Care and Wellbeing Portfolio Board minutes: September 2022

Attendees and apologies

• Christine McLaughlin
• Richard Foggo
• Donna Bell  
• David Martin
• Eddie Fraser  
• Gillian Russell  
• Gregor Smith
• John Burns  
• Jason Leitch
• Linda Bauld  
• Linda Pollock  
• Liz Sadler
• Michael Chalmers  
• Mary McAllan  
• Robbie Pearson
• Stephen Gallagher
• Tim McDonnell  

Apologies

• Aidan Grisewood  
• Angela Leitch
• Alex McMahon
• Hugh McAloon
• Nicola Dickie  
• Nick Morris  
• Richard McCallum
• Ralph Roberts  
• Stephen Lea-Ross

Items and actions

Welcome and apologies

The Chair opened the meeting, noted apologies and welcomed new members to the Board; Jason Leitch (National Clinical Director) and Gillian Russell (Director of Health Workforce). Noted slight change in order of the agenda with the change request being discussed first.

Meeting minutes from the last meeting held on 18 August 2022

Minutes of the Meeting on 18 August 2022 were agreed as an accurate record. No matters arising.

Change request IUUC/IPC Programmes – John Burns (JB)

John Burns, SRO for Integrated Planned Care (IPC) and Integrated Urgent and Unscheduled Care (IUUC) Programmes, introduced the change request for both Programmes to the Board.  The IUUC collaborative, established in June 2022, supports and drives improvement across the Urgent and Unscheduled Care Pathway. IPC have been working to set ambitious targets for improvement and looking to work with teams across Scotland for delivery. Both programmes have progressed towards BAU, with an operational emphasis hence the request to transition both Programmes out of the existing governance of the Care and Wellbeing Portfolio to BAU under the Operational Delivery Programme Board. This will be an opportunity to develop a new Programme within the Care and Wellbeing Portfolio (CWP) which is focused on NHS Reform and links to ambitions of CWP as well as the National Care Service.

Summary of Board discussion on this item:

• emphasised need for coherence within the proposed NHS Reform Programme and to be continually challenged on this
• cautious about scope relative to ongoing programmes
• need to be cognisant of strategic coherence with NCS Programme
• initial thoughts on proposed Programme to be shared with Board members for early feedback
• need for commitment to co-design and people with lived experience to be involved in early discussions for NHS Reform work
• utilise lessons learned from IPC/IUUC Programmes into NHS Reform Programme proposal
• new programmes should think about avoiding the need for care or limiting its necessity

Board approved the change request to close the IUUC and IPC Programmes out with the governance of the CWP. Programme closure reports will be circulated to Board members in October with a discussion paper on the new NHS Reform Programme brought to the November CWP Board meeting.

Actions:

• IUUC/IPC Programme closure reports to be shared with Board members in October and paper on new NHS Reform Programme in November

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 and lack of year one delivery plan. Path to green is to develop draft delivery plan for next Portfolio Board in Nov which will outline new programme to replace IPC and IUUC and demonstrate clearer progress in a number of priority areas – aspects of PPC beyond MDTs, Place and Wellbeing Programme, Workforce and Digital.

Niamh O’Connor reminded the Board that the Marmot Model is being used as the conceptual foundation for the Portfolio.  This model clarifies how we improve “health and wellbeing for all” and “reduce health inequalities”.  This connects directly to the Programmes and Enablers and clarifies where more work is needed.

An update on engagement across SG portfolios identified areas of coherence and opportunities to support across DGs.  This includes pre-birth to three, tackling economic inactivity. The cost-of-living crisis was noted as having an impact on population health and has therefore been a key item of discussion when engaging with DGs and through the focus on employability and pre-birth to three programmes.

Summary of Board discussion on this item:

• current implementation gap, with a need for sharpened focus on deliverables
• need for a cross-portfolio and wider public sector approach
• methodology used should be transparent and measurable
• board would like to see how each of cross government areas are being taken forward
• there remains difficulty for Board members to articulate to others how they can contribute to the CWP
• work to continue identifying key engagements for CWP
• pre-birth to three work has inadequate programme infrastructure so far and requires more CWP programme support

Actions:

• CM/RF to have discussion with JL and GS on methodology and the existing implementation gap within CWP
• PMO to share a version of delivery plan with portfolio board members ahead of next board

Programme progress – Tim McDonnell (TM), Liz Sadler (LS)

Programme Directors provided a brief update on their respective Programmes.

Tim McDonnell highlighted Preventative and Proactive Care (PPC) progress over the past month. PPC charter has been updated to reflect the Programme shift to delivery phase and new governance and the establishment of the Programme Delivery.

Liz Sadler provided an update on the Place and Wellbeing Programme (PAW). The Anchors workstream is the most developed, starting to move into delivery, with a delivery group in place and three Task/Finish groups (workforce, procurement and land and assets). A paper on Anchors will be brought to the next CWP Board. Communities and Enabling Local Change workstreams both being scoped with the former adopting a co-production approach with stakeholders and the steering group expected to agree scope in October.

Portfolio outcomes and indicators – Nicola Edge (NE), Mel Giarchi (MG)

Niamh O’Connor introduced the item, one of the key products from the Analysis and Evidence charter - Portfolio outcomes and indicators and a measurement framework to track progress over time.

Nicola Edge presented the aim of the work to bring consistency, coherence, and alignment in the use of data and indicators, not just within CWP and Health and Social Care but to align – or influence – the National Performance Framework (NPF), Covid Recovery Framework and other Scottish Government frameworks. The team have been working with colleagues to get this alignment right and take the opportunity to build consistency across portfolios. A suite of indicators and draft dashboard for the Health and Social Care system, including population health has been developed. A collaborative approach is required working with Public Health Scotland who hold a lot of this data and resource.

