NHS Chief Executives minutes: January 2020

Attendees and apologies

NHS Board Chief Executives:

• John Burns, NHS Ayrshire and Arran 
• Ralph Roberts, NHS Borders  
• Jeff Ace, NHS Dumfries and Galloway 
• Paul Hawkins, NHS Fife (Vice Chair of CEs Group) 
• Cathie Cowan, NHS Forth Valley 
• Amanda Croft, NHS Grampian 
• Jane Grant, NHS Greater Glasgow and Clyde 
• Iain Stewart, NHS Highland 
• Calum Campbell, NHS Lanarkshire 
• Tim Davison, NHS Lothian 
• Gerry O’Brien, NHS Orkney 
• Michael Dickson, NHS Shetland 
• Grant Archibald, NHS Tayside 
• Gordon Jamieson, NHS Western Isles (by VC) 
• Jann Gardner, Golden Jubilee Foundation 
• Robbie Pearson, Healthcare Improvement Scotland 
• Angiolina Foster, NHS 24 
• Stewart Irvine, Deputy Chief Executive, NHS Education for Scotland 
• Gerry McLaughlin, NHS Health Scotland 
• Colin Sinclair, NHS National Services Scotland 
• Pauline Howie, Scottish Ambulance Service (Chair of CEs Group) 
• Robin McNaught, Finance Director, State Hospital  

Scottish Government:

• Malcolm Wright, Director General Health and Social Care/Chief Executive NHS Scotland 
• Shirley Rogers, Director of EU Exit and Transition, Chief People Officer NHS Scotland and Director of Health Workforce, Leadership and Reform (confirmed) 
• John Connaghan, Chief Performance Officer NHS Scotland and Director of Delivery and Resilience (confirmed) 
• Elinor Mitchell, Director for Community Health and Social Care 
• Donna Bell, Director of Mental Health 
• Richard Foggo, Director of Population Health 
• Caroline Lamb, Director of Digital Reform and Service Engagement 
• Fiona McQueen, Chief Nursing Officer Scotland 
• Gregor Smith, Deputy Chief Medical Officer 
• Richard McCallum, Deputy Director of Health Finance, Corporate Governance and Value 
• Lynne Nicol, Head of Openness and Learning Team (for Jason Leitch)  

In attendance:

• David Williams, Director of Delivery, Health and Social Care Integration 
• Ken Donaldson, Dumfries and Galloway Medical Director (for Tracey Gillies) 
• Colin Briggs, Director of Planning
• Robert Kirkwood Corporate Business Management Team (Secretariat) 
• Sarah Hildersley, Corporate Business Management Team (Secretariat) 
• Alan Coopert, NHS Scotland Executive Support 
• Chris Campbell, NHS Scotland Executive Support 
• Alan Morrison, Capital Accounting and Policy Manager (Agenda Item 6) 
• Aidan Grisewood, Head of Primary Care (Agenda Item 8) 
• Naureen Ahmad, Head of GP Contract Development and Implementation (Agenda Item 8) 
• Yvonne Summers, Head of Operational Planning and Performance (Agenda Item 9) 
• Tony Allan, Operational Planning Manager (Agenda Item 9) 

Apologies:

• Jeane Freeman, Cabinet Secretary for Health and Sport 
• Gary Jenkins, State Hospital
• Angela Leitch Public Health Scotland 
• Alex McMahon, Chair of SEAT
• Jason Leitch National Clinical Director Scotland 
• Catherine Calderwood, Chief Medical Officer Scotland 
• Michael Chalmers, Director for Children and Families 
• Rose-Marie Parr, Chief Pharmaceutical Officer 
• Tom Ferris, Chief Dental Officer 
• Gregor Mcnie, Cancer, Rare Diseases and National Planning Team 

Observers:

• Robert Law, Cancer, Rare Diseases and National Planning Team 
• Andrew Fleming, Head of NHS Territorial Board Sponsorship and Ministerial Support

