NHS Chairs minutes: June 2024

Attendees and apologies

NHS Chairs

• Linda Semple, NHS Ayrshire and Arran, Interim Chair
• Karen Hamilton, NHS Borders
• Nick Morris, NHS Dumfries and Galloway
• Patricia Kilpatrick, NHS Fife
• Neena Mahal, NHS Forth Valley, Interim Chair
• Alison Evison, NHS Grampian
• Lesley Thomson, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland
• Lorna Birse-Stewart, NHS Tayside
• Susan Douglas-Scott, NHS Golden Jubilee
• Carole Wilkinson, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24 (first hour only)
• Gordon Greenhill, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Brian Moore, State Hospital for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish Government Officials

• Neil Gray, Cabinet Secretary for Health and Social Care
• 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
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Gillian Russell, Director of Health Workforce
• Angie Wood, Director of Social Care Resilience and Improvement
• Christine McLaughlin, Co-Director of Population Health
• Donna Bell, Director of Social Care and NCS Development
• Anne Armstrong, Interim Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Anna Dominiczak, Chief Scientific Officer
• Gregor Smith, Chief Medical Officer

In attendance

• John Innes, Aspiring Chairs Programme
• Beth Hamilton, NHS Tayside – Vice Chair

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hobkirk, Board Governance and Appointments Team
• Sam Martens, NHS Executive Support to NHS Board Chairs Group

Apologies

• Lesley Bowie, NHS Ayrshire and Arran (Linda Semple attending)
• Martin Hill, NHS Lanarkshire
• Gillian McCannon, NHS Western Isles
• David Garbutt, NHS Education for Scotland
• Annie Gunner Logan, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland (Gordon Greenhill attending)
• Tom Steele, Scottish Ambulance Service 
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Jenni Minto, Minister for Public Health and Women’s Health
• Christine McKelvie, Minister for Drugs and Alcohol Policy
• Caroline Lamb, DG HSC/CE NHS Scotland
• Fiona Hogg, Chief People Officer
• John Harden, Deputy National Clinical Director
• Richard Foggo, Co-Director of Population Health
• Stephen Gallagher, Director for Mental Health
• Andrew Watson, Director for Children and Families
• Tim McDonnell, Director Primary Care
• David Plews, Head of Health Strategy and Planning
• Saira Kapasi, Head of Support for DG HSC and CE NHS Scotland
• Robert Kirkwood, Head of People and Governance Team

Items and actions

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 the change in meeting time.

He welcomed Linda Semple, Interim Chair, NHS Ayrshire and Arran to the meeting who is covering for the next 6 months while Lesley Bowie is on sabbatical and John Innes who was attending as a participant on the Aspiring Chairs programme.

The Cabinet Secretary noted that this was Nick Morris’ last meeting of the NHS Chairs Group, as he stands down from his role as Chair of NHS Dumfries and Galloway on 31 July 2024. He thanked Nick for his time as Chair since taking up the position in 2019 and for his contribution as the previous Chair of the NHS Chairs Group. 

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 2024 were approved.

The actions noted from the minutes are in the main complete or in progress. The action relating to comparative performance data was discussed under agenda item 5 of this meeting. 

Matters arising

There were no matters raised.

Cabinet secretary remarks

The Cabinet Secretary reiterated the need for continued effort to address recovery and improvement in services post Covid, reflecting on the added financial pressure and effort of boards to realise savings and efficiencies while delivering safe and effective services. He then gave some introductory remarks which covered:

• delayed discharges - the Cabinet Secretary asked for Chairs and boards to refocus their attentions on delayed discharge, with the aim of returning them to pre-pandemic levels by winter. Collaborative response and assurance group (CRAG) meetings have been stepped up to weekly to ensure engagement across health and social care partners
• vaccinations – with vaccination rates of uptake falling, boards need to continue to ensure that there are as few barriers as possible for communities to access vaccinations. The Cabinet Secretary asked Chairs to continue to advocate the uptake of vaccinations across their health board areas and advise ways to maximise vaccination rates
• reform and Improvement – the reform and improvement programme is based on the delivery of the national clinical strategy for Scotland which was published in 2016. It was noted that there are a significant number of change programmes underway and that the landscape could be simplified. The Cabinet Secretary asked Chairs to flag any barriers to implementing improvements as early as possible
• equality, diversity and inclusion – the Cabinet Secretary highlighted the increased emphasis on anti-racism and addressing racialised health inequalities in board plans. He reminded Chairs of their role in helping drive forward positive cultures of equality within their boards

There was a further discussion about delayed discharge. 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 number of Chairs shared in the chat box challenges around staffing to support social care with colleagues offering ideas and examples of solutions. Chairs agreed to collaborate to explore ideas for tackling delayed discharge.

