Care and Wellbeing Portfolio Board minutes: May 2023

Attendees and apologies

• Richard Foggo (Chair)
• Alan Gray
• Donna Bell  
• Eddie Fraser  
• Hugh McAloon
• Jason Leitch
• John Burns  
• John Nicolson
• Karen Duffy
• Kim Walker  
• Linda Bauld  
• Malcolm Summers
• Michael Chalmers  
• Niamh O’Connor
• Nick Morris  
• Paul Johnston
• Stephen Lea-Ross
• Susan Webb
• Tim McDonnell  

Apologies

• Aidan Grisewood  
• Alex McMahon
• Christine McLaughlin
• David Martin
• Gregor Smith
• Karen Reid
• Linda Pollock 
• Mary McAllan  
• Nicola Dickie  
• Richard McCallum
• Robbie Pearson
• Stephen Gallagher

Items and actions

Welcome and apologies

The board welcomed new members Paul Johnston (Public Health Scotland Representative), Caroline Hiscox (Vice Chair of NHS Chief Executives Group), Marion Bain (Clinical Lead for Place and Wellbeing) and Julie White (Representative from Chief Officers for Health & Social Care Scotland) to the meeting. The board also thanked Liz Sadler for her service as programme SRO for Place and Wellbeing and welcomed Linda Bauld in her new role in the Portfolio as SRO for Place and Wellbeing. The board also thanked Michael Chalmers for his contributions in his role as Director for Children and Families and welcomed him in his new role as Director lead on Prevention. Andrew Watson was also welcomed by the board as the new Director for Children and Families.

Meeting minutes from the last meeting held on 19 January 2023

Minutes of the meeting on 19 January 2023 were agreed as an accurate record. 

There was one outstanding action for the Workforce Enabler to provide a progress update on their charter after receiving comments from the board. Stephen Lea-Ross advised that Workforce are progressing, and the Charter will be ready to be shared at the next board meeting. This will take account specifically of comments from Jan's meeting on defining 'growth'; digital skills; productivity/efficiency and link between workforce interventions across health and social care. Some of the reform asks around planned care and workforce diversification are shaping up well with more to do to urgently to look at activity/reform asks for workforce in the primary care/community care/ multi-disciplinary teams space. 

Strategic overview – Niamh O’Connor (NO), Kim Walker (KW) 

Niamh O’Connor described the wider policy context and the progress since the previous Portfolio board meeting noting the wider operating environment, a new First Minister, changes in ministerial portfolios and the publication of the new FM Prospectus – Equality, Opportunity, Community on 18 April 2023. 

Niamh O’Connor highlighted progress against several of the Marmot objectives contributing to the Portfolio’s aims; wellbeing economy, economic inactivity, and a health and social care director’s discussion being prepared for June, a fourth workstream is being scoped in place and wellbeing focused on current gaps in the Portfolio – contribution to health prevention, refresh of the thinking around early childhood development transformational change; and Programme for Government consideration in the coming months. Key actions surrounding diet, drugs, and alcohol are progressing with a debate in Parliament on food environment on 30 May, a Scottish Government report on minimum unit pricing is expected September 2023 and a tobacco plan expected in autumn. 

Kim Walker presented the RAG assessment of delivery confidence for the Care and Wellbeing Portfolio (CWP) as amber, due to scope instability the potential impact for 2023-24 and beyond. No risks required escalation but a summary of changes to RAG was provided:

• horizon scanning and operating environment risk status increased from low to high to reflect the current operating environment with financial restrictions and the impact of the cost of living crisis 
• delivery scope and coherence risk decreased from very high to high, due to the increasing stakeholder awareness of the prevention agenda, contributions to the Portfolio aims becoming clearer across some areas and emerging continuous improvement plan support with mitigation of both risks

Dependency management remains an issue with assessment of impact raised from medium to high. which is being actively managed.

Kim Walker also thanked board members for their participation in year one reflection meetings to discuss what has gone well and what can be improved at the Portfolio board. Key themes and actions from these meetings will be pulled into an improvement plan and shared with the Board at a future meeting. Achievement of the improvement plan provides potential path to green.

Summary of board discussion on this item:

• consider whether the overarching risk of population health inequalities and life expectancy is sufficiently coming through the risk management
• year one of the Portfolio was focused on implementing structure, now work must be focused on achieving the Portfolio’s aims
• need to move away from a system that only focuses on immediate aims and instead shift to recovery and renewal and transformation in the longer term
• consider how investment can be used in prevention to allow focus on the longer-term reform work 
• public sector reform will be one of the largest dependencies for CWP. Consider how we work with community planning partnerships (CPPs) through local outcome improvement plans, Local Government, Community Partnership Improvement Board and Ministerial engagement to build on work already progressing

Actions:

• KW bring back a continuous improvement plan from the year one reflection feedback to a future meeting
• portfolio team to consider community planning item for a future meeting

Innovation – Anna Dominiczak (AD)

Anna Dominiczak, Lead for Innovation, provided an overview of  progress since the August 2022 Portfolio board meeting, including a draft of the Innovation Charter. 

Two of the key areas of work, the Innovation Design Authority (IDA) and the Accelerated National Innovation Adoption (ANIA), are fully established. Capacity within the ANIA pathway has increased with additional funding approved and staff recruited. The IDA has approved two areas for national adoption via ANIA pathway, digital dermatology and diabetes closed loop systems.

Emerging benefits of the IDA and ANIA are becoming visible, working collaboratively to provide a coherent pathway for selecting and prioritising innovation identifying opportunities for ‘big wins’ in acute services and public health prevention interventions. A focus on transformative innovations will drive opportunities for high value jobs and economic growth to aid in recovery. 

