Care and Wellbeing Portfolio Board minutes: July 2023

Attendees and apologies

• Christine McLaughlin, Co-Director Care and Wellbeing Portfolio, Scottish Government, (Chair)
• Andrew Watson, Portfolio Lead for Children’s Health and Wellbeing, Scottish Government  
• Carole Hiscox, NHS Chief Executive Group Representative, NHS Grampian
• David Martin, Non-Executive Director, Scottish Government
• Eddie Fraser, SOLACE representative, SOLACE
• Gregor Smith, Portfolio Clinical Lead, Scottish Government
• Hugh McAloon, Director Mental Health, Scottish Government
• John Burns, Executive Sponsor for NHS Recovery Renewal and Transformation, Scottish Government  
• Karen Duffy, Programme SRO Preventative and Proactive Care Programme, Scottish Government  
• Linda Bauld, Programme SRO Place and Wellbeing, Scottish Government  
• Linda Pollock, Enabling Function SRO for Service Co-design and Improvement, Scottish Government  
• Marion Bain, Clinical Lead for Place and Wellbeing Programme, Scottish Government  
• Nicola Dickie, COSLA representative COSLA
• Nick Morris, NHS Board Chairs Representative, NHS Dumfries and Galloway
• Paul Johnston, Chief Executive Public Health Scotland, Public Health Scotland
• Robbie Pearson, NHS Chief Executive Group Representative, NHS Health Improvement Scotland  
• Stephen Lea-Ross, Enabler Lead for Workforce, Scottish Government
• Susan Webb, Directors of Public Health Representative, NHS Grampian
• Tim McDonnell, Executive Sponsor for Preventative and Planned Care, Programme Scottish Government  
• In Attendance:
• Chris Stothart, Strategic Reform, Team Scottish Government
• Donald McLeod, PMO Project Manager, NHS NSS
• David Plews, Programme Lead for NHS Recovery, Renewal and Transformation, Scottish Government  
• Elsa Mackie, PMO Project Support Officer, NHS NSS
• Jenna Johnson, PMO Project Manager, NHS NSS
• James Wilson, Strategic Reform Team, Scottish Government
• Kat Troake, Strategic Reform Team, Scottish Government  
• Malcolm Summers, Portfolio Policy Lead, Scottish Government  
• Michael Chalmers, Prevention Lead, Scottish Government
• Niamh O’Connor, Portfolio Policy Lead, Scottish Government
• Nicola Edge, Enabler Lead for Analysis and Evidence, Scottish Government 
• Steve Carter, Strategic Reform Team, Scottish Government
• Gordon Paterson, NES Representative (deputy for Karen Reid), NHS National Education Scotland
• Hannah Keates, presenter for New Deal with Local Government, Scottish Government
• Derek Grieve, PPC representative (deputy for Donna Bell), Scottish Government
• Emma Wylie, PAW Programme Manager, NHS NSS
• Fiona Bennet, Enabler Lead for Finance (deputy for Alan Gray), Scottish Government
• Christine Jack, Chief Officer Executives Representative (deputy for Julie White), Scottish Government
• Osiris Ointa, Employability Team DG Economy (observer with Mutual Mentorship Programme), Scottish Government 
• Anne Armstrong, Deputy Chief Nursing Officer, Scottish Government
• Jordan Smyth, PMO Project Support Officer, NHS NSS
• Apologies:
• Alan Gray, Enabler Lead for Finance, Scottish Government
• Aidan Grisewood, Lead Director for Economic Transformation Strategy, Scottish Government
• Donna Bell, Executive Sponsor for Preventative and Planned Care Programme, Scottish Government  
• Kim Walker, National Programme Director, NHS NSS  
• Karen Reid, Chief Executive NHS National Education Scotland, NHS National Education Scotland
• Mary McAllan, Covid Recovery Strategy, Scottish Government 
• Richard Foggo, Co-Director Care and Wellbeing Portfolio, Scottish Government  
• Alex McMahon, Chief Nursing Officer, Scottish Government
• Jason Leitch, National Clinical Director, Scottish Government
• John Nicholson, Deputy Director Population Health Strategy and Improvement, Scottish Government
• Julie White, Chief Officer Executive Group representative, NHS Dumfries and Galloway
• Stephen Gallagher, Enabling Function SRO for Data and Digital, Scottish Government  
• Richard McCallum, Enabling Function SRO for Finance, Scottish Government  

