Health inequalities: Place and Wellbeing Programme Board minutes - April 2023

Attendees and apologies

• Elizabeth Sadler (Chair), Deputy Director for Covid-Ready Society, Scottish Government
• Naureen Ahmad, Deputy Director for General Policy, Scottish Government
• Linda Bauld, Chief Social Policy Advisor, Scottish Government
• Lorna Birse-Stewart, Chair, NHS Tayside
• Sam Cassels, Place Principle Advisor, Scottish Government
• Angela Davidson, Deputy Director for Improving Mental Health and Wellbeing Scottish Government
• Margaret Douglas (Deputising), Consultant, Public Health Scotland
• Susan Gallacher, Preventative and Proactive Care, Primary Care Programme Lead, Scottish Government
• Lynn MacMillan, Head of Health Inequalities Unit, Scottish Government
• Gerard McCormack, Head of Transformation, Performance and Improvement, Improvement Service
• Fraser McJannett (Deputising), Programme Director, Executive Support Team, NHS Scotland
• Dona Milne, Director of Public Health, NHS Lothian
• Lynne Nicol, Deputy Director Planning and Quality, Scottish Government
• Jane O’Donnell, Deputy Director for Local Government and Analytical Services, Scottish Government
• Susan Paxton, Director, Scottish Community Development Centre
• Carol Potter, Chief Executive, NHS Fife
• Arlene Reynolds (Deputising), Senior Professional Advisor in Public Health, Scottish Government
• Pamela Smith, Head of Health, Wellbeing, and Social Care, Public Health Scotland
• Kerri Todd, Head of Health Improvement, NHS Lanarkshire

Apologies

• Marion Bain, Public Health Advisor, Scottish Government
• Chik Collins, Director, Glasgow Centre Population Health
• Ellie Crawford, Primary Care Strategy Unit, Scottish Government
• Eddie Folan, Chief Officer for Health and Social Care, COSLA
• Gordon Paterson, Director of Social Care, NHS Education for Scotland
• Diane Stockton, Head of Clinical, Public Health Intelligence and Research, Public Health Scotland

Items and actions

Welcome

Elizabeth Sadler, Deputy Director for COVID-Ready Society with Scottish Government, welcomed the members and guests to the first Programme Board. Elizabeth Sadler noted that she is stepping down from her role as Senior Responsible Officer for the Place and Wellbeing Programme then welcomed Linda Bauld, Chief Social Policy Advisor, Scottish Government, who has agreed to chair the Programme Board moving forward. It was decided that the Place and Wellbeing Programme will be aligned to the Population Health Strategy and Improvement division, under the leadership of Niamh O’Connor, Deputy Director, who will be supporting the programme’s day to day activities. Margo Murphy, Anchors workstream lead for the Place and Wellbeing Programme within Scottish Government, was also noted as a new team member joining the Anchors team.

Terms of Reference

Lynn MacMillan, Head of the Health Inequalities Unit, provided an overview of the Terms of Reference for the Place and Wellbeing Programme and noted that purpose of the Board is to provide direction and oversight to the delivery of the Programme. The Board will report to the Care and Wellbeing Portfolio Board and will also be supported by the Programme’s workstreams to take the work forward.

Lynn MacMillan described the main responsibilities of the Board as set out in the paper. The proposal is for the Board to meet at least four times a year, until 2025. Lynn MacMillan asked the Board to consider the approval of the terms of reference.

Elizabeth Sadler invited the Board for any comments and highlighted the plan to introduce a fourth workstream within the programme whose focus would be around main avoidable harms including, diet, tobacco, and alcohol. The Charter and the terms of reference will be updated to reflect the changes once included.

With regards to the principles section, Dona Milne, Director of Public Health for NHS Lothian, asked if the word ‘population’ could replace ‘citizen’ in the Terms of Reference as it is more exclusive.

Margaret Douglas, Public Health Medicine Consultant at Public Health Scotland, noted interest in having a discussion on the new fourth strand to understand how the work can be converted into achievable deliverables.

Elizabeth Sadler noted that the section on membership needs to be amended to reflect Linda Bauld’s role moving forward.

Action 1

• replace the word ‘citizen’ for word ‘population’ within the Terms of Reference to encourage inclusivity

Action 2

• update the membership to reflect the changes noted in the Programme Board meeting

Decision 1

• the Board endorsed the current remit of the group Terms of Reference with the acknowledgement that the changes outlined will be brought to the next programme Board for approval

Workstreams – Updates and Workplans

Anchors Workstream

Lynn MacMillan provided an overview of the Anchors Workplan and ran through the aims and objectives of the Anchors workstream.

Lynn MacMillan noted that the overall aim of the Anchors Workstream is to support Health Boards to be effective anchor institutions. Scottish Government is working closely with Public Health Scotland to understand what can be done at a national level to support work at a local level across Scotland.

The workplan has been developed around the key objectives and deliverables as outlined in the paper. The workplan also sets out who will lead on outputs, and a broad delivery timeline.

