NHS Chairs minutes: June 2023

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
• Janie McCusker, NHS Forth Valley        
• Alison Evison, NHS Grampian
• John Brown, 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
• 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
• 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
• Fiona Hogg, Chief People Office
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health Finance and Governance
• Hugh McAloon, Interim Director of Mental Health and Wellbeing
• Christine McLaughlin, Co-Director of Population Health
• Siobhan Mackay,  Interim Deputy Director of Primary Care (on behalf of Tim McDonnell
• Anne Armstrong , Deputy Chief Nursing Officer (on behalf of Alex McMahon)
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Robert Kirkwood, Head of People and Governance Team

In attendance 

• Dr Rak Nandwani, Non-Executive member, Public Health Scotland
• Fraser McJannett, NHS Executive Support to NHS Board Chairs and Chairs
• Dr Fatim Lakha, Public Health Scotland

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Hannah Mackay, Board Governance and Appointments Team

Apologies

• Doug Moodie, Care Inspectorate
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gillian Russell, Director of Health Workforce (Fiona Hogg attended)
• Tim Mcdonnell, Director of Primary Care (Siobhan Mackay attended)
• Alex McMahon, Chief Nursing Officer (Anne Armstrong attended)
• Gregor Smith, Chief Medical Officer
• Richard McCallum , Director of Health Finance and Governance
• Richard Foggo , Co-Director of Population Health
• Alison Strath, Chief Pharmaceutical Officer
• Stephen Gallagher, Director of Digital Health and Care
• Saira Kapasi, Head of Support for DG HSC and CE NHS Scotland
• David Plews , Head of NHS Service Development

 

Items and actions

Welcome, apologies for absence and attendees.

The Cabinet Secretary welcomed everyone to the meeting and thanked colleagues for their attendance. 

The welcome was extended to Dr Rak Nandwani who was observing this meeting. Dr Nandwani is a Non-Executive Director at Public Health Scotland and a member of the new Aspiring Chairs Programme, shadowing David Garbutt, Chair, NHS Education for Scotland.

To help with inclusivity with those attending virtually, the Cabinet Secretary reminded in-person attendees to also join the meeting from their laptop as it is more visible as to who is speaking in the room. 

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 22 May 2023 were approved.

Matters arising

There were no matters arising raised.

Cabinet secretary remarks

The Cabinet Secretary informed NHS Chairs that the British Medical Association (BMA) have advised that Junior Doctors rejected the pay deal on offer and have announced they will take strike action for 72 hours from 7am on 12 July, with the withdrawal of all care and no derogations in place. He emphasised that he would continue to engage with the BMA to seek a negotiated settlement to avoid strike action. NHS boards must however ensure that all necessary mitigations are in place, should strike action go ahead. 

Officials notified NHS boards on 14th June of an additional £200 million to support delivery and help reduce financial pressures, while maintaining focus on service improvement. The Cabinet Secretary highlighted that, with this, a clear expectation on NHS boards has been set with savings targets through the sustainability and value programme – to deliver 3% recurring savings in 2023-24.

Finally, the Cabinet Secretary informed Chairs that the new mental health and wellbeing strategy will be published on 29 June. The new strategy will help support NHS boards to plan to ensure that they meet changing mental health needs over the coming years. It was highlighted to Chairs that a deep dive on mental health and drugs deaths will come to the next Chairs meeting in August.

Standing item

NHS recovery and performance - NHSC/23/24/04 (John Burns)
John Burns, Chief Operating Officer NHS Scotland, provided a national overview of NHS recovery and performance. A paper was circulated in advance and slides were displayed during the meeting which covered planned care and unscheduled care (including cancer and delayed discharges). Winter planning was the focus of the deep dive as agenda item 6. 

Planned care

John Burns shared with NHS Chairs the latest data on how NHS boards are meeting the Treatment Time Guarantee (TTG). This included a breakdown of numbers for new outpatient and inpatient/day cases. The total list sizes have increased with additions being greater than removals, but the growth rate has slowed down more recently.