Items and actions

Welcome and apologies

The Chair opened the meeting, noted apologies, and welcomed new member Andrew Watson as the Director for Children and Families. Meeting minutes from the last meeting held on 30 May 2023

Minutes and Actions from the last meeting held on 30 May 2023 were agreed as an accurate record.

Strategic overview – Niamh O’Connor (NO) 

Niamh O’Connor described the progress since the previous Portfolio Board meeting, highlighting advice shared with the Cabinet Secretary on 13 July on delivering commitments to long term reform and improving population health. This advice includes a high-level scope and timeframe for a long-term population health plan and the commitment to long term plans for integrated health and social care reform using the established CWP governance structures. Subject to Ministerial response to the advice, further engagement will take place with key partners – including through groups such as the Community Planning Improvement Board (CPIB), NHS Chairs, NHS Chief Executives and COSLA. 

Niamh O’Connor also highlighted the Care and Wellbeing Portfolio (CWP) Dashboard which was launched as a development product on 20 June. Engagement with users is underway to develop content, indicators, and optimising usability nationally and locally. Four measures – life expectancy, healthy life expectancy, avoidable mortality, and premature mortality – are being reviewed to consider what the most appropriate headline metrics are for the Portfolio, which would highlight the difference between the Portfolio delivery being on track and the status of population health measures. Recent high-profile research was highlighted, and analysts are working to develop a regular analytical insights pack to provide a synopsis of research and analysis to draw out latest insights through a Scottish lens for the Portfolio. 

The RAG assessment of delivery confidence for CWP remains at amber reflecting ongoing need to clarify the precise scope in key areas – NHS Recovery, Renewal and Transformation (RRT), Workforce; and delivery confidence for 2023/24 and beyond. There are no changes to risk or issue assessment since the last Portfolio Board and CWP continues to manage two high risks through mitigation. A path to green is emerging though a refinement of strategic objectives and the programme Senior Responsible Officers (SROs) were asked to provide updates on their status and a pathway to green as part of their verbal programme updates. 

Summary of Board discussion on this item:

• it is helpful to have a clear picture of public health and inequalities through the metrics presented. Welcome proposal for long term approach to address these challenges
• it is vital to develop long term approach through engagement and drawing on expertise across the Board
• the Board found it encouraging to see the development of the plans and evolution of governance building upon what is already existing within CWP
• the Board requested that the Portfolio considers broader areas of population health challenges out with CWP scope and how these interdependencies can all make progress towards desired outcomes
• the Board is keen to understand Ministerial ambitions around population health and highlighted the importance of ensuring coherence across population health and system plans

Actions:

• NO to circulate initial version of Analytical Insights Pack to members and the Board to provide feedback
• analysis and evidence to provide update on Analytical Insights Pack at future meeting

Programme updates – Karen Duffy (KD), John Burns (JB), Linda Bauld (LB)

Karen Duffy provided an update on Preventative and Proactive Care (PPC) and noted that although the RAG status has moved from Green to Amber there has been positive progress across PPC. The change in RAG status is linked to two very high-level risks relating to Scottish Government internal workforce constraints for GIFRE and the delay in securing funding for PPC Digital. It is noted that there has been a huge amount of interest in the work of the GIFRE work in general, and this was added to following the team’s presentation at the recent NHS Scotland event. The team needs to grow to meet the workload demand. Action plans are in place to realign staff and expand the resources for GIRFE. GIRFE has produced over 150 journey maps and are identifying key themes to work through, with plans for engagement with participants so that learnings can be built into the prototype design. It is proposed that the Board has a discussion on GIRFE at the November Portfolio Board to deliver a more substantive agenda item and for wider discussion.

