NHS Chairs and Chief Executives Joint Meeting minutes: March 2023

Attendees and apologies

NHS Chairs

• Lesley Bowie,NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders
• Nick Morris, NHS Dumfries and Galloway
• Tricia Marwick, NHS Fife
• Alistair Morris, NHS Fife (Vice Chair)
• Janie McCusker, NHS Forth Valley
• Alison Evison, NHS Grampian
• John Brown, NHS Greater Glasgow and Clyde
• Boyd Robertson, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland
• Patricia Kilpatrick, NHS Tayside (Vice Chair)
• Gillian McCannon, NHS Western Isles
• Carole Wilkinson, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24
• David Garbutt, NHS Education for Scotland
• Susan Douglas-Scott, NHS Golden Jubilee
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Tom Steele, Scottish Ambulance Service
• Brian Moore, State Hospitals Board for Scotland
• Doug Moodie, Care Inspectorate
• Suzanne Dawson, Scottish Health Council

NHS Chief Executives

• Claire Burden, NHS Ayrshire and Arran
• Ralph Roberts, NHS Borders
• Jeff Ace, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Cathie Cowan, NHS Forth Valley
• Caroline Hiscox, NHS Grampian
• Jane Grant, NHS Greater Glasgow and Clyde
• Pamela Dudek, NHS Highland
• Jann Gardner, NHS Lanarkshire
• Michael Dickson, NHS Orkney and Shetland
• Grant Archibald, NHS Tayside
• Robbie Pearson, Healthcare Improvement Scotland
• Jim Miller, NHS 24
• Karen Reid, NHS Education for Scotland
• Carolynne O’Connor, NHS Golden Jubilee (Deputy Chief Executive)
• Paul Johnston, Public Health Scotland
• Paul Bassett, Scottish Ambulance Service (Deputy CE & Chief Operating Officer)

Scottish Government

• Caroline Lamb, DG HSC/CE NHS Scotland
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Gillian Russell, Director of Health Workforce
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health Finance and Governance
• Donna Bell, Director of Social Care and NCS Development
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Richard Foggo, Co-Director of Population Health
• Christine McLaughlin, Co-Director of Population Health
• Tim Mcdonnell, Director of Primary Care
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Anna Dominiczak, DCMO Chief Scientist Office
• Luska Jerdin, Head of Mental Health Performance and Improvement (On behalf of Hugh McAloon)
• Elizabeth Sadler, Senior Responsible Officer for Place and Wellbeing Programme
• John Nicholson, Deputy Director for Strategic Capabilities
• Niamh O’Connor, Deputy Director for Strategic Capabilities
• Karen Duffy, Delivery Director, Directorate for Health, and Social Care 
• Kat Troake, Team Leader for Strategic Reform

Directors of Profession

• Susan Webb, Chair of the Scottish Directors of Public Health (NHS Grampian)
• Julie Carter, Director of Finance (SAS)
• Jacqui Jones, Director of HR (NHS NSS)
• Claire Pearce, NMAHP Director and Deputy Chief Executive/Chair of SEND 
• Ann Gow, Executive/Chair of SEND NMAHP Director and Deputy Chief Executive/Chair of SEND
• Michael Kellet, Director of Strategy, Governance & Performance, Public Health Scotland
• Scott Heald, Director of Data and Digital Innovation, Public Health Scotland
• Rachel McAdams, Project Manager, Public Health Reform (PHR) team, Public Health Scotland
• Fatim Lakha, Consultant Public Health Medicine, Clinical and Protecting Health Directorate, Public Health Scotland
• Joy Tomlinson, Director of Public Health for NHS Fife
• Kim Walker,National Programme Director, NHS National Services Scotland

Other Attendees

• Una Barclay, Team Leader for Anchors
• Kimberley Smith, Place and Wellbeing Policy Advisor
• Naureen Ahmad, Deputy Director of General Practice Policy
• Joanna Macdonald, Deputy Chief Social Work Advisor
• David Thompson, Head of Innovation Adoption, Chief Scientist Office

Secretariats

• Robert Kirkwood, Head of People and Governance Team
• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hildersley, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, Executive Support to NHS Board Chairs and Chief Executives
• Sam Martens, Policy & Business Analyst, Executive Support Team, NHS
• Rhea Crighton, Policy & Business Analyst, Executive Support Team, NHS

