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

Attendees and apologies

• Linda Bauld (Chair), Chief Social Policy Advisor, Scottish Government
• Bobbie Benson (deputising), Non-Executive Board member, NHS Tayside
• Eilidh Currie, Senior Research Officer, Scottish Government
• Chik Collins, Director, The Glasgow Centre for Population Health
• David Cowan, Head of Regeneration, Architecture and Place Unit, Scottish Government
• Ellie Crawford, Primary Care, Scottish Government
• Ruth Glassborow, Director for Place and Wellbeing, Public Health Scotland
• Lynn MacMillan (deputising), Head of Health Inequalities Unit, Scottish Government
• Dona Milne, Director of Public Health, NHS Lothian
• Katherine Myant, Senior Principle Researcher, Scottish Government
• Lynne Nicol, Deputy Director of Planning and Quality,  Scottish Government
• Niamh O'Connor (deputising), Deputy Director of Population Health, Scottish Government
• Gordon Paterson, Director of Social Care, NHS Education for Scotland
• Arlene Reynolds, Senior Professional Adviser in Public Health, Scottish Government
• Kimberley Smith, Place and Wellbeing Programme Communities lead, Scottish Government
• Kerrie Todd, Head of Health Improvement, NHS Lanarkshire
• Kim Walker, National Programme Director, Care and Wellbeing Portfolio, National Health Service Scotland

Apologies

• Úna Bartley, Place and Wellbeing Programme lead, Scottish Government
• Lorna Birse-Stewart, Chair, NHS Tayside
• Sam Cassels, Place Principle Adviser, Scottish Government
• Eddie Follan, Chief Officer for Health and Social Care, Convention of Scottish Local Authorities
• Susan Gallacher, Preventative and Proactive Carem Primary Care Programme lead, Scottish Government
• Calum Irving, Deputy Director for Straetgic Third Sector and Public Service Leadership
• Michael Kellet, Director of Place and Wellbeing, Public Health Scotland
• Gerard McCormack, Head of Transformation, Performance, and Improvement, Public Health Scotland
• Fraser McJannett, Programme Director, Executive Support Team, NHS Scotland
• Margo Murphy, Place and Wellbeing Programme Anchors lead, Scottish Government
• Susan Paxton, Director, Scottish Community Development Centre
• Carol Potter, Chief Executive, NHS Fife
• Chris Stothart, Place and Wellbeing Programme Enabling Local Change lead, Scottish Government

Items and actions

Welcome and apologies

Linda Bauld, Chair of Programme Board and Chief Social Policy Advisor for Scottish Government, opened the meeting and welcomed the members and guests to the Place and Wellbeing Programme Board. Several changes to membership were noted. Sam Cassels, who was the place principal advisor in Scottish Government has left his post. David Cowan, who is the Head of Regeneration, Architecture and Place Unit at Scottish Government has joined the Board. Callum Irving, who is Deputy Director at Strategic Third Sector and Public Service Leadership at Scottish Government has joined the Board has replaced Jane O'Donnell, Deputy Director for Local Government and Analytical Services, Scottish Government. Ruth Glassborow, who is Director of Place and Wellbeing at Public Health Scotland has replaced Michael Kellet, Director of Place and Wellbeing, Public Health Scotland. .

Introduction

Linda Bauld provided the Board with an overview of the agenda and the noted areas in particular that the presenters would like to draw attention to.

Minutes from previous Board meeting

The minutes from the meeting on 9th August were approved by the Board.

Programme update

Emma Wylie, Programme Manager for the Scottish Government Place and Wellbeing Programme, NHS National Services, Scotland, provided a verbal overview of the key developments for the Place and Wellbeing Programme that have occurred since the last Programme Board.

The Strategic Plans from NHS Boards for the Anchors workstream are due in on 27th October. The workplan for Communities that looks into the detail of community planning partnerships has been updated and the milestones adjusted. Work has progressed on the Population Health Plan (PHP), which will be discussed at the Board for the first time today. The risk register for the programme has moved from green to amber due to the ongoing resource risks that are impacting the Anchors, Communities, and Enabling Local Change workstreams.