Items and actions

Agenda

• welcome, apologies for absence and attendees 
• minutes of the previous meeting - 13 November 2019 – NHSCE/19/20/27 
• matters arising 
• feedback from the Chief Executives private meeting 
• EU withdrawal 
• infrastructure – NHSCE/19/20/28 
• performance (including winter) and targets – NHSCE/19/20/29 
• primary care – NHSCE/19/20/30 
• expectation of boards in escalation 
• any other business 
• date and time of next meeting  

Minutes

Welcome, apologies for absence and attendees 

Malcolm Wright, DG Health and Social Care and Chief Executive NHS Scotland welcomed everyone to the meeting. A list of attendees and apologies for absence are provided at Annex A.  

The DG passed on the Cabinet Secretary’s apologies due to attending a family funeral.   

Minutes of the previous meeting - 13 November 2019 – NHSCE/19/20/27 

The minutes of the meeting held on 13 November were approved.   

Matters arising 

There were no matters arising.  

Feedback from the Chief Executives private meeting 

Pauline Howie, Chair of the Chief Executives Group gave an update on the discussions from the private meetings. This included: 

• annual operating plans
• Office 365 implementation
• Netherlands Executive Exchange delegation  

Malcolm Wright, DG Health and Social Care and Chief Executive NHS Scotland then gave a brief update on areas of interest to the Cabinet Secretary. These included: 

• primary care
• mental health
• stakeholder relationships
• clinical leadership

EU withdrawal - verbal 

Shirley Rogers, Director of EU Exit and Transition, Chief People Officer NHS Scotland and Director of Health Workforce, Leadership and Reform gave a verbal update to the Group on EU Withdrawal. The UK leave the EU on 31 January 2020 when they will then enter a transition phase which will run until 31 December 2020.   

The Scottish Government Cabinet Sub-Committee is meeting regularly and priorities for Health and Social Care have been identified. The need to support EU staff members was key and this would be discussed at the forthcoming meeting with NHS HR Directors. 

Chief Executives welcomed the update and the opportunity for further discussion. Shirley Rogers would work with Jeff Ace, Chief Executive, NHS Dumfries and Galloway to  keep Chief Executives fully briefed.

Action:

• Shirley Rogers to liaise with Jeff Ace to provide briefing in relation to EU withdrawal arrangements  

The agenda running order was altered to take performance, then primary care and afterwards infrastructure.   

Performance (including winter) and targets – NHSCE/19/20/29

John Connaghan, Chief Performance Officer, NHS Scotland, and Director of Delivery and Resilience indicated that the main focus of this agenda item would be unscheduled care. He gave an update on the latest performance figures and current forecasts show that NHS Scotland is in a better position this year than last year with a significant reduction projected for end of March for outpatients.   

In relation to the Treatment Time Guarantee (TTG) there is more work to be done and John Connaghan would welcome a fuller discussion at a future private meeting on this.  

He then invited Chief Executives to give a brief update on respective areas of work. These included:

• access collaborative
• cancer diagnostics
• mental health

Tim Davison, Chief Executive, NHS Lothian then led a presentation on improving unscheduled care performance which builds on previous discussions in November.   

The presentation set out a renewed focus on 3 key areas: primary care access, capacity and capability, social care access, capacity and capability and creating peak flow capacity and capability in our acute hospital front door systems and specialty IP beds. There also needs to be a whole system approach to ensure that improved performance can be delivered, recognising the central role played by councils and IJBs as well as health boards.   

Colleagues welcomed the presentation and agreed that the Unscheduled Care Programme Board should be revised from 1 April 2020 with the view to a new whole system accountability framework being put in place.   

Richard Foggo, Director of Population Health advised that colleagues were meeting on 5 February for further discussions on a renewed Health and Social Care Strategy and Delivery of this following discussions at the end of 2019. 

