NHS Chairs minutes: August 2024

Attendees and apologies

Health Board Chairs

• Fiona Sandford, NHS Borders, Vice Chair
• Alistair Morris, NHS Fife, Vice Chair
• Neena Mahal, NHS Forth Valley
• Alison Evison, NHS Grampian
• Lesley Thomson, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson , NHS Shetland 
• Beth Hamilton, NHS Tayside, Vice Chair
• Gillian McCannon, NHS Western Isles
• 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

Scottish Government Officials

• Neil Gray, Cabinet Secretary for Health and Social Care
• Maree Todd, Minister for Social Care, Mental Wellbeing 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
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Donna Bell, Director of Social Care and NCS Development
• Richard Foggo, Co-Director of Population Health
• Tim McDonnell, Director Primary Care
• Anne Armstrong, Deputy Chief Nursing Officer
• Gregor Smith, Chief Medical Officer
• Alison Strath, Chief Pharmaceutical Officer
• Angie Wood, Interim Director, Social Care Resilience, and Improvement
• Robert Kirkwood, Head of People and Governance Team
• Laurie Whyte, Board Governance and Appointments Team

Secretariat

• Kat Dobell, Board Governance and Appointments Team
• Terry Brown, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, NHS Executive Support to NHS Board Chairs and Chief Executives

Other Attendees

• Martin Fairbairn. NHS Forth Valley, Non-Exec Director (attending with Neena Mahal)
• John Nicholson, Deputy Director for Population Health Strategy and Improvement
• Linda Bauld, Chief Social Policy Adviser and SRO

Other Attendees – Aspiring Chairs Programme

• Cathy Fallon, Public Health Scotland 
• Charles Vincent, NHS Greater Glasgow and Clyde

Apologies    

• Linda Semple, NHS Ayrshire and Arran (no deputy available)
• Karen Hamilton, NHS Borders (Fiona Sandford attending)
• Marsali Craig,  (Interim) NHS Dumfries and Galloway (no deputy available)
• Patricia Kilpatrick, NHS Fife (Alistair Morris attending)
• Lorna Birse-Stewart, NHS Tayside
• Tom Steele, Scottish Ambulance Service
• Christine McKelvie, Minister for Drugs and Alcohol Policy
• Jenni Minto, Minister for Public Health and Women's Health
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Christine McLaughlin, Co-Director of Population Health
• John Harden, Deputy National Clinical Director
• Stephen Gallagher, Director of Mental Health
• Alan Gray, (Incoming) Director of Health and Social Care Finance and Governance
• Andrew Watson, Director for Children and Families

Items and actions

MINUTES

Welcome, apologies for absence and attendees

Neil Gray, Cabinet Secretary for NHS Health and Social Care welcomed everyone to the meeting and thanked colleagues for accommodating this shortened meeting. 

A welcome was extended to those attending from the Aspiring Chairs programme who attended as part of their development.

The Cabinet Secretary noted that this would have been Richard McCallum’s last meeting in his in role as Director of Finance, Digital and Governance before moving to the Scottish Exchequer on 19 August 2024. Richard was unable to attend today, and thanks were given in his absence. It was noted that Alan Gray would be stepping into the Director of Finance role on an interim basis until March 2025 to allow for a substantive recruitment process and Christine McLaughlin would take on Director responsibility of Digital. 

A full list of attendees and apologies is noted in annex A.

Minutes and actions from the previous meeting 

The minutes of the meeting held on 26 June 2024 were approved. 

The following actions were noted at the June meeting and are in progress/complete. 

• NHS Chairs asked to highlight barriers to undertaking improvements to the Cabinet Secretaries and officials. This is an open invitation for Chairs and thanks was given to those who have taken up the opportunity to raise barriers
• Susan Douglas-Scott, Chair, NHS Golden Jubilee and Angie Wood, Director of Social Care Resilience and Improvement agreed to take forward a conversation on how the NHS academy can look to support upskilling communities to take on social care roles in community and care homes. A paper was received from Susan Douglas-Scott on how the academy was supporting workforce development for health and social care
• Christine McLaughlin and Carole Wilkinson to discuss when key digital topics could be scheduled for NHS Chairs meetings including a session where NHS boards can highlight local innovation projects. Cyber Security would be discussed at the next private Chairs meeting and further items would be planned over the coming months

Matters arising

There were no matters raised by NHS Chairs.

The Cabinet Secretary raised two key items before moving onto delayed discharge and the population health framework. 

Cabinet Secretary remarks

The Cabinet Secretary noted the financial challenge continued to be a significant issue across Scotland. He highlighted the importance of accurate and transparent financial reporting, with regular communication between NHS boards and Scottish Government. 

The Cabinet Secretary asked NHS Chairs to ensure they were working to use efficiencies wherever possible and share with each other what was working well and could be replicated elsewhere.

The Cabinet Secretary issued a letter to Chief Executives in May regarding Placental Growth Factor (PLGF) testing. Noting that the First Minister was keen that issues were taken on board and that further work was being conducted by Scottish Government officials on how to respond when issues were raised.

Delayed discharge (NHSC/24/25/13)

The Cabinet Secretary recognised that despite some improvements in a few local systems, delayed discharge figures remained high. This is indicative of wider issues within the whole system and these need to be addressed locally.