The call was opened for comments. Bob Benson, Non-Executive Board member, NHS Tayside, noted a particular interest in the Anchor work and asked what process is in place to backfill organisations or Health Boards who were considering becoming Test Sites but have paused. In response Lynn Macmillan, Head of Health Inequalities Unit, Scottish Government, replied that there remains sufficient Health Boards operating as test sites across the programme at this point in time, and the position is kept under review.

DG Health and Social Care Funding for Communities

Kimberley Smith, Place and Wellbeing Programme Communities lead, Scottish Government, provided a recap of the funding objective for Communities, then provided a summary of the results from the mapping exercise, and the three areas of improvement undertaken.

Approximately 33 million is currently being awarded by health and social care policy teams to fund local community organisations that are in scope of the Place and Wellbeing Programme. The mapping exercise confirmed a variation in grant management and the data alongside wider research and stakeholder engagement informed the development of three suggested areas for improvement:

• Move to less restrictive grant criteria and more meaningful monitoring
• Increase consistency of multi-year awards and grant timelines
• Join up approval processes

Resource allowing, the next steps are to hold workshops with policy teams and budget holders to progress actions under each improvement area.

Summary of the Board discussion on this item:

• The Board expressed gratitude on the level of commitment across the programme of work
• David Cowan, Head of Regeneration, Architecture and Place Unit, Scottish Government, expressed interest to engage with the Communities workstream to maximise the impact of health, and other funding.
• The Board asked what thought process was behind the decision not to identify improvements under the theme of inclusion (which was included in the paper’s annex).
• The Board queried what ideas there were for phase two of this work and how improvements would align across a wider range of funding mechanisms.

In response, Kimberley Smith explained that following the short-term actions to improve current grant processes, the Programme team will explore possibilities for future changes including the consideration of the activities that are funded, the reach of the funding (in terms of inclusion and equity) and how the grants process is managed and delivered. Actions in this latter phase will need to coincide with progress being made under objective 1 (promoting the contribution of community organisations in reducing health inequalities).

Action 1

• Kimberley Smith to engage with David Cowan’s team to look at ways of maximising improvements to funding outwith health and social care

Anchors metrics

Kathreine Myant, Senior Principle Researcher, Scottish Government, and Lynn MacMillan provided a recap on the method used to develop a set of metrics to baseline anchors activity of Boards and noted the request for the Board to agree the proposed set of Anchors metrics.

The NHS Boards are due to submit their Anchor strategic plans at the end of October, which will be used as a benchmark of where they are in relation to procurement, workforce, and the use and disposal of land and assets that benefit local communities.

The workforce metrics have focus on employability programmes and the accreditation of NHS Boards. A key element of the workforce metrics is measuring the distribution of the workforce, workforce leavers, applicants, and success rates. National Education for Scotland (NES) will collect data centrally for individual boards.

The objective for the procurement element of this work is to enable boards to maximise or spend on local procurement. The metrics are looking at spend on local and supported businesses and third sector bodies, which is a new inclusion.

The focus of work on land and assets is to enable health and social care bodies to adopt policies that allow their property and assets to be used and disposed of for the benefit of their local community and economy. A series of questions are proposed to support the gathering of data, which included two narrative questions to try and capture the nuance around the land and assets work and use by communities and any key barriers (wording of this has been altered following feedback from the testing boards).

Despite of a number of limitations that have been acknowledged, there is confidence that the best and most robust metrics have been captured. The proposed new objective for the Anchors workforce strand has been approved by Anchors Strategic Group and Anchors Delivery Group.

Summary of the Board discussion on this item:

• Appreciation was conveyed for the high quality of work demonstrated in the paper.
• A suggestion was made to provide a narrative to describe what an Anchors institution is and what is its purpose.
• The Board queried:
  • If there were any scope to consider the Child Poverty Delivery Plan priority families as a target group.
  • If the discussions relating to NES being responsible for collating data centrally on workforce have already taken place and which colleagues have been involved.
  • The potential of the land and assets workstream to enable regeneration in local communities was noted (given in many communities there are, for example, NHS buildings no longer in use that could be focus of local regeneration for community wealth building purposes).

The Board endorsed the Anchors metrics paper.