Colleagues also referred to Professor Sir Lewis Ritchie’s 2015 Report on the National Review of Primary Care Out of Hours Services (pulling together: transforming urgent care for the people of Scotland) and the recommendations set out in the report.   

The opportunity to develop new plans and ways of working was highlighted and Chief Executives involvement is central to this. Tim Davison, John Connaghan, Elinor Mitchell, Director of Community Health and Social Care and Richard Foggo would liaise on other discussions following this meeting. Unscheduled Care should return to a future meeting. 

Actions:

• Treatment Time Guarantee (TTG) to be scheduled at a future private meeting – John Connaghan and Executive Support Team 
• Tim Davison, John Connaghan, Elinor Mitchell, Director of Community Health and Social Care and Richard Foggo to liaise on other discussions following this meeting 
• unscheduled care to be scheduled at a future meeting – SG Secretariat 

Primary Care – NHSCE/19/20/30 

Elinor Mitchell, Director of Community Health and Social Care introduced the item on primary care, setting out that primary care is the corner stone of the NHS and a critical part of the health and social care integration reform journey.  

Aidan Grisewood, Director of Primary Care then provided Chief Executives with an update on primary care improvement plans, resilience of services, leadership and out-of-hours provision. A paper had been circulated to Chief Executives in advance of the meeting.   

Chief Executives welcomed the update and recognised areas of reform that were set out in the paper, some Boards were currently working on these collectively. It was recognised that significant progress in implementing the GMS contract was underway however challenges remain.   

Out of hours services across Scotland will require strong leadership to ensure best practice is being adopted to make sure these urgent care services are delivered safely, effectively and that they remain resilient. 

Infrastructure – NHSCE/19/20/28 

Alan Morrison, Capital Accounting and Policy Manager provided an update on Infrastructure. This had previously been discussed with Chief Executives at a private meeting in November.  

A paper which provided Chief Executives with a summary of the current and planned arrangements for the management and strategic development of NHS Scotland’s infrastructure portfolio had been circulated to Chief Executives in advance of the meeting. 

The Director General will be writing shortly to Chief Executives regarding governance arrangements in relation to delivering safe health services.   

Further discussion on infrastructure and capital investment should be included as part of the meeting being led by Richard Foggo on 5 February.   

Action:

• infrastructure and capital investment to be included in 5 February meeting being led by Richard Foggo 

Expectation of boards in escalation - verbal 

Yvonne Summers, Head of Operational Planning and Performance gave a short presentation to Chief Executives on the escalation process within NHS Boards.

There was recognition that NHS Scotland is working in a more complex governance and operational landscape and the current escalation process had to updated. A review of the process is underway which will set out a renewed escalation process and what NHS Boards can expect in future. 

A Review Group is capturing information in relation to what currently happens including strengths and weaknesses of the current approach and will also identify areas for improvement. It will take account of approaches used elsewhere and link to existing work being undertaken by the Corporate Governance Steering Group.   

The Project Oversight Group co-chaired by John Connaghan and Elinor Mitchell will speak with COSLA to ensure a streamlined process in the future across the whole system.   

Malcolm Wright invited Pauline Howie to consider how Chief Executives can play into this review work. 

Action:

• Project Oversight Group co-chairs to speak with COSLA about future streamlined escalation process across the whole system 
• Pauline Howie to consider how Chief Executives can play into the review of the escalation process 

Any other business 

Malcolm Wright raised two items of AOB: 

• Conference of the Parties (COP) 26
• the new Workforce Planning Unit

Further information on both of these points is available in the update from St Andrew’s House paper.   

Date and time of next meeting 

The next NHS Chief Executives Business Meeting will take place on Wednesday 11 March 2020 at 13:00 in the Fettes Suite, Scottish Health Service Centre, Crewe Road South, Edinburgh  EH4 2LF. 

Office of the Chief Executive NHS Scotland 16 January 2020 

Other papers issued were: NHSCE/19/20/31 – an update from St Andrew’s House

NHS Chief Executives minutes: January 2020

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