Karen Duffy also highlighted that the Waiting Well workstream will return to green status as NHS Inform are now working with team to finalise the landing page and products. This work is expected to conclude in October. Scoping has also commenced for an additional workstream surrounding cardiovascular disease (CVD), and discussions on scope are underway. The draft plan will be discussed with CMO on 8 August and the intention is that the workstream will be formally created and report into PPC.

Summary of the Board discussion on this item:

• there is good engagement with Board colleagues which can be built on going forward. DCMOs have been updated and this work has also been discussed with Medical Directors 
• it is important understand how GIRFE is drawing in learning for public services and linking back to CPPs
• the information from the journey maps have been insightful to identify issues such as stigma, the referral train, cyclical decline, and delays getting to the root cause of issues. Social care colleagues asked if there were any insights in journey maps that might help in the more rapid preventative space ahead of winter and surge planning
• Chief Officers and HSCPs are linking GIRFE work to frailty and have a series of sessions planned which is linked to winter planning/admission avoidance and may enable more traction
• SAMD (Medical Director’s Group) is keen to be involved with next stages

Action – KD to bring GIRFE to a future Portfolio Board as a substantive item for further discussion.

John Burns provided an update on NHS Recovery, Renewal and Transformation (RRT). Driving recovery through annual and medium-term planning is on track with good engagement across Boards. The work is developing long term planning supporting the population health and service reform; initially engaging with Board Chief Executives (BCEs) to look towards future requirements on the system. This includes a short life working group on national and regional planning of services. Engagement is progressing with BCEs and the Strategic Coordination Group (SCG) specifically to look towards future requirements for services, particularly with digital services, though focus continues to be primarily on current capacity pressures ahead of another challenging winter.

Summary of the Board discussion on this item:

• it is important to consider how we deliver NHS services through a population lens and upstream prevention
• this work needs to be developed on a whole system basis and in partnership with local community planning, and Health and Social Care Partnerships
• there is further consideration required to understand how we link growing intelligence base to future planning

Linda Bauld provided an update on Place and Wellbeing (PAW), highlighting the current RAG status as amber and plans to move towards green. In June, the Scottish Government issued guidance to all national and territorial NHS Boards to support them with the development of their Anchor Strategic Plans which are due to be submitted in October. Analysts are working on appropriate metrics to support NHS Boards to establish a baseline on their contributions as anchor institutions. The Enabling Local Change workstream held a key stakeholder session to identify opportunities to strengthen health’s contribution to Community Planning Partnerships (CPPs) and are working with leads to coordinate engagement with local partners following the soft launch of the CWP Dashboard. The Communities workstream is developing a communications strategy and the team are also mapping grants from DG Health and Social Care to relevant local community and voluntary organisations to inform key short-term actions to implement through the next financial year. As previously discussed by the Board, a gap in primary prevention around major population health risk behaviours has been identified and PAW is scoping the work on a long-term population plan as a fourth workstream of the programme.

Summary of the Board discussion on this item: 

• it is important to review what has been done to assess state of readiness and capability of CPPs to improve population health and wellbeing and what work needs to be done with CPPs to ensure good health involvement, and that health is an effective CPP partner
• effective working relationships with CPPs are essential and the Board is interested to understand the status of these and what could be improved

Action – LB to provide an update on review of CPP working relationships and how they can be improved at a future Board meeting. 

New Deal with Local Government – Nicola Dickie (ND), Hannah Keates (HK) 

Nicola Dickie introduced the New Deal with Local Government, which includes an agreement signed by local and national government on 30 June titled the Verity House Agreement. 

The Agreement has been developed to reset the relationship between the two spheres of government and better enable them to achieve shared priorities of tackling poverty, transforming our economy through a just transition to deliver net zero and, delivering sustainable, person-centred public services. 

