Care and Wellbeing Portfolio Board minutes: October 2024

Attendees and apologies

• Richard Foggo, Co-Director Care and Wellbeing Portfolio, Scottish Government (Chair)
• Marion Bain, Clinical Lead – CMO Directorate, Scottish Government
• Linda Bauld, SRO Place and Wellbeing Programme
• John Burns, Executive Sponsor NHS Acute Reform, Scottish Government
• Nicola Dickie, COSLA Representative, COSLA
• Karen Duffy, SRO Preventative and Proactive Care, Scottish Government
• Nicola Edge, Portfolio Lead for Analysis and Evidence, Scottish Government
• Eddie Fraser, SOLACE Representative, SOLACE
• Stephen Gallagher, Director of Mental Health, Scottish Government
• Aidan Grisewood, Director for Economic Transformation Strategy, Scottish Government
• Caroline Hiscox, Vice Chair of NHS Chief Executives Group, NHS Grampian  
• Calum Irving, Covid Recovery Strategy ( Deputy), Calum Irving
• Paul Johnston, Public Health Scotland Representative, Public Health Scotland
• Tai MacLennan, Portfolio Lead for Workforce, Scottish Government
• Mairi MacPherson, Deputy for Andrew Watson - Portfolio Lead for Children's Health and Wellbeing, Scottish Government
• Tim McDonnell, Executive Sponsor for Preventative and Proactive Care Programme, Scottish Government 
• Christine McLaughlin, Co-Director Care and Wellbeing Portfolio, Scottish Government 
• Julie Murray, Representative from Chief Officers for Health and Social Care Scotland, 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
• Gordon Paterson, Deputy National Education Scotland (NES) Representative, NES
• David Plews, NHS Acute Reform Planning Lead, Scottish Government
• Stephen Rae, Deputy for Alan Gray - Portfolio Lead for Finance, Scottish Government
• Tom Steele, Board Chairs Representative, NHS
• Malcolm Summers, Strategic Reform Lead, Scottish Government
• Kim Walker, National Programme Director, NHS NSS
• Susan Webb, Directors of Public Health Representative, NHS Grampian

 

Apologies 

• Anne Armstrong, Interim Chief Nursing Officer, Scottish Government
• Donna Bell, Executive Sponsor for Preventative and Proactive Care Programme, Scottish Government
• Anna Dominiczak, Portfolio Lead for Innovation, Scottish Government
• Alan Gray, Portfolio Lead for Finance, Scottish Government
• Caroline Lamb, Chief Executive of NHS Scotland and Director General for Health and Social Care, Scottish Government
• Clare Morrison, Enabler Lead for Service Co-Design and Improvement, Scottish Government
• Robbie Pearson, Chair of NHS Chief Executives Group, Health Improvement Scotland
• Karen Reid, NES Representative, NES
• Andrew Watson, Director for Children and Families, Portfolio Lead for Children’s Health and Wellbeing, Scottish Government

Items and actions

Welcome and Apologies

The Chair opened the meeting, noted apologies, and welcomed new member, Tom Steele, NHS Board Chairs’ Representative.

Meeting minutes from the last meeting held on 25 June 2024

Minutes and Actions from the last meeting held on 25 June were agreed as an accurate record.

Matters Arising: the Chair highlighted the recent publication, by the Non-Communicable Diseases (NCD) Alliance, of a 10-year vision on Scotland’s Health the work is relevant to the work of the Care and Wellbeing Portfolio Board.

 

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

Niamh O’Connor provided an update on key engagements and strategic insights for the Care and Wellbeing (CWP) since the last meeting. Latest life expectancy figures have shown the highest annual improvement since 2012-14 and are now 76.9 for males an 80.9 for females. Prior to 2012-2014, improvements to circulatory disease mortality were driving a lot of the improvements in life expectancy. After 2012-2014, these improvements started to slow. At the same time, other causes of death were increasing, especially drug related deaths and deaths from dementia and Alzheimer’s. The combined effect of these led to the stall in life expectancy improvements. Some causes of death saw improvements in the most recent years, particularly respiratory disease and cancers.
Population projections suggest that life expectancy in 2045 will increase for both males and females. The projections are based on long term trends in data and the most recent version from 2020 projects lower life expectancy than any of the previous versions. Updated 2022-based projections are planned for publication in November 2024.
Consideration is being given to a new stretch aim within the Population Health Framework (PHF) and Board members were directed to the material in the Analytical Insights Pack on key measures such as life expectancy and healthy life expectancy. Wider developments from the UK Government budget are also expected to have impacts on health outcomes. The recent UK budget was described by the Office for Budget Responsibility (OBR) as one of the largest increases in spending, tax and borrowing in history at the macro level with the potential to have significant long-term effects.   Several announcements at the micro level – duty changes on health harming products and an increase to the living wage – have the potential to contribute to impacts on the drivers of economic inactivity. 
Kim Walker provided an overview of Portfolio progress since the last meeting and referred members to the Portfolio reporting pack that was shared with the papers. The core deliverables in the 2024/25 plan are largely on track with some Programmes advancing deliverables (Cardiovascular Disease (CVD), Waiting Well, Getting it Right for Everyone (GIRFE) and Primary Care Multidisciplinary Teams (MDTs), Population Health Plan, Anchors) and are on track to deliver benefits whilst others have made limited progress due to financial restrictions impinging on key decisions (innovation, digital) and pace and lack of definition of NHS Acute Reform Programme within the CWP. 
Portfolio delivery RAG assessment remains at amber which is based on recognition of progress to date coupled with ongoing work required to progress defining scope for NHS Acute Reform, Workforce, and the refresh of enabler charters. Progress has been made on managing and mitigation of Portfolio-level risks, and we continue to monitor 3 medium and 1 high risk at Portfolio level.