Apologies

• Lorna Birse-Stewart, NHS Tayside (Chair)
• Calum Campbell, NHS Lothian (Chief Executive)
• Gordon James, NHS Golden Jubilee (Chief Executive)
• Mary Morgan, NHS National Services Scotland (Chief Executive)
• Pauline Howie, Scottish Ambulance Service (Chief Executive)
• Colin Briggs, Director of Planning (NHS Lothian)
• Nick Fluck, Medical Director/Co-Chair of SAMD
• Crawford McGuffie, Medical Director/Co-Chair of SAMD
• John Burns, NHS Scotland Chief Operating Officer
• John Harden, Deputy National Clinical Director
• Stephen Gallagher, Director of Digital Health and Care
• Hugh McAloon. Interim Director of Mental Health and Wellbeing (Luska Jerdin, Head of Mental Health Performance and Improvement attending)
• Michael Chalmers, Director for Children and Families
• Graham Ellis, Deputy Chief Medical Officer
• Linda Pollock, Interim Director of Healthcare Quality and Improvement

Items and actions

Minutes

Welcome, apologies for absence and attendees

Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship, chaired today’s meeting on behalf of Caroline Lamb, Director General Health and Social Care who was unable to attend the full session. Richard Foggo, Co-Director of Population Health was compere.

Paula welcomed everyone to the meeting - online and in person - and thanked them for their participation in today’s discussions which would see actions agreed to contribute to the next stage of development of the longer-term strategic transformation of health and care services and outcomes in Scotland.

Further thanks were given for the huge effort around the preparation for today’s meeting. 

It was noted that there would be a short pause in the meeting for the announcement of the new Leader of the SNP party.

A welcome was extended to Paul Johnston to his first meeting as Chief Executive of Public Health Scotland.

A full list of attendees and apologies for absence are provided in Annex A. 

Update from Gregor Smith, Chief Medical Officer

Gregor Smith, Chief Medical Officer, provided an update which outlined challenges on population health in Scotland, now and in the future. He noted that The OECD Health Statistics 2022 (Organisation for Economic Cooperation and Development) estimated that 20% of healthcare provided is not effective, therefore priority needs to be given to improving health outcomes. This includes addressing stalling life expectancy rates which have slowed down over the last 10 years and reducing health inequalities. Other contributing factors to population health which were noted included: a need to personalise our approach to care and Health’s contribution to climate change.

Outputs from 15 March NHS Chief Executives session 

Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship, gave feedback from the NHS Chief Executives strategic session held on 15 March 2023. The session focussed on identifying opportunities whilst balancing demands on workforce, performance and finance. She indicated that discussions are underway regarding: 

• data insights
• modelling around planned and unscheduled care
• trajectories for waiting times
• productivity
• sustainability and value
• longer term transformation work

Actions from 15 March 2023 are still in draft form and need to be finalised by the NHS Chief Executives. These will then be considered against horizon 1 and horizon 2 and will support the development of a planning delivery framework. 

Ralph Roberts, Chief Executive, NHS Borders, and Chair of the Chief Executives Group added that the focus should be on how we deliver change in a better and faster way. The need to recognise where we will be with the scale of the workforce when demographics change. He listed the following key themes that had been identified:

• creating the right context and authorising environment for change
• addressing capacity in social care
• addressing workforce challenges and capacity (recognising the financial realities)
• delivering agreed national programmes at pace
• digital and innovation - locally and nationally
• primary care renewal
• future capacity/demand modelling for hospital services
• medicine policy (recognising the financial realities and value based care principles)
• capital plan

Ralph Roberts indicated that the next steps would be to finalise these themes and ensure that there were clear approaches to delivering this. The intention was to review this at the next Board CE meeting. He added that this work should be taken forward as a collaboration between the Scottish Government and NHS Boards.

The Care and Wellbeing portfolio: one year on

Niamh O’Connor, Deputy Director for Strategic Capabilities provided an update on the work being delivered under the Care and Wellbeing portfolio with a focus on prevention, innovation and service re-design. She recapped on the fundamental policy framework that underpins the portfolio based on the evidence base of factors that improve population health and wellbeing, reduce inequalities and improve system sustainability. A slide presentation covered:

• care and wellbeing policy framework
• care and wellbeing governance structure
• recent deliverables across primary, secondary and tertiary prevention categories
• Scottish burden of disease

John Nicholson, Deputy Director for Strategic Capabilities added that a core part of the portfolio response was to combine and improve coherence on cross portfolio policy and delivery on wider determinants, with strategic reform in population health policy; reform in integrated health and social care in the community; and wider NHS service transformation. The portfolio comprises of three main programmes underpinned by seven strategic enablers. The three main programmes are:

• place and wellbeing
• preventative and proactive care
• NHS recovery, renewal and transformation

The seven strategic enablers are: 

• analysis and evidence
• innovation
• workforce
• finance
• digital and data
• co-design
• quality improvement

The importance of aligning wider policies (and cross-portfolio working with wider social and economic policy and delivery) to the Care and Wellbeing portfolio and addressing inequalities was noted.