An Anchors Delivery Group is in place and Task and Finish Groups have been established to focus on the three key strand: workforce, procurement, and land and assets. The Delivery Group agreed the Task and Finish Groups for land and assets and procurement will remain in place to help with progress within these areas. An Anchors Strategic Workforce Group has been established to progress workforce objectives with key stakeholders. This group is chaired by David Miller, Human Resources Director, Fife.

NHS Fife and NHS Lothian have agreed in principle to be test sites to understand the barriers and enablers around the use and disposal of land for the benefit of the local community.

The NHS Scotland Delivery Plan Guidance asks all NHS Boards to develop an Anchors Strategic Plan by October 2023.

Lynn MacMillan asked the Board for comments and approval of the draft Anchors workplan.

Carol Potter, Chief Executive of NHS Fife, outlined that recent discussions with the Board and Chief Executives was positive. There is a need to have a self-fulfilling approach that can be effective to achieve the results intended and the delivery plan will help drive the work forward.

Sam Cassels, Place Principle Advisor for Scottish Government, commented that the shared use and joint use of buildings is really difficult in practice. Scottish Futures Trust have done a lot of work on this from which we can learn.

Pamela Smith, Head of Economy, Poverty and Environment at Public Health Scotland, noted the importance of not losing sight of the impact that the Boards, as Anchors have on the wider determinants of health.

Naureen Ahmad, Deputy Director, General Practice Policy in Scottish Government, asked about primary care and integration with National Care Service. Lynn MacMillan agreed to follow up with Naureen Ahmad. Consideration is also needed around how Health Boards work with other anchor institutions in the future within communities.

Kerri Todd, Head of Health Improvement for NHS Lanarkshire, accepted for practical reasons, starting the work with Boards but suggested the team was mindful of local contexts that Boards are working in i.e. to think about Local enterprise partnerships.

Action 3

• Lynn MacMillan to engage with Naureen Ahmad to consider primary care and integration approach with National Care Service

Decision 2

• the Board endorsed the Anchors workplan direction of travel

Enabling Local Change Workstream

Chris Stothart, Enabling Local Change Workstream Lead, presented to the group and provided an update of the changes made to date. The strategic aim and objectives have been updated and will be reflected in the Portfolio Charter for Portfolio Board approval.

The Localised Working Programme is being progressed jointly by Public Health Scotland and Scottish Directors of Public Health through a programme Oversight Group. Chris Stothart noted he will continue to attend these meetings to understand workstream linkages and to also learn about phase 1 progress at the three sites engaged so far.

The Population Health Dashboard is being progressed by the Analysis and Evidence Enabler within the wider Portfolio. Chris Stothart noted the workstream’s role will be to support work planned to understand dashboard utility at a local level.

Chris Stothart also met with Scottish Directors of Public Health representative to agree coordination of a paper from public health system leaders identifying what can be done nationally to strengthen focus on Community Planning Partnership.

For the next reporting period, Chris Stothart hopes to engage Community Planning Improvement Board via their Secretariat and the Scottish Directors of Public Health Group and Public Health Scotland members to describe the aims and objectives of the Programme and workstream. Consideration to be given to building stronger ties between the workstream and the Shaping Places for Wellbeing Programme. Chris Stothart to attend the Localised Working Programme Oversight Group to review progress updates from pathfinder sites and consider proposal for further roll-out of the programme.

Chris Stothart proposed a Delivery Group to be set up before the next programme Board, to identify key deliverables for the workstream and make recommendations to the Board as well and to agree activity within existing networks.

Chris Stothart asked the Board to approve the updated workstream text for the Programme Charter, the Enabling Local Change work plan, and the proposal to establish an Enabling Local Change Delivery Group.

Elizabeth Sadler asked the Board for comments and the following were made:

• Margaret Douglas is keen to be involved in the development of the dashboard as she has experience of issues with the granularity of data and suggested a possibility to link with ScotPHO. Margaret Douglas also expressed interest in developing the Community Planning Partnership objective to consider use of a ‘Health in All Policies’ approach and impact assessments at a local level
• Dona Milne expressed full support of the workstream and welcomed the wording for how Government delivers locally. Scott Heald, Director of Data and Digital Innovation with Public Health Scotland is supporting the development of the Care and Wellbeing Portfolio dashboard and Dona Milne proposed it would be good to meet to discuss the possible relationship of work being undertaken
• Arlene Reynolds, Senior Professional Adviser in Public Health in Scottish Government, provided feedback from Marion Bain, Deputy Chief Medical Officer, on this work. Arlene Reynolds felt the workstream was looking good and making good progress. However, she felt there was still some way to go for community planning to work and commented that she wasn’t sure how the actions proposed were going to make a difference and how do we do things differently this time to make a real difference
• Gerard McCormack, Head of Transformation, Performance, and Improvement with the Improvement Service, asked for clarity around if a new local/community plan was being proposed. Gerard also suggested that the Community Planning Managers Network should be engaged, as they understand what is happening on a daily basis and have the local knowledge which should be taken into consideration. Chris Stothart confirmed that the intention is to use existing local plans (Local Outcome Improvement Plans) and to explore what can be done to further support them. This could include exploring how tools like the dashboard could be used to look at accountability of outcomes, nationally and locally. Chris Stothart indicated the intention is still to reach out to the Network but had held off with hopes of approaching them with a clearer offer/ask

