NHS Chairs and NHS Chief Executives joint meeting minutes: March 2022

Attendees and apologies

NHS Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders
• Nick Morris, NHS Dumfries and Galloway
• Tricia Marwick, NHS Fife
• Janie McCusker, NHS Forth Valley
• John Tomlinson, NHS Grampian
• John Brown, NHS Greater Glasgow and Clyde
• Boyd Robertson, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland
• 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, The State Hospitals Board for Scotland
• Suzanne Dawson, Scottish Health Council Healthcare Improvement Scotland

NHS Board Chief Executives 

• Claire Burden, NHS Ayrshire and Arran
• Ralph Roberts, NHS Borders
• Jeff Ace, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Cathie Cowan, NHS Forth Valley
• Caroline Hiscox, NHS Grampian
• Jane Grant, NHS Greater Glasgow and Clyde
• Pamela Dudek, NHS Highland
• Heather Knox, NHS Lanarkshire
• Calum Campbell, NHS Lothian
• Michael Dickson, NHS Orkney
• Michael Dickson, NHS Shetland
• Grant Archibald, NHS Tayside (part meeting)
• Claire Pearce, NHS Tayside   (attending on behalf of Grant Archibald)
• Gordon Jamieson, NHS Western Isles
• Robbie Pearson, Healthcare Improvement Scotland
• Jim Miller, NHS 24
• Karen Reid, NHS Education for Scotland
• Jann Gardner, NHS Golden Jubilee
• Vicky Bibby, Public Health Scotland (on behalf of Angela Leitch)
• Pauline Howie, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• Humza Yousaf, Cabinet Secretary for Health and Social Care
• Kevin Stewart, Minister for Mental Wellbeing and Social Care
• Maree Todd, Minister for Public Health, Women's Health and Sport
• John Paul Marks, Permanent Secretary
• Caroline Lamb, DG/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Dave Caesar, Senior Strategic Advisor (Attending on behalf of Director of HW)
• David Miller, Chief People Officer
• Jason Leitch, National Clinical Director
• John Harden, Deputy National Clinical Director
• Linda Pollock, Interim Director of Healthcare Quality and Improvement
• Richard McCallum, Director of Health Finance and Governance and Value
• Donna Bell, Director of Social Care and NCS Development
• Richard Foggo, Director for Covid Public Health
• Michael Kellet, Director of Population Health
• Tim Mcdonnell, Director of Primary Care
• Christine McLaughlin, Director of Testing
• Jonathan Cameron, Director for Digital Health and Care
• Gregor Smith, Deputy Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Tom Ferris, Chief Dental Officer
• Robert Kirkwood, OCENHS Team
• Laurie Whyte, OCENHS Team
• Kat Dobell, OCENHS Team
• Hannah Mackay, OCENHS Team
• Carol Hunter, OCENHS Team

Other attendees

• Colin Briggs, Director of Planning, NHS Lothian
• Alan Gray, Director of Finance, NHS Grampian
• Jacqui Jones, Director of HR, NHS NSS (also attending on behalf of Mary Morgan)
• Ann Gow, NMAHP Director and Deputy Chief Executive/Chair of SEND, Health Improvement Scotand
• Malcolm Summers, Head of Strategic Reform (for Care and Wellbeing Portfolio interests)
• Susan Webb, Public Health, NHS Grampian (on behalf of Director of Public Health)
• Rachel Nicholson, Deputy Private Secretary
• Graham Ellis, SCS, Directorate for CMO            
• Natali Dimitrova, Redress Scotland Implementation Team Leader 
• Kelly Savage, Private Secretary 
• Roslynn Barclay, Executive Support to NHS Board Chairs and Chief Executives
• Nicola Gordon, Executive Support Team NHS, Policy Adviser

