NHS Chief Executives meeting: January 2023

Attendees and apologies

NHS boards

• 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
• Jann Gardner, NHS Lanarkshire (joined at 14:30)
• Calum Campbell, NHS Lothian
• Michael Dickson, NHS Orkney and Shetland
• Grant Archibald, NHS Tayside
• Gordon Jamieson, NHS Western Isles

Special Health Boards

• Robbie Pearson, Healthcare Improvement Scotland
• Jim Miller, NHS 24
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Michael Kellet, Public Health Scotland, Director of Strategy, Governance and Performance
• Pauline Howie, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• 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
• John Harden, Deputy National Clinical Director
• Richard McCallum, Director of Health Finance and Governance and Value
• Angie Wood, Interim Director, Social Care Resilience and Improvement
• Gavin Gray, Deputy Director, Improving Mental Health Services
• Richard Foggo, Co-Director of Population Health
• Christine McLaughlin, Co-Director of Population Health
• Niamh O’Connor, Deputy Director, Social Research
• John Nicholson, Deputy Director for Testing & Contact Tracing Policy
• Gregor Smith, Chief Medical Officer
• Alison Strath, Chief Pharmaceutical Officer
• Naureen Ahmad, Deputy Director General Practice Policy Division
• Neil Robertson, Unit Head - General Practice Policy and Strategy
• Alan Gray, Infrastructure Planning Lead
• Robert Kirkwood, Head of the Office of the Chief Executive (part meeting)
• Kat Dobell, OCENHS Team
• Sarah Hildersley, OCENHS Team
• Carol Hunter, OCENHS Team

Other Attendees

• Colin Briggs, Director of Planning (NHS Lothian)
• Julie Carter, Director of Finance, NHS Grampian/Chair of Finance Directors
• Jacqui Jones, Director of HR, NSS/Chair of HRDs
• Claire Pearce, NMAHP Director, NHS Tayside/Chair of SEND
• Fraser McJannett. Executive Support to NHS Board Chairs and Chief Executives
• Dr Andrew Buist, Chair of the Scottish General Practitioners Committee
• Dr Andrew Cowie, Deputy Chair of the Scottish General Practitioners Committee
• Dr Patricia Moultrie, Deputy Chair of the Scottish General Practitioners Committee
• David Prince, Head of Primary Care Policy Officer, BMA
• Francesca Capaldi, Clinical Fellow (Observer)
• Lucy Pullar, OCENHS Team (Observer)

Apologies

• Angela Leitch, Chief Executive, Public Health Scotland
• Jason Leitch, National Clinical Director 
• Graham Ellis, Deputy Chief Medical Officer
• Donna Bell, Director of Social Care and National Care Service Development
• Tim Mcdonnell, Director of Primary Care
• Hugh McAloon, Interim Director of Mental Health
• Crawford McGuffie, Medical Director, NHS Ayrshire and Arran/Co-Chair of SAMD
• Ann Gow, NMAHP Director and Deputy Chief Executive/Chair of SEND

Items and actions

Agenda

• welcome, introductions and apologies for absence
• minutes of the previous meeting (12 October 2022)
• matters arising
• feedback from Chief Executives private meeting - (Ralph Roberts, Chief Executive NHS Borders/Chair of NHS Chief Executives Group)
• Primary Care update – NHSCE/22/23/16 - (Naureen Ahmed, Deputy Director General Practice Policy)
• finance update – NHSCE/22/23/17 - (Richard McCallum, Director of Health Finance and Governance)
• NHS reform (including sustainability and value) - (John Burns, Chief Operating Officer NHS Scotland)
• any other business
• date and time of next meeting
  • NHS Chief Executives business meeting – Wednesday 15 March 2023 at 14:00

Welcome, apologies for absence and attendees

Caroline Lamb, DG Health and Social Care and Chief Executive NHS Scotland, welcomed everyone to the meeting. A special welcome was extended to Jann Gardner, new Chief Executive NHS Lanarkshire and Gordon James, new Chief Executive NHS Golden Jubilee to their first meeting in their new roles. 

It was noted that Agenda items 6 and 7 would be discussed together with feedback from the Chief Executives paper on reform.

A list of attendees and apologies for absence are provided. 

Minutes of the previous meeting – 12 October 2022 

The minutes of the meeting held on 12 October 2022 were approved.

Matters arising

A late return to the update from SAH document was noted around industrial action. Unison, Unite and the CSP have accepted the pay deal and on 13 January 2023 RCN, GMB and RCM announced they were suspending industrial action in Scotland and entering into pay negotiations for 2023/2024.

Feedback from Chief Executives private meeting

Ralph Roberts, Chief Executive NHS Borders/Chair of NHS Chief Executives Group provided feedback from the private meeting. These included:

• Caroline Hiscox will take over from Robbie Pearson as Vice Chair of NHS Chief Executives Group in April 2023
• radiotherapy service for children and young persons
• cancer waiting time performance and other priorities
• digital items:
  • IT support for new Hearing Screening Service
  • E-rostering
  • IT interface issues
  • Covid Inquiry
• redress scheme
• systems pressures and reform

Primary care update -

Naureen Ahmed, Deputy Director General Practice Policy introduced Dr Andrew Buist, Chair, Dr Andrew Cowie, Deputy Chair and Dr Patricia Moultrie, Deputy Chair, members of the Scottish General Practitioners Committee (SGPC) and David Prince, Head of Primary Care for BMA. 