Summary of Board Discussion on this item:

• significant amount of information available with ScotPHO profiles – need to be sure the data is used effectively 
• use data available to target areas for population health most effectively 
• due to scale and complexity of Health and Social Care Reform amber RAG assessment is appropriate at this time 
• the Board noted update and accepted assessment of progress

Action: JB and AM to add information on data variation to make sure inequalities cover population health, service reform, and delivery to ensure coherence and consistency

 

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

Karen Duffy reported on the Preventative and Proactive Care (PPC) Programme, which is currently reporting as a green RAG status. The GIRFE ‘Team around the Person’ toolkit will be published late November 2024, to allow wider use across Scotland’s HSCPs. The next phase of work will focus on digital and information sharing initiatives culture and leadership requirements.
Primary care phased investment is progressing, with four demonstrator sites working with fully expanded MDTs. Primary Care reform work continues and for the PPC elements, the joint teams are working on which key elements will report up through the PPC programme. 
The CVD Hub on NHS Inform has relaunched to improve the information that the public can access. A National stretch aim has been agreed with CMO and the Cabinet Secretary around reducing avoidable CVD deaths by 20 percent over the next 20 years. The definition of avoidable are those deaths considered either preventable or treatable through public health interventions or timely and effective healthcare in the under 75-year age cohort. The CVD risk factors programme is focusing on measures that can increase earlier identification and proactive management of modifiable risk factors which lead to CVD (and multiple other disease burden areas) such as smoking, obesity, high glycemia (blood sugar), high lipids (blood fat levels), and high blood pressure. At present the transforming models of care workstream is designing the horizon one deliverables that can commence live work in clinical practice early in 2025.
Waiting Well is progressing well, with a toolkit being utilised across Scotland Health Boards. A national learning network has been established to facilitate knowledge sharing. Community appointments are increasingly being developed and run across many health boards, which aims to support people earlier and explore meeting their needs whilst on lists, but also some of the interactions may lead to people coming off lists. This is many in the allied health professional space at present e.g. physiotherapy waiting lists. 
The critical role of the Board was emphasised in providing strategic oversight while focusing on delivery. The collaboration between local leadership and national oversight is vital for the success of ongoing initiatives.

Board Discussion on this item:

• the Board asked when data will be available that shows CVD is having a positive impact on health, which is being worked up jointly through PPC and the Health and Social Care Analytics team
• delivery elements being proposed for Scotland are based on strong evidence of interventions that are well proven medically and elsewhere in the UK and internationally - therefore, the question is not whether these interventions will work, it is more the how to bring these in across the Scottish system in this current fiscal position, with the elements specific to the Scottish GMS space
• consider how to ensure funding is allocated for this area of work, to offer the level of reach that will then be able to show improvements in health at individual and population levels

