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

Attendees and apologies

• Angela Davidson, Deputy Director for Improving Mental Health and Wellbeing, Scottish Government
• Chik Collins, Director, Glasgow Centre for Population Health
• Calum Irving, Deputy Director for Strategic Third Sector and Public Service Leadership, Scottish Government
• Dona Milne, Director of Public Health, NHS Lothian
• Kerri Todd, Head of Health Improvement, NHS Lanarkshire
• Lynn MacMillan (Speaker), Head of Health Inequalities Unit, Scottish Government
• Linda Bauld (Chair), Chief Social Policy Advisor, Scottish Government
• Marie Burns, Leader of North Ayrshire Council
• Marion Bain, Deputy Chief Medical Officer, Scottish Government
• Niamh O'Connor, Deputy Director for Strategic Capability Division, Scottish Government
• Ruth Glassborow (Speaker), Director for Place and Wellbeing, Public Health Scotland
• Eilidh Currie (Speaker), Principle Research Officer, Scottish Government
• Neil Cardwell (deputy), Engagement and Collaboration Team Leader, Primary Care Strategy unit, Scottish Government
• Sheila McCole (deputy), Non-Executive Member, NHS Tayside

Apologies

• Carol Potter, Chief Executive, NHS Fife
• David Cowan, Head of Regeneration, Architecture and Place unit, Scottish Government
• Ellie Crawford, Primary Care, Scottish Government
• Eddie Follan, Chief Officer Health and Social Care, COSLA
• Emma Wylie, Programme Manager, NHS National Services Scotland
• Gerard McCormack Head of Transformation, Performance, and Improvement, Improvement Service
• Gordon Paterson, Director of Social Care, NHS Education for Scotland
• Lorna Birse-Stewart, Chair, NHS Tayside
• Lynne Nicol, Deputy Director Planning & Quality, Scottish Government
• Susan Gallacher, Deputy Director GP practice, Scottish Government
• Sam Martens, Policy & Business Analyst, NHS National Services Scotland
• Susan Paxton, Acting Director, Scottish Community Development Centre

Items and actions

Welcome and apologies

Linda Bauld welcomed Board members and guests to the meeting. Apologies and deputies have been noted below.

Minutes from previous Board meeting

 No objections were noted to the minutes from the meeting on 4th June 2024, which were approved by the Board.

Programme update

Ian Tervit provided an overview of the workstream highlight reports and programme risks

The programme continues to track as amber, with workstreams Anchors and Communities tracking as green due to deliverables being on track or slightly delayed. Enabling Local Change workstream is currently tracking as amber due to focus on the Population health framework but the stocktake report is still progressing. The Population Health Framework is also tracking as amber due to the tight timescales around the engagement currently underway.

It was noted that a path to green has been added to risks within the risk register where appropriate. Most high risks are centred around funding and capacity pressures. The risk presented on capacity and resource has moved from red to amber due to replacement resource within the Scottish Government Anchors team and a new lead for the Land and Assets task and finish group alongside the timing of the risks which are identified as affecting the outcomes of the programme rather than the delivery itself.

Discussions continue with Scottish Government to understand how risks that currently sit outside the governance of the programme can be jointly managed.

Population Health Framework update

Lynn MacMillan provided an update on the work accomplished over the last few months and outlined the planned next steps and timelines for the framework.

An engagement document has been produced to support the ongoing discussion around content for the framework, which was circulated in advance of this Programme Board (Developing a Population Health Framework for Scotland). Analysts are developing an Evidence Narrative document which will be published alongside the Framework.

The driving force behind developing the framework is to accelerate recovery and improvement of population health in Scotland, with a focus on whole system prevention. The Framework is being developed by considering the four primary drivers of population health (please refer to page 5 of the document). A fifth driver is also considering actions needed to move to a prevention based system.

Another development that has been introduced since the Board last met is the proposed guiding principles for the framework. The purpose of the principles is to help shift the balance in terms of how we approach population health over the next ten years. The engagement document sets out this overall approach, discusses the five drivers of population health, and proposes potential actions for each based on engagement to date.

Engagement is ongoing and is being led by Scottish Government, COSLA, Public Health Scotland and Directors of Public Health. Several groups are taking the document to a number of their Board meetings, and advisory forums and networks for discussion. L.ynn MacMillan thanked the groups involved for their contributions.

