NHS Chief Executives Meeting: January 2024

Attendees and apologies

NHS Boards

• Crawford McGuffie, NHS Ayrshire and Arran, Medical Director/Co-Chair of SAMD (on behalf of Claire Burden)
• Ralph Roberts, NHS Borders
• Katy Kerr, NHS Dumfries and Galloway, Finance Director (on behalf of Jeff Ace)
• Carol Potter, NHS Fife
• Amanda Croft, NHS Forth Valley, Interim Chief Executive
• Adam Coldwells, NHS Grampian, Interim Chief Executive
• Jane Grant, NHS Greater Glasgow and Clyde
• Pamela Dudek, NHS Highland
• Jann Gardner, NHS Lanarkshire
• Calum Campbell, NHS Lothian
• Laura Skaife-Knight, NHS Orkney
• Brian Chittick, NHS Shetland
• Caroline Hiscox, NHS Tayside, Interim Chief Executive
• Gordon Jamieson, NHS Western Isles

Special Health Boards

• Robbie Pearson, Healthcare Improvement Scotland (Chair of CEs)
• Jim Miller, NHS 24
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Ruth Glassborow, Public Health Scotland, Director of Place and Wellbeing (on behalf of Paul Johnston)
• Michael Dickson,  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
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Saira Kapasi, Head of Support for DG HSC and CE NHS Scotland
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• John Harden, Deputy National Clinical Director
• Donna Bell, Director of Social Care and NCS Development
• Angie Wood, Director of Social Care Resilience and Improvement
• Christine McLaughlin, Co-Director of Population Health
• Tom Ferris, Chief Dental Officer
• Alison Strath, Chief Pharmaceutical Officer
• Robert Kirkwood, Head of People, Governance and Appointments

Other Attendees

• Lorraine Cowie, Head of Strategy and Transformation, NHS Highland (on behalf of Kirstin Dickson, Chair of Directors of Planning)
• Susan Webb, Director of Public Health, NHS Grampian
• Crawford McGuffie, Co-Chair of Medical Directors/Medical Director, NHS Ayrshire, and Arran (also deputising for Claire Burden)
• Julie Carter, Director of Finance, SAS
• Jacqui Jones, Director of HR, NHS Lanarkshire
• Claire Pearce, Chair of SEND/NMAHP Director and Deputy Chief Executive, NHS Tayside
• Scott Urquhart, Director of Finance, NHS Forth Valley
• Craig Marriott, Director of Finance, NHS Lothian
• Fiona Bennett, Interim DD NHS, Integration and Social Care Finance, Scottish Government

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hildersley, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, Executive Support Team

Apologies

• Claire Burden, NHS Ayrshire and Arran (Crawford McGuffie attending)
• Jeff Ace, NHS Dumfries and Galloway
• Paul Johnston, Public Health Scotland (Ruth Glassborow attending)
• Kirstin Dickson. Chair of Directors of Planning/Director of Planning, NHS Ayrshire, and Arran (Lorraine Cowie attending)
• Jason Leitch, National Clinical Director
• Richard Foggo, Co-Director of Population Health
• Stephen Gallagher, Director of Mental Health
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Tim McDonnell, Director of Primary Care
• Andrew Watson, Director for Children and Families
• David Plews, Head of NHS Service Development

Items and actions

Minutes

Welcome, apologies for absence and attendees

Caroline Lamb, DG Health and Social Care and Chief Executive NHS Scotland, welcomed everyone to the meeting. 

Caroline thanked Chief Executives for their ongoing leadership, and for the continued hard work of their teams through this challenging time. This was a time to come together, innovate and embrace this challenge as an impetus for change.

The UK Covid-19 inquiry hearings would be held over the next few weeks in Edinburgh. This would, no doubt, draw in significant media interest and Caroline asked Chief Executives to be aware and ensure capacity within their communications team for queries coming out of this. 

Caroline advised Alex McMahon would officially retire from his role as Chief Nursing Officer (CNO) on 17 May. Anne Armstrong, currently the Deputy Chief Nursing Officer, would work alongside Alex in the role of interim CNO as he reduces his working weeks, towards his retirement. Anne will take on the role of Interim Chief Nursing Officer from 26 April 2024. Recruitment to the substantive role of CNO would commence towards the end of this year and an update on timescales would be provided in due course.

The Cabinet Secretary for NHS Recovery, Health and Social Care asked if officials could consider and deliver a budget session for Chairs and Chief Executives to update them on the situation. His office was advised that finance would be the main agenda item at today’s meeting and that there would be a finance deep dive at the next Chairs meeting on 29 January.

A list of attendees and apologies for absence are provided in annex a. 

