Care and Wellbeing Portfolio Board minutes: January 2024

Attendees and apologies

•    Richard Foggo, Co-Director Care and Wellbeing Portfolio, Scottish Government, (Chair)
•    Christine McLaughlin, , Co-Director Care and Wellbeing Portfolio, Scottish Government
•    Marion Bain, Chief Medical Officer Directorate, Scottish Government
•    Linda Bauld, Senior Reporting Officer, Place and Wellbeing Programme, Scottish Government
•    Steven Carter, Strategic Reform Lead, Scottish Government
•    Nicola Dickie, Director for People Policy, CoSLA
•    Anna Dominiczak, Portfolio Lead for Innovation, Scottish Government
•    Karen Duffy, SRO Preventative and Proactive Care Programme, Scottish Government
•    Angiolina Foster, Chief Executive, NHS 24 and Board Chairs Representative (Deputy for Nick Morris, Chair, NHS Dumfries and Galloway)
•    Stephen Gallagher, Director of Mental Health, Scottish Government
•    Ruth Glassborow, Director of Place and Wellbeing at Public Health Scotland, Public Health Scotland
•    Alan Gray, Portfolio Lead for Finance, Scottish Government
•    Aidan Grisewood, Director for Economic Transformation Strategy, Scottish Government
•    Christine Jack, Representative from Chief Officers for Health and Social Care Scotland (Deputy for Julie White)
•    Alistair Hodgson, Portfolio Lead for Digital and Data, Scottish Government
•    Paul Johnston, Chief Executive, Public Health Scotland 
•    Roa Johnstone, CWP Programme Manager, NHS NSS
•    David Martin, Non-Executive Director, Scottish Government
•    Tim McDonnell, Executive Sponsor for Preventative and Proactive Care Programme, Scottish Government
•    Anita Morrison, Portfolio Lead for Analysis and Evidence, Scottish Government
•    Claire Morrison, Portfolio Lead for Service Co-Design and Improvement, Scottish Government
•    John Nicholson, Deputy Director – Population Health Strategy and Improvement, Scottish Government
•    Niamh O’Connor, Deputy Director – Population Health Strategy and Improvement, Scottish Government
•    Shantini Paranjothy, Director of Public Health, NHS Grampian, Deputy for Susan Webb
•    David Plews, Long Term Planning Lead, Scottish Government
•    Karen Reid, Chief Executive, NHS Education for Scotland
•    Paula Speirs, Long Term Planning Programme, Scottish Government
•    Chris Stothart, Strategic Reform Lead, Scottish Government
•    Malcolm Summers, Strategic Reform Lead, Scottish Government
•    David Thompson, Innovation Enabler Lead, Scottish Government
•    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 Clare Morrison, Enabler Lead for Service Co-Design and Improvement to her first meeting and Alistair Hodgson, Digital and Data Enabler Lead in place of Richard McCallum, the new Senior Reporting Officer (SRO) for Digital and Data. 

Meeting minutes from the last meeting held on 26 July 2023

Minutes and Actions from the last meeting held on 26 July 2023 were agreed as an accurate record.

Strategic Overview – Niamh O’Connor (NO), Aidan Grisewood (AGri), Christine McLaughlin (CMcL)

Niamh O’Connor provided an update on the key areas of Care and Wellbeing Portfolio (CWP) Engagement since the July meeting and Strategic Insights relevant to the Portfolio mission to improve population health, inequalities, and system sustainability. New data has been released from National Records of Scotland in September 2023 on life expectancy, the Scottish Health Survey published data in December 2023 at a population health level on the key drivers for health and the health of the nation, and regular data is being shared on system sustainability and winter pressures for the development of a Whole System Dashboard. These data sets provide core indicators to measure population health, key drivers for health, inequalities and predict the demand on health and social care. 

Niamh O’Connor also highlighted the development of the Population Health Plan is continuing at pace, with the current focus being on initial engagement with key partners and Scottish Government Ministers. The second phase of engagement is moving to the development phase of the plan. National action is ongoing with key milestones in the next eight weeks looking at regulation on the food environment, minimum unit pricing for alcohol, and a four nations approach to creating a tobacco free generation and tackling youth vaping. Audit Scotland plans to release their annual report on the NHS in Scotland in late February which will be likely to include material commenting on and relevant for reform in health and care throughout Scotland. 

Action – NO/HSCA to share latest analytical insights pack with Board members after the meeting. 

Aidan Grisewood shared the latest update on the National Strategy for Economic Transformation (NSET), which was published two years ago. The 10-year strategy requires a refresh due to changes in the fiscal environment, economic cost of living crisis, and a new First Minister. The actions in NSET will also be reviewed and prioritised to focus on a fairer, greener, and growing economy. A critical area for improvement is in economic inactivity, which currently sits at 22 percent of working age population. There is an opportunity for health and economy to continue to work together to create a wellbeing economy and define how the NHS, one of the largest employers in Scotland, can improve health in the workplace. Higher education in Scotland is internationally recognised, and there is an opportunity to enhance the level of investment into businesses and innovation enterprises. The next key milestone of NSET will be in May, where it will link into the Medium-Term Financial Framework to create a more fiscally sustainable Scotland. 

