NHS Chief Executives minutes: May 2024

Attendees and apologies

NHS Boards

• Ralph Roberts, NHS Borders
• Katy Kerr, NHS Dumfries and Galloway, Director of Finance 
• 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
• Fiona Davies, 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 Wilson, NHS Education for Scotland, Director of NMAHP
• Gordon James, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Paul Johnston, Public Health Scotland
• Paul Bassett, Scottish Ambulance Service, Deputy Chief Executive
• 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
• Fiona Hogg, Chief People Officer
• John Harden, Deputy National Clinical Director
• Angie Wood, Director of Social Care Resilience and Improvement
• Anne Armstrong, Interim Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Robert Kirkwood. Head of People, Governance and Appointments
• Aislinn Ni Ghrainne, Head of Strategic Briefing and Insights Unit
• Fiona Bennett, Interim Deputy Director, NHS Integration and Social Care Finance (for Agenda Item 5)
• Jack Gillespie, Head of Financial Improvement and Financial Support NHS Scotland (for Agenda Item 5)

 Other Attendees

• Kirstin Dickson, Chair of Directors of Planning/Director of Planning, NHS Ayrshire and Arran
• Crawford McGuffie, Co-Chair of SAMB/Medical Director, NHS Ayrshire and Arran
• Claire Pearce, Chair of SEND/NMHAP Director, NHS Tayside
• Craig Marriott, Director of Finance, NHS Lothian
• Elaine Watson, HRD Secretariat/NHS Tayside
• Jim Crombie, Deputy Chief Executive, NHS Lothian

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobel, 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)
• Julie White. NHS Dumfries and Galloway (Katy Kerr attending)
• Karen Reid, NHS Education for Scotland (Karen Wilson attending)
• Michael Dickson, Scottish Ambulance Service (Paul Bassett attending)
• Susan Webb, Director of Public Health, NHS Grampian
• Boyd Peters, Co-Chair of Medical Directors/Medical Director, NHS Highland
• Julie Carter, Chair of Directors of Finance/Director of Finance, SAS (Craig Marriott attending)
• Jacqui Jones, Chair of HRDs/Director of HR, NHS Lanarkshire (Elaine Watson attending)
• Neil Gray. Cabinet Secretary for NHS Recovery, Health and Social Care
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Christine McLaughlin, Co-Director of Population Health
• Donna Bell, Director of Social Care and NCS Development
• Gregor Smith, Chief Medical Officer
• Andrew Watson, Director for Children and Families
• Saira Kapasi, Deputy Director, Support Division for DG/NHS Scotland CE

Items and actions

Welcome, apologies for absence and attendees

1.    Caroline Lamb, DG Health and Social Care and Chief Executive NHS Scotland, welcomed everyone to the meeting. She noted the Cabinet Secretary’s apologies who was unable to attend due to events following the appointment of the new First Minister. 

2.    Caroline Lamb acknowledged that it was Calum Campbell’s last meeting and thanked him for his service, not only as Chief Executive of NHS Lothian since June 2020, but also NHS Lanarkshire and NHS Borders. Calum Campbell demits office on 31 May 2024, at which point Jim Crombie will take up the role of Interim Chief Executive. 

3.    Caroline Lamb welcomed Jim Crombie to the meeting, who was attending with Calum Campbell, ahead of taking up his role as Interim Chief Executive of NHS Lothian, along with Jenny Long, who was attending as part of the Aspiring Chief Executive Officers programme.  

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

Minutes of the previous meeting – 15 March 2024 – NHSCE/23/24/29

5.    The Minutes of the meeting held on 15 March 2024 were approved.

6.    Three actions were noted from the previous meeting.  The first action is completed, the second action will be covered under Agenda Item 5 of today’s meeting and the third action will be brought to a future meeting.  

Matters arising

7.    There were no matters arising.

Feedback from Chief Executives meetings

8.    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:

• Financial position
• Chief Executive portfolio updates
• Hospice Care and working with independent hospices
• Health in Custody
•  Infected Blood Inquiry
• Agenda for Change/staff pay
• CELCIS Contract
• Chief Executive development
• Promoting Health and Tackling Healthcare Inequality

9.    Paul Johnston, Public Health Scotland was invited to provide an update on Population Health. He noted that discussion from the morning’s meeting took place around:

•    How to get a greater level of granularity to be able to increase preventative focus across Health and Social Care; and agreement on approaches needed as a starting point.
•    Areas of focus for prevention.
•    Support required for community partnerships to maximise their role.
•    Accountability of Boards to support prevention.
•    The good work carried out by Healthcare Public Health Action Team on ‘Waiting Well’ work taken forward under the auspices of the Care and Wellbeing Portfolio.

