NHS Chairs minutes: January 2024

Attendees and apologies

Health board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders 
• Nick Morris, NHS Dumfries and Galloway
• Alistair Morris, NHS Fife
• Allan Rennie, NHS Forth Valley, Vice Chair (attending on behalf of Janie McCusker)
• 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 
• Lorna Birse-Stewart, NHS Tayside
• 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, NHS State Hospital for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish government officials

• Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care
• Jenni Minto, Minister for Public Health and Women's Health
• 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
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Saira Kapasi, Head of Support for DG H&SC and CE NHS Scotland
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Christine McLaughlin, Co-Director of Population Health
• Anne Armstrong, Deputy Chief Nursing Officer (attending on behalf of Alex McMahon)
• Alison Strath, Chief Pharmaceutical Officer
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Robert Kirkwood, Head of People and Governance Team

Secretariat

• Kat Dobell, Board Governance and Appointments Team
• Hannah Mackay, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team  

Other attendees

• Patricia Kilpatrick, NHS Fife
• Fraser McJannett, NHS Executive Support to NHS Board Chairs and Chairs
• Louise Dowdles, PS Cabinet Secretary for NHS Recovery, Health and Social Care
• Gerrard Ellison, PS Minister for Public Health and Women's Health

Apologies 

• Janie McCusker, NHS Forth Valley (Allan Rennie attending)
• Richard Foggo, Co-Director of Population Health
• John Harden, Deputy National Clinical Director
• Gregor Smith, Chief Medical Officer 
• Alex McMahon, Chief Nursing Officer (Anne Armstrong attending)
• David Plews, Head of NHS Service Development

Items and actions

MINUTES

Welcome, apologies for absence and attendees

The Cabinet Secretary welcomed everyone to the meeting and highlighted the Microsoft Teams protocol.

It was acknowledged that Patricia Kilpatrick was in attendance with Alistair Morris interim Chair of NHS Fife, before taking up post as Chair of NHS Fife on 1 February 2024.

The Cabinet Secretary advised Alex McMahon would officially retire from his role as Chief Nursing Officer on 17 May. Anne Armstrong, currently the Deputy Chief Nursing Officer, would work alongside Alex in the role of interim CNO as he reduces his working weeks, towards his retirement. Anne will take on the role of Interim Chief Nursing Officer from 26 April 2024. Recruitment to the substantive role of Chief Nursing Officer would commence towards the end of this year and an update on timescales would be provided in due course.

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 18 December 2023 were approved.

Matters arising

There were no matters raised.

The Cabinet Secretary provided updates on the following actions from the previous meeting.

• Chief Medical Officer to bring an item to NHS Chairs meeting on data and modelling – Chief Medical Officer Directorate are liaising with EAVE 11 study team on a suitable date for this discussion and then secretariat will consider if this is best suited to be discussed at a private NHS Chairs meeting or at this meeting
• The following action was noted as closed as the Cabinet Secretary received a written update from a number of boards in advance:
  • NHS Chairs to ensure all arrangements are in place to manage increasing winter pressures particularly on ambulance turnaround times

Cabinet Secretary remarks

The Cabinet Secretary highlighted that finance and sustainability is the deep dive today and therefore wouldn’t go in to detail on the budget, however, did want to reiterate the importance to get to balance for 23/24. This is an important step ahead of 24/25, ensuring that money is spent as effectively as possible.

Vaccination uptake in the health and social care workforce remains lower than the previous winter and lower than anticipated. Public Health Scotland are working with boards on actions and communications to promote uptake. NHS Chairs were asked to encourage staff to come forward and take advantage of the vaccination offer available to staff.

Legislation was introduced to the Health, Social Care and Sport Committee on 16 January 2024 to bring Physician Associates (PAs) and Anaesthesia Associates (AAs) into statutory regulation by the GMC. This was approved by the Committee with a significant majority. Local plans for PAs and AAs will come into effect and NHS Chairs were asked to ensure they were familiar with numbers within their own staff group and that regulation requirements from the GMC would fit in with their own boards structure. 

The Health and Care (Staffing) (Scotland) Act 2019 were will come into force from 1 April 2024. Boards may encounter challenges relating to these changes and Chairs should ensure action plans and oversight mechanisms are in place locally to support these processes. 

Standing items

Quality assurance - (post Letby) - progress update (NHSC/23/24/16)

A paper on Quality assurance (post Letby) has been circulated for noting. Chairs are asked to note the update and should contact officials directly if they wish to follow up on anything raised within the paper.

NHS Recovery and Performance - NHSC/23/24/14 (John Burns)
John Burns, NHS Scotland Chief Operating Officer provided a summary of progress from the last meeting via a slide presentation. This covered:

• whole system data dashboard
• planned care
• cancer
• urgent and unscheduled care
• delayed Discharges Sitrep

Planned Care
The slides reflected that the level of activity within planned care had started to improve after the festive period and it was encouraging to see a faster recovery than in previous years. Work done now will be the building blocks for 2024/25. 

Ophthalmology and orthopaedic surgical lists were being looked at with the aim to have a minimum of 14 standard cataract operations per day / 4 joint operations per day list. National capacity would be explored to ensure NHS boards maximise capacity, where they may not have it locally. Work this year has achieved a baseline to build an improved productivity opportunity.