Action – AGri requested slot at a future meeting to discuss progress on the NSET refresh. 

Christine McLaughlin provided the Board with an update on Health and Social Care Reform work to improve sustainability. With the challenging fiscal landscape for 2023/24 and 2024/25, a change in approach is needed in the short term to create a path to balance and long-term service sustainability. CWP has focused on horizon three (transformational) activities since it became operational, but the financial challenges provide an opportunity for the Portfolio to review of current objectives and consider horizon one (current system) activities that can be integrated into current structures. Work is being scoped to identify four programmes of work to support the path to financial balance and will be brought back to the Board in April for further discussion along with proposals for how this impacts on the scope and governance of Care and Wellbeing. These programmes include Innovation and Value-Based Health Care, Workforce Sustainability, Service Sustainability and Reform, and Scottish Government Approach to funding commitments. Current work being developed within CWP will not be on pause while this is scoped, such as the Population Health Plan within Place and Wellbeing and Preventative and Proactive Care programme activities. 

Action – Bring back proposals for scope and governance of CWP once further detail has been scoped to the Board for review in April. 

Summary of the Board discussion on this item:

• Request to ensure service sustainability includes all interdependent services (such as primary, community and social care support) while recognising focusing on acute services will also be required to achieve balance across the Health Boards
• The Board welcomes the idea of a 10-year population health plan to act on key health issues, such as obesity, alcohol and tobacco with the request drugs is included in the same discussion
• The Board recognises the risk of challenging fiscal decision-making that could have unintended consequences on longer term reform and population health outcomes and the importance of achieving clarity on scope  
• Opportunities exist within the workforce to scope better outcomes, further efficiencies and make improvements to productivity through innovation and technology 
• A new senior clinical and public health advisory forum created by CMO was highlighted to the Board that is reviewing the use of data and information, innovations, and the current challenges of obesity in Scotland 
• Health Board Chief Executives have set up a subgroup to support work on population health , further engagement was recognised as a key point to developing this work, with a request that IJBs, local authorities, and leisure trusts are included 

Portfolio Delivery – Kim Walker (KW), Anna Dominiczak (AD), Karen Duffy (KD), Linda Bauld (LB), Alan Gray (AGra), David Plews (DP), Anita Morrison (AM), Alistair Hodgson (AH), Clare Morrison (CM)

Kim Walker shared the latest RAG assessment of CWP, which remains at amber. The Portfolio is managing and mitigating overall risk on financial and workforce constraints through prioritisation within the CWP Delivery Plan and reviewing capacity to deliver with tighter control on reporting of risks/issues through individual Programmes. Financial constraints are impacting current ability to forecast a clear path to green for next reporting period and wider challenges across the health and social care system may require change in current Portfolio scope to manage delivery expectations with ambitions for short to medium and long-term reform.

The risk surrounding delivery coherence has changed from high to medium due to the development of 2023/24 delivery plan with high level milestones included for population health, Preventative and Proactive Care (PPC), service reform, and sustainability. 

The Chair asked the Board to consider and approve the overall Portfolio RAG status assessment and no concerns were raised. 

Anna Dominiczak provided the Board with an update on the Innovation enabler. It is currently assessed as a red RAG status with ANIA having high risks on sustaining current resource levels. The enabler is working with finance colleagues to move forward with recruitment to mitigate risk. Other areas of Innovation are progressing well, with discussions ongoing with economy to do a deep dive on how to improve efficiency with the two existing programmes – digital dermatology and closed loop diabetes. There is also four nations activity on innovation and horizon scanning which may increase our ability to do things faster, cheaper, and more efficiently. 

The Board noted the red risk and the current mitigation actions in place for Innovation. 

Karen Duffy provided an update on behalf of the Preventative and Proactive Care (PPC) programme, which is progressing at pace. Waiting Well has seen significant progress, with physical resources (promoting the online Waiting Well Hub and key waiting well messages) soon to be shared with GP practices and outpatient departments for display. The eight Getting it Right for Everyone (GIRFE) pathfinder teams are developing national prototypes, beginning with the team around the person theme in collaboration with people with lived experience. 3 new partner areas have been onboarded. 

The cardiovascular programme (CVD) is launching on 25th January, which aims to identify those with risk factors for CVD focusing on high lipids, high blood pressure, high blood sugars and obesity. When these risk factors are found early and early interventions (social/lifestyle medicine and traditional medical approaches) introduced this can lead to reversal or halting of risk and prevention of disease escalation, which has main benefits for diabetes, stroke and heart disease reductions. Primary Care PPC continues, and specifically there was mention of the four demonstrator sites selected reflecting a diverse range of settings for a phased approach to fully implementing Multi-Disciplinary Teams (MDTs). The importance of prevention was stressed to improve population health and sustainability and the PPC programme has several ideas to support the longer-term health and services reform work.

