NHS Chairs minutes: April 2023

Attendees and apologies

Health Board Chairs

• Robert Martin, NHS Ayrshire and Arran, Vice Chair (V)
• Karen Hamilton, NHS Borders
• Nick Morris, NHS Dumfries and Galloway
• Alistair Morris, NHS Fife (V)
• Janie McCuske, NHS Forth Valley
• Alison Evison, NHS Grampian
• John Brown, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin HillNHS, Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary RobinsonNHS, Shetland (V)
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles (V)
• Susan Douglas-Scott, NHS Golden Jubilee 
• Carole Wilkinson, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Tom Steele, Scottish Ambulance Service
• Brian Moore, State Hospitals Board for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish Government Officials

• Michael Matheson, Cabinet Secretary for NHS Recovery, Health & Social Care
• Jenni Minto, Minister for Public Health and Women's Health
• 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
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health Finance and Governance
• Donna Bell, Director of Social Care and NCS Development (V)
• Hugh McAloon, Interim Director of Mental Health and Wellbeing
• Richard Foggo, Co-Director of Population Health (v)
• Christine McLaughlin, Co-Director of Population Health
• Siobhan Mackay, Deputy Director NHS 24 and SAS Sponsorship (V) (attending on behalf of Tim McDonnell)
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer V)
• Alison Strath, Chief Pharmaceutical Officer (V)
• Angie Wood, Interim Director of Social Care Resilience and Improvement (V)

In Attendance

• Robert Kirkwood, Head of People and Governance Team
• Laurie Whyte, Board Governance and Appointments Team (V)
• Kat Dobell, Board Governance and Appointments Team
• Hannah Mackay, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, NHS Executive Support to NHS Board Chief Executives and Chairs
• Sam Marten, NHS Executive Support Team 

Apologies

• Lesley Bowie, NHS Ayrshire and Arran (Robert Martin attending)
• Doug Moodie, Care Inspectorate
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• John Harden, Deputy National Clinical Director
• Graham Ellis, Deputy Chief Medical Officer
• Stephen Gallagher, Director of Digital Health and Care
• Tim Mcdonnell, Director of Primary Care (Siobhan Mackay attending)
• Linda Pollock, Interim Director of Healthcare Quality and Improvement
• Michael Chalmers, Director for Children and Families

Items and actions

Agenda

1. Welcome, apologies for absence and attendees
2. Minutes and actions from the previous meeting (30 January 2023)
3. Matters arising
4. Cabinet Secretary remarks 
5. NHS recovery and performance (John Burns)
6. Discussion with Chairs on issues and challenges
7. Feedback from Chairs private meeting
8. Any other business
9. Date and time of next meeting

• NHS Chairs meeting 22 May 2023

Minutes

Welcome, apologies for absence and attendees

The Cabinet Secretary welcomed colleagues to his first meeting with NHS Chairs as Cabinet Secretary for NHS Recovery, Health, and Social Care. He reflected on his previous role as Health Minister and noted familiar faces who have been in various roles. 

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

Minutes and actions from the previous meeting

The minutes of the meeting held on 30 January 2023 were approved.

Matters arising

There were no matters arising.

Cabinet Secretary’s remarks

The Cabinet Secretary acknowledged the challenges that NHS Boards have faced over the past few years and thanked Chairs for their leadership during this time. He conveyed his expectation, going forward, is for Chairs to provide clear assurance on delivery of Ministerial priorities, on recovery and performance. 

The Cabinet Secretary reminded Chairs of the three key priorities set out by the First Minister in his statement to the Scottish Parliament last week. These were: 

• equality – tackling poverty and protecting people from harm
• opportunity – a fair, green and growing economy
• community – prioritising our public services

The Cabinet Secretary introduced Jenni Minto, Minister for Public Health, and Women's Health. The Minister noted that, living on a rural island with a rural constituency, she was interested to understand the differences across Scotland’s NHS. She welcomed the opportunity to meet with NHS Chairs and looks forward to having challenging, creative conversations in future which focus on solutions. 

The Cabinet Secretary then opened the discussion to Chairs for comment. Nick Morris, Chair of NHS Board Chairs Group (BCG), welcomed the Cabinet Secretary to the BCG and indicated the desire to work collaboratively with him and his Ministers on delivering improved healthcare to the people of Scotland. He advised that BCG had made improvements in the last few years, since his previous engagement with the group, to ensure that it aligned its work to Ministerial priorities and collaborated on identifying assessed risk and solutions.

