NHS Chief Executives minutes: March 2022

Attendees and apologies

NHS Board chief executives

• Claire Burden, NHS Ayrshire and Arran
• Ralph Roberts, NHS Borders (Chair of CEs Group)
• 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
• Pam Dudek, NHS Highland
• Heather Knox, NHS Lanarkshire
• Calum Campbell, NHS Lothian
• Michael Dickson, NHS Orkney and Shetland
• Grant Archibald, NHS Tayside
• Gordon Jamieson, NHS Western Isles
• Jann Gardner, NHS Golden Jubilee
• Robbie Pearson, Healthcare Improvement Scotland (Vice Chair of CEs Group)
• Jim Miller, NHS 24
• Stewart Irvine, NHS Education for Scotland (for Karen Reid)
• Mary Morgan, NHS National Services Scotland
• Angela Leitch, Public Health Scotland
• Pauline Howie, Scottish Ambulance Service

Scottish Government

• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer .Planning and Sponsorship
• Gordon James, Deputy Chief Operating Officer, Performance and Delivery
• Gillian Russell, Director of Health Workforce
• Richard McCallum, Director of Health Finance and Governance
• Donna Bell, Director of Social Care and NCS Development
• Michael Kellet, Director of Population Health
• Jonathan Cameron, Interim Director for Digital Health and Care
• Graham Ellis, Deputy Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Robert Kirkwood, OCENHS Team
• Kat Dobell, OCENHS Team
• Sarah Hildersley, OCENHS Team
• Carol Hunte, OCENHS Team

In attendance

• Colin Briggs, Chair of Directors of Planning/NHS Lothian
• Alan Gray, Director of Finance, NHS Grampian
• Jacqui Jones, Director of HR, NHS National Services Scotland
• Alan Morrison, Interim Deputy Director Health Infrastructure, Investment and PPE
• Phillip McLean, Head of NHS Facilities and Environmental Sustainability
• Roslynn Barclay, Executive Support
• Nicola Gordon, Executive Support

Apologies

• Caroline Lamb, DG HSC/CE NHS Scotland
• Karen Reid, NHS Education for Scotland
• Gary Jenkins, State Hospital
• Ken Donaldson, Medical Director/Co-Chair of SAMD   
• Ann Gow, NMAHP Director and Deputy Chief Executive/Chair of SEND 
• David Miller, Chief People Officer
• Richard Foggo, Director for Covid Public Health
• Christine McLaughlin, Director of Testing 
• Gregor Smith, Chief Medical Officer
• John Harden, Deputy National Clinical Directo

Items and actions

Agenda

• welcome, introductions and apologies for absence
• minutes of the previous meeting – 10 November 2021 NHSCE/21/22/20
• matters arising
• climate change and decarbonisation - NHSCE/22/23/01
• finance planning - 2023 and beyond - NHSCE/22/23/02 (Richard McCallum, Director of Health Finance and Governance)
• national care service - update (Donna Bell, Director of Social Care and NCS development)
• feedback from Chief Executives private meeting (Ralph Roberts, Chief Executive NHS Borders/Chair of NHS Chief Executives group)
• any other business
• date and time of next meeting
  • NHS Chief Executives business meeting - Wednesday 11 May 2022 at 14:00

Welