NHS Chief Executives Meeting: May 2023

Attendees and apologies

NHS 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
• Jann Gardner, NHS Lanarkshire
• Laura Skaife-Knight, NHS Orkney
• Michael Dickson, NHS Shetland
• Grant Archibald, NHS Tayside
• Gordon Jamieson, NHS Western Isles
• Robbie Pearson, Healthcare Improvement Scotland
• Steph Phillips, NHS 24, Director of Transformation, Strategy, Planning and Performance
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Paul Johnston, Public Health Scotland
• Pauline Howie, Scottish Ambulance Service
• Gary Jenkins, State Hospital

Scottish government

• Michael Matheson, Cabinet Secretary for NHS Recovery, Health, and Social Care
• 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
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health Finance and Governance
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Angie Wood, Director of Social Care Resilience and Improvement
• Christine McLaughlin, Co-Director of Population Health
• Alex McMahon, Chief Nursing Officer
• Hugh McAloon, Interim Director of Mental Health and Wellbeing
• Alison Strath, Chief Pharmaceutical Officer
• Laura Zeballos, Deputy Director, Health Workforce Pay, Practice and Information Governance
• David Plews, Head of NHS Service Development
• Mo Rooney, Deputy Director, Safer Communities
• Gavin Gray, Deputy Director, Improving Mental Health Services
• Nina Mackenzie, Clinical Leadership Fellow, Medical Education, Training and Development

Functional group directors

• Colin Briggs, NHS Lothian Director of Planning/outgoing Chair of Directors of Planning
• Kirstin Dickson, NHS Ayrshire and Arran Director of Planning/incoming Chair of Directors of Planning
• Nick Fluck, NHS Dumfries and Galloway Medical Director/Co-Chair of Medical Directors Group
• Susan Webb, Chair of the Scottish Directors of Public Health (NHS Grampian)
• Anne MacPherson, NHS Greater Glasgow and Clyde Director of HR and Organisational Development
• Anne Marie Cavanagh, NHS Golden Jubilee Executive Nurse Director

Secretariats

• 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 to NHS Board Chairs and Chief Executives

Apologies

• Jim Miller, NHS 24
• Crawford McGuffie, NHS Ayrshire and Arran Medical Director/Co-Chair of Medical Directors Group
• Jacqui Jones, NHS National Services Scotland Director of HR/Chair of HRDs
• Claire Pearce, NHS Tayside NMAHP Director and Deputy Chief Executive/Chair of SEND
• Donna Bell, Director of Social Care and NCS Development
• Stephen Gallagher, Director of Digital Health and Care
• Tom Ferris, Chief Dental Officer
• John Harden, Deputy National Clinical Director
• Graham Ellis, Deputy Chief Medical Officer
• Andrew Watson, Director for Children and Families
• Robert Kirkwood, Head of People, Governance and Appointments

Items and actions

Minutes

Welcome, introductions and apologies for absence

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

Caroline thanked Ralph Roberts for his input over the past 2 years as Chair of the NHS Chief Executives Group. She then welcomed Robbie Pearson, Chief Executive, Healthcare Improvement Scotland, former Vice-Chair as the new Chair and Caroline Hiscox, Chief Executive, NHS Grampian as the new Vice-Chair.

Caroline welcomed Laura Skaife-Knight, Chief Executive, NHS Orkney and Paul Johnston, Chief Executive, Public Health Scotland to their first NHS Chief Executives Business meeting, since taking up their roles. She also introduced Fiona Hogg, who has joined the Scottish Government as the new Chief People Officer for NHS Scotland. 

Mo Rooney and Gavin Gray, as part of their Developing Diverse Leadership programme, were in attendance as observers.

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

Minutes of the previous meeting – 18 January 2023

Minutes of the previous meeting held on 18 January 2023 were approved.

Matters arising

There were no matters arising.

Policy prospectus

Caroline introduced Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care who led a discussion on the policy prospectus ‘New Leadership – A Fresh Start’ published on 18 April 2023. The document details the key aims the government intends to achieve in each Cabinet portfolio and sets out actions to tackle poverty, build a fairer, greener, and growing economy, and improve public services by 2026.