An overview was provided of the work which was being taken forward by the Centre for Sustainable delivery (CFSD) - perioperative delivery group in relation to driving sustainable improvements in theatre pathways across NHS Scotland. 

John Burns advised that planned care plans for 2023-34 will be finalised around the end of June. A discussion took place with NHS Chief Executives on 14 June at which agreement was to focus on long waits in 2023-24 and collaborative work at NHS Scotland level to develop a multi-year delivery plan to address the total waiting list. The development of the plan will include clinical engagement facilitated by CfSD and regional planners to ensure that regional/national opportunities are maximised. The aim is to have completed this work by the end of summer.

A deep dive into cancer performance was conducted at the previous NHS Chairs meeting and therefore the brief update focused on cancer patient flow and what was being done to sustain recent improvements. It was highlighted that achievement of the 62-day treatment time standard continued to be more challenging than the 31-day standard.

Unscheduled care

John Burns gave an overview of overall performance which has been stable in the last few weeks. He shared with NHS Chairs the key points from a deep dive with NHS Chief Executives on 13 June, which focussed on variation across NHS boards, agreeing a target operating model for each local system and further opportunities to improve flow navigation. It was highlighted that the numbers of delayed discharges were currently in the region of around 1600 and it was important to bring this down to below 1200.

The Cabinet Secretary thanked John Burns for his update on NHS recovery and performance. He invited NHS Chairs to contribute to the discussion by outlining what their boards were doing to improve performance.

John Connaghan, Chair, NHS Lothian, raised the action which was assigned to him at the previous meeting to share NHS Lothian’s cancer management plan to share learning across boards. John referred to the paper circulated and encouraged Chairs to use Margaret Kelly to conduct an audit on cancer performance as it formed the basis of the board’s ongoing improvement action plan. The Cabinet Secretary asked Chairs to ensure they are familiar with the work taken forward by Margaret Kelly and to consider if further engagement would be helpful for their own board.

Action: Chairs to ensure they are familiar with the work taken forward by Margaret Kelly and to consider if further engagement would be helpful for their own board in relation to cancer performance. 

John Brown, Chair, NHS Greater Glasgow and Clyde, expressed that data from the flow navigation hub was starting to emerge in relation to redirection. He considered whether this could be upscaled by NHS 24 rather than the calls coming to the hub. John Burns highlighted that a discussion would take place with NHS 24 team to explore this.

Action: John Burns to consider the early data emerging from the flow navigation hub at NHS Greater Glasgow and Clyde and consider options.

Deep dive

Winter planning - NHSC/23/24/05 (Paula Spiers)

Paula Spiers, Deputy Chief Operating Officer - Planning and Sponsorship, led the agenda Item which provided a deep dive into winter planning. Paula referred to the paper which was circulated in advance and displayed a presentation during the meeting.

The lessons learned from 22/23 winter were outlined and included:

•    target high impact areas through stronger understanding of whole system data alongside demand and capacity forecasting
•    planning required to begin a lot earlier
•    key policy interventions
•    strengthened the role of performance data into our planning and preparedness
•    greater coordination across services to provide whole-system approach

Paula Speirs emphasised that the resilience priorities which were set in October 2022 remain key to the winter approach, as well as planning for a more resilient system overall. She indicated that planning and delivery for winter had begun much earlier this year, across NHS boards, Health and Social Care partnerships, third sector services and policy teams. A programme team has been established to co-ordinate and develop a Scottish Government, NHS Scotland and COSLA approach for Winter 23/24.

A winter Event on 22 August will take place to finalise components of the winter plan and associated actions. The Cabinet Secretary and Councillor Kelly, COSLA will be in attendance.

