. The consultation on the restriction of the promotion of foods high in fat, salt, and sugar closes on 21 May with responses welcome from Board members. 

Nicola Edge, Analysis and Evidence Lead, highlighted the release of the CWP dashboard, ongoing work on Health Economics and joint work with PHS to improve and streamline the landscape of health inequalities reporting. The Analysis and Evidence charter is being refreshed for 2024-25 to continue to help inform priorities and insights for the future. 

Kim Walker shared the latest RAG (red, amber, green) assessment which remains at amber to reflect ongoing challenges of policy coherence and delivery confidence and work still required to identify priorities and benefits for 2024-25 delivery plan. The Portfolio is managing and mitigating three risks and one issue; however, none are currently being escalated. Six areas of work in the Portfolio have been highlighted as initial priorities and the most likely to impact positively on Portfolio aims for 2024-25: Getting it Right for Everyone (GIRFE), Primary Care Reform, Cardiovascular Disease (CVD), Anchors Institutions, the Population Health Framework, and National Clinical Framework. The National Clinical Framework is still being scoped as part of the new programme of NHS Acute Reform work to date. Three sessions with Programme SROs have reviewed existing Portfolio scope and discussed priorities for 2024-25. The focus of these sessions is to complete a series of deep dives on priority areas to ensure the work is aligned to the strategic direction and that appropriate connections are being made. There has been significant strategic engagement across the Portfolio with system partners to shape and create the conditions for change. 

Christine McLaughlin updated the Board on DG Health and Social Care Reform work. Progress has been made across government to develop the way forward within the reform policy and delivery, and with Ministers in April. This has re-affirmed the need for reform as set out in Programme for Government and the Government Policy Prospectus. The Cabinet Secretary for NHS Recovery, Health and Social Care will set out plans for reform more formally in Parliament in the coming weeks, which include the outline plans for national engagement with a broad range of stakeholders and focus on delivering real change. The focus remains on improving population health, tackling health inequalities, building safe and sustainable services, ensuring the right access to the right services, attracting, and retaining the best staff to our NHS, and reducing unwarranted variations that persist across systems. The Portfolio has several key developments in this space, including the Population Health Framework, and NHS Acute Reform Programme, and two areas within the Preventative and Proactive Care programme – Getting it Right for Everyone (GIRFE) and Primary and Community Care Reform.   

Summary of the Board discussion on this item:

• Noted the need for more analysis in the Portfolio to use as guidance for prioritisation and insights 
• Requested the link between the economy and health are considered when determining priorities of the Portfolio
• The importance of coming together across SG directorates and across the system 

Action – all to review Analytical Insights pack and feedback on what they would like to see in future iterations.

Programme Updates – Karen Duffy (KD), Linda Bauld (LB), Paula Speirs (PS)

Karen Duffy provided an update on Preventative and Proactive Care (PPC), noting Getting it Right for Everyone (GIRFE), and Primary Care are being discussed as a separate agenda item. PPC has reflected on the progress and lessons learned for its workstreams throughout 2023-24, noting the programme is currently reporting as Green RAG. Waiting Well was a primary focus for the year, with the launch of the Waiting Well hub on NHS inform and materials now with GPs and planned care departments. The Waiting Well framework has been developed and will be shared with Health Board leadership in May. The Cardiovascular Disease (CVD) workstream has now been initiated and has planned workshops to develop scope and its priorities. Programme is hosting a workshop in May to review priorities for the year ahead.

Linda Bauld provided an update on the Place and Wellbeing (PAW) programme, which is currently reporting as Amber RAG due to significant resource and capacity risks. The Communities and Enabling Local Change workstreams have slowed due to these limited resources. Work is ongoing with the Enabling Local Change working group to agree a workplan for 2024-25 and continue to build relationships with Community Planning Partnerships (CPPs). 

Good progress is being made on the Anchors workstream, which has now received strategic plans from Health Boards and plan to review and discuss with each Board over the next month. A clear set of metrics has been developed in conjunction with the Analysis and Evidence Enabler to monitor baseline Anchors activity. The long-term Population Health Framework is continuing at pace, with COSLA formally agreeing to co-produce the framework. Engagement for the Framework is continuing with further workshops underway in the coming weeks.