Minutes of the previous meeting – 15 November 2023 – NHSCE/23/24/22

The minutes of the meeting held on 15 November 2023 were approved.

Three actions noted from the previous meeting have been completed and the remaining one is in progress.

Matters arising

There were no matters arising.

Feedback from Chief Executives operational meeting

Robbie Pearson, Chief Executive, Healthcare Improvement Scotland/Chair of NHS Chief Executives Group provided feedback from the Chief Executives operational meeting. This included discussion on:

• national care service
• financial outlook
• covid – lessons learned

Finance – NHSCE/23/24/23

Richard McCallum, Director for Health and Social Care Finance, Digital and Governance introduced this item to colleagues. A short paper had been circulated to colleagues in advance, sharing again the budget letter which issued in December 2023 which set out the position for boards.

Richard talked to a couple of slides during the meeting which included:

• health and social care reform 2024/25

Discussion followed around the budget position and corresponding work required by NHS Scotland to set out the range and scale of options required to move to financial balance. One of the biggest pressures will be the provision for 2024-25 pay offer and agenda for change reform. The Cabinet Secretary recognises the financial challenge and is keen to understand what reform is necessary to address this. 

Calum Campbell, Chief Executive, NHS Lothian, advised that he and his teams were committed to having a plan by 31 March 2024 with some difficult decisions to be made.

Craig Marriott, Director of Finance, NHS Lothian, outlined NHS Lothian’s position and steps they are looking at to achieve financial balance and a plan going into 2024-25. The 9- step programme of work included:

• bridging actions
• corporate controls
• stop and assess – service capacity
• LSDF-led major service change
• stop ana Assess – treatment options
• (permanent) choices
• efficiency programmes
• national workstreams
• communication and engagement

In summary, Craig noted a forecast deficit of £133 million which equates to circa 7% efficiency target across NHS Lothian. There is a commitment to have a plan in place by 1 April 2024 with the focus being on bridging actions before impacting on clinical care. Other priorities would need to be curtailed to meet the financial challenge. Finance underpins the 3 strands of governance and will need real change with robust authorisation management.

Amanda Croft, Interim Chief Executive, NHS Forth Valley, introduced Scott Urquhart, Director of Finance, NHS Forth Valley who outlined NHS Forth Valley’s position and steps to be taken. This included:

• baseline revenue budget
• annual fixed PFI costs subject to RPI inflation
• unfunded contingency beds in place
• projected deficit 2023/24 – under review (2%)
• 2023/24 savings plan – mainly on track: majority is non-recurring
• annual increase on supplementary staffing costs
• mitigating actions going into 2024/25 – immediate and medium term financial sustainability action plans
• engagement and appetite – key enablers such as:
  •  weekly executive leadership teams finance sessions and workshops
  • close engagement with partnership colleagues and area partnership forum
  • video messages/staff and boards comms briefings/”Spend Well” campaign

It was noted that the plan would continue to evolve, with the performance and resources committee looking at the detail around the plan and assessment of what initial savings are required for 2024-25.

Laura Skaife-Knight, Chief Executive, NHS Orkney talked through a few slides sharing NHS Orkney’s position following escalation of the board for finance in November 2023. This included:

• actions taken from the first stage of formal escalation
• drivers of deficit and 2023-24 financial position
• NHS Orkney’s responses to financial challenge – in year opportunities

Laura noted that escalation status has encouraged impetus and focus on recovery and there is a lot of change underway. The whole organisation has been mobilised to engage colleagues and to have open and honest communications with staff, the local community, and the media, with regular doard Development sessions on finance and recovery taking place. 

A discussion followed in relation to various aspects from the presentations. All agreed that there were common themes across the individual board plans. All 3 contributors today referenced the need to take forward actions in a cohesive way across all boards. Ministers are aware of the pressures, and conversations will follow around the scale of the financial challenges going forward. It was noted that allocations from the Scottish Government were also being reviewed to address the financial challenge. 

Caroline Lamb thanked Chief Executives for their honesty, commitment, and hard work. She stressed the importance of working through what the whole system options would be and how the work would be done. A bespoke, targeted, and focussed conversation would be required to look at a national approach as far as possible. It was important to get the right results in the short, medium, and longer terms and the Scottish Government would be keen to work with boards to understand where there could be risk and how to gather this information as a subset of wider work on vulnerable services. 

Action: Scottish Government and NHS Chief Executives to work closely in relation to the path to balance and be clear about actions and timelines

Any other business

There were no other items of business.

Date and time of next meeting

NHS Chief Executives Business meeting – Wednesday 13 March 2024 at 14:00. A decision would be made whether this will take place as hybrid or virtually and colleagues advised.

Office of the Chief Executive NHS Scotland