Care and Wellbeing Portfolio Board minutes: November 2022

Attendees and apologies

• Richard Foggo (Chair)
• Christine McLaughlin 
• Aidan Grisewood  
• Alan Gray
• Angela Leitch
• Alex McMahon
• David Martin
• Eddie Fraser  
• Gregor Smith
• Hugh McAloon
• John Burns  
• Judith Proctor
• Karen Reid
• Linda Bauld  
• Linda Pollock  
• Liz Sadler
• Michael Chalmers  
• Nicola Dickie  
• Nick Morris  
• Robbie Pearson
• Stephen Gallagher
• Stephen Lea-Ross

Apologies

• Donna Bell  
• Gillian Russell  
• Jason Leitch
• Mary McAllan  
• Richard McCallum
• Ralph Roberts  
• Tim McDonnell  

Items and actions

Welcome and apologies

The Chair opened the meeting, noted apologies and welcomed new members to the Board: Hugh McAloon (Director of Mental Health), Alex McMahon (Chief Nursing Officer), and Karen Reid (Chief Executive of National Education Scotland).

Meeting minutes from the last meeting held on 18 August 2022

Minutes of the meeting on 15 September 2022 were agreed as an accurate record. No matters arising.

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

Kim Walker provided an update to the Board on Portfolio progress which is currently assessed as amber and attributed to the extended definition phase of the Portfolio. KW pointed members towards the draft 2022 to 2024 Portfolio Delivery Plan (appendix 3 of the papers), which will provide a visible path to green. The Delivery Plan demonstrates the Portfolio content has started to mature, with further content to be shared with the Board in January. The Delivery Plan and remaining Programme Charters coming to the Board for approval in January will provide a baseline of planned activity over the next two years. KW welcomed further discussions on the development of the plan with members outside the meeting.

Niamh O’Connor provided an update on engagement since the last Portfolio Board. The Portfolio is gaining more requests for engagement, showing that the Portfolio is gaining traction and becoming more recognised. Since the last Board there has been a strategic session held with the Directors of Pharmacy, as well as discussion with the Scottish Government executive team on prevention in the context of Care and Wellbeing. In the coming months the focus will be on engaging with National Health Boards.  

Actions:

•  2022 to 2024 Delivery Plan to be shared with board members in January

Programme progress – Karen Duffy (KD), Liz Sadler (LS), John Burns (JB)

Programme Directors/Senior Responsible Owners (SRO) provided a brief update on their respective Programmes.

Karen Duffy highlighted Preventative and Proactive Care (PPC) progress over the past month. PPC launched on 26 October via webinar with over 300 people attending. Feedback has been very positive. After the launch, letters for expressions of interest for GIRFE pathfinders have been gathered as part of the application process, a panel will review the inputs in November and agree successful pathfinders with work starting through winter and spring. The Waiting Well workstream remains in discovery phase, with workshops taking place from November onwards to agree the scope. PPC have provided their first verbal update to Ministers, with feedback focused on removing barriers of data sharing and tackling siloed practices. Sessions are planned for December to develop Programme impact measures and outcomes working with colleagues from Analysis and Evidence. Board members commented on the importance of ensuring new pathfinders are not established which duplicate existing ones.

Actions:

• KD to arrange a meeting with PS to discuss the process for determining pathfinders and the overarching approach to prevention

Liz Sadler provided an update on the Place and Wellbeing (PAW) Programme. The Enabling Local Change workstream is renewing its scope to focus on what national support would be helpful to ensure consistent and proactive engagement with Community Planning Partnerships (CPPs) across Scotland. PAW will bring a revised Programme charter to the board in January for approval. A workshop is due to take place next week on the Community-led Health and Wellbeing Improvement workstream to test the framework and set objectives. Further discussion on this work will take place at the Programme Board at the end of November.

John Burns directed the Board towards the Integrated Unscheduled and Urgent Care (IUUC) and Integrated Planned Care (IPC) closure reports (Paper 2 and 3). The Programmes have now been concluded with activity moved to business as usual under the NHS Scotland Chief Officers Office. Risks have been closed or transferred across to appropriate groups to ensure they are monitored and mitigated. The Board approved the closure of the IUUC and IPC Programmes and noted the risks are closed or transferred.