Linda Bauld provided an update on the Place and Wellbeing (PAW) Programme, and noted both the Anchors and Communities workstreams are reporting green with key deliverables on track or slightly delayed, mainly due to capacity within teams. The recruitment of a new Anchors lead has seen a positive impact and progress on the workload of the team. An evidence review conducted by Anchors colleagues has highlighted the vital role of community organisations in improving health and well-being and a recent workshop with partners focused on recommendations to enhance the influence/role of community organisations. The Procurement workstream has identified £0.5 billion additional spend that could remain with local suppliers. During the next quarter the focus will be to develop an implementation plan, finalise the evidence review and utilise it as the foundation for an internal communication strategy and conduct a series of workshops aimed at improving the grant-making process for both formal and local change initiatives. 
Enabling Local change is reporting amber because of limited capacity due to key resource being redirected to the PHF. This has delayed the stocktake report which is currently in draft form and under review by Scottish Government and Public Health Scotland.
The PHF is moving forward with ongoing engagement activity. Feedback review and content development is underway with initial drafts being put together for the PHF including system summaries and the evidence narrative. Current timeframe for publishing the PHF is now early 2025.
The overall RAG status for PAW remains amber largely due to the very tight timescales surrounding the publication of the PHF and the limited progress within the Enabling Local Change workstream.
John Burns provided an update on NHS Acute Reform and reported that all workstreams are progressing well, although it was noted at the August Planning Delivery Board (PDB) that the Diagnostics workstream is reporting as amber. Going forward the PDB will meet on a 6-weekly basis, aligned to and feeding into, the new NHS Scotland Executive Group which is co-chaired by Caroline Lamb and Robbie Pearson. 
Services are being reformed but ways of working also need to be reviewed to look across Scotland and change leadership to embed and effect change. To support this change in thinking there will be updated planning guidance for NHS Scotland focussing on population level planning. This recognises the critical role of planning for different populations and recognised the importance of place/local planning for outcomes and improved experience at population level. Bespoke programmes of work are being developed to tackle sustainability issues for oncology, vascular, diagnostics and remote and rural islands care.  
The National Clinical Framework will become a valuable tool in looking at how to transform and change the way services are delivered, and it is essential that the NHS Scotland approach for change is clear in its ambition on expected outcomes to achieve this. It was noted that the Stakeholder Advisory Group has been established as well as work with The ALLIANCE and Health Improvement Scotland Community Engagement. An engagement approach is being developed for staff, working closely with NHS Boards.
The Board noted programme updates and accepted assessment of progress.

Action: KD to review when data on short term value of work going on so far for CVD and share data with Board at next meeting

 

Changes to CWP Governance – Christine McLaughlin (CMcL)

Christine McLaughlin updated that developments in SG-wide governance to support reform are underway to align with the First Minister John Swinney’s Programme for Government which focuses on eradicating child poverty, growing the economy, tackling the climate emergency, and improving public services.
A Public Sector Reform (PSR) Board, chaired by Louise MacDonald has been established to lead Public Service Reform. The first meeting was held on 26 September and a deep dive on HSC reform is planned for 25 November. The executive Team and Cabinet are also having joint meetings to oversee and deliver the First Minister’s four priorities, with a key focus on prevention. A new risk has been added to the Corporate Register, structured around the Kings Fund 4 Pillars of health to prevent ill health.
A new Stakeholder Advisory Group, chaired by Neil Gray to provide advice on healthcare reform, brings together a cross-section of HSC stakeholders including professional associations, COSLA, the ALLIANCE, regulators and others in service delivery, including some members of this Board.  
An internal Reform Executive group has been setup under Health and Social Care Management Board. It will meet for the first time in November to improve internal SG management of reform policy and strategy. It will also enable collective input to the wider SG governance structures to increase internal coherence and collective focus.
The CWP Portfolio Board continues to play a key advisory role in the overall reform contribution to the new HSC vision and a review of membership and scope is planned for early 2025 to ensure alignment with new governance and advisory mechanisms.
Summary of Board Discussion on this item:

• ensure there is coherence across various strands of work and there are clear governance links across the groups
• the Board noted the changes in Scottish Government Health and Social Care governance and connectivity with wider Scottish Government governance

Action: CMcL to share an update on governance digitally after the Reform Executive introductory meeting

 

Engagement for the Population Health Framework – Linda Bauld (LB)

Linda Bauld updated the Board on the status of the development of the PHF which has seen significant progress since the last Board meeting in June. The PHF will take a cross-government and cross-sector approach to population health, focused on primary prevention, stopping health problems arising in the first place. The PHF will make a decisive contribution to realising the Health and Social Care vision, primarily through coordinated activities addressing the prevention and people and place elements. Actions for the PHF are still being identified and agreed. The overarching driving force behind developing the PHF is to accelerate the recovery and improvement of population health in Scotland with a focus on whole system primary preventative action. 
Stakeholders have been engaged throughout the phase three engagement period and are active contributors to the development of the final PHF. Over 60 stakeholder engagement sessions have taken place with 50 written responses received that have been analysed for key themes and gaps.
Key risks, issues and dependencies for the developing PHF are reported through the accompanying Place and Wellbeing Programme report. Phase four of developing the PHF is now underway to finalise the PHF for publication, and the PHF will be brought back to the next Portfolio Board for a progress update.
Summary of Board Discussion on this item:

• the development of the PHF has been overseen by this Board who has collective ownership of it
• identify what is already happening across Programme for Government and build upon that 
• key to align commercial determinants of health to the PHF
• leadership is essential to guide and shape work 
• the Board noted update and accepted assessment of progress for the PHF

Action: LB to provide an update on the PHF for discussion in January before the PHF goes to Parliament.

 

AOB

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

The next Care and Wellbeing Portfolio Board will be held on 22 January at 10:00. 

Following this meeting an update was emailed to the board.  This noted that due to diary issues the Care and Wellbeing Portfolio board on 22 January was to be rescheduled.