Health inequalities: Place and Wellbeing Programme Board minutes - February 2024

Attendees and apologies

• Linda Bauld, Chief Social Policy Advisor, Scottish Government
• David Cowan, Head of Regeneration, Architecture and Place Unit, Scottish Government
• Isabella De Wit (Speaker), Head of Recruitment and Capacity Building, Scottish Government
• Eddie Follan, Chief Officer Health and Social Care, COSLA
• Susan Gallacher, Deputy Director, GP practice, Scottish Government
• Vicki Harris (deputy), Primary Care Strategy Policy Team Lead, Scottish
• Erica Hawes (deputy), Improving Mental Health and Wellbeing, Scottish Government
• Calum Irving, Deputy Director, Strategic Third Sector and Public Service Leadership, Scottish Government
• Lynn MacMillan, (Speaker), Head of Health Inequalities Unit, Scottish Government
• Sam Martens, Policy and Business Analyst, NHS National Services Scotland
• Sheila McCole (deputy), Non-Executive Member, NHS Tayside
• Gerard McCormack, Head of Transformation, Performance, and Improvement, Improvement Service
• Dona Milne, Director of Public Health, NHS Lothian
• Lynne Nicol, Deputy Director Planning & Quality, Scottish Government
• Niamh O'Connor, Deputy Director, Strategic Capability Division, Scottish Government
• Gordon Paterson, Director of Social Care, NHS Education for Scotland
• Susan Paxton, SDSC, Acting Director, Scottish Community Development Centre
• Pamela Smith (deputy), Head of Service, Public Health Scotland

Apologies

• Marion Bain, Deputy Chief Medical Officer, Scottish Government
• Lorna Birse-Stewart, Chair, NHS Tayside
• Ellie Crawford, Primary Care, Scottish Government
• Chik Collins, Director, The Glasgow Centre for Population Health
• Angela Davidson, Deputy Director for Improving Mental Health and Wellbeing, Scottish Government
• Ruth Glassborow, Director, Place and Wellbeing, Public Health Scotland
• Carol Potter, Chief Executive, NHS Fife
• Kerri Todd, Head of Health Improvement, NHS Lanarkshire

Items and actions

Welcome and apologies

Linda Bauld welcomed members and guests to the meeting and also introduced Caitlin Frickleton, the new Communities Lead.

Introduction

Linda Bauld provided the Board with an overview of the agenda.

Minutes from previous Board meeting

No corrections were noted to the minutes from the meeting on 7th December 2023 which were approved by the Board.

Programme update

Emma Wylie referred Board members to paper 2 – The Risk Escalation report and noted that the main risks relate to capacity issues within NHS Boards and relevant Scottish Government teams.

A deep dive has been conducted into healthy weight as part of the Population Health Plan activity, with further workshops being planned.

Úna Bartley and Isabella De Wit provided an overview of the Risk Escalation paper then asked for comments from board members.

Linda Bauld noted that capacity and fiscal pressures are not just affecting this programme of work.

Pamela Smith noted how working with local employability partnerships, which have a focus on child poverty,  could support NHS Boards with  capacity issues in relation to employability. Dona Milne noted that there was not a total recruitment freeze across all Boards and there was still scope to use any vacancies to support the Anchors agenda.

Dona Milne noted that NHS Lothian was still willing to be a test site. Una Bartley will contact DM with regards of being a test site.

Lynn MacMillan highlighted that the Anchors Strategic Plans (ASPs) and the planned discussions with Boards in May will provide  greater clarity on the work the Boards are undertaking to progress Anchor activity and where there are areas that require further support.

Decision 9

• The Board accepted the mitigations in the Risk Escalation report.

Community-led health and wellbeing

Una Bartley talked through the report and the findings from the engagement exercise undertaken by  three Third Sector Interfaces (TSIs) which focussed on three themes: Influence; Capability; Land and Assets.

The Board were asked to comment on the findings in the report. Sheila McCole  expressed concern that there was a lot of partnership working already being undertaken between local authorities and  local community organisations, and there was a risk of duplicating effort. It was noted that the report on the engagement undertaken by TSIs simply reflected the feedback and experiences of the local community groups who had participated in the engagement exercise, and that a proposed workshop led by Community Health Exchange (CHEX) with community organisations and their statutory partners would provide more detail on how to enhance those partnerships.

Pamela Smith noted how the findings on Community Planning Partnerships (CPPs) link into the Enabling Local Change (ELC) workstream.

Dona Milne noted that NHS Lothian are working to map  their assets. It was recognised that while there is a desire to transfer assets for community benefit, the worst buildings should not be dumped onto the community sector. Shelia McCole expressed concern that community organisations sometimes underestimate the cost of taking these buildings on.