The Marmot conceptual framework is the underpinning model (see above), using six cross portfolio domains and two delivery mechanisms. The team have worked through alignment and mapping of NPF and Covid recovery dashboard across Marmot to identify indicators and have added additional population health measures for CWP which will have to be dynamic and developed over time. For example, NCS will include additional outcomes and indicators as progress is made. NE displayed an example of what indicators would look like on the dashboard. Deep dive sessions on indicators will be planned to identify trends in what is changing, why, and what can be done about it. These questions will reach beyond health and across Portfolios (with one of the early deep dives planned to be on children at risk of obesity).

Mel Giarchi updated on the balanced scorecard which has been developed to monitor performance of the current system and improvements. This data is available monthly, with hot topics developed between which are of interest to the Executive Team. Outcomes focused logic modelling is being undertaken for the health and social care delivery system and indicators will be merged into the balanced scorecard to give a set of outcomes indicators for the system to compliment Marmot. Work on winter planning, focused on capacity and pressures, will be wrapped into the same product to support planning.

The scorecard is being moved into an interactive dashboard which will have four quadrants; patients and citizens; internal and organisational; innovation and change; and financial. Within each quadrant there are key outcomes and within these, multiple indicators of system performance and key improvement activities and how these relate to the CWP and component programmes. Currently there are forty five indicators with near time management information.

Summary of Board discussion on this item:

• opportunity to use this work to frame the work on NHS Reform
• consideration needed on how the scorecard will be shared with the wider system including Chief Executives and Chief Officers beyond Scottish Government
• difficulty in providing regular updates to population health indicators
• need to demonstrate which measures are driven by legislation
• requires alignment to the Promise plan
• importance of collective ownership to avoid risk of creating a repository of data and dashboards
• clear links to the Data Strategy
• request for regular updates on the progress of the work

The Board approved the overall approach, with the understanding connections will continue to be made with others.

Actions:

• NO/NE/MG to link in with Gavin Henderson’s team on alignment of the outcomes and indicators work to the Promise plan

Preventative and Proactive Care – Donna Bell (DB), Tim McDonnell (TM)

Tim McDonnell and Donna Bell, SROs for PPC Programme, provided an update on changes to the PPC Programme Charter and presented a paper on the PPC approach to Digitally Enabled Multidisciplinary Team’s (MDTs).

Changes to the PPC Charter include defined scope, remit, vision, aims and strategic objectives. The strategic objectives have been framed to ensure the GIRFE multi-agency approach can be utilised to design, test and evaluate. GIRFE has its own steering group and SRO, which will help ensure the model is understandable, usable, and transmissible in both a national and local environment. The GIRFE model will be co-designed.

The Board endorsed the updated PPC Charter.

Tim McDonnell highlighted the headlines from the Digitally Enabled MDT Paper. PPC are focusing on enabling the MDT workforce in Scotland. To date there has been a significant expansion in the multi-disciplinary workforce in primary care, circa 70% of the full delivery aspiration. PPC are monitoring and evaluating how the MDT approach is delivering benefits. The Primary Care Improvement Plan and joint working will give greater insights into the impacts MDT is having on primary care and mental health. Three of the PPC objectives; GIRFE Framework, enhanced preventative and proactive approaches across Primary Care, and the Waiting Well Framework will test, shape and enhance MDT working and approaches to holistically meeting people’s wellbeing needs: 

The GIRFE model can be used by MDT’s to improve holistic, person-centred and co-ordinated care and support for citizens wellbeing needs. Five GIRFE place-based pathfinders will help bring the conceptual model to life. These will be prisons; addiction services; older people and frailty; families with multiple or complex needs and deep-end GP practices. These projects will bring together agencies to provide person-centred care, resulting in fewer conflicting interventions. This approach expands beyond health and will work in partnership with others to help the health and social care world reach other supporting services. PPC are looking for people working in this way already to identify how they would apply or use the GIRFE model to make improvements. The minimum viable model is ready, with invites of interest shared early October and a PPC overarching launch event taking place late October. In addition, PPC are planning a further six GIRFE specific engagement sessions as well as planning to attend Chief Officers, SEND, Chief Social Work Officers, Medical Directors and AHP Directors.

Tim McDonnell and Donna Bell asked for the board’s expectations of the PPC programme relating to the ‘digitally enabled’ part of Multi-Disciplinary Teams.

The Board noted the progress of MDTs.

Summary of the Board discussion on this item:

• useful to link with work underway on the Digital Front Door
• programme should not duplicate pathfinder work across government
• digitally enabled teams require system interoperability and citizen access to data
• currently a self-care gap in the Portfolio (drugs, obesity, smoking etc.)
• demand on MDTs will need to be managed, there for people who really need it
• the rollout of M365 provides functionality which will be useful for MDT’s. This does not mean people will use it, or use it optimally, therefore need to ensure appropriate support is provided
• further engagement between PPC Programme and Digital Enabler required

Actions:

• DB/TM to engage with SG on scoping the digital ask of MDTs within the PPC Programme

Any other business

The chair proposed, given scale of discussions, a monthly meeting may not be the best approach, and therefore propose to move to bi-monthly, with the next meeting in November. This will allow time for work to progress and have the right level of engagement before coming to the Board. Updates on topics of interest would be provided between meetings. The chair asked for feedback on future agenda items.

Actions:

• Board members to feedback thoughts on future agenda items

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

The next Care and Wellbeing Portfolio Board will be held on 10 November at 14:00.