Martin Cheyne, Chair, NHS 24 noted that NHS24 is now recognised as being a 24-hour service, an anchor for the health service and has the potential to support the Primary Care sector going forward. The Board is currently developing a new app to help combat waiting times. 

The Cabinet Secretary reminded Chairs that although there has been progress, there is still considerable recovery work to be taken forward. Chairs should be ensuring that their Boards are using evidence to inform the approach taken, and that what works well should be shared for a consistent once for Scotland approach with built in flexibility to local systems. 

Emergency and unscheduled care and winter pressures (John Burns, NHS Scotland Chief Operating Officer)

John Burns, NHS Scotland, Chief Operating Officer, gave a presentation which provided an update on current plans, board activity and performance trends across: 

• planned care
• cancer
• diagnostics and imaging
• unscheduled care

It was noted that working with the National Centre for Sustainable Delivery (CfSD) will be key to progress innovations across the priorities. The CfSD will provide service innovation and redesign through:

• fully scaling high impact programmes (ACRT, PIR, ERAS, Day Surgery, Cytosponge, CCE)
• adopting ‘hospital within a hospital’ model
• extending scope of day surgery 
• waiting list validation 
• adopting minimum standards per procedure across theatre productivity
• adopting recommendations from the atlas of variation maps
• maximising throughput through NTCs
• high-volume pathway redesign
• maximising digital capacity

John Burns advised that work has already started on winter planning, they are looking at how NHS boards can further utilise hospital at home and reduce self-attenders. 

The Cabinet Secretary asked Chairs to share their performance against cancer and accident and emergency waiting times. Current data shows that cancer performance is around 66.2% and is not showing any indication of changing. Chairs were asked to outline what is causing this and offer solutions and assurance that their leadership teams are focused on this. 

There was agreement that reasons for current performance are complex and multi-faceted. There was acknowledgement that there is a lot of work going on to address issues but that there should be more focus on the delivery of improvements with clear outcomes and close monitoring within boards that improvement is happening. 

The Cabinet Secretary indicated that his expectation is for Chairs to inform of the current situation, what plans are in place to support change and improvement, what the plans are currently delivering and what is expected to be delivered in future. 

Action: Chairs to report back at a future meeting on improvement in cancer pathway and performance. 

There was a further discussion on delayed discharge and ED pressures with Tom Steele, Chair, Scottish Ambulance Service highlighting current issues with turnaround times for ambulances and increased patient acuity with patients experiencing life threatening symptoms increasing from 17% to 24% of 999 demand since 2019. SAS is working with NHS24 to establish a collaboration board with the goal of treating people in the best place at right time and taking pressure off  emergency departments .

The Cabinet Secretary stated he required an understanding of the cause of delayed discharge and what could be done in individual areas to address the productivity gap. There needs to be significant improvement over the next 6 months ahead of winter, with a full understanding of where the issues lie.

Action: Chairs to report back their assessed understanding of the causes of delayed discharges and work taking place to address this.

Feedback from Chairs private meeting

Nick Morris fed back from the Chairs private meeting held this morning. He shared that Gillian Russell, Director of Health Workforce and her team attended to discuss:

• workforce planning
• productivity
• visibility of leadership
• delivery of support to staff
• training opportunities across the organisation
• service model and workforce strategies

The Cabinet Secretary commented that social care has not held the same value in society as the NHS, and that this was reflected through pay. He indicated that before tackling this issue, there is a longer piece of work needed on improving population health and reduction of social inequality. Chairs were keen to explore improvements in Social Care and care at home workforce capacity as a potential solution to patient flow problems.

The Cabinet Secretary concluded he was looking forward to developing relationships with Chairs and Chief Executives and would attend the next Chief Executives meeting on 3 May 2023. He stated he was keen to have an open and constructive dialogue with Chairs and intended on meeting with them individually over the coming months.

Any other business

There were no further items of business raised.

Date and time of next meeting

The next NHS Chairs meeting will take place on 22 May 2023.

The Cabinet Secretary indicated that his preference going forward, would be to meet monthly. Dates to be confirmed.