Dr Andrew Buist advised the BMA meets with the Cabinet Secretary 4 times a year, with the last meeting taking place in November 2022. The Cabinet Secretary asked the group to come to this meeting to reinforce the critical alignment between GPs and Boards. Dr Buist asked the Chief Executives for reflections on GP services given the huge system pressures currently being experienced.

The Chief Executives welcomed the opportunity to engage with GPs and the following points were discussed:

• GP premises and the expanding population issues
  • local housing developers must adhere to legislation that ensures they make provisions for schools. Legal advice has suggested this legislation can be used to make provisions for health. A Local Government Planning Act is currently going through Parliament and there is the opportunity for health requirements to be included
• how to maximise local services
  • the need to reprofile the model and for NHS boards to work closely with GPs and HSCPs on how to do this
• the need for appropriate services around chronic conditions, including utilisation of nurse practitioners and pharmaceutical resources, where appropriate
• an interface group has been running for a number of years looking at Practice sustainability and the interface of the system. Key issues on:
  • Practices at high risk
  • discussions required around collaborative working with ntegration Joint Boards (IJB) and the Scottish Government to be able to sustain the system in the future
• NHS Education for Scotland (NES) has looked at what support they can provide for wellbeing and training in mental health for GPs and community pharmacists across Scotland
• The Scottish Ambulance Service (SAS) already work closely with Primary Care colleagues and asked if there was more support they could provide

Gregor Smith, Chief Medical Officer emphasised the critical role that GPs undertake in the system and highlighted the many issues they have had to respond to in the past 3 years. He highlighted the urgent need to have a clear vision on new approaches that address the needs around secondary prevention, such as cardiovascular care, before next winter.

Dr Buist concluded it was a productive first discussion. He reflected on the needs of patients and the importance of continuity of care through primary and acute sectors. He highlighted the need for a national conversation, to improve the quality of data and to build on the ideas of realistic medicine and establish appropriate expectations in the population. Recruitment in remote and rural areas remain a challenge and the workforce needs to be built up to be able to fill these posts. It was agreed that regular conversations are crucial at national and local levels to address the range of issues.

It was agreed that Naureen Ahmed would set up a smaller group to take discussions further with Chief Officers and the BMA and return to the larger group with an update. She thanked Dr Buist, Dr Cowie, Dr Moultrie and David Prince for their input.

Action: Naureen Ahmed to set up smaller groups including Chief Officers and the BMA to discuss issues, before returning to the main group with an update

Caroline Lamb noted the Cabinet Secretary for Health and Social Care would be provided with an update on this item

Action: Naureen Ahmed to provide feedback on this agenda item to the Cabinet Secretary for Health and Social Care

NHS reform (Including sustainability and value)/finance update – NHSCE/22/23/17

Christine McLaughlin, Co-Director Population Health advised that work has been undertaken between the NHS Chief Executives support team and the Care and Wellbeing portfolio team to ensure coherence across the various pieces of work on reform, sustainability and value.

John Burns, NHS Scotland Chief Operating Officer stated that building on our recovery work and work to renew and transform is key and discussions have recently taken place on how to approach that. With the system currently in a recovery phase, it was suggested that the focus should be on how to develop and deliver on key priorities. The aim was to provide advice to the Cabinet Secretary this week on some of that process. 

It was acknowledged that the revised Chief Executives paper had not been seen by all colleagues and it would be circulated in due course.

Action: Ralph Roberts to circulate the revised Chief Executives paper/feedback to Chief Executives and Scottish Government colleagues by 27 January 2023

Colleagues noted that:

• guidance is required on how/what to prioritise and improve. Important to use broader assets in the system and capitalise on all expertise and all professions
• to enable activity around reform boards need permission to act including: open sharing of information; authorisation; political engagement; and, public understanding
• inequalities remained a key issue
• cardiovascular disease highlighted as a clinical priority
• improvement required in data gathering
• better performance matrices are necessary to support work towards a sustainable system
• aligning reform with financial plans and the constraints around this

Finance update – (Richard McCallum, Director of Health Finance and Governance)

Richard McCallum, Director of Health Finance and Governance and Value provided a paper for the meeting. He noted the need to be clear about what will be delivered via the sustainability and value programme. A finance meeting is scheduled for Friday 20 January with Directors of Finance. Financial reports have been shared with Directors of Finance and will be shared with Chief Executives.

Action: Richard McCallum to share Financial Reports with Chief Executives

Caroline Lamb stated a discussion paper will be prepared on performance and sustainability which will help to inform what can be achieved in the short term and a paper will also be prepared on how to transform and redesign services. There are a number of strategies dating back to 2010 that need to be considered and it will be important to discuss how these are currently being interpreted and implemented. 

Action: John Burns, Chief Operating Officer co-ordinate paper on performance and sustainability to inform short term work

Any other business

There was no other business.

Date and time of next meeting

NHS Chief Executives Business Meeting – Wednesday 15 March at 14:00.