Care and Wellbeing Portfolio Board minutes: August 2022

Attendees and apologies

• Richard Foggo
• Aidan Grisewood  
• Angela Leitch
• Donna Bell 
• David Martin
• Eddie Fraser  
• Gregor Smith
• Judith Proctor
• Linda Bauld  
• Liz Sadler
• Michael Chalmers  
• Richard McCallum
• Robbie Pearson
• Stephen Lea-Ross

Apologies:

• Christine McLaughlin
• Gillian Russell 
• John Burns  
• Linda Pollock  
• Mary McAllan  
• Nicola Dickie  
• Nick Morris  
• Ralph Roberts  
• Tim McDonnell  

Items and actions

Welcome and apologies

The Chair welcomed attendees. Apologies were noted, as below.

The Chair welcomed new members to the Board; Linda Bauld, Chief Social Policy Advisor; Liz Sadler, Programme Director for Place and Wellbeing Programme; Stephen Gallagher, Director for Digital Health, and Care.

Meeting minutes from the last meeting held on 23 June 2022

Minutes of the Meeting on 23 June 2022 were agreed as an accurate record. No matters arising to bring to the Boards attention.

Strategic overview – Kim Walker (KW), Malcolm Summers (MS)

Kim Walker provided an update to the Board on Portfolio progress through definition phase continuing to develop the Portfolio framework (strategic framework and delivery plan) as the methodology to enable delivery of a Portfolio of this size and complexity. The papers on the agenda (Innovation, Strategic Engagement and Co-Design) continue to define the scope and reach (within, across and beyond Health and Care) of the Portfolio and embed the conditions for success.

Kim Walker directed members attention to the Programme Charters and Status reports providing a collective update on progress which will now be supplemented with short updates from Programme Directors. Current RAG status is Amber with Portfolio still in definition phase. Some progress being made in enablers (e.g. Co-design traction in PPC and work Analysis and Evidence colleagues are doing on population health outcomes indictors). IPC and IUUC Programmes are being re-shaped, with Place and Wellbeing defining key milestones for Anchor Institutions and PPC have redefined their charter and outlined a Programme plan with critical path.

Kim Walker outlined the plan to start reporting very high red risks at Portfolio level. Current risks include the limited financial envelope the CWP is working within and consequently the ability for Programmes to achieve their ambitions. Full mitigations for these risks sit with HSCMB rather than Portfolio. Kim Walker asked the Board to consider if they will accept and tolerate this risk, collectively working within the budget available and de-risk this to amber. The second very high risk highlights the time and energy required on definition and lack of delivery plan for the Portfolio in 2022 to 2023. The Portfolio team are taking action to mitigate this working with Programmes and enablers to agree year one deliverables between now and the October Board. KW welcomed feedback from the board on the substance of the update and how it is presented.

Malcolm Summers provided a policy update for CWP. The Strategic Capabilities division have been focusing on Director General (DG) deep dives to identify how to work with other government departments on upstream determinants of health and care and explore mutual work that will add to the CWP mission and objectives. Joint priorities emerging are: (1) DG Economy: tackling economic inactivity; (2) DG Education and Justice: refresh early years transformation Programme; and (3) DG Communities: focus on child poverty pathfinders and community planning. Meetings with DG Net Zero and DG Exchequer to follow.   It is important the Portfolio continues to have an agile scope to respond to emerging risks. The Board recognise the likely impact of cost crisis on population health and health inequalities.  Emerging priority is to include Non Communicable Disease (NCD) reforms (alcohol, tobacco, drugs) within scope.

Comments from Board members included:

• consider mitigating actions for risks which will help to set expectations across system
• acknowledgement that due to finance risk there is the need to identify how to share resource nationally and locally to make the most of the limited resources
• the need for benefits realisation to capture how the CWP is doing things differently  

Actions:

• KW/PMO to develop benefits realisation approach for the Portfolio

Programme updates – Donna Bell (DB), Liz Sadler (LS)

Programme Directors provided a brief update on their respective Programmes.