The Agreement highlights the importance of local by default and national by agreement, which recognises the importance of having a ‘once for Scotland’ approach to national standards and prioritisation with the ability to implement change at a local level. This is based on the idea that councils know best how to serve the people in their communities and, by giving them greater flexibility over how they use their budgets and regularly reviewing their powers and funding, we can empower them to put that knowledge into practice. 

One of the priorities of this Agreement will be to deliver on what has been lost in recent years across Scotland around key metrics, such as healthy life expectancy, with the longer term aim of working towards further improvements in public services. Strong links are developing across CPPs and the Enabling Local Change workstream within PAW, which aims to support the contribution of health in the community planning space. Workshops to explore the Verity House Agreement and further engagements will be held in the next few weeks to explore how the Agreement will be brought together in a solutions-focused way. 

Summary of Board discussion on this item: 

• the Board recognises the important milestone of the Verity House Agreement as a moment to strengthen partnerships across government and the value if principles in the Agreement are adhered to
• there is an opportunity to frame climate change not only as a threat but an opportunity to improve population health
• the Board would like to consider how the Verity House agreement can be used to make progress on areas such as healthy life expectancy and avoidable mortality
• local Health Boards need to be included as partners in developing work as one of the largest employers locally
• the Portfolio will need to consider how this is weaved through current CWP areas of work going forward, particularly with links in Anchors workstream within PAW
• it is important to have national standards alongside local flexibility in delivery
• it is necessary to consider public bodies landscape alongside changing delivery structures (NCS etc)

Health and Work: Economic Inactivity and Population Health – James Wilson 

James Wilson presented on Health and Work: Economic Inactivity and Population Health to Board members.

The Population Health Strategy and Improvement Division in the Scottish Government is taking forward key areas of cross-government work that sit within the Care and Wellbeing Portfolio. This approach recognises the importance of focusing on social determinants out with the health directorates to improve population health. 

Being in good work is a key policy objective of the Care and Wellbeing Policy Framework, which is founded on the objectives of Professor Michael Marmot’s review. Therefore, the focus of this work is on actions that can be taken to stem the flow of people moving from employment into economic inactivity due to ill health, recognising the importance of that area of work, and delivering coherence as part of the broad framework of services that exist in health, social care, employability, and employment support. 

The presentation outlined the initial key deliverables for 2023/24, focusing on a phased approach – discovery to understand existing services, needs and evidence base; designing an ideal service through system engagement and investment landscaping; and formulating an options appraisal with recommendations to share with Ministers. 

The Board was asked to provide feedback on the scope and direction of the work before the draft action plan is finalised, to agree on the governance approach suggested for CWP cross-government deliverables and identifying any further connections to this work. 

Summary of Board discussion on this item: 

• the Board recognised the value and opportunity to improve population health and offered support for the work
• further consideration is required to identify the dependency on health and care workforce constraints and how it might impact this model
• the Portfolio will need to review how we can help support people who are economically inactive to return to employment as well as prevent people moving from employment into economic activity
• the Board noted the connections with Local Health Boards and PHS surrounding existing work and opportunity for partnership
• additional consideration is required to ensure there is support for people furthest from employment
• the work will need to consider how mental health conditions can be a focus along with musculoskeletal health
• there is an opportunity to link up with Waiting Well workstream in PPC

Action – Portfolio Board members to provide any further feedback on scope of Health and Work to James Wilson. 

Decision – The Board, provided support for the scope of the work and agreed cross-government delivery group would report through the Care and Wellbeing Portfolio Board. 

AOB

The Chair asked members to share any future agenda items for the Board meetings. 

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

Action – Board members to feedback thoughts on future agenda items.

The next Care and Wellbeing Portfolio Board will be held on 20 September at 1400. 

Following this meeting an update was emailed to the board.  This noted that due to diary issues the Care and Wellbeing Portfolio board on 20 September had been cancelled. The next meeting was held on 24 January 2024.