Care and Wellbeing Portfolio Board minutes: June 2024

Attendees and apologies

• Christine McLaughlin, Chair, SRO Care and Wellbeing Portfolio, Scottish Government 
• Linda Bauld, SRO Place and Wellbeing Programme, Scottish Government 
• John Burns, Executive Sponsor NHS Acute Reform, Scottish Government 
• Steven Carter, Strategic Reform Lead, Scottish Government   
• Amanda Cronin, Enabler Lead for Service Co-Design and Improvement (Deputy for Clare Morrison), Scottish Government 
• Karen Duffy, SRO Preventative and Proactive Care Programme, Scottish Government   
• Nicola Edge, Portfolio Lead for Analysis and Evidence, Scottish Government   
• Christine Jack, Health and Social Care Scotland Representative (Deputy for Julie White), Health and Social Care Scotland 
• Roa Johnstone, CWP Programme Manager, NHS NSS 
• Mary McAllan, Covid Recovery Strategy, Scottish Government   
• Tai MacLennan, Portfolio Lead for Workforce, Scottish Government 
• Anita Morrison, Portfolio Lead for Analysis and Evidence, Scottish Government   
• David Plews, NHS Acute Reform Lead, Scottish Government 
• John Nicholson, Deputy Director Population Health Strategy & Improvement, Scottish Government 
• Niamh O’Connor, Deputy Director Population Health Strategy & Improvement, Scottish Government 
• Paula Speirs, NHS Acute Reform SRO, Scottish Government   
• Chris Stothart, Strategic Reform Lead, Scottish Government   
• Malcolm Summers, Strategic Reform Lead, Scottish Government   
• David Thompson, Innovation Enabler Lead (Deputy for Anna Dominiczak), Scottish Government 
• Emma Wylie,  Place and Wellbeing Programme Manager, NHS NSS

Apologies:

• Nicola Dickie, Director for People Policy, COSLA
• Anna Dominiczak, Portfolio Lead for Innovation, Scottish Government
• Graham Ellis, Deputy CMO, Scottish Government
• David Martin, Non-Executive Director, Scottish Government
• Richard McCallum, Portfolio Lead for Digital and Data/Finance, Scottish Government
• Nick Morris, Board Chairs Representative, NHS 
• Clare Morrison, Enabler Lead for Service Co-Design and Improvement, HIS
• Robbie Pearson, Chair of NHS Chief Executives Group, Health Improvement Scotland 
• Kim Walker, National Programme Director, NHS NSS

Items and actions

Welcome and Apologies

The Chair opened the meeting, noted apologies, and welcomed new member Tai MacLennan, Portfolio Lead for Workforce.

Meeting minutes from the last meeting held on 23 April 2024

Minutes and Actions from the last meeting held on 23 April were agreed as an accurate record.

Strategic Overview – Niamh O’Connor (NO), Malcolm Summers (MS), Mary McAllan (MM), Roa Johnstone (RJ)

Niamh O’Connor provided an update on the Care and Wellbeing Portfolio (CWP), detailing key engagements and progress since the last meeting. Upcoming data on Scotland’s life expectancy (September) and healthy life expectancy (December) will be released by National Records of Scotland (NRS). The previous release on healthy life expectancy showed the rate of decrease for males slowing, but female healthy life expectancy was still decreasing at a faster rate. Economic indicators show recovery, with inflation reducing from 11.1% in October 2022 to 2% in May, and health services are gradually recovering, as evidenced by the highest levels of inpatient and day-case treatment activities since the pandemic as of March 2024.  

Premature mortality (deaths under the age of 75) remains elevated compared to pre-pandemic levels, though the latest 2022 data published by NRS are positive and shows a decrease over the year. Drug-related deaths, a significant factor in life expectancy and premature mortality, declined between 2021 and 2022 (based on official NRS stats); however, recent more frequent interim management data from Police Scotland shows an increase in suspected drug deaths (over the last year up to March 2024), potentially due to new synthetic drugs, though this is not confirmed.  

Significant political developments include the appointment of a new First Minister, who has prioritised eradicating child poverty, improving the economy, improving public services, and tackling climate change. The Drugs and Alcohol Minister has been incorporated into the Health and Social Care Portfolio to ensure greater policy coherence in achieving health outcomes. And on the theme of public service reform, the other major development since this Portfolio Board last met is the Cabinet Secretary for Health and Social Care set out his vision for health and care reform in the Scottish Parliament earlier this month on 4 June with prevention and early intervention as strong themes.