The Cabinet Secretary thanked Paula for the presentation and invited contributions from those who had been engaging with officials to highlight the role of NHS Chairs as leaders, and their contribution to winter planning their engagement with local partners such as Chairs of Integration Joint Boards. Examples were provided by Martin Hill, Chair, NHS Lanarkshire, Meghan McEwan, Chair, NHS Orkney, Martin Cheyne, Chair, NHS 24 and Tom Steele, Chair, Scottish Ambulance Service.

Martin Hill shared details about what NHS Lanarkshire is doing to improve operational flow. This work has been split into three phases with the final phase on reform due to start towards the end of 2023. In his role as Chair, his focus was on improving governance as well as data collection. Martin Hill outlined how NHS Lanarkshire has prioritised whole system working, and that they are working closely with the Scottish Ambulance Service (SAS) and NHS 24. The importance of focussing on primary prevention measures was emphasised, not just within health, but for example social inequalities and wider population health. 

Meghan McEwan, Chair, NHS Orkney, gave an overview of how NHS Orkney was working closely with the Health and Social Care Partnership (HSCP) to address high levels of vacancies which are a barrier to delivering services like hospital at home. She emphasised her leadership role as Chair, by adding clear objectives to the executive team for this to remain on the radar ahead of winter.

Martin Cheyne, Chair, NHS 24, indicated that the board was close to meeting their recruitment targets which will ensure that they have sufficient capacity to meet demand. NHS 24 has implemented a new call back system which ensures patients do not lose their space in the queue and receive a call back, was working well, and calls about mental health were being answered within 5 minutes. He advised that the use of NHS Inform was significant and was working well for re-directing patients.

Tom Steele, Chair, SAS, highlighted the use of triaging non-life-threatening calls to advanced paramedics. Patients had high satisfaction rates with a high number of them not requiring an ambulance. He advised that safe handover guidance has been shared with boards to improve hospital turnaround times. In terms of demand and capacity, demand has risen by 12% and capacity has risen by 8% due to 460 new Scottish Government funded clinical staff. He highlighted that the board were staffing up earlier ahead of winter, compared to last year. The Cabinet Secretary highlighted that to meet the targets in relation to handover from ambulances, boards needed to ensure that there is a place of care within the hospital available.

Action: NHS Chairs to ensure appropriate place of care is available for patients when they arrive from ambulances. 

The Cabinet Secretary highlighted the importance of engagement at a local level in relation to planning for winter, including other public organisations, third sector and private sector. These conversations should be taking place now to ensure appropriate winter preparedness. 

Action: NHS Chairs should be thinking about who they need to be engaging with at a local level in terms of planning for winter. They should ensure that their boards have good lines of communication and engagement with partners and conversations now take place. 

Angiolina Foster, Chair, Public Health Scotland, highlighted the support that Public Health Scotland (PHS) has been providing to NHS Tayside around demand/capacity modelling and winter planning. She stressed that this offer of support was available to all boards and encouraged NHS Chairs to accept the opportunity. She highlighted a workshop which was taking place the following day and hoped that all boards would be represented at that. It was raised that there was the need to better understand social care capacity within the winter planning process as this had materialised as a key weakness in the 2022/23 resilience work.

The Cabinet Secretary highlighted that the winter planning item would return to a future meeting later in the year. 

Acion: Winter planning to be scheduled at a future NHS Chairs meeting later in the year.

Feedback from NHS Chairs private meeting

Nick Morris provided feedback from the NHS Chairs private meeting which took place in the morning and included:

•    escalation Framework
•    sponsorship Models
•    current inquiries
•    burden of disease
•    CPP partnership

Any other business

There was no other business raised. 

Date and time of next meeting

The next NHS Chairs meeting will take place on 21 August 2023. During this time, the Cabinet Secretary emphasised the importance to continue to focus on recovery plans, unscheduled care and planned care. He indicated that he planned to visit NHS Boards during summer recess.

Office of the Chief Executive for NHS Scotland