NHS Chief Executives Meeting: March 2024

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 Jeff Ace for his service as Chief Executive of NHS Dumfries and Galloway. She also thanked Pam Dudek for her time as Chief Executive of NHS Highland. Both Jeff and Pam demit office on 31 March 2024. 

Caroline welcomed Julie White incoming Chief Executive of NHS Dumfries and Galloway and Fiona Davies incoming Chief Executive of NHS Highland to the meeting and looked forward to working with them. 

Caroline highlighted that Jason Leitch, National Clinical Director had announced he would be moving on from his current post and she thanked him for his service, especially during the COVID pandemic. There would be time to reflect on his contributions before he leaves the role on 30 April 2024.

Caroline also thanked Alex McMahon for his time as Chief Nursing Officer has and noted that Alex has now reduced his working week to 3 days ahead of his retirement on 17 May.

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

Minutes of the previous meeting – 17 January 2024 – NHSCE/23/24/25

The minutes of the meeting held on 17 January 2024 were approved.

One action was noted from the previous meeting as being complete. However Caroline reflected that ongoing discussion will continue between Scottish Government and NHS Chief Executives regarding the path to balance. 

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:

• board sponsorship including new framework documents for territorial and national NHS boards
• office 365 licences
• use of agency staffing
• structure around non-pay elements of agenda for change
• financial position

Financial and system balance – NHSCE/23/24/26

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 outlining the agenda item for discussion/next steps. 

Richard talked to a presentation during the meeting with key points including:

• financial position 23/24 and 24/25
• financial challenge
• decision laking Levels
• 3% recurring savings target
• level C decisions and 15 box grid
• polypharmacy
• non elective spells average length of stay
• medicines switches
• planning and delivery board and choices programme

Craig Marriott, Director of Finance, NHS Lothian then talked to a presentation following recent discussions with NHS Directors of Finance. It was stated that the presentation had a single focus on finance only. The key points included:

• scale of financial planning
• approach
• underpinning principles
• access funding (scheduled care)
• allocations
• medicines
• workforce
• national programmes
• next Steps

Craig encouraged Chief Executives to take action now and that short term actions may provide some stability to take a more measured approach for a sustainable system as boards move forward. 

Richard McCallum added that a review on previous commitments was under way. The consequential funding received from the UK Government was less than expected and a risk based judgement regarding funding received in the future is essential, to give Chief Executives’ clarity on what it would mean for boards. It was recognised that the 3% Recurring Savings Target would not be enough to balance and would only take reform so far therefore focus would be on further choices. 

Discussion followed around the budget position and corresponding work undertaken by NHS Scotland to set out the range and scale of options required to move to financial balance. A conversation would be required to articulate to Ministers, the impact of proposals. Richard McCallum and Caroline Lamb are meeting with the Cabinet Secretary on 14 March to discuss the current position and next steps. 

Caroline Lamb reiterated that this item was purely finance focused, and that all present understood the need to balance funding against quality and safety and delivery. She flagged the costs associated with supplementary staffing and encouraged Chief Executives a to engage with HR Directors to look at how boards could offer greater flexibility and family friendly working.

Calum Campbell, NHS Lothian noted that a plan is required for balance and there was potential for Directors of Finance (DoFs), Chief Executives and Scottish Government colleagues to agree and collectively move forward together. With regards to agency work, boards do offer flexibility but there was a need to underpin this with service change. There was opportunity now to get into detail on what to do on a one Scotland basis.

Karen Reid, NHS Education for Scotland (NES) suggested looking at workforce diversification, linking to savings management and fiscal sustainability and questioned whether posts needed to be filled like for like. She also noted that under the suggestion to pause national digital platform and digital front door, NES had permanent contractual and legal liabilities totalling c£6m which meant the net saving was £3m not the proposed £9m per annum.

Adam Coldwells, said that NHS Grampian was keen for a Once for Scotland approach however had concerns around some Boards not being able to provide basic provision if not utilising agency Staff. Chief Executives are tasked with balancing staff governance, financial and clinical governance. Boards needed to be risk informed towards what is best for the public and staff. Pressure on finance needs to be reshaping the NHS into what is affordable and sustainable. 

Calum Campbell, NHS Lothian, added that we need a sustainable model and if actions were not taken now, the impact would be a significant deterioration in performance. This would require a national strategy to have an affordable system with the key focus on being explicit about the balance between national action and local change.

All agreed that a national view was needed and difficult decisions made quickly, centred upon prioritising what changes could be made in the short term. Engagement with trade unions would be crucial. 

Richard McCallum added that the new financial year would be starting in two weeks. There were challenges around receiving consequentials late and the Scottish Government has made a commitment to Ministers to get this moving quickly, working through it from a national perspective. Additional allocations were being looked at now rather than later. 

Action: Richard McCallum to review allocation of consequentials to prepare for 2024/25

NHS recovery and performance – NHSCE/23/24/27

John Burns, Chief Operating Officer introduced this item to colleagues. A short paper and presentation had been circulated to colleagues in advance of the meeting setting out what would be discussed:

• planned care/waiting lists
• unscheduled care
• cancer Waiting Times

Discussion followed around the main areas of challenge. Chief Executives were asked for assurances from teams that boards were maximising services, using the National Elective Coordination Unit (NECU) validation programme and continuing to work with centre for sustainable delivery. The data showed that boards that utilised these programmes were seeing a positive impact in their system. The UK Government is due to release their NHS Improvement plan on productivity next month and Scottish Government is looking at productivity in the widest sense on cross working and collaboration. 

Action: Dougie McLaren, Deputy Chief Operating Officer – Performance and Delivery, to bring to Chief Executives Scottish perspective on the productive operational opportunities.

Pam Dudek, NHS Highland, stressed that the correct language is important in keeping people engaged when discussion productivity. She also questioned needing a simultaneous conversation around mental health sustainability and unscheduled care reform. Today’s meeting focussed on the acute side, but it needs to be about the whole system. It was agreed that there needed to be a future session with Mental Health Policy colleagues to look at the strategy and planning for performance and reform in this area. 

ACction: Mental Health Policy colleagues to come to a future NHS CE business meeting to discuss strategy and planning for performance and reform

Any other business

There was no other business raised. Caroline thanked everyone for their time and commitment during these difficult and busy times and colleagues would continue to work closely together to deliver the change required. 

Date and time of next meeting

NHS Chief Executives Business Meeting – Wednesday 8 May 2024 at 14:00. This meeting will take place fully virtually. 

Office of the Chief Executive NHS Scotland