Apologies

• Keith Redpath, NHS National Services Scotland, Chair
• Paul Edie, Care Inspectorate, Chair
• Mary Morgan, NHS National Services Scotland, Chief Executive (Jacqui Jones attending)
• Angela Leitch, Public Health Scotland, Chief Executive (Vicki Bibby attending)
• Gordon James, Deputy Chief Operating Officer - Performance and Delivery
• Graham Foster, Director of Public Health, NHS Grampian (Susan Webb attending)
• Nick Fluck, Medical Director/Co-Chair of SAMD
• Gillian Russell, Director of Health Workforce (Dave Caesar attending)
• Michael Chalmers, Director for Children and Families
• Gordon James, Deputy Chief Operating Officer - Performance and Delivery

Items and actions

Agenda

• welcome, apologies for absence and attendees (Caroline Lamb)
• Permanent Secretary remarks
• framing and context
  • key Message from Cabinet Secretary
  • update on NHS Recovery/Delivery Plan (John Burns)
  • update on Care and Wellbeing Portfolio (Richard Foggo and Christine McLaughlin) 
• emerging practices
  • delivering care as close to home as possible – an enhanced community offer (Robbie Pearson, CE, HIS and Pauline Howie, CE, Scottish Ambulance Service.
  • delivering care in Scotland’s remote and rural communities – building local with and in local communities (Michael Dickson, CE, NHS Shetland/Orkney)
  • working in partnership across the Public Sector - Caring for Ayrshire (Lesley Bowie, Chair, NHS Ayrshire and Arran)
• plenary session
  • structured discussion, led by Caroline Lamb
• actions/close

Welcome, apologies for absence and attendees 

Caroline Lamb, DG/CE NHS Scotland, welcomed everyone to the meeting. A list of those present ad apologies is provided.

Caroline highlighted the continued pressures on the system as it tried to move through and out of the pandemic. Despite the pressure, it remained important to focus on the scale of transformation that was required across health and social care and the opportunities that existed to deliver this. 

Permanent Secretary’s remarks

The recently appointed Permanent Secretary, John-Paul Marks, thanked colleagues on the call for their leadership during such a challenging period. Although there continues to be high COVID-19 hospitalisation numbers, he encouraged those present to take stock and begin to consider the transformational roadmap that will place the health and care system on a sustainable path.

Framing and context

Key message from the Cabinet Secretary

The Cabinet Secretary thanked the Permanent Secretary for his comments. He reflected that there have been many periods of challenge throughout the pandemic and paid tribute to the leadership shown. He acknowledged that the pandemic would be with us for many years and that it was essential that boards had in place effective delivery plans, which took account of emerging challenges. He expressed that it was essential for communications to the public to be clear and open, highlighting potential difficult trade-offs as the health and care system continues to respond and transform through the pandemic. Colleagues were also reminded that, despite the challenges, there was now an opportunity to change outdated practices and accelerate transform services. 

Update on NHS recovery/delivery plan 

John Burns, Chief Operating Officer for NHS Scotland, introduced the work that was being finalised to translate the Recovery Plan commitments, and Care and Wellbeing deliverables, into a Delivery Framework. He emphasised the importance of taking a “once for Scotland” approach to build on, improve and to drive forward ways of building a new and sustainable model of service. Recovery would need to be clear on what the priorities are, with a focus on high impact changes.

The challenge going forward was highlighted as continuing to respond and manage COVID-19, whilst also planning for the future.

Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship, presented slides which covered:

• overview of current planning landscape
• developing our NHS
• summary of delivery framework
  • progress Update – Planned Care and Unscheduled and Urgent Care
  • draft short and medium-term deliverables
  • next steps

Update on care and wellbeing portfolio 

Richard Foggo, Director for COVID Public Health, gave a brief overview of the progress to date on developing the Care and Wellbeing Portfolio. He noted that, as well as systems pressures caused by the pandemic, Scotland has also had historically acute levels of ill-health. The Care and Wellbeing Portfolio represented a joint endeavour to recover from the pandemic and deliver a healthy Scotland. 

Christine McLaughlin, Director of Testing, highlighted that the first NHS Recovery Plan, which was produced at the beginning of the pandemic, had been developed into a broader foundation for the Care and Wellbeing Portfolio. She indicated that there was now a need to develop a cohesive and clear Delivery Plan which included a prioritisation approach, taking account of the Resource Spending Review.