Action 2

• Confirm with Gordon Paterson, Director of Social Care, NHS Education for Scotland, the process agreed with NES to collect data centrally on workforce to be distributed to Health Boards

Population Health Plan

Lynn MacMillan provided an overview of the work to date on the Population Health Plan (PHP) and described the thinking and approach to the work.

Lynn MacMillan set out the context to this work. Trends in Scotland have shifted over the last two decades from a picture of improving life expectancy with narrowing inequalities, to life expectancy stalling and then declining in some areas in most recent years. Our initial thinking is that a population health plan must focus on primary prevention and will link into longer terms plans to integrate health and social care. To help prioritise the areas of focus, analysts are pulling together evidence on past future trends, forecasts of diseases, and what is expected to be the greatest threats or issues in the future.

We expect the PHP to consider health harming activities, wider social economic drivers of equalities and how positive health and well-being can be promoted. Other opportunities being considered are how things can be done differently for example, the use of digital solutions to support people with mental health.

Engagement has been undertaken with key health and government partners to help develop the plan. There are plans to widen discussions and engagement to academics, voluntary sector, and businesses. In parallel to this work, we are also looking at how we transition existing plans and frameworks into this new approach. Engagement with policy colleagues is in progress to address the short-term priorities that are required prior to any PHP and to identify common themes and actions the could feature within the long-term plan.

Summary of the Board discussion on this item:

• The Board welcomed the initial thinking to where the collective focus of PHP should be, and the leadership provided.
• A suggestion was made to factor in the places impacted and the services available in these areas.
• The Board stressed the importance of drawing out the social determinants area, as well as ensuring that the plan refers to Glasgow Centre for Population Health (GCPH) research findings.

Enabling Local Change

Niamh O'Connor, Deputy Director of Population Health, Scottish Government, provided an overview of the Enabling Local Change (ELC) workplan.

Three ELC workshops have been run over the previous months, which included representation from COSLA, Public Health Scotland, Scottish Directors of Public Health, Improvement Service, Community Planning Network, Health Promotion Managers Network and DG Communities. The ELC workplan is separated into three main objectives:

• Objective 1 – Strengthen Health’s Contribution to CPPs
• Objective 2 – Care and Wellbeing Dashboard
• Objective 3 – The Public Health System’s Offer of Support to Community Planning Partnerships (CPP)  

The focus at this Board is on objective 1. This objective is broken down into four areas of activity:

1. Identify ‘good’ practice examples from Scotland and elsewhere – builds on work already underway led by the Health Promotion Managers Network who published a report looking at examples of how Health Improvement Teams are contributing to CPPs.
2. Engage wider CPP Partners to develop a shared vision for health’s involvement in CPPs –includes engaging a wide range of partners, principally members of the Community Planning Network, to consider proposed ‘good’ practice examples, identified opportunities and barriers, areas for improvement and enabling conditions.
3. Enhance health leadership, commitment, and involvement in CPPs – is focused on strengthening health board commitment to CPPs and reinforcing the importance of local partnership working in Annual Delivery Plan guidance for 2024/25 and health board strategic planning.
4. Ensure alignment with wider Scottish Government and Local Government policy landscape – to stay connected to and inform ongoing developments in order to improve coherence.

The Board were encouraged to state if they are content with direction of travel of the workplan, approve the proposed work plan around the four areas in the first objective, and were also asked if they were content for ELC to set up a Delivery Group, which would include the representatives who attended the three workshops.

Summary of the Board discussion on this item:

• The Board found the presentation around the proposed work plan useful.
• The Board asked for consideration around interfaces between this work and its Delivery Group with the work of other existing groups. RG offered to discuss this further if helpful.

The Board endorsed the ELC workplan and the set-up of the new ELC Delivery Group.

Action 3

• Board to consider the governance around ELC workplan objective 3 to ensure there is clarity on the interfaces across the work that is ongoing in the community planning space

AOB

Arlene Reynold, Senior Professional Adviser in Public Health, Scottish Government, announced that she will be leaving the Board shortly and is looking to find a replacement for her place on the Board.

Linda Bauld also thanked all who contributed to the meeting and summarised the key focus for the next Programme Board.

The next Programme Board meeting will take place on 7th December 2023, 09:00 – 10:30.