The board was asked to consider three items for decision: (1) IDA makes decisions on transformative innovation once for Scotland and is requesting the ability for devolved decision-making from the Portfolio Board, (2) permission to hold off bringing social care transformative innovations into the IDA until 2024, when there will be evidence of its effectiveness, (3) approval of the Innovation Enabler Charter. 

Summary of board discussion on this item: 

• links between Innovation, digital and workforce need to be robust to help teams continuously improve ways of working
• important to develop and understand how social care is integrated into the IDA and activate when the timing is right, using learning from 2023-24
• unintended consequences and benefits must be captured to understand the full impact of an intervention
• ask for broader focus on diabetes prevention and remission, significant future innovations with major public health importance
• recognition that all work within CWP should be focused on reform and innovation, as business as usual is not within scope of the Portfolio

Decisions:

• the board agreed the IDA will have delegated decision-making authority to agree high impact innovations for national adoption
• the board agreed to delay the introduction of social care into ANIA until 2024 when there is evidence of the IDA’s impact and effectiveness. Focus for 2023 will be planning to make this successful
• the board agreed the charter and the actions set out within, with the caveat that Innovation adopts the Board’s comments

Service co-design and improvement enabler 

Jason Leitch, National Clinical Director, presented proposed change to combine the co-design and quality improvement enablers into one – service co-design and improvement. Both enablers are currently embedded in the Portfolio and provide a person-centred methodology to the CWP; co-design is working with those who use and work in services to design better services based on what is needed e.g., getting it right for everyone (GIRFE)/national care service (NCS), while quality improvement is working with service users and service providers (across primary, secondary and social care) to own and drive local improvement. 

Both methodologies have strong links to wider communications and engagement through citizens panels, service change and the NHS RRT programme. The service co-design and improvement enabler would continue to work closely with communications and engagement to have a robust commitment to engaging with the public.

The recommendation to the board was to bring the two methodologies together to complement one another and provide a coherent service continuously improve services within CWP and ensure the work has a person-centred focus. 

Summary of board discussion on this item: 

• there is a risk that combining into one enabler creates confusion and we lose the individual strengths of the Scottish approach to service design and quality improvement
• current thinking is theoretical and tangible examples would provide more context for the board to agree upon
• opportunity to increase collaboration within CWP and consider how to improve ways of working across the Portfolio
• combining the two enablers allows for the use of one or both methodologies in a blended model and toolkit.  The board is keen to see practical examples of how the methods can be used in the blended model of change, and to demonstrate impact and outcome

Action: 

• JL and LP provide tangible examples of the value added by bringing the enablers together to a future board meeting

Decision: The board agreed the proposal set out in the paper, with the request that the enabler comes back to a future meeting with tangible examples on the value added by combining the enabler.

Extended community treatment and care (Andrew Chapman) 

Andrew Chapman presented the paper setting out the principles and rationale for further development and roll out of community treatment and care services (CTACs) to move towards a more preventative and non-medicalised model of healthcare as a one stop shop in the community. 

CTACs are currently working to reduce the burden on GP services as part of the 2018 GP contract. All Health Boards are required to deliver elements of CTACs through the GP contract, however there is variation across boards and an opportunity to evolve these into more integrated hubs across primary, secondary and social care with partnerships in local communities. 

The proposal is to expand CTACs (referred to as eCTACs) to support existing core community services – general practice multi-disciplinary teams (MDTs), community pharmacies, dentists, optometrists, care services, community nursing and mental health by connecting them through a locality “hub” anchored in local communities. The focus is on promoting health and wellbeing through preventative action, support, and advice in local communities, taking a three-horizon approach with first horizon testing the concept of eCTACs across the system working with GIRFE pathfinders.

The board was asked for agreement to take forward a test of change to understand the feasibility of eCTACs, and report back with a revised three horizon approach later in the year. 

Summary of board discussion on this item: 

• essential that this is framed in the right way and does not duplicate the work Integrated Joint Boards (IJBs) have taken forward already on MDTs based in local communities, though recognition that there is variation across localities. Further work is required to clearly define the scope of eCTACs
• supportive of a function that would be the intermediary between practice level and hospital level for the community, but a need to more clearly define scope and understand how this fits into a refreshed broader model of community health and care.local flexibility and clarity on funding streams is needed as a single model for eCTACs would not fit everywhere in Scotland
• focus should be on developing work based on community and population need, with a preventative focus, which would help develop coherence across teams
• wider discussion required to understand the workforce and digital planning needs

Action: 

• AC to further define the scope of eCTACs using the three horizons approach and bring a paper back to the board at a future meeting

Decision: The board agreed to progress work on eCTACs in principle, through initiation of a working group under the preventative and proactive care programme, with the caveat that a paper is brought back which addresses the feedback noted above.

Any other business

The chair invited programmes to raise any exceptions or issues that had not been covered in the agenda via Teams chat.

Nicola Edge, Lead for Analysis and Evidence, provided a brief update via Teams chat on their charter. The charter has been updated with new deliverables and timescales for 2023-2024, deepening work in close partnership between Scottish Government and Public Health Scotland (PHS) on priority areas including a) indicators and outcomes dashboard b) economic analysis c) data improvement and user experience measures. The Analysis Oversight Group is now established and working well across partners to support collaboration and maximise value of analytical work. Also work to extend development of outcomes, measures etc. to social care to ensure coherence and alignment with NCS. Analysis and evidence plan to come back to future board with proposition on a regular analysis insights update for the Portfolio to help disseminate and apply learning and insights to support CWP and its partners.

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

The next Care and Wellbeing Portfolio board will be held on 26 July at 2pm.