Donna Bell, highlighted Preventative and Proactive Care (PPC) have shaped the Programme over recent months to feature work further upstream in disease management and creating a wider approach to multi-disciplinary/multi-agency working. The Getting it Right for Everyone (GIRFE) framework and national practice model will provide models for agencies to work within. All agencies, as well as third sector, are working with person-centred outcomes in mind. DB identified, a more preventative and proactive approach in collective engagement across Waiting Well and other areas needs developed. PPC have gaps in impact measures and are working to understand how to measure good outcomes and change. PPC will reflect on the Health and Social Care Framework to consider the application to the Programme.

Liz Sadler, recently appointed SRO for Place and Wellbeing Programme, noted the recent Programme steering group, which focused on Anchors, as the most developed workstream. Place and Wellbeing are working with Chief Executive of NHS Fife to drive this work forward which will focus on procurement, workforce, and land assets. Task and finish groups will be established to develop this work. LS advised, a paper on Anchors will be brought to a future Board, identifying key milestones and next steps. For the communities work, Place and Wellbeing will take a framework approach and will co-produce this with stakeholders. The Enabling Local Change workstream is at early stages, with work planned to scope over coming weeks and present a paper to the next steering group in October. LS highlighted the resourcing challenges faced in this workstream, and the need to bring learning and insights together.

There was no representative for IPC/IUUC Programmes in attendance due to technical difficulties. Updates will be provided at the next Board.

Innovation as an enabler of recovery, reform and sustainability in Health and Social Care – Anna Dominiczak (AD)

Anna Dominiczak, Chief Scientist for Health, presented a paper on behalf of the Innovation Design Authority (IDA). The presentation highlighted the need for cost-saving, outcome-improving, experience-enhancing innovations to be rapidly identified and adopted to address the pressure and challenges currently facing Health and Social care.

AD advised, in September 2021 the Health and Social Care Management Board (HSCMB) agreed to create the Accelerated National Innovation Adoption (ANIA) Pathway and hold a series of innovation Summits with key partners. The summits concluded in June 2022 and identified the governance/leadership gap in innovation which could be filled with the development of an IDA.

The IDA has now been established and will meet for the first time on Monday 22 August 2022. This group will provide system leadership and co-ordination for a once for Scotland approach to the identification, assessment and national adoption of innovations which could have a transformative impact on recovery, reform and system sustainability within health and social care. AD shared some of the innovations which will be considered at the first IDA meeting. These include; Digital Enabled Once for Scotland Dermatology referral and Triage Pathway; Technology Enabled Theatre Scheduling Tool and Diabetes Closed Loop System for Type one Diabetes.

A key challenge will be the identification of budget provision to fund investment propositions which have been endorsed by the IDA and this Board. Additional work is needed to estimate the quantum of funding needed over the remainder of 2022 to 2023 and then 2023 to 2024. The IDA will return to the Portfolio Board once this funding requirement has been scoped and considered in further detail. 

The collaborative approach was welcomed, and discussion points included:

• IDA should turn attention to cross cutting priorities across government such as climate change and sustainability
• collective thinking required to incorporate social care into the ANIA Pathway and make further connection with economy colleagues
• consider adding further representation to the IDA, to include an IJB Chief Officer and CSWO to the Board
• acknowledgement of other groups looking at innovation and adaption, therefore a need to connect to other groups such as non-clinical adaptation work
• importance of capturing where benefits of innovation are realised in order for resource to be directed to ensure innovation is sustainable.
• involvement and support from Health and Social Care Partnerships Chief Officers

The Board noted the creation of the IDA and agreed it will report to the CWP Portfolio Board.

Actions:

• LS to set up a meeting with AD and team to discuss potential connections with non-clinical adaptation work
• AD and DB to discuss incorporating social care into the ANIA Pathway and governance routes which would be required
• JP to arrange meeting with AD to discuss HSCP CO involvement in the IDA

Strategic engagement – John Nicholson (JN), Aidan Grisewood (AG), Sam Hawkins (SH), Lewis Hedge (LH)

John Nicholson presented the proposed communication narrative and engagement strategy for the initial phase of the Portfolio. The strategy intent is to create a consistent and clear message for those working across the Portfolio both within and out with Health and Care.

