NHS Chairs minutes: October 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
• Peter Murray, Vice Chair, NHS Lothian (on behalf of John Connaghan)
• 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
• Doug Moodie, Care Inspectorate
• 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
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Hugh McAloon, Interim Director of Mental Health and Wellbeing
• Alex McMahon, Chief Nursing Officer 
• Alison Strath, Chief Pharmaceutical Officer
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Saira Kapasi, Head of Support for DG HandSC and CE NHS Scotland
• Robert Kirkwood, Head of People and Governance Team

Secretariat

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

• Annie Gunner Logan, Vice Chair, NHS Education for Scotland (observer attending with David Garbutt)
• Neil Harrison, Team Leader Healthier Marketing (observer for Winter comms)
• Susan Gallagher, Deputy Director of General Practice Policy (attending for Primary Care Item)
• Andrew Chapman, Unit Head - GP Contact and Operation (attending for Primary Care Item)
• David Notman, Policy Adviser – Dentistry, Optometry and Audiology (attending for Primary Care Item)
• Sean More, Senior Policy Officer – Primary Care (attending for Primary Care Item)
• Josh McGinlay, Senior Policy Officer – Primary Care (attending for Primary Care Item)
• Lorna Kelly, National Strategic Lead for Primary Care, Health and Social Care Scotland (attending for Primary Care item)

Apologies

• John Connaghan, NHS Lothian (Peter Murray attending)
• John Harden, Deputy National Clinical Director
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gregor Smith, Chief Medical Officer
• Stephen Gallagher, Director for Mental Health 
• Donna Bell, Director of Social Care and NCS Development
• Tim McDonnell, Director for Primary Care
• Andrew Watson, Director for Children and Families
• 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 in person and virtually.

The Cabinet Secretary welcomed Annie Gunner Logan, recently appointed as Vice Chair, NHS Education for Scotland, who attended the meeting alongside David Garbutt, as an observer.

The Cabinet Secretary highlighted that this was the first meeting with Carole Wilkinson who recently took on the role of Chair of NHS Chairs Group and Alison Evison as Vice Chair and he looked forward to working them in this capacity.

The Cabinet Secretary thanked John Brown, Chair of NHS Greater Glasgow, and Clyde, as this was his last NHS Chairs meeting before stepping down from his role at the end of November. John has been in post since 1 December 2015 and served two terms as Chair. He has also been instrumental in developing the blueprint for good governance for NHS Scotland and the global citizenship programme. 

To help with inclusivity with those attending virtually, the Cabinet Secretary reminded in-person attendees to join the meeting from their laptop with the volume on their laptops and their mics muted.

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 21 August 2023 were approved.

Matters arising

There were no matters raised.

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

• NHS Chairs to review current governing processes on whistle blowing and ensure a culture of accountability and action within the organisation to assure the public and ministers that issues are appropriately managed – this would be covered during today’s meeting
• NHS recovery and performance item to include trend slides on demand and capacity for future NHS Chairs meetings and Directorate of the Chief Operating Officer to consider the management data available with a view to including data on longer cancer waiting times for future NHS Chairs meetings – both of these actions have been incorporated into the NHS recovery and performance item on today’s agenda
• Hugh McAloon to share Mental Health delivery plan with NHS Chairs for feedback – the Mental Health delivery plan was shared with IJBs, Chief Executives, Health and Social Care Partnership Chief Officers and third sector interfaces

The following actions were noted as closed items:

• NHS Chairs to consider what they are doing to raise awareness of the Medication Assisted Treatment (MAT) standards in their board, and how to encourage accountability for delivery, particularly in supporting services, such as primary care, mental health, and beyond
• NHS Chairs to consider the level of funding available, and the information available to them, and consider whether the board is truly maximising the resources they have or whether more needs to be done to make full use
• NHS Chairs to consider how, as leaders, they can support mental health and substance use services to participate in this work and deliver better outcomes for people with co-occurring conditions

Cabinet Secretary remarks 

The Cabinet Secretary advised he was keen to work with NHS Chairs on delivering a plan to reduce waiting times and noted work had been done on what could be achieved over the next three years. This would look at how to utilise new annual funding of £100 million to help reduce inpatient and day-case waiting lists by an estimated 100,000 patients over the next 3 years and how to manage resources to maximise the use of National Treatment Centres.

The Cabinet Secretary advised NHS Chairs that the winter plan would be published in Parliament on 24 October 2023. The plan brings together best practice and improvement work, learning from previous winters and focuses on two key elements: Hospital at Home and recruitment to the Scottish Ambulance Service (SAS). He added that, the Winter Communication Plan has now been issued to NHS boards. This is a joint communication plan developed in collaboration with NHS Scotland to provide a whole system approach to communications over winter.

The Cabinet Secretary indicated that, this winter, NHS boards were better prepared and had more data around issues in the system. He thanked NHS Chairs for their input to feed into the process, encouraging them to ensure they have appropriate channels of engagement to touch base with local stakeholders and give them assurances about winter. He noted that it was the NHS Chairs’ responsibility to deal with localised media issues and to ensure they had a sufficiently trained spokesperson.

Finally, the Cabinet Secretary thanked NHS Chairs for their staff nominations for the Scottish Health Awards which will take place on Thursday 2 November at the O2 Academy in Edinburgh.

Action: NHS Chairs to ensure they have a trained spokesperson to deal with localised media issues.