Malcolm Summers discussed the recent parliamentary debate on 4 June, which highlighted the new vision for Health and Social Care (HSC). The primary focus is on prevention, early intervention, and integrating various elements of the Portfolio to advance the health agenda, including cross-government collaboration. The vision, developed from extensive analysis, aims to guide change with four key objectives:  Access, Prevention, Quality, and People and Place.  The CWP delivery plan will align with this vision, mapping its reform contributions while acknowledging the broader impact of ongoing activities and reforms. Key deliverables are under review to assess the Portfolio’s contribution to outcomes, determining which areas should be prioritised or deprioritised.  

Mary McAllan addressed the cross-government prevention strategy, highlighting the unsustainability of current arrangements in the medium term without significant service reforms. The strategy envisions a decade-long programme extending beyond the current parliamentary term. It aims to establish place-based, relational public services focused on prevention, improving outcomes, reducing demand, and addressing inequalities. Discussions on prevention are ongoing across various government sectors, with public bodies already focusing on efficiency and productivity drivers. There is a proposal to implement the Marmot theory at local level, addressing both systemic and individualistic perspectives of prevention. Differentiating between population-level prevention and intensive public service users is crucial. Effective partnership working and clear communication with local partners is essential for successful implementation.  

Roa Johnstone shared the latest RAG assessment, which remains at amber, indicating ongoing financial constraints and their impact on the capacity to delivery necessary reforms effectively. Priorities for 2024-2025 have been reassessed, emphasising key priority areas including GIRFE, Primary Care Reform, Population Health Framework, Anchors, Cardiovascular Disease, and National Clinical Framework. Portfolio-level risks have been actively managed, with three of four risks unchanged for the quarter. However, efforts to enhance Portfolio coherence through SRO and Delivery Leads meetings have somewhat mitigated these risks. 

Action – Board members to review Portfolio pack and provide feedback on scope and priority areas to PMO

The Scottish Government has incorporated a preventative population health risk into its corporate risk register, enhancing alignment across government efforts to promote public health. There is potential scope for the Permanent Secretary to attend the next Portfolio Board meeting to outline how this initiative aligns with their strategic priorities. 

Summary of Board discussion on this item:

• ensure comprehensive mapping of multiple overlapping activities
• incorporate the needs of individuals using public services intensively into the Getting it Right for Everyone (GIRFE) workstream
• define the Portfolio’s population-level approach to reflect this work
• clarify how the Portfolio describes work and communicates roles to partners
• ensure funding clarity for prioritised areas 
• clarify the Board’s unique contribution to this initiative

Programme Delivery – PPC – Karen Duffy (KD)

Karen Duffy reported on the Preventative and Proactive Care (PPC) programme, which is currently reporting as a green RAG status.  Significant advancements have been made, including the adjusted milestone for publishing the GIRFE toolkit in September 2024. Live testing of the ‘team around the person’ prototype is ongoing, with refinements being made with support from Digital Policy colleagues and further testing pre national publication. The Cardiovascular Disease (CVD) workstream has delivered a series of workshops to improve the identification and management of CVD risk factors. 

Primary Care continues to progress with Multi-Disciplinary Team phased improvement plan with demonstrator sites, alongside further scoping for primary and community reform aspects. The Community Glaucoma Service is on track for rollout in 10 out of 14 Health Boards by April 2025, with ongoing conversations to mitigate funding and resource risks in the remaining 4 Health Boards for complete rollout by March 2026.  The first meeting of the Primary Care and Community Health Steering Group on 15 May 2024 focused on developing a Route Map for future sector operation, marking a significant milestone in Primary Care and Community Health reform. 

Waiting Well (WW) successfully launched a WW toolkit to all boards and is establishing a learning network. Funding constraints may hinder the development of future digital solutions to track Waiting List progress, placing this work under the control of DHAC and Scottish Government’s Planned Care division, and therefore out of scope for WW to deliver.

Following the PPC workshop on 13 May it was proposed that digital initiatives will no longer report as a distinct workstream within PPC. All workstream initiatives will continue to report through their respective digital governance routes with any relevant updates integrated under the Delivery Director’s section. 

Summary of Board discussion on this item:

• concerns were raised regarding the ability of the work to progress at the necessary pace and scale with current resources to impact population health effectively
• the programme is consolidating activities within existing resources to ensure cohesive efforts across existing programmes of workc
• current dependencies are under evaluation, alongside considerations of citizen and service user experiences.  The objective is to incorporate these insights into the programme’s development, ensure comprehensive issue reporting, and expedite resolutions where necessary
• emphasis was placed on identifying ways for the Portfolio to support and empower local teams in their work
• the Board approved the closure of Digital PPC workstream, directing all activities to report through their respective digital governance routes

NHS Acute Reform Update – John Burns (JB)

John Burns provided an update on NHS Acute Reform and the parliamentary debate in June, highlighting its pivotal role in fostering discussions and initiatives across NHS Scotland. Emphasis was placed on guiding principles centred on acute services, integrating pathways from primary care and communities, and ensuring coherence in service models through CWP contributions.  Key principles include population-level planning, collaboration with Health Boards beyond traditional boundaries, and optimising outcomes for population health, grounded in value-based health and care. This work builds upon the National Clinical Strategy with a focus on evidence-based quality, safety, outcomes, and delivery, in partnership with clinical colleagues.  

