NHS Chairs minutes: January 2023

Attendees and apologies

Health Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders
• Nick Morris , NHS Dumfries and Galloway
• Tricia Marwick,NHS Fife
• 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
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee 
• Carole Wilkinson, Healthcare Improvement Scotland
• Mike McCormick, NHS 24, Vice Chair (on behalf of Martin Cheyne)
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Tom Steele Scottish, Ambulance Service
• David McConnell, NHS State Hospitals Board for Scotland (on behalf of Brian Moore)
• Doug Moodie, Care Inspectorate

Scottish Government officials

• Humza Yousaf, Cabinet Secretary for Health and Social Care
• Kevin Stewart, Minister for Mental Wellbeing and Social Care
• Maree Todd, Minister for Public Health, Women's Health, and Sport
• Caroline Lamb, DG HSC/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gillian Russell, Director of Health Workforce
• John Harden, Deputy National Clinical Director
• Richard McCallum, Director of Health Finance and Governance (attending at 15:00)
• Donna Bell, Director of Social Care and NCS Development
• Hugh McAloon, Interim Director of Mental Health and Wellbeing
• Richard Foggo, Co-Director of Population Health
• Christine McLaughlin, Co-Director of Population Health
• Tim Mcdonnell, Director of Primary Care
• Stephen Gallagher, Director of Digital Health and Care
• Graham Ellis, Deputy Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Angie Wood, Interim Director, Social Care Resilience, and Improvement
• Robert Kirkwood, Head of OCENHS Team
• Laurie Whyte, OCENHS Team

In attendance

• Alan Gray, Infrastructure Planning Lead
• Mike Andrews, Population Team Leader, Population and Migration
• Sarah Ormerod, Cross-Government Communications Lead for Population
• Chris Stothart, Strategic Reform Team Leader, Strategic Reform Unit
• Francesca Capaldi, Scottish Clinical Fellow
• Fraser McJannett, Executive Support to NHS Board Chairs and Chief Executives
• Nicole Smith, Executive Support to NHS Board Chairs and Chief Executives
• Kat Dobell, OCENHS Team
• Carol Hunter, OCENHS Team

Apologies

• Lesley Bowie, NHS Ayrshire and Arran (no deputy)
• Janie McCusker, NHS Forth Valley 
• Martin Cheyne, NHS 24 (Mike McCormick (VC) attending)
• Brian Moore, The State Hospitals Board for Scotland (David McConnell attending)
• Jason Leitch, National Clinical Director (John Harden attending)
• Alison Strath, Chief Pharmaceutical Officer
• Gregor Smith, Chief Medical Officer
• Michael Chalmers, Director of Children and Families 

Items and actions

Agenda

• welcome, apologies for absence and attendees
• minutes and actions from the arevious meeting (12 December 2022)
• matters arising
• Cabinet Secretary remarks 
• emergency and unscheduled care and winter pressures (John Burns, NHS Scotland Chief Operating Officer) (paper no. NHSCH/22/23/11)
• planned care (John Burns, NHS Scotland, Chief Operating Officer) (paper no. NHSCH/22/23/12)
• standing items:
  •  Health and Social Care workforce – culture – NHS Tayside (Lorna Birse-Stewart, Chair, NHS Tayside) (paper no. NHSCH/22/23/13)
• population strategy and Ministerial Population Taskforce (Mike Andrews, SG Population Team Leader and Sarah Ormerod, SG Cross-Government Communications Lead for Population) (paper no. NHSCH/22/23/14)
• feedback from Chairs Private meeting
•  any other business
•  date and time of next meeting
  •  NHS Chairs meeting 27 March 2023

Welcome, apologies for absence and attendees

The Cabinet Secretary welcomed everyone to the meeting. He noted that Paul Johnston, current Scottish Government Director General for Communities will take over as Chief Executive of Public Health Scotland in March, following the retirement of Angela Leitch. He also made NHS Chairs aware that Gordon James becomes the substantive Chief Executive of NHS Golden Jubilee in February.

The Cabinet Secretary noted apologies and acknowledged those who represented by deputies. A full list of attendees and apologies is provided at annex A.

Matters arising

There were no matters arising.