NHS recovery and performance - NHSC/23/24/08 (John Burns)

John Burns, NHS Scotland Chief Operating Officer provided a summary of progress from the last meeting via a slide presentation and highlighted areas where there were positive trends. This covered:

• planned care:
  • new outpatient/inpatient/day cases
  • planned care activity
  • centre for sustainable delivery key principles
  • releasing outpatient capacity through design
  • NECU waiting list validation
  • cancer performance
• urgent & unscheduled care:
  • NHS 24
  • SAS
  • accident and emergency core sites weekly unplanned attendances
  • emergency admissions and average length of stays
• delayed discharges sitrep
• whole system data dashboard

 John Burns advised that there two data dashboards have been developed. Whole system and social, care which provide insight into current and emergent pressures in the system. John noted that the data showed what was going on in other parts of the country, by NHS Board and HSCP. The new dashboards would be available during November.

NHS Chairs were encouraged to explore with their teams what work was being taken forward and what impact it would have to help and support the unscheduled care and delayed discharge pressures.

Tom Steele, (SAS) stressed the importance of clinical leadership in making sure plans are working on the ground to get patients into wards to free up delayed discharge. The Cabinet Secretary was keen to get the SAS perspective over the next few weeks to see if there was improvement. 

John Brown, NHS Greater Glasgow, and Clyde commented that Clinical Leaders need appropriate support and training to have the level of expertise required before taking on their role. The Cabinet Secretary noted he was open to exploring any issues and putting a plan in place to help develop leaderships skills. He asked NHS Chairs to look at their area to see if there is a need to take forward.

Action: NHS Chairs to explore with their teams what work was being taken forward and what impact it would have to help and support the Unscheduled Care and Delayed Discharge pressures.

Action: NHS Chairs to look at the need for a formal plan to help develop clinical leaderships skills.

Quality assurance (post Letby) – progress update - NHSC/23/24/09 (Alex McMahon)

Alex McMahon, Chief Nursing Officer stated that he had been looking at assurance work with his co-chairs of the quality assurance group, Gillian Russell, Director of Health Workforce and Jason Leitch, National Clinical Director. 

The Cabinet Secretary previously wrote to NHS boards to seek assurance around clinical and corporate governance and how they used it. NHS boards provided a large range of issues and much information to look at in its entirety. The quality assurance group has met twice and agreed terms of reference. 

It was agreed that minutes and papers would be published, and the rroup would report to the Health and Social Care Management Board (HSCMB) and risk committee. The UK Government have engaged with regulators, members of public and families. Work will start next month on three key areas: family’s experiences; conduct of staff and boards; leadership; and effectiveness of management. 

It was noted that the going forward the group will focus on transparency, learning and encouraging people to be confident to speak out and raise issues to eradicate the stigma around whistleblowing. It will also seek to identify any gaps in the governance system.

The Cabinet Secretary proposed that considering the Thirlwall Inquiry, quality assurance should become a standing item for the next few months as work progresses. This will be monitored at each meeting as appropriate.

Action: Secretariat to arrange for quality assurance (post Letby) – progress update item to be added as a standing item at future NHS Chairs meetings.

Primary care – NHSC/23/24/10 (Susan Gallagher)

Susan Gallagher, Deputy Director of General Practice Policy, introduced Andrew Chapman, Unit Head - GP Contact and Operations provided an update on the role of primary care in the system, strategic reform, and multi-disciplinary teams within the context of wider health and social care reform and the future role of the GP. 

David Notman, Policy Adviser – Dentistry, Optometry and Audiology then updated NHS Chairs on reform of dentistry and optometry services. It was noted that there has been significant recovery of dentistry services, but that payment reform was challenging.

Alison Strath, Chief Pharmaceutical Officer, followed with an overview of reform of pharmacy services. She informed NHS Chairs about the work of NHS Pharmacy First Scotland, the digital prescribing and dispensing programme and advances in pharmacogenomics. Work is also underway with NHS National Services for Scotland to invest in prescribing training, with the aim that all pharmacists graduating from 2026 onwards being qualified as independent prescribers.

Two territorial Chairs, Lesley Bowie, NHS Ayrshire and Arran and Alison Evison, NHS Grampian, and Vice-Chair of NHS Chairs group, highlighted a range of projects and developments in primary care in their local systems. Alison Evison advised that in response to sustainability challenges NHS Grampian has three workshops scheduled for autumn 2023 on developing a shared vision for general practice. The first workshop identified mental health and wellbeing; digital learning; and information sharing as areas of focus for a whole system approach locally, noting that additional sustainability challenges would benefit from a national approach. 

Carole Wilkinson, Healthcare Improvement Scotland (HIS) and Chair of Chairs group, advised that HIS was working with colleagues in the Scottish Government around GP contracts, supporting learning and development and GP clusters, lead role in the SPSP in primary care and in demonstrating the benefits for GPs and patients of MDTs.

The Cabinet Secretary concluded that the discussion highlighted aspects of primary care where services are evolving. He emphasised the importance of multi-disciplinary teams and how they are critical to meeting future demands and ensuring patients have access to the right care at the right time. He also reminded NHS Chairs of the need to keep the public informed. Progress will continue to be monitored and discussed at a future NHS Chairs meeting next year.

Feedback from NHS Chairs private meeting

Carole Wilkinson, Healthcare Improvement Scotland (HIS) and Chair of Chairs group fed back from the morning’s NHS Chairs private meeting. Discussions took place around:

• the overarching role of NHS Chairs 
• national and regional planning
• healthcare and death in custody
• development of an action plan for the away day scheduled for November

Any other business

There was no other business raised.

Date and time of next meeting

The next NHS Chairs meeting will take place virtually on 11 December 2023. 

Office of the Chief Executive for NHS Scotland