The Cabinet Secretary emphasised the importance of engaging with healthcare staff across Scotland, supported by ongoing efforts to establish structured engagements and an external professional advisory group led by the Chief Medical Officer. National public engagement initiatives discussed in parliament aim to incorporate public feedback into decision-making processes.     

Purposeful engagement efforts are underway to involve clinicians in developing the National Clinical Framework and expanding consultations to broader stakeholder groups. Reviews are underway to evaluate immediate priorities where services are at critical risk in terms of delivery across Scotland: Oncology, Vascular, Rural and Island, and Diagnostics. Task groups within these areas will recommend future clinical operating models for delivery aligned with population health strategies, integrating acute reform efforts.  

Summary of Board discussion on this item:

• consideration required to ensure feasibility of outlined ambitions
• prioritise understanding of existing public feedback before making additional requests 
• the Board agreed this is a transformative piece of work in development 

Population Health Framework – Draft Outline – Linda Bauld (LB)

Linda Bauld updated the Board on the Population Health Framework (PHF), highlighting recent progress in collaboration with COSLA to co-create a clear, simple, insightful, impactful framework. Emphasis is placed on addressing primary drivers of population health, although there is awareness of the need to consider whole systems, evidence and knowledge sharing comprehensively. The framework aims to adopt a data-driven approach incorporating visions and targets, particularly amidst resource constraints.    

Focused workshops have been delivered on: Diet & Healthy Weight (9 Feb 2024); Early Childhood Development (7 May 2024); Healthcare Inequalities (12 June 2024); Place & Communities (19 June 2024) and evidence sessions on: Diet & Healthy Weight (8 Mar 2024); Place & Communities (28 Mar 2024); Early Childhood Development (8 May 2024). Wider stakeholder engagement sessions & meetings will take place during the summer, with NHS Chairs (26 August 2024 -  tbc); Ms Minto and Cllr Kelly joint COSLA HSC Board (20 September 2024 - tbc); all CPPs (via DPH network and COSLA).

Summary of the Board discussion on this item:

• the Board to evaluate if the PHF adequately encompasses the necessary scope for achieving required change
• query regarding a lack of stretch aims around adulthood obesity and whether the two programmes (PAW and PPC) could target this at a preventative level 
• clarification required on the partnership strategy, particularly regarding close collaborations with education and community sectors 
• emphasis on the critical importance of coherence and resource allocation, particularly in budgetary terms  
• proposal for an in-person session to enhance collective understanding and alignment on the Board’s objectives and limitations  
• the Board agreed on the necessity for robust challenge and emphasised the value of evidence-based, substantive discussions
• call for clarity and communication on the reform’s vision and strategic planning, including fostering compassionate leadership and cultural change to support capacity planning

Action – PJ to follow up with NO and JN to gain further understanding of engagement to ensure coherence across the PHF.

CWP Governance – Christine McLaughlin (CM)

Christine McLaughlin outlined efforts to refine the scope and governance of the Portfolio.  Ensuring effective governance without undue bureaucracy is paramount amidst evolving landscapes. A review of CWP governance will consider alignment with broader NHS reforms, including the National Care Service (NCS), and the new Health and Social Care vision. The goal is integration across components to enhance Portfolio effectiveness and coherence, promoting unified engagement in reform initiatives rather than disparate projects.  

Emphasis will be placed on the Portfolio Board’s role as it has been operating as an advisory board rather than a decision-making board. There is consideration on the development of a design authority, which will be explored further in the coming months. Proposed governance changes will involve consultation with the Board, aiming to maintain the CWP Board and formalise it as an advisory board, while refining subordinate levels. Strengthened connections with the NCS and NHS Planning and Delivery Board are anticipated.    

Action – CM to update the Board on governance revisions for CWP for feedback before final approval 

Summary of Board discussion on this item 

• members acknowledged the importance of coherence and emphasised that resource allocation, including financial considerations, is critical to service delivery 
• emphasis on the need for thorough follow-up to realise the benefits of developed plans
• consideration required on how the Portfolio uses resources, ensuring a value-based approach   

Action – Board members to provide feedback on the operational aspects of the CWP Portfolio Board and propose potential governance changes

AOB

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

The next Care and Wellbeing Portfolio Board will be held in late October, with an opportunity for the Board to meet in person.