Emerging practices

Robbie Pearson, Chief Executive, Healthcare Improvement Scotland and Pauline Howie, Chief Executive, Scottish Ambulance Service delivered presentations on “Delivering care as close to home as possible – an enhanced community offer.” This covered:

• Hospital at Home
• HIS Service Innovation Spread Assessment
• HIS Support for spread of Hospital at Home model
• impact of Hospital at Home

Michael Dickson, Chief Executive NHS Shetland/Orkney, presented a slide pack on “Delivering care in Scotland’s remote and rural communities – building local with and in local communities”. This covered:

• working together – focusing on mental health, cancer, elective care, and radiology/diagnostics
• supporting the future:
  • using new technologies to enhance care and increase equity of access
  • driving sustainable models of care
  • embedding “No boundaries” 
  • flexible workforce offer (HMRC) 
  • leveraging innovation to accelerate net zero
  • using the uniqueness of the North to build capacity

Lesley Bowie, NHS Ayrshire and Arran, provided a slide presentation which covered “Working in partnership across the Public Sector - Caring for Ayrshire”. This covered:

• CfA, the past, the present and the future – a journey through time
• the difference in equalities and amenities
• pathogenesis/salutogenesis
• health and care system – shows different areas of care
• whole system approach (collaboration and partnership working, population health benefit)

It was noted that Caring for Ayrshire was a good example of the impact of partnership working within a mainly rural community with high unemployment and increased deprivation and inequalities.

Plenary session - sdiscussion, led by Caroline Lamb

Caroline Lamb led a structured discussion centred around key priority themes, which were: reframing the performance system discussion to focus on outcomes; system leadership and culture to drive transformation; and, communicating with the public. 

It was acknowledged that there was also a need to embed workforce planning into this work to ensure that roles requiring to be filled are clearly defined. It was also noted that a different approach would be required to encourage staff to react in a positive way to discussions about improvement and to support staff to change whilst they are working in a pressurised environment.

The discussion highlighted: tackling health inequalities and the need for a larger, pan-Scottish Government, COVID strategy with aims for addressing systemic inequalities; making progress to a wellbeing economy and creating fully inclusive public services; the opportunity to revisit the 2016 National Clinical Strategy; the importance of embedding workforce planning in the transformation work; and the need for collaborative governance arrangements across public services to support transformation.

It was recognised that tackling inequalities could not just be taken forward as part of the approach to health and care recovery, instead it needed to be seen as part of the broader SG recovery plan. Many of the issues that were drivers of inequalities (e.g. housing, education etc.) lay with other areas of government, so a whole system approach was essential for success. Angiolina Foster, Chair of Public Health Scotland, offered to provide a paper that describes a public health approach to prevention, though which partners across the system would work together to tackle the fundamental drivers of population health and inequalities. 

Action: Angiolina Foster, Chair, Public Health Scotland, to provide paper on behalf of Public Health Scotland in relation to a whole-system approach to prevention.

Actions/close

The Cabinet Secretary summarised that recovery will take years and it was important to be clear with communities about the scale of the challenges ahead. He reflected that performance measures would be important going forward and that investment into digital infrastructure would need to match the ambition. 

The need to frame the impact of pandemic in a positive way was raised by colleagues, as it has given the system an opportunity to re-design. The Cabinet Secretary expressed that it would be helpful to pick up the emerging key themes from the meeting and organise a deep dive.

The Permanent Secretary concluded that he would like another meeting with more time and focus on strategic transformation. Health and wellbeing is at the heart of everything and all portfolios and there was a requirement to keep sharing to ensure programmes are having the desired impact. It was essential to continue collaborating and learning with stakeholders and communities.

Caroline Lamb highlighted the next steps, including the issue of planning guidance on the Delivery Framework by late April, and that any decisions that are required in the short term decisions must be taken forward with a clear view that they will also contribute to the longer term aims. 

Action: deep dive on key themes to be arranged for a future date.