Paula Speirs provided an update on the emerging NHS Acute Reform programme of work. A key component of this work is the development of the National Clinical Framework. This will focus on reforming services and will set out the clinical direction of travel. It will be developed based on existing policy strategies (underpinned by the National Clinical Strategy) as core components, to ensure the NHS remains safe, effective, and person-centred. Work is underway to plan the next phase of development of the NCF, bringing in outputs of the recent Review of Networks. This includes development of an engagement plan, which has begun with establishing a working group of Board Comms and Engagement Leads, which also includes Healthcare Improvement Scotland Community Engagement.

Summary of Board discussion on this item

• Suggestion that a matrix is developed to show where good practice is happening that can be shared with health boards and encourage them to adopt similar practices for Anchors
• Board members were keen to understand how NCF connected to the wider work within the portfolio looking at services across the health and social care system
• Board members were keen CWP Board purpose was to continue to explore the coherence and connections across the programme of system and population health reform
• Clarity requested from Board members on programme updates and the roles and the purpose of the Portfolio Board going forward across the work being updated

Actions

• Linda Bauld to share note on progress to improve working relationships with CPPs to close off action from a previous Board meeting
• CWP reviewing scope and governance to continue to reflect appropriate role for portfolio board

Preventative and Proactive Care Programme – GIRFE and Primary Care – Karen Duffy (KD)

Karen Duffy (KD) introduced Ellie Crawford (EC), Grant Laidlaw (GL) Katie Morris (KM) and Rachel Dowle (RD) who were in attendance to present on this agenda item.

Getting it Right for Everyone (GIRFE) is building on existing plans to provide a more personalised way for people to access consistent, multi-agency healthcare. The GIRFE team is working collaboratively with teams across the Scottish Government to ensure join-up, clarity, and sharing of best practice, engaging throughout the co-design process with professional advisors and policy teams working in across primary care, realistic medicine, Getting it Right for Every Child (GIRFEC), Keeping the Promise, Drugs and Alcohol policy, and much more.

GIRFE pathfinders and partners are co-designing with people with lived experience taking a multi-agency approach to support and services from young adulthood to end of life care. Pathfinders submitted hundreds of ideas and concepts during the ideation stage of the co-design process and re-engaged with people with lived experience to develop these ideas and initiatives, ensuring it is built on learnings from the national insights found via the journey mapping stage.

Due to the ‘Team around the Person’ being fundamental to all the other groupings of work, and being the heart of GIRFE, this theme was selected first in the prototyping stage. Within this the pathfinder teams and partners will prototype around My Team, My Coordinator, Peer Support, Sharing Information, My Plan and Positive First Contact. Work related to the other thematic groups identified such as stigma and digital innovation will be picked up throughout the co-design process, due to the overlaps and dependencies. The outputs will be published in June 24 and a toolkit will be available shortly after.

Ellie Crawford (EC) presented on Primary Care and noted that that there has been significant expansion in the multi-disciplinary team (MDT) workforce with over 4,700 staff working in services including physiotherapy, pharmacy, and phlebotomy. However, implementation gaps remain which is why PPC has introduced the Primary Care Phased Investment Programme. Delivered by Healthcare Improvement Scotland (HIS), this programme will work with four demonstrator sites to implement MDTs and community care and treatment centres as two priority areas of the 2018 GP contract more fully in line with a shared local understanding of service requirements and population healthcare needs. 

Wider Primary Care Reform is being progressed as part of overall Health and Social Care reform space. It aims to develop a refreshed role and vision for Primary Care, focusing on sustainable services, integration of primary care in the community and enhancing the experience of the workforce. The programme will develop a culture of continual improvement across primary care settings and build evidence to understand the context for full implementation including long-term Scottish Government investment. A Primary Care Steering group is being formed in May to engage with the primary care system and develop a route map for sustainability and reform.

Action - update on PPC to be brought back to future meeting.

Summary of Board discussion on this item

• Challenge to the implementation of GIRFE etc, how is it scaled up nationally and a need for clarity that you can’t opt out; what’s the end state; what does good look like.
• Encourage more governance nationally to complement local development
• Need to understand development of MDTs with evidence/research of impact - could this increase capacity of up to 20%?
• Crucial that we clearly communicate the expectations to the workforce and encourage them to take a leap of faith to adopt new working practices
• Request further understanding how learning and impact of individual pieces of work will be shared and implemented 

AOB

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

The next Care and Wellbeing Portfolio Board will be held on 25 June 2024 at 10:00.