10.    John Burns, Chief Operating Officer, added that discussions were being held with the Public Service Reform Team in the Scottish Government to ensure that connections to this work were being recognised. The Care and Wellbeing Portfolio should help to maximise the contribution of partners around the prevention agenda and ensure the right community planning and outcome measures were in place. 

NHS performance and recovery – NHSCE/24/25/01

11.    John Burns, Chief Operating Officer introduced this item to colleagues. A short paper had been circulated to colleagues in advance of the meeting which set out key topics to be discussed, this included:

•    Planned Care/Waiting Lists:
o    Centre for Sustainable Delivery (CfSD) heat maps.
o    Enhanced 2024-25 plans and trajectories.
•    Unscheduled Care:
o    Action programme building on CfSD discovery.
•    Cancer Waiting Times:
o    Backlog reduction.

12.    John Burns noted the importance of balancing performance outcomes with achieving financial balance and invited Fiona Bennet to give an overview of the financial implications for 2024-25. 

Action: Chief Executives were invited to update on what work is being taken forward and what impact it will have, including sharing learning and good practice to scale up activity and improvement.

13.    John Burns reminded colleagues that a National Improvement Plan has been in place for several years but that it was not being consistently delivered across Scotland. He asked Chief Executives to seek assurance from their Executive teams and evidence that they were delivering, or planning to deliver, against this Plan.

Action: Chief Executives to seek assurances from Executive Teams that they are delivering against the National Improvement Plan.

14.    There was a discussion about standardising the way in which bids come into Boards.  John Burns advised that this should be set out in the Board’s Delivery Plan and that the Scottish Government have, in the past, always contacted Boards about their activity via Planned Care Leads.  He agreed to review the process and how it is communicated to Boards.

Action: John Burns to look at the process and communication on how bids to Boards with additional capacity are submitted.

15.    Fiona Bennett, Interim Deputy Director NHS Scotland Finance and Jack Gillespie, Head of NHS Scotland Financial Improvement and Support were invited to provide an update on Finance including the 15-box grid. A short presentation was shared. The key points were:

•    3% Recurring Savings Target applies to all Boards, and for most this sits alongside further options to move towards financial balance Medicines Switches should be optimised; and
•    Remote Outpatient Appointments should be reviewed.

16.    Caroline Lamb thanked Fiona Bennet and Jack Gillespie for their presentations. She highlighted the areas noted on the 15-box grid and asked Chief Executives for assurance that these were being focussed on. 

17.    Chief Executives asked for clarity on the expectations of a balanced budget. Fiona Bennett clarified a balanced budget should be £0 deficit.  Boards should be ensuring 3% recurring savings from baseline funding, plus what is needed to break even on top of that. She explained that the 15-box grid was a framework designed to support Boards to focus on specific areas which will help them to identify potential savings, but was not intended to answer the full question of the financial challenge. Brokerage caps have been put in place for Boards at level 2 or 3 of the Support and Intervention Framework for finance.

18.    Chief Executives welcomed the clarity provided. It was noted that Boards are working hard to balance all aspects of governance and the expectations of what was to be delivered and that they may need to make different decisions going forward, because of the discussion. It was acknowledged that Boards would need support and a further commission would be looked at on local level Board Choices 

Action: John Burns, Richard McCallum, Fiona Bennett and Paula Speirs to provide clarity on specific commission to Boards to look at choices to reduce the financial pressure, while still maintaining / focussing on service delivery. 

NHS reform – NHSCE/24/25/02

19.    John Burns, Chief Operating Officer introduced this item to colleagues. This agenda item provided an update to Chief Executives following Cabinet approval on the Reform paper on 16 April 2024. A presentation was shared and would be circulated after the meeting. Key topics included:

• reform through NHS Scotland Planning and Delivery Board
• approach to NHS Reform

20.    John Burns outlined that reform is not just about the delivery of services but also the way that the Scottish Government and Health Boards work together. He highlighted that the Planning and Delivery Board would support collective leadership with a local, regional, and national perspective. The Board will not only focus on performance but financial implications and look at supporting national improvements centrally. 

21.    Further work on Reform is in progress with a parliamentary debate to take place in June 2024. 

Any other business

22.    There was no other business raised. 

Date and time of next meeting

23.    The next meeting was scheduled to take place on Wednesday 12 June 2024 at 14:00.  This meeting has been cancelled due to several other meetings with key stakeholders taking place over 10 to 12 June.

24.    The next meeting will therefore take place on 11 September 2024.  
Office of the Chief Executive NHS Scotland
9 May 2024

Other papers

One other paper was circulated ahead of the meeting for colleagues’ information:

NHSCE/24/25/03 – An Update from St Andrew’s House has been circulated to attendees sharing key information from across the Health and Social Care Directorates