Feedback from the discussions will be reviewed and used to inform the final framework. The plan is for the final framework to go to Ministers and COSLA in November for sign off, with the aim to have the document published in December. While the framework will not be published before the next meeting of this group, it is proposed that we consider how to support its implementation at the Place and Wellbeing Programme Board in December.

Linda Bauld welcomed the Board to raise any comments or questions.

Calum Irving highlighted that some of the feedback coming through relates to colleagues not understanding the term ‘third sector’ and noted that it would be very useful to use consistent terminology with the document.

Kerri Todd raised concern from colleagues that the framework is too broad and that it doesn’t take into account the reality around current resource constraints. Colleagues have also expressed the need to clarify terminology like “whole system approach” and what that means in practice.

Sheila McCole noted there is tension between longer term prevention and the immediate pressures, and asked for clarity on what the short term actions on early years (0-2 years) would be. Sheila McCole queried what good looks like for the framework and whether a baseline would be conducted to help focus efforts and to use to measure the desired change. Noted the importance of Local Authority Chief Executives being on board with the framework and focus on Community Planning Partnerships (CPP), cautioning that CPPs function differently in different areas. Also raised the possibility of using impact assessments which address population health to support with implementation of the framework locally.

Dona Milne highlighted feedback from the CPP engagements that Integrated Joint Boards (IJBs) are not mentioned, so it is important to ensure their role is clear. There is a challenge bringing Health and Social Care Partnerships and IJBs on board due to resource constraints.

Marion Bain noted that the feedback from engagement from the Chief Medical Officer and Deputy Chief Medical Officer is to make sure that the framework is positioned, contextualised and takes other areas of work and the current pressures into consideration.

Lynn McMillan confirmed that it would be helpful to ensure that terminology is correct when referring to different sectors. Noted the concern regarding the framework being broad but the focus on specific actions from 0-2 years will help to focus on key areas.

Action 19

• Programme to revise and seek to use consistent terminology with the document – Calum Irvine to provide accepted terminology.

Action 20

• Programme to clarify terminology ‘whole system approach’ and what that means in practice.

Action 21

• Programme to review the groups that need to be acknowledged/recognised in the document.

Public Health Scotland Marmot Places update

Ruth Glassborow provided an update on the work being done around Marmot Places which is a collaboration between Public Health Scotland and the Institute for Health Equity and three local areas within Scotland.

The overall purpose of Marmot Places is to strengthen and accelerate the actions needed to improve Scotland's health, well-being and reduce health inequalities. The Marmot eight principles will be built upon and will include the concept of ‘shifting the dial’ on health inequalities. Both areas are connected with the population health work.

The aim is to combine learning and actions to help reduce health inequalities. Funding is not provided but resource will be offered and made available in terms of input from the Institute of Health Equity, and Public Health Scotland. A report will be produced in June 2026 for each the three areas, followed by combining the learning into a set of national and local recommendations.

The process to select the three local areas is ongoing. Twelve self-assessments have been returned, and the decision about which three will be chosen will be a joint process between Public Health Scotland, COSLA and the Institute for Health Equity. The three sites will be nominated in early November 2024.

Linda Bauld welcomed the Board to raise any comments or questions.

Sheila McCole noted that across Tayside, all of the three Community Planning Partnerships are going through some transition and reformatting so unsure if any of them would have been in a position to respond at this particular time. It would be beneficial to include all of the local authorities, the new Chief Officers of the Health Social Care partnerships and the Chief Execs as well as the Chairs of the Community Planning Partnerships (CPPs) to share any learning or activities that are coming out of the Marmot work. Also noted is that local political leadership buy-in is key to the success of this work.

Ruth Glassborow confirmed that the national learning network will provide this opportunity. Noted that the importance of local political leadership has come out strongly as a key enabler for success in work across the rest of the UK and hence will be a key focus of this work. Also highlighted COSLA as part of the decision panel for the three areas.

Anchors: review of metrics and proposed ask in Annual Delivery Plan Guidance

Eilidh Currie provided an update on the proposed changes  to the metrics to measure Anchor activity following a light touch review. The second half of the presentation was led by Úna Bartley who provided an outline on the proposed ask of Boards, as Anchor institutions, for the 2025/2026 Annual Delivery Plan (ADP) guidance.