Decision:

• The Board approved the closure of IUUC and IPC Programmes and noted the risks are closed or transferred

NHS reform – John Burns (JB), Paula Speirs (PS)

John Burns and Paula Speirs provided an overview to the NHS service reform work which will be integrated into the Care and Wellbeing Portfolio (CWP). John Burns highlighted the Programme will be anchored into wider public sector reform. The Programme proposal has been shared with Board Chief Executives (BCEs) and Health and Social Care Directors, with the intention to go to Cabinet Secretary in the coming months. The NHS service reform work will build on the change which has already been started through various strategies to pivot how care is delivered and bring the care model as close to home as possible. Workforce and financial considerations will be crucial to maximise resources. Emphasis was placed on the need for the programme to be founded on current evidence, not just burden of disease but what constitutes good outcomes in healthcare and look through different lenses of population health and service models.

The key priorities for the work will include (1) building services around population need and person-centred care, (2) an NHS focused on prevention, (3) services successfully managing multiple morbidities, (4) delivery of a sustainable model for workforce, finance, estates, etc.

The work will take a tiered approach, making a shift towards providing care in hospital settings only where clinically necessary and delivering more in communities to help deliver better experiences and outcomes. The model is focus on empowering the population to look after themselves and prioritises healthy living. There will have to be flexibility in local areas depending on population needs, however the programme looks to set out an optimal model which can be adopted nationally. This will include more diagnostics, mental health support and long-term condition management in communities.

The work still needs to be worked up formally and is anticipated to become a formal programme in near future. This will be done within the CWP and will interconnect with the other two programmes, PPC and PAW. A more detailed plan and Programme Charter will be brought back to the Board in January.

Summary of Board discussion on this item:

• need to understand the outputs of this work
• understand analytical capabilities and workforce and how these come together with NHS service reform work
• the NHS service reform work touches all areas of CWP Programmes. Programmes need to consider how they can link to the work ahead of the next update in January
• for this work to be a gamechanger it must be refined to target inequalities
• emphasis was put on the need to have support for health literacy in place to avoid transfer of burden of care to the community without any support
• stronger connections between digital, workforce planning and service design are required to consider new service model versus traditional models
• consideration should be made to the cultural considerations of integrating a Multi-Disciplinary Team (MDT) model that enables trust with teams to reduce unnecessary gatekeeping behaviour, as this can often account for much of a team's time and cost
• the need to factor aspects of prevention and early intervention that are outside of the NHS control
• public and political optics on the programme will be crucial to engage with the public to change behaviour and expectations. Politically need to engage to change model of working. Other areas such as housing, welfare rights and digital capabilities will need to be integrated to this work
• need to identify expectations of Health and Social Care Partnerships (HSCPs) and Integrated Joint Boards (IJBs) in this work
• suggest exploring, (possibly via a CPP pilot area) how data sharing is used to support targeted interventions at individuals and families at known risk. Policy level interventions need to be supported by micro level person centred interventions
• dependencies exist not just in CWP but across government. This should be further highlighted in the next update to the Board

The Board approved the initial Programme development, with the understanding further connections will continue to be made to integrate into the Portfolio.

Actions:

• NHS service reform to come to January Portfolio Board with a further update and Programme Charter

Place and Wellbeing, anchors – Liz Sadler (LS)

Liz Sadler provided an update on the Anchors workstream in the Place and Wellbeing Programme, which is being taken forward in partnership with Public Health Scotland (PHS). This workstream aims to redirect wealth back into local communities to help address the wider determinants of health inequalities and improve population health. NHS Boards and HSCPs are already anchor institutions within communities but being exemplar anchors involves taking a deliberate and proactive approach to sustainability. By being an employer of choice, this can help tackle determinants of health, reduce inequalities and over time improve population health.

LS advised the workstream will have an initial focus on supporting the national and territorial health boards to be effective anchor institutions through amplifying existing work in local areas. This will provide a firm foundation to take the next steps to work across CPPs using existing structures to build a broader base of anchors which support and catalyse across the whole system.

Engagement has started with COSLA in social care to work on how boards can work closer with CPPs. GP’s and pharmacists in communities will also be included.

Three Task and Finish groups have been established which focus on land and assets, procurement, and workforce. These groups have identified key actions and the best way forward. The aim is to use existing groups where possible, with metrics being established to baseline at a local and national level. A communications tool will be developed to help understand the role of anchors.