The communications activity will be supported through existing internal teams and resources, however as specific communications interventions are developed there is likely to be a requirement for extra resources and funding to support this. Once sufficiently developed any investment proposals will be brought to the Portfolio Board at a future date for consideration.

The CWP propose to conduct communications and engagement in three levels; Portfolio, Programme and individual service level.  

Portfolio level communications and engagements will be focused on internal staff and system leaders and partners to build awareness and commitment, including collaborative cross DG working within Scottish Government, external system, and options for wider external engagement of stakeholders in Scotland and internationally. Proposed engagement with the public on the Portfolio is not currently needed nor appropriate. JN noted the Cabinet Secretary is currently considering advice on establishing a CWP Strategic Engagement Forum and an Independent Advisory Group.

To support Portfolio communications, a core summary narrative has been developed to outline what the CWP is; what it seeks to achieve, why now, and what is comprises. JN welcomed comments and feedback from the board on this and other communications materials shared with the Board. Initial feedback from colleagues suggested including reference to economy and the role this plays in the Portfolio. 

The Board supported the suggestion of a Portfolio launch event later this year, targeted at system leaders and key stakeholders to increase coherence and understanding of what the Portfolio is and what it is aiming to achieve.  

Each Programme is responsible for its own communication and engagement. The Portfolio Communications team are following up with Programmes to gather a clear understanding of the detailed engagement plans each Programme has in place or is developing to consider where we can pool resources to reduce duplication and maximise impact.

The CWP necessitates detailed and comprehensive design and delivery work to ensure it is co-designed, person centred and addresses the implementation gap between policy and delivery. The Scottish Approach to Service Design will be used for service level engagement, to co-design with both users and providers. The co-design approach to date has focused on PPC, with the Portfolio team working with the Office of the Chief Designer to agree additional priority areas, focusing on the nine key areas of focus that the Portfolio has agreed.  

The strategy was approved by the Board, noting this was iterative and could be adapted as the Portfolio matures.

Actions:

• Board members to feed back any comments on the Engagement and Communications paper

Aidan Grisewood provided an update on the Economic Transformation Strategy, a ten year plan which was published in March 2022. The Strategy was designed to address the long-standing structural issues within the Scottish economy, of which health is an enabler of economic activity.

Economy colleagues discussed cross sector working and the ways Health and Economy influence each other, such as on boosting tax receipts, reducing levels of poverty, improving health outcomes and increasing overall economic capacity. Colleagues identified the more people who engage with the labour market will help with equality outcomes, child poverty and health outcomes. DG Economy are in discussions with ministers to look at this in more detail, with health as a key focus. Connections have been made with health colleagues and within the CWP to explore supporting individuals on waiting lists and in pain management, those who are out of labour due to long term health and investigating other interventions which can support people to enter the labour market.

Comments from the Board included:

• opportunity through the Anchors' work to explore and enhance connections to local employability and economies
• need for connection with data and new emerging poverty team in PHS undertaking similar work
• synergies between work in industry and academia and connections to be made
• consider how could work with more private sector businesses on corporate social responsibilities to target communities who are further away from the labour market

It was noted proposals on Health and economic inactivity would be taken to Ministers in September, and the Board offered further connections and support to develop these.

Actions:

• AG to connect AD with colleagues working on economic inactivity in the industry
• AG and AL to connect to discuss synergies with economic transformation work and PHS Team undertaking similar work

Co-design – Cat MacAulay (CM)

Cat Macaulay provided an update on how the Portfolio is working to embed Co-design across the Portfolio. It is clear the understanding of and engagement with service design, co-design and lived experience is inconsistent. Paper five outlines the narrative to help address this. Work is taking place to understand where best to apply co-design and learn from other experiences, ensuring clear differentiation between co-production and co-design.

A proposal for a Lived Experience Experts Panel will support multiple teams and projects across CWP and NCS to link volunteer participants with lived experience to projects that would benefit from the insight of their lived experience or participate in design decision making. In addition, a Design Repository will be available to ensure we do not repeat work already done.

The Board noted the need for investment in the Lived Experience Experts Panel and Design Repository, with more detailed proposals brought to a future Board.

The chair apologised for timekeeping and for the brevity of the co-design slot and Board members were encouraged to provide feedback digitally.

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 15 September at 14:00.