The Cabinet Secretary advised NHS Chief Executives that he would welcome the opportunity to meet with them in person in the months ahead. He informed them that he met with the NHS Chairs Group on 24 April 2023 and heard first-hand of boards’ experiences and challenges. He reiterated to NHS Chief Executives that he uses his meetings with the NHS Chairs Group to get assurances from them against key priority areas and, in the short-term, he will have a particular focus on recovery and performance. 

The Cabinet Secretary reminded NHS Chief Executives, that the Executive Team needs to provide accurate and timely information to Chairs so that they are suitably prepared ahead of these key meetings. 

The Cabinet Secretary asked NHS Chief Executives to ensure that innovative initiatives that are improving outcomes are shared across NHS Scotland and that the NHS Chief Executives Group could play a significant role in minimising variation. He acknowledged progress that has been made during the recovery phase to improve performance but stressed that a sharp focus is now needed on delivery and sustaining recovery, particularly going into winter. 

The Cabinet Secretary stated that he was keen to understand what further support NHS Chief Executives need from Ministers and Scottish Government. He acknowledged the challenges around staff morale and stressed the importance of making staff feel valued. He asked NHS Chief Executives to collectively address this as a priority.

Unscheduled care

Caroline Hiscox, Chief Executive, NHS Grampian led the agenda item on Unscheduled Care. She gave a slide presentation which would be shared following the meeting. This centred around:

• approach of NHS Chief Executives
• focus on delivery.
• collaborative working
• working with NHS Chairs
• providing leadership 
• positive engagement with Scottish Government
• current operating environment
• workforce
• financial position
• safety model of care and sustainability
• whole system approach and performance
• winter 2023/24 priority actions

There was a discussion about some of the positive changes that have been made to assist recovery, with recognition that more still needs to be done to look at capacity and performance across the entire system and develop a sustainable model of care. Going forward, there was agreement that there should be some focussed dialogue on medium to long-term ambitions around:

• primary prevention model
• digital and innovation
• services based on population requirements

Recognising the need for significant collaborative leadership, support required from the Scottish Government would include:

• strengthening place of primary care
• strong and initiative-taking communications
• collaborative working
• commitment to dual aspects of delivering transformation

The Cabinet Secretary thanked NHS Chief Executives for their presentation. He acknowledged what needs to be done in the short term to alleviate current pressures, and asked NHS Chief Executives to focus on developing a medium to long-term vision of a sustainable NHS.

Winter preparedness 2023/24

John Burns, Chief Operating Officer, confirmed work had already started with NHS Chief Executives on winter planning. He emphasised the importance of having input from across Health and Social Care and told colleagues that draft plans should be ready by the end of June. He introduced Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship who gave a presentation which outlined the following: 

• in summary, a focus on how we progress towards a more resilient health and care system
• roadmap of milestones and how we want those to be delivered
• overview of project components including collaborative work around:
  • unscheduled care
  • hospital at home
  • hospital occupancy/delayed discharge action plan
  • demand and capacity

Pauline Howie, Chief Executive, Scottish Ambulance Service (SAS) highlighted the new safe handover principles and importance of including this within winter planning efforts. She also drew attention to the work underway on alternatives to hospital admission , for example, “call before convey” to support management of patients out with accident and emergency departments.

The Cabinet Secretary added that in addition to the progress already taken forward in some health boards, NHS Chief Executives should focus on where and why improvements were not being made at pace in some areas. He also noted an increasing number of complaints around primary care. 

Carol Potter, Chief Executive, NHS Fife noted that her board had just published working on their population health strategy, which incorporated feedback from partners on how to shift towards prevention and promote healthy living in the community.

Paul Johnston, Chief Executive, Public Health Scotland informed colleagues of the projections around the burden of disease, which predicts population health across the next 20-years. A recent poverty summit concluded that deep poverty has a devastating impact on people’s physical and mental health, reinforcing why the health system needs to play a part in tackling poverty. It was noted that the Care and Wellbeing programme provides good opportunities for NHS Boards to do this as anchor employers.

Karen Reid, Chief Executive, NHS Education for Scotland (NES) raised the possibility of how diversification of the workforce can support the system, for example through advanced practitioners and pharmacists. She also indicated that consideration is being given to community hybrid models, the productivity gap and how technology and health innovation can deliver better effective care for our systems. 

Claire Burden, Chief Executive, NHS Ayrshire, and Arran shared an example of work that has been carried out within mental health to improve access standards: working with Health and Social Care community partners and the Scottish Ambulance Service to direct people to the appropriate level of care. There has been good, sustained progress in Ayrshire and Arran, and she encouraged other Chief Executives to learn from their experience.

The Cabinet Secretary welcomed the progress that has been achieved in some areas and stressed the need for sustainability to build around that. He asked NHS Chief Executives to ensure that they share their improvement learning with each other and that they implement best practice, adapting where appropriate. 

The Cabinet Secretary left the meeting.

Pay update

Caroline Lamb gave thanks for the presentations and input from NHS Chief Executives before asking Gillian Russell, Director of Health Workforce to provide an update on current pay negotiations. 

Gillian Russell noted timely progress was being made on the follow through from the agreements made for the agenda for change negotiations; working with employers and staff to take forward a review of contracts and a proposition to move to 36 hr week with protective time for learning.

She advised that junior doctors have been calling for pay restoration and that the Government have been working with Karen Reid (NES) to develop guidance so that is ready ahead of the outcome of the ballot for strike action. Calum Campbell, Chief Executive, NHS Lothian has been involved in working groups around this and had preliminary conversations around protected learning time and terms and conditions.

Finance forward look: 2023/24

Richard McCallum, Director of Health Finance and Governance stated there has been discussion about financial resourcing, and on pay pressures at the last action officers (AO) meeting. He indicated that he had received financial plans from NHS Chief Executives and noted the letters issued to all boards regarding next steps. He also advised that he has discussed providing tailored support to relevant Board Chief Executives and that work was continuing to support financial improvement workstreams in sustainability and value.

Sponsorship update

Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship, provided an update on enhancing sponsorship of health boards, further to the paper that was shared in advance of the meeting, with two primary areas of focus:

• establishing a sponsorship hub
• territorial board sponsorship

All public sector bodies are required to have in place a framework agreement with the Scottish Government. These are already in place for National Boards but not for Territorial Health Boards. Colleagues will work with Boards, through the Board Secretaries Network, to develop a single framework document which can be used and adapted appropriately for Territorial Health Boards, by September.

Action: Paula Speirs to arrange meeting with colleagues from Board Appointments and Governance Unit to discuss plans to create a framework agreement for territorial health boards by September.

John Burns summarised that across the different items it is clear what needs to be progressed for winter. There needs to be a greater understanding of demand capacity in the health service but also in social care to understand what is possible in the system. His team will work collectively with Chief Executives and Chief Officers to ensure a draft plan is ready by June. 

Caroline Lamb agreed that further work was required by the oversight group to determine how many care beds there are and how they relate to demand and flow, so that boards can quickly understand capacity. 

Karen Reid stated that NES can “lift and shift” care home data but there should be the opportunity to use the public cloud to assist. Caroline Lamb agreed that if appropriate, she would follow that up to see how to use the data across the system more intelligently.

Action: Caroline Lamb to investigate the use of the public cloud to assist NES in “lift and shift” of data for care homes

Any other business

The Good Food Nation team are in the process of drafting a national Good Food Nation Plan, this will be consulted upon over the summer and a definitive version published in late 2024. There is a legislative requirement for health boards and local authorities to prepare healthy food nation plans of their own, to be published at the end of 2025. Colleagues were looking for contacts within NHS boards as to who they should engage with to develop plans. 

Action: Executive Support Team to identify contacts in Boards for the Good Food Nation Team

Date and time of next meeting

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