The workstream is building on activity already being taken forward. Anchors will need strong and sustained leadership to achieve ambitions.

LS welcomed feedback on the proposed milestones of the workstream and the benefit of prioritising anchors within the NHS.

The Board was supportive of the development of the Anchors workstream and noted the proposed milestones. Summary of the Board discussion on this item:

• identified the NHS Climate and Sustainability Strategy has an overlap with Anchor institutions. Should consider effort is not duplicated. LS identified these connections are already in place
• need for empowerment to encourage individuals to make decisions on a local basis
• opportunity to connect with Scottish Leadership Forum
• PHS are working with NSS on procurement. This work has been engaging with Scot Excel in establishing anchor institutions and the importance of local purchase. There is an opportunity to share tools with others
• suggestion early learning and childcare is a good opportunity to bring in anchor interventions at an early stage
• shared leadership is essential and needs to be across all portfolios
• ask to Board members to think about work which is already being done in respective organisations which can be brought to CWP and avoid additional commissions of work

It was agreed a further update on Anchors will be provided to the Board in March.

Actions:

• Board members to think about work already being done in respective organisations which can be brought to CWP to avoid additional commissions of work
•  LS to bring an update on Anchors workstream to Board in March

Digital and data – Stephen Gallagher (SG)

Stephen Gallagher presented a summary of the first Digital Delivery Plan for Health and Care and the Digital Charter.

Key areas in this work require integration, imagination and innovation. The integration of the Digital strategy with the Portfolio will identify how the strategy speaks to each of the service models and programmes to ensure digital considerations are made in everything. The interrelated nature of the enablers means that services may need to be redefined and Digital needs to be a part of this.

The Digital Enabler is integrated with the Innovation ANIA pathway. The work in innovation will alter the forward content of the Digital Delivery Plan.

Summary of Board discussion on this item:

• more needs to be done to educate on digital skills and the use of Artificial Intelligence
• explicit link with NHS Reform, specifically to give confidence to the workforce to use systems the way they are intended and leverage the benefits
• identified the dependency between workforce and digital. This should be clear when the Workforce charter is presented to the Board

The Board endorsed the Digital and Data Charter.

Actions:

• SG to arrange meeting with KR on education in digital skills

Finance – Alan Gray (AG)

Alan Gray provided an update on the Finance Enabler. Thus far, a draft of the medium-term financial framework has been developed and is being used to consult and engage with key stakeholders on the outlook for the next five years.

A sustainability and value programme has been established to support NHS Boards and Integration Authorities achieve efficiency, productivity and quality improvements. This board will be co-chaired by a Board Chief Executive and an Integration Joint Authority Chief Officer. Four workstreams have been established to help deliver this: being environmentally and socially sustainable, delivery of better value care, making effective use of resources and optimising capacity, and managing demand within available resources.

In addition, the strategic planning framework for infrastructure planning has been drafted, with meetings being held with NHS Boards to set out the whole system planning approach and the immediate implications of the Capital Spending Review.

An integrated approach to determine the priorities of the Portfolio is needed, considering the financial position and requirements to deliver savings and efficiencies. Further work can then be undertaken to develop relevant plans and ensure these are deliverable and affordable.

Summary of Board discussion on this item:

• financial planning needs to be rooted in the three horizon perspective
• ensure consistency of message at all levels
• focus on not making lots of short term decisions which will take the portfolio too far away from vision which aspire to
• think collectively and link in with teams to identify priorities
• explore how health economics capacity can support this work

Actions:

• AM to meet with AG to discuss how health economics capacity being developed by Analytics and Evidence Enabler can support the Finance Enabler.

Any other business

The Chair thanked board members for their valuable discussion and opened for comments on the progress of the Portfolio.

Summary of Board members comments:

• importance of work in helping to prevent future impacts of pandemics
• meetings have become more discursive
• important to communicate clearly with staff and partners. The Portfolio approach is what makes this work unique, therefore this should continue to be displayed rather than always delving deeply at programme level
• clear coherence between population and prevention work and enabling work in the long term

The Chair asked the Board to consider attending future meetings in person, at a venue TBC. The option will remain to join virtually to make the Board accessible to all.

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

The next Care and Wellbeing Portfolio Board will be held on 19 January at 14:00.