The review process identified a small number of changes which have been discussed and agreed with a number of groups including the Anchors Delivery Group.

Board members approved the proposed changes. The updated metrics will be sent to Boards, and they will be asked to use them to submit data on their Anchor activity for 2023/2024 by March 2025.

Anchors and Annual Delivery Plan (ADP) Guidance

Over the course of May and June, territorial boards and National Boards were asked for feedback on the process of drafting and progressing an Anchor Strategic Plan. As part of the discussions, feedback was also sought on whether an ask should be included in the ADP for 2025 on Anchors and what that should look like.

Strong support was received for an ask to keep the focus on the prevention agenda, however it was agreed that one approach would not be appropriate for all Boards. The Boards also asked to be notified early of the priority areas in advance of the ADP guidance being issued.

Current thoughts are to include some minimal requirements for all Boards and to also ask the Boards to identify a number of measurable objectives to progress in the Anchors work. Specific asks are likely to be included for NES, NHS and PHS to progress aspects of the workstream at national level.

Linda Bauld welcomed the Board to raise any comments or questions.

Kerri Todd queried whether it was easy for procurement leads to extract the required information from the systems in place.

Eilidh Currie responded to confirm that a key principle behind the metrics was to not overburden Health Boards to generate data and the proposed changes on procurement had been agreed with a number of Heads of Procurement.

Dona Milne raised a concern about removing the metric on spend by the third sector given the danger of funding allocated to the community and voluntary sector being reduced due to financial pressures.

Calum Irving noted that it would be helpful to use the same term and definition for the ‘third sector’ across the Anchor and Communities workstream, and one that is accepted by stakeholders in that sector.

Eilidh Currie responded that the metric on spend by the third sector had been removed for the coming year as there had been confusion about the definition and source for the data, but that there would be discussions with Public Contracts Scotland to see if agreement could be reached on a definition and source to reinstate a metric on third sector spend for future years.

Ruth Glassborow offered to support the work around employability metrics to explore the opportunities for closer alignment with the data that local employability partnership report through Community Planning Partnerships.

Action 22

• Eilidh Currie to meet with Public Contracts Scotland to discuss the definition and data source to collect data on spend with third sector organisations.

Action 23

• Pamela Smith (Ruth Glassborow's Head of Service) to meet with Eilidh Currie to look at the opportunities for Public Health Scotland to explore with Scottish Government the opportunities for further refinement of the employability metrics.

Communities – Recommendations on influence and capacity of community and voluntary organisations

Úna Bartley reminded Board members of the aim and objectives of the workstream then provided an update on the engagement to date to agree recommendations on how the community and voluntary sector could have more influence over decisions, which would support health and wellbeing within their local communities.

In October 2023, three Third Sector Interfaces (TSIs) were asked to engage with community led organisations to produce a list of actions which were discussed at a workshop in December 2023 with the TSIs and policy leads from Scottish Government. Community Health Exchange (CHEX) held a workshop in September to build on the findings from that engagement to produce a draft list of recommendations.

The next steps for the workstream are to take the draft recommendations and meet with policy colleagues in Scottish Governments that are working on areas where some of these recommendations could sit. A final set of recommendations will be brought to the Community Core Group in November followed by the Programme Board in December.

Linda Bauld welcomed the Board to raise any comments or questions.

Ruth Glassborow noted that Community Planning Improvement Board have recently published their paper on the fair funding across the voluntary sector and to ensure that members of the workstream were cited on that, with the key issue to understanding how to get that implemented.

Angela Davidson highlighted the report of the third year of their Communities Mental Health and Well-being Fund, which has been well received by the sector.

AOB

The Board did not raise any AOB.

Linda Bauld advised that the next Programme Board meeting scheduled for 4th December 1pm – 2.30pm, where the following agenda items will be covered:

• Report providing an evidence base on the role of local community and voluntary organisations in reducing health inequalities
• An update on Enabling Local Change and how work is progressing.
• Focus on the content of Population Health Framework and the learning around the engagement phase.
• Initial points around Governance and the role of this group with regard to Population Health Framework implementation (tbc).

Linda Bauld concluded the meeting and thanked the Board and speakers for their contributions.