Decision 3

• the Board endorsed the proposals but felt more focus is required on the Community Planning Partnership objective and to consider the need for a workstream Delivery Group, given other groups with similar remits. Lorna Birse-Stewart, Chair for NHS Tayside, asked for both to be addressed at a meeting with key workstream stakeholders prior to the next Board

Communities Workstream

Kimberley Smith, Communities Workstream lead, presented to the Board an overview of the aim and workstream objectives.

Kimberley Smith noted that there is an established Communities Core Group that is made up of representatives from the community and voluntary and public sectors at both a local and national level. As set out in the paper, the key role of the group is to steer the development of several outputs. The first meeting was held in November which refined the workstream objectives.

The paper lists key outputs that the Communities Core Group will deliver. The main one is the development of an engagement plan to be implemented this autumn which aims to co-design principles to inform future decision-making around grant funding. A workshop is planned in May to facilitate to take the work forward.

After more in depth discussion around the national data dashboard the decision to remove that specific output was made, given that it is likely that access and learning from local data will be of more use to community and voluntary organisations. The national data dashboard is now included in the effective engagement with Public Health teams, which will link to the work Public Health Scotland are doing including around data, within the Localised Working Programme.

Kimberley Smith asked the Board to consider the approval of the work plan, pending any concerns raised by the Communities Core Group in May.

Sam Cassels emphasised the importance of stories which can be more impactful than evidence finding. Elizabeth Sadler is also in full support of stories and has asked for this to be considered throughout the programme. To support this, Carol Potter provided link to Helen’s Story. Also, Angela Davidson, Deputy Director for Improving Mental Health and Wellbeing within Scottish Government, flagged a forthcoming evaluation of the Mental Health communities fund, which will include a range of case studies.

Pamela Smith noted the importance of funding reaching across themes across local and national level but ensuring that multiple demands on the sector are avoided.

Action 4

• Place and Wellbeing Workstreams to consider the use of real-life stories to support the aims and objectives

Decision 4

• the Board endorsed the Communities work plan and look forward to receiving updates at future meetings

Anchors: Communications Strategy

Katherine Goodwin, Head of Covid Highest Risk Division in Scottish Government provided an overview of the Anchors Communications Strategy to the Board.

The communication strategy sets out key messages which have developed with Public Health Scotland. Katherine Goodwin stressed the importance of bringing the strategy to life through case studies, stories, and life experience; to help meet the Anchor’s objectives.

The paper also outlines the roles and responsibilities, predominantly across Scottish Government and the Public Health Scotland which is delivery focused.

Katherine Goodwin asked the Board to approve the Anchors Communications Strategy (which has approved by the Delivery Group) and to encourage the sharing of case studies.

Arlene Reynolds noted that Marion Bain had questioned whether the life stories examples included were the best ones to use in terms of impact to aid the support of health services. She also feedback that she was not getting confidence that the work would deliver what was being proposed.

Dona Milne found it helpful to articulate the action being taken that contributes to other priorities and that anchors is the mechanism. She is planning a session with her Financial Director to help explain what the proprietary work is in terms of procurement and is willing to share the document she has prepared.

Sam Cassels emphasised that there is a risk of over emphasising on a small number of case studies. There is a need to collect more to show the full richness, rather than relying on a few stories that need to tick all the boxes.

Decision 5

• the Board endorsed the Communications Strategy. Elizabeth Sadler also thanked Katherine Goodwin for providing support to produce the paper

Risk Management Strategy

Ian Tervit, Project Manager with NHS National Services Scotland, provided an overview of the Risk and Issue Management Strategy to the Board. Ian Tervit has taken the risk management approach within the Scottish Government for the Place and Wellbeing Programme. The paper outlines the role of the Programme Board for managing risks, the tolerance levels that will be reported up to the Board and the process which will be taken for reporting and escalating risks.

A RAID log for the programme will be managed by the programme support team which will report all amber risks with a score of forty or higher to the Care and Wellbeing Portfolio Board. The risks and updates will also be recorded in the highlight reports that are required for the Place and Wellbeing Programme Board which occur every two months. The next steps to be taken is to seek agreement to engage with Programme Workstreams/projects to embed Risk and Issue Management Strategy.

Ian Tervit asked the Board to approve the Programme Risk and Issue Management Strategy, the proposed risk tolerance levels as well as the proposed reporting for all levels of Programme.

Decision 6

• the Board endorsed the Risk Management Strategy proposals