Consideration has been being given to how to reduce backlogs in radiology by looking at digital and remote working and there has been engagement with clinicians to understand what more could be achieved,

Cancer
Cancer statistics showed more people were being treated overall but there was no impact on the 62 day standard. Clinicians were balancing urgent referrals with the backlog. The Scottish Government are working with NHS boards to reduce the backlog and support options are being looked at through national and regional working. Trajectories were based on funding and a review of where predictive performance was not achieved was being reviewed to look at improving the 62 day standard. The 31 day standard had dipped but consistent performance indicates it is going to rise.

Urgent and unscheduled care
Data indicated a busy festive period with a return to normal by 14 January. Scottish Ambulance Service (SAS) played a major role in managing hospital admissions by providing care and support out with hospital.

The Scottish Government were working with NHS boards through CfSD, preparing reports and setting out actions around length of stay. The whole system oversight group is looking at key metrics for improvement for each system. Improvement would be assessed to see what trajectories they would provide and to encourage a drive to improvement. Work has already started on looking at winter planning for the 2024/25 and readiness for the upcoming Easter break. 

The Cabinet Secretary welcomed the fact that the ability to maintain and protect elective care over winter was higher than the previous year but unscheduled care had broadly not improved and more progress was required. The 62 day cancer standard was very challenging but expectations were that the 31 day standard would be maintained. In view of the deteriorated performance, the Cabinet Secretary asked NHS Chairs for assurance that issues would be identified and improvements made. 

NHS Chairs discussed their local challenges and opportunities in relation to performance and verbally assured the Cabinet Secretary of their commitment to continuous improvement.

Deep dive
Finance and sustainability – NHSC/23/24/15 (Richard McCallum)

Richard McCallum, Director of Health and Social Care Finance, Digital and Governance, updated Chairs on the impacts of the 2024/25 budget, reform and choices work, Including next steps with delivering a path to balance. The following was set out:

• financial overview - the 2024/25 budget presents a significant challenge for NHS Boards and a step change will be required on our programme of reform. There is a gross pressure of £1.5bn in 2024/25 for the Portfolio. We must agree on the areas of focus for change in 2024/25 which will deliver a path to balance for health and social care
• authorising environment for reform – decisions will be required by both NHS Boards and Scottish Government to enable the levers for change at the scale required
• risks, safety and communication – the scale of the financial deficit introduces a level of risk into the system at a level not seen before, and Chairs must ensure they continue to hold boards to account for all aspects of their performance. Communication with staff and the public will be key as difficult decisions are reviewed

Lesley Thomson, Greater Glasgow and Clyde, and Nick Morris, Dumfries and Galloway, contributed to this item by discussing the following:

• the scale of the challenge requires systematic and collaborative review of the delivery of services at national, regional and local level
• boards will develop work under the 15 point plan where they have control but seek to understand what can be developed by Scottish Government, e.g. enabling programmes on medicines, staff T&C, etc
• boards will have limited scope for acceptable service changes in the absence of a nationally agreed strategy and communications plan supporting a robust and clear authorisation framework
• staff morale and staff concerns around the care provided
• the need for close working with clinical colleagues and local authorities to address local issues
• systematic review – this is being looked at by CfSD, focussing on short stay admissions as well as clinical leadership and ownership of the pathway

Lesley advised that boards are currently working on maximising current year finances and have commenced discussions on next year financial plans. Board chairs assured that there was focussed and increased governance and oversight recognising the extent of the financial challenge. The need to work collaboratively with SG colleagues on communication and the authorising environment were essential.

The conversation opened up to the group who discussed the following points:

• national perspective to support measures within their power to take forward now
• draft annual plans are integral to understanding what needs to be done within boards and sighting Scottish Government on schemes that are likely to need ministerial awareness or approval in order to support engagement with local interest groups. ADP’s provide assurance that spending intentions are made in the best way possible
• communication needs to be dynamic in managing the dialogue with staff, staff side organisations and the public. The Scottish Government can help facilitate and support this which development of a clear communications strategy that supports boards. Boards need to ensure collective agreement on proposed service changes prior to issuing of localise communications
• collaborative approach to engagement and delivery to ensure whole system understanding of challenges, solutions and consequences
• ongoing engagement to be a permanent process and conversations with staff should have a collaborative approach

Gary Robinson, NHS Shetland, and Gillian McCannon, NHS Western Isles, shared their concerns around the reliability of transport to the rural areas and Islands. The impact on patients and visiting consultants from the short term cancellation of flights due to technical and adverse weather. A tripartite discussion with Loganair would be welcomed. Sarah Compton-Bishop, NHS Highland also noted the importance of rural and island health boards being community hubs and wider community impact. The Cabinet Secretary agreed this discussion should be taken forward by Officials to seek assurance Loganair is able to support the NHS service delivery with an appropriate flight schedule. 

Action: officials to seek assurance through a tripartite conversation that Loganair is able to support the NHS service delivery with an appropriate flight schedule.

The Cabinet Secretary summarised, stating that this was a challenging time but there was also the opportunity to look at how services were being delivered and if a different approach could improve. A close collaboration was needed around communication and should be managed properly to help maintain a sustaining environment. Effective management was important to facilitate the authorising environment needed for change and a communication framework was required to agree at national level, while adding individual elements to it. An update would be provided regarding the financial situation, going forward. Getting a balance this year would be beneficial for the next financial year.

Action: financial update to be included in future meetings. 

Feedback from NHS Chairs private meeting

Carole Wilkinson provided a brief update from the Chairs private meeting which took place earlier today:

• finance
• population health
• community engagement

Any other business

There was no other business raised.

Date and Time of Next Meeting

The next NHS Chairs meeting will take place on 25 March 2024 where the deep dive item will be on population health.

Office of the Chief Executive for NHS Scotland
29 January 2024