Setting the context: demographic change and the Scottish burden of disease

Angiolina Foster, Chair, Public Health Scotland and Scott Heald, Director of Data and Digital Innovation, Public Health Scotland gave a presentation which focused on demographic change and the Scottish burden of disease which is forecast to increase by 21% over the next 20 years. It also highlighted growing inequalities with the more deprived parts of Scotland experiencing lower life expectancy and fewer years of life in good health.

To reverse or change this projection, it was noted that there is an opportunity to reset priorities by focussing on measuring what matters (reviewing current performance measures for NHS Boards with a balance of monitoring current system pressures along with a focus on prevention); working in a whole system way (across health and care, but also linking to other factors in prevention including education, housing, justice and the economy); and making greater use of public health data expertise and modelling.

Care and Wellbeing portfolio deliverables: deep dives

Carol Potter, Chief Executive, NHS Fife gave a presentation on the role of Anchors. This covered:

• the Anchors workstream
• the remit of the Anchors delivery group
• key strands – workforce; procurement; land and assets
• local examples – new green space strategy

Colleagues agreed that a matrix could be developed to support work within Anchors delivery. It was noted that NHS Lothian and NHS Fife have offered to be test sites to help understand the enablers and barriers to implementation. NHS Chairs and Chief Executives were encouraged to look at what was happening in their own boards to support wider government priorities and embed the Anchors mindset into local policies.

Innovation as an enabler

Anna Dominiczak, Chief Scientist Health presented slides demonstrating the work of the Innovation Programme as an enabler of the Care and Wellbeing portfolio. She detailed the ‘Once for Scotland’ approach in developing and delivering innovation adoption and shared details of the funding model for 2023/24 and 2024/25. She also described joint work of the Accelerated National Innovation Adoption Pathway (ANIA) and the Innovation Design Authority (IDA) as an integral part of the end-to-end innovation pathway. Two approved value cases have been described, these are: digital dermatology and type 1 diabetes – closed loop system. 

Tom Steele, co-chair of the IDA explained that a SG/NHS operational process, ANIA and governance process IDA had now been established to evaluate and scale at a national level, new scientific and technological developments. Emerging areas such as genomics, AI and big-data analytics offered massive opportunities to transform healthcare delivery and illness prevention and management.

Preventative and proactive care

Karen Duffy, Delivery Director discussed the current work plan for Preventative and Proactive Care (PPC) programme. This aims to focus over the next 2-3 years, on implementing in a series of focused workstreams - which all have the core aim of increasing and improving preventative and proactive ways of working together.

Within the workstreams, there will be a mixture of focus, such as wider societal and cultural behaviour changes required (Living Well) , through to supporting people during set phases in their life (e.g. Waiting Well), ensuring more holistic and co-ordinated support e.g. GIRFE (Getting It Right For Everyone), reaching people with the highest health inequalities and more preventative and proactive care at home and in communities (Primary Care PPC, Digital PPC, Secondary prevention);

Colleagues noted the work that is being taken forward to develop a GIRFE model for Scotland. The GIRFE model is currently in the co-design phase, with a cohort of HSCPs. GIRFE will be a multi-agency approach of support and services from young adulthood to end of life care; through individualised support and services.

Breakout sessions on the Care and Wellbeing portfolio deliverables 

Colleagues were allocated to one of six breakout sessions which focussed on one of the Care and Wellbeing portfolio deliverables: innovation; Anchors; and preventative and proactive care. Each session was allocated a set question, which colleagues were asked to discuss and provide feedback to the wider group. The questions were:

• innovation (groups 1 and 4): what is our collective risk appetite to introduce transformative innovations at scale, at speed and once for Scotland?
• Anchors (groups 2 and 5): when considering workforce, procurement and land and assets in your role as leaders of an Anchor institution, where could your board make the greatest impact for your local population?
• preventative and proactive care (groups 3 and 6): delivering service change in the challenging financial context will require us to use our workforce and capability in a more efficient and effective way. To create the environment for change and to steer the planning and delivery of this – how can we take this forward together? What actions do we need?

Conclusion

Christine McLaughlin, Co-Director of Population Health concluded with thanks to those who attended the joint meeting of NHS Chairs and NHS Chief Executives. Colleagues were asked to be mindful of the content of the information shared and the work that went into developing the session from those involved in delivering the Care and Wellbeing Portfolio. She encouraged colleagues to make use of their new knowledge and consider how best it can be employed in their Boards.