Action: NHS Chairs asked to highlight barriers to undertaking improvements to the Cabinet Secretaries and officials.

Action: 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.

Standing item – NHS recovery and performance (NHSC/24/25/09)

The Cabinet Secretary invited John Burns, Chief Operating Officer to lead the standing agenda item on NHS recovery and performance. A paper had been circulated to attendees in advance of the meeting and John provided a slide presentation. An extended slide pack would be circulated following the meeting so that Chairs could more closely examine the cross-board data and information regarding productivity and improvement. The slides included data on:

• planned Care
• cancer waiting times
• unscheduled care

John Burns advised that overall demand on the system is in line with the historical trends. It was noted that planned care activity levels have increased across all areas. It was highlighted that the focus for improvement continued to be on reducing long waits and that the Centre for Sustainable Delivery (CfSD) was engaging with boards to support and monitor delivery against the additional £30 million to support key areas requiring additional support in particular diagnostics, orthopaedics and cancer. 

John Burns shared information about performance against cancer waiting times targets, with improvement still required to meet the 62-day target.  He indicated that the national elective coordination unit was continuing to support boards through specific campaigns, but that embedding good practice needs clear commitment from teams and boards needed to scrutinise and assure delivery of these improvements.

The renewed focus on delayed discharge highlights the importance of pathways linked to unscheduled care and good discharge process that avoids delay. The CfSD diagnostic teams have been finalising improvement plans with Boards, this will include working on delivery against plans with Chief Executives across Summer and Autumn. 

Discussion on Delayed Discharge continued with Angie Wood, Director of Social Care Resilience and Improvement, asking Chairs to ensure engagement with Integrated Joint Boards on this topic. They have a critical role in ensuring their non-executive members are advocating and ensuring strategies and plans are in place to support delivery. 

Digital and innovation (NHSC/24/25/10)

The Cabinet Secretary invited Richard McCallum, Director Finance, Digital, Governance and Christine McLaughlin, Co Director Population Health to lead this item. A paper had been circulated to attendees in advance of the meeting and slides where shared during the meeting. 

Richard McCallum introduced the item and highlighted a range of topics that would be worth discussing with Chairs over the next year. This included; cyber security, information governance, digital front door, major contact replacements and the pipeline of innovation including AI.

Action: Christine McLaughlin and Carole Wilkinson to discuss when key digital topics could be scheduled for Chairs meetings including a session where boards can highlight local innovation projects. 

Christine McLaughlin then provided some additional context as highlighted in the parliamentary debate on reform and improvement, on the role of innovation and the importance of national adoption, where there are clear benefits. Dame Anna Dominiczak, Chief Scientific Officer then gave a brief overview of the ‘digital dermatology’ programme and the work of ANIA, which supports the adoption of innovation. Digital dermatology is a key project that is now being implemented across NHS Scotland and will reduce waiting times and support early diagnosis.

Christine McLaughlin invited Chairs to reflect on how implementation and learning is going in their board with regards to innovation and digital dermatology in particular.

Neena Mahal, Interim Chair, NHS Forth Valley, added that further developments on AI driven dermatology is being taken forward in NHS Forth Valley as part of the south east innovation hub. This would include diagnosis within 25 minutes using the technology, this would then be checked by senior dermatologists.

Colleagues reflected on the scale of challenge that digital innovations can have on digital teams within boards. Often these teams have limited resources including workforce and technology infrastructure. The fragility of these services should be taken into account and learning taken from this.

Feedback from NHS Chairs private meeting

The Cabinet Secretary invited Carole Wilkinson, Healthcare Improvement Scotland, and Chair of NHS Chairs Group, to provide feedback from the NHS Chairs private meeting. 

Carole Wilkinson noted the themes reflected in the discussion on Monday included:

• reform and improvement – Caroline Lamb
• consistent national messaging to support local arrangements 
• finance – Richard McCallum
• Chairs discussed the difficult decisions required to manage the financial situation and asked for political support and cover when difficult choices are being discussed

Any other business

The Cabinet Secretary and NHS Chairs took the opportunity to thank Richard McCallum for his support over the years as Director of Health and Social Care Finance, Digital and Governance and wished him well for his new role as Director of Public Spending in the Scottish Exchequer.

There were no items of other business.

Date and time of next meeting

The next NHS Chairs meeting will be scheduled for August with date/time to be confirmed it will be a virtual meeting.