Linda Bauld shared a progress update on the Place and Wellbeing programme (PAW) and its key areas: Anchors, Enabling Local Change, Communities, and the Population Health Plan. The Anchors workstream has asked for a baseline of activity from Health Boards by the end of March. Once submitted, they will meet with each Board to discuss plans. The Land and Assets workstream have identified capacity issues within some Boards who are no longer able to proceed as a test site. Task and Finish Groups have been established for the workforce strand of Anchors and are progressing actions against the workplan. The next quarter will focus on commissioning communications assets for NHS Boards and confirming test sites for the procurement workstream with NHS Ayrshire and Arran. 

The Enabling Local Change workstream has agreed a workplan and three high-level objectives – strengthen the health contribution to CPPs, support CWP Dashboard development, and the public health system’s offer to support to CPPs. The Communities workstream has agreed their workplan and are progressing with a variety of local engagement activities with the community and voluntary sector. Additional engagement is underway to develop the Population Health Plan in the coming months. 

Alan Gray shared the latest progress update on the Finance enabler. Currently the rate of expenditure is more than current funding, with focused work underway on the path to balance and the detail to be published on the Medium-Term Financial Framework in March. New capital spend infrastructure projects have been paused due to the findings of the capital spend review, which highlighted the need for maintenance work only. This will have a significant impact on what can be progressed in the short and medium term. These funding challenges provide an opportunity to accelerate the number of changes that can be progressed. 

David Plews provided an update on the Health and Social Care Long Term Planning work. Progress is ongoing to translate the national clinical strategy to the national clinical framework, focusing on acute services. This will include considering what it would look like to deliver more in the community using technology and innovation to reduce pressure on acute services. This work is currently being progressed through the Health and Social Care Management Board governance structure, but feedback will continue through the CWP Portfolio Board due to interest and potential links with other programmes within CWP. 

Anita Morrison shared a progress update on the Analysis and Evidence enabler, with significant progress being made in the last six months. The Care and Wellbeing Dashboard is now being integrated into the SCOTPHO platform through joint work with Public Health Scotland (PHS).  A key advantage is that the ScotPHO platform has a wide user base and it is anticipated that the dashboard will be instrumental in tracking the progress of the forthcoming Population Health Plan. Further developments will continue, including adding equalities and geographic breakdowns for local planning. A near-time data service is also in development with National Services Scotland (NSS), PHS, and the Scottish Government. It includes operational measures for the NHS for winter planning with daily, weekly, and monthly updates as appropriate. As of today, there are 600 users. 

Anita Morrison also noted that the Public Health Scotland Team who lead on the Scottish Burden of Disease (SBoD) study are now undertaking further scenario modelling of risk factors including smoking and obesity. There is also work on-going to translate the future burden of disease projections into the potential future demand for health services and are to map NHS costs to SBoD categories. 

Finally, Anita highlighted that the health economics team in Health and Social Care Analysis (HSCA) have completed a range of work including an evidence review on health inequalities and prioritisation to support with financial decisions, a presentation on the economic contribution of the Scottish health economy and are undertaking a review of international evidence on what works to keep people in employment. 

Alistair Hodgson provided an update on the Digital and Data enabler. The NSS SEER platform is now live, which will increase the capability for Health Boards to integrate and analyse data. An updated CHI system is now live, and work is ongoing with COSLA and SOLACE to integrate individual social care information into CHI. Office 365 integration continues with opportunities identified to support strategic aspirations, such as MDTs. Issues with budget have been identified and are being worked through for the digital front door and integrated health and social care record work. Further assessment required to understand what can be invested in and when it can be delivered. Discussions are ongoing with Chief Executives to accelerate work that doesn’t require additional investment. 

Clare Morrison provided an update on Service Co-Design and Improvement, highlighting that further work is required to integrate the two areas – Service Co-Design and Quality Improvement – into one enabler and develop a governance group to oversee the work. Work within both components continues at pace and is developing in the meantime with the launch of the second cohort of the Coaching Leading Improving in Complex Systems (CLICs) on 23rd February. CLICs will support senior staff to develop leadership skills. GIRFE pathfinders are at the prototyping phase of the design process, with national sense-making and planning focussing on the priority area 'the team around the person'. Prototyping with people with lived experience and staff will take place up to the end of March.

Summary of the Board discussion on the portfolio, programme, and enabler updates:

• Consideration required to understand how we can help local systems get ready for change and why some systems progress quicker than others when implementing change
• Ensuring a focus on analytical work to track population health outcomes would help mitigate any unintended harms 
• Consider how the Verity House Agreement aligns with the programmes being developed
• Agreement on the timing being right for a reflection and resetting phase for CWP

AOB

The Chair asked members to share any future agenda items for the Board meetings and were invited to reflect on how the CWP Board could improve for future meetings. Summary of the Board discussion below: 

• Request to meet in person for a future Portfolio Board meeting
• Request that papers are shared in good time to allow Board members to review the detailed reports in advance 
•  Connections between programmes are starting to emerge, but it would be useful to draw out further in the Portfolio 
• Clarity required on what the Portfolio Board provides governance for versus other forms of governance when programme updates are provided.

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

The next Care and Wellbeing Portfolio Board will be held on 24 April at 14:00.