Angie Wood, Director of Social Care Resilience, and Improvement was invited to give a short presentation on delayed discharge and the work underway through CRAG (Charging for Residential Accommodation Guide). A paper was circulated in advance and slides were displayed during the meeting. The following key points where noted:

• the First Minister and COSLA have jointly agreed to driving down rates by October 2024
• recognising the impact from Covid on delays and the need to manage ebbs and flows to push overall numbers down
• national picture of the Weekly Delayed Discharge Data with statistics for the previous week
• most were standard delays with half sitting in the acute setting
• there continues to be variation in the approach taken to this and Scottish Government officials are working with local areas to understand this and ensure that best practice is being adopted
• the Centre for Sustainable Delivery (CfSD) is undertaking work to support discharge practice 

The conversation was opened to the group and the following points were discussed:

• accessibility of CRAG data to NHS Chairs providing a regular update locally, regionally, and nationally
• agreement that this requires a whole system approach and not just individual hoards/Health and social care partnerships
• the need for input from and through Integration Joint boards to ensure a whole system approach
• focus on unscheduled care as well as emergency receiving capacity

Action: Angie Wood to ensure CRAG data is accessible to NHS Chairs and to ensure whole system approach includes integration joint boards.

Ten Year Population Health Framework - NHSC/24/25/14 (Linda Bauld/Richard Foggo)

The Cabinet Secretary introduced the item on developing the population health framework. He reminded NHS Chairs that he has recently set out his vision in Parliament, including the need for early intervention, maximising access, and accessibility, and improving services. The population health framework will give focus on how to work across public and private sector, keeping people well in their communities with a range of prevention actions to help maintain good health. 

The Cabinet Secretary introduced the item on developing the population health framework. He commented that the trends on Scottish health were not heading in the right direction and what we do at the population level – particularly by way of preventing ill-health – is going to be vital if we are to reverse these trends. 

The Cabinet Secretary also referenced his HSC vision that he set out in Parliament recently, including the need for a focus on prevention and early intervention, improving population health, providing quality services and maximising access. He highlighted that the population health framework is needed to be a clear articulation of how we will work across overnment - and across sectors - to deliver on prevention and keep people well in our communities . 

The Cabinet Secretary stressed the importance of the Framework being jointly developed between the Scottish Government and COSLA and the vital contribution that NHS boards will make in the successful delivery of the framework on the ground.  NHS Chairs input to date has been highly valued and will ensure the Framework can help to improve health and reduce inequalities across Scotland.

A summary development document was issued in advance of this meeting and Linda Bauld, Chief Social Policy Adviser gave an overview of the paper and next steps in the process to develop the population health framework over the autumn. The following was covered:

• the framework would be for the whole system
• what would add value/what the framework is not intended for
• primary prevention would be the focus
• the framework would be concise, readable and brief
• it would be structured around five drivers of: social & economic factors; places & communities; healthy living; health & care; and a prevention focused system
• consideration would be given to a national population health target or stretch aim
• the final engagement document would be used by all to support discussions with stakeholders and help shape the final framework
• that an evidence narrative and series of whole system approach (two page) system summaries would be published alongside the framework

Linda Bauld concluded by inviting NHS Chairs to consider two specific topics in connection with the framework – engagement and accountability.

Lesley Thomson, NHS Greater Glasgow and Clyde and Angiolina Foster, Public Health Scotland led the initial response to Linda’s input. It was noted that the collective narrative on population health was a new and welcome direction and the experience of non-executive board members should be utilised to support this. NHS GGC has held a seminar to maximise the skills of the non-executives and explore what support they could offer and various groups should be included from out with NHS Scotland. 

Angiolina commented on the approach to execution and implementation of the Framework being key and that we need to think what will make this approach different to the past.  Points were also made about careful thought needed to overarching aims or targets (e.g. to avoid exacerbating health inequalities while delivering improvements in overall population health) and to consider the accountability for delivery of the framework and how that sits alongside other existing priorities and accountability arrangements. There was positivity and support for the work, and all Chairs were encouraged to participate and input.  Comments from the wider Chairs group included:

• work with industry and businesses needs to be included in this work not only in relation to procurement, but there is opportunity to work constructively with the wider private sector - with encouragement not only to focus on larger businesses but also on small and medium-sized enterprises
• a recent meeting was held with Directors of Population Health across the UK, where opportunities with the new UK Government regarding transformation and prevention were discussed
• a national policy framework around social prescribing would be useful. 
• a barrier is information governance and would be helpful if that could be an enabler rather than a barrier
• the importance of developing a cross party agreement on the framework, making it easier to balance investment decisions, short and long term
• thought to be given about how best for boards to engage with CPP’s on this work
• question about how best to define healthcare inequalities - a workshop has been requested with Scottish Government to go through this. Poverty and deprivation issues should be prioritised and reflected in population health groups 
• the need to recognise the inequities in the system and how this can affect staff as well as their communities. 
• a request for clear national public messaging on key prevention issues such as obesity
• consideration of the role of a new citizen’s contract with the Scottish population
• ensuring the right skills for the workforce as we move forward, including team mixes and the individual skills to deliver the service

The Cabinet Secretary commented that this was a crucial and inspiring piece of work and stressed the importance of having further discussions on this outside of this meeting - encouraging Chairs to be involved with policy colleagues. He also highlighted that a key part of this will need to include consideration of what this will mean for the workforce, around change and shift in prioritisation. He concluded by saying that this had been a helpful, positive conversation and was grateful for the NHS Chairs’ input. 

Any other business

There were no other items of business.

Date and Time of Next Meeting

The next NHS Chairs meeting will take place as a hybrid meeting on 06 November 2024. Venue to be confirmed.