Niamh O’Connor noted the risk around the duplication of effort in this space. Susan Paxton advised that there is a desire to have those conversations with local partners, by bringing together members of the CHEX network with their local statutory partners. Susan Paxton noted that looking at existing good practice is a good place to start, and then given capacity issues, exploring what are the clear priorities and the most impactful actions we can take which are within our gift?

Úna Bartley confirmed that the next steps are to hold an action-based workshop with CHEX member organisations and crucially their public sector partners, to develop tangible examples of what could increase influence and capability of local organisations, and then to arrange a round table with Scottish Government policy leads to agree final set of recommendations.

Enabling local change – progress update

Chris Stothart provided an update on ELC to the Board and noted during this reporting period there has been a delay in progressing workstream activities as planned due to capacity issues. Work is underway to get back on track and identify further resource to support workstream delivery. Community Planning Improvement Board are being kept updated on workstream progress and have agreed to send a representative to the ELC Delivery Group to report back and help strengthen links with their Board.

2024/2025 Annual Delivery Plan NHS Board Guidance issued 4th December 2023 included an ELC related deliverable requesting health boards to set out how they engage with local partners: "Commitment and contributions (leadership, funds, staffing and other resources) to Community Planning Partnerships (CPPs) to improve local outcomes agreed in Local Outcome Improvement Plans and Locality Plans". Returns are due back on 7th March 2024, which will provide insight on what current contributions from health partners to CPPs. These findings will be reviewed alongside  other key sources and a grey literature review.

The next ELC Delivery Group meeting will be held in March where there is an aim to confirm the new delivery plan with the following three key milestones:

• Stocktake - Bring together learning and recommendations from multiple sources into a single report.
• Engagement - Explore opportunity to collaborate with the Community Planning Network and other partners to run a CPP partner dialogue event in 2024 focused on health partner contributions.
• Implementation – Based on recommendations in Stocktake report and partner discussions, group to consider a range of activities to implement.

There are plans to meet with leads to discuss how ELC activities fit with the developing Population Health Plan and required contributions in the coming months.

The call was opened for comments. Pamela Smith noted the work in Anchors on local employability partnerships, and land and assets which are linked to CPPs, how are we pulling all of the different areas together across the different workstreams. Chris Stothart responded and explained that we are seeing how we do this, but we do have an initial report from Directors of Public Health (DsPH) on ‘Health’s Contribution to CPPs.’ Dona Milne asked what else DsPH could do to help. Chris Stothart noted that there is so much variation in this area and we hope through the initial review of ADP returns and other sources that we can identify some areas for quick wins in the initial period. Dona Milne expressed that local public health team set-up vary across the country. What resources sit with teams and how much of the resource is available in each area is hard to pull together with such big differences. The PHP might offer some support to redirect the focus to more upstream actors, helping boards make decisions on how they use resources.

Population health plan progress update

Lynn MacMillan provided an overview of the background to the work to date and the current progress, outlining key discussions had with PHS colleagues in the recent workshop.

The call was opened for comments.

Niamh O'Connor confirmed that progress is being made, with the initial engagement phase complete and work progressing into content development phase. Consideration is required as to what is being produced and also the scale of the response nationally and locally. If the plan goes from six priorities to four pillars, it will not be an active shift as the current priority areas will remain.

Dona Milne noted that in Lothian, there has been a lot of time and resource spent going out to conduct smoking cessation work, which was very time consuming with little results. It is important not to silo these things as people present with a variety of issues. We need to consider how can we make better use of time and resource to focus the approach for multiple issues. Lynn MacMillan responded and advised that we have had a lot of discussion about how to frame the plan. We have had workshops around the diet alcohol etc, that have discussed the need to look at local action and place-based initiatives, which would comfortably sit within a place and community element of the plan.

Linda Bauld stressed the importance of recognising the wider determinants of health, and these areas need to be championed in the report. Place, Service, Legislation, without disrupting the local teams when they cover this. It will be important to keep connecting with Preventative and Proactive Care (PPC) Programme. Lynn MacMillan agreed that there is clearly a cross-over between the work on the Population Health plan and work on services and reform. We are keeping a dialogue with PPC and looking at how we can work together when we can. It is a grey area, so we are working that out but will ensure these connections are made.

Calum Irving noted the struggle to connect these topics, and how it overlaps with so many work areas that it could go on forever. There is a piece of horizon scanning needs to be completed on things in the system to deliver meaningful change.

Linda Bauld advised that it is important to note that coherence across the policy areas needs to be good, and it is vital to ensure efforts are made to work on this.

Action 14

• PHP policy to meet with Calum to discuss links with wider work including public service reform (NO).

Any other business – all

Linda Bauld thanked the Board for their contributions and noted that the next Programme Board meeting will be held on Tuesday 9th April 09:00 – 10:30. The next agenda will include an update on the return of anchors metrics data from NHS Boards, and an ELC paper describing the collective ways the Public Health system (PHS and local public health teams) could support local partners.