Minutes and actions from the previous meeting

The minutes of the meeting held on 12 December 2022 were approved.

The Cabinet Secretary provided an update on the following actions from the previous meeting:

• Chief Nursing Officer to provide an update to NHS Chairs on the work that is being carried out by the nursing group, in relation to reducing agency staff, a paper would go to the private Chairs meeting in February and shared with the wider Chairs group
• Boyd Robertson to provide further information to the Cabinet Secretary on speaking up guardian services. Information was provided to the Cabinet Secretary on 9 January 2023. The Cabinet Secretary was keen for this to be revisited
• Susan Douglas-Scott to provide further information to the Cabinet Secretary on the spiritual and pastoral care work. Information was provided to the Cabinet Secretary on 26 January 2023

Cabinet Secretary’s remarks

The Cabinet Secretary expressed thanks to NHS Chairs for their leadership over which has been a challenging winter period for the health and social care system. He asked NHS Chairs to pass his gratitude to staff and thanked them for focussing their efforts on improvements made to unscheduled and planned care.

The Cabinet Secretary gave brief update on agenda for change (AfC) pay negotiations. He confirmed that negotiations began on 19 January 2023 to secure a pay uplift for 2023/24 for NHS (AfC) staff. The intent is to present a credible offer to unions, committees and NHS boards by the middle of February. 

The Cabinet Secretary informed NHS Chairs that the inaugural meeting of the National Primary Care Out of Hours Leadership Group took place on 20 January 2023. The group has been tasked with developing options for a more sustainable out of hours service. It will consider the transformational changes required to the system to fully integrate out of hours with wider urgent and unscheduled care services. It was agreed that this should be discussed further at a future NHS Chairs meeting.

Action: secretariat to schedule an agenda item on out of hours services at a future NHS Chairs meeting.

Finally, NHS Chairs were made aware that meetings will be arranged towards the end of March in relation to winter planning 2023/2024 and the recovery and rural transformation work. The aim of the meetings would be to bring in external stakeholders to discuss what transformation would look like over the next decade and beyond.

The Cabinet Secretary noted that agenda items on emergency and unscheduled care and winter pressures and planned care are normally standing items, but that for this meeting, they were being taken as substantive items.

Emergency and unscheduled care and winter pressures (paper no. NHSCH/22/23/11)

John Burns, NHS Scotland, Chief Operating Officer, led the agenda Item on emergency and unscheduled care, and referred to the paper circulated prior to the meeting. He acknowledged the hard work undertaken across NHS Scotland to combat system pressures and gave an update on the various pathways which have been developed to reduce attendances at emergency departments, with a focus on right place, right care.

John Burns indicated that the level of delayed discharges in the system was continuing to have an impact on overall performance. He advised that a communication had been shared with NHS Chief Executives which outlined the key actions that were being taken to support improvements. In addition, the NHS Response Group was due to discuss discharge and occupancy when they met on 29 January 2023.

 The Cabinet Secretary sought assurances from NHS Chairs on what they were doing to address system pressures. This included evidence of how they are working together, to build up shared leadership of the whole-system and how boards were benchmarking practices against that of other boards.

Several NHS Chairs provided feedback to the Cabinet Secretary about the actions that they were taking in their boards to support system pressures. This included:

• work in NHS Dumfries and Galloway, and a few NHS boards to improve patient flow. In particular, planned day discharge, discharge without delay and removing exit blockages within accident and emergency departments
• NHS Fife have adopted the practice of discharging patients into interim care wards to enable staff to have difficult conversations with families and advise them of their options following discharge
• the new Chief Executive of NHS Lanarkshire, Jan Gardner, had implemented a number of different methodologies to reduce delayed discharge which had been successful. Proposals which incorporated learning from Northumbria, NHS Tayside and NHS Greater Glasgow and Clyde have now been agreed by the board
• NHS Lothian noted some improvements within NHS Lothian, around daily discharge practices. The Board has given some consideration to longer term planning over the next 5-6 years and a paper will be submitted to the Scottish Government around plans 
• small changes in NHS Western Isles have had a big impact, with the acute assessment unit (AAU) operating 5 days, working well with out of hours services and hospital at home, and improvements to planned and orthopaedic care
• NHS Borders reported successful negotiations through the care agenda, with the Integration Authority and Care Inspectorate. An agreement has been made with the Local Authority to reopen care beds, with assurances that they will be staffed
• NHS Greater Glasgow and Clyde noted that strategies that have been implemented for example, antibiotics at home, COPD and diabetes is working and the Board is looking for further opportunities

 John Brown, Chair of NHS Greater Glasgow, and Clyde added that he was working collaboratively with other NHS boards to find solutions and shared the example of colleagues from NHS Tayside having visited to learn about learn about triage practices which they have now implemented.

The Cabinet Secretary thanked NHS Chairs for their assurances and stressed the importance of working collaboratively across the whole system.

Planned care including cancer performance (paper no. NHSCH/22/23/12)

John Burns, NHS Scotland, Chief Operating Officer, provided an update on planned care, which included cancer performance and referred to the paper circulated prior to the meeting. The following was highlighted:

• guidance to support planning for planned care in 2023/24, would be issued by the end of January, setting out key priorities in line with targets announced last summer
• the National Elective Co-ordination Unit (NECU) at the Centre for Sustainable Delivery can support the delivery of high-volume waiting list validation. All NHS boards are encouraged to contact colleagues for support
• ongoing work with NHS Golden Jubilee to identify additional theatre capacity. Boards were encouraged to maximise this capacity
• funding has been identified and allocated to several NHS boards to support additional diagnostics
• cancer care continues to be a priority. A few improvement programmes have been established and are underway via the National Early Diagnosis and Cancer Performance Team.
• the primary function of the Cancer Performance and Delivery Board (CPDB) is to support an NHS Scotland approach and provide oversight of national and local plans to support the delivery of cancer waiting times (CWT) standards

Standing items

Health and Social Care Workforce – Culture – NHS Tayside (Paper no. NHSCH/22/23/13) Lorna Birse Stewart, Chair, NHS Tayside, provided a verbal briefing covering three key aspects:

• staff wellbeing recognised as key aspect of risk around workforce
• culture programmes
• spiritual care for staff and patients (this included a PowerPoint presentation on spiritual care and wellbeing

NHS Tayside have established a range of supportive measures for staff helping to prevent mental health issues developing and promoting overall wellbeing in the workforce. This was initiated during COVID and continues to have positive outcomes. Culture programmes promote positive workplace culture to allow staff and employees to understand their organisation and to feel their voice matters.

The Cabinet Secretary thanked Lorna Birse Stewart for her presentation and noted the importance that culture programmes have in promoting a positive workplace culture. 

Population strategy and ministerial population taskforce (paper no. NHSCH/22/23/14)

Mike Andrews, Population Team Leader led the agenda item on Scotland’s Population Strategy. He gave a presentation which covered the following key points: 

• population strategy framing around family/health/attraction/balance
• family friendly nation – aim action/next steps
• healthy living society – aim/action /next steps. Value of Ms Todd and Cabinet Secretary as members of taskforce
• attracting and welcoming people to Scotland
• a more balanced population. Rural visa pilot proposal agreement from UK Government’s independent Migration Advisory Committee. Still awaiting response from Home Office.

Sarah Ormerod, Cross-Government Communications Lead for Population, followed with a presentation on wider communication initiatives within the population programme to promote Scotland. This included an update on a campaign to recruit GPs to work in Scotland and ongoing support for international and domestic applicants. 

NHS Chairs thanked colleagues for an informative presentation which highlighted multiple policy areas working together. They indicated that they would be keen to see how they can support this work, including how to extend this to bring staff into lower paid posts within the NHS and wider public sector. There was consensus that it would be helpful if, going forward, this work jointly addressed how it will support the impact of an aging population and address health inequalities. The Cabinet Secretary suggested that this be placed on the agenda for a future Chairs meeting.

Action: secretariat to schedule wider discussion on population at future NHS Chairs meeting.

Feedback from Chairs private meeting

There was no feedback provided.

Any other business

There were no further items of business raised.

Date and time of next meeting

NHS Chairs meeting 27 March 2023

The Cabinet Secretary indicated that consideration was being given for this meeting to be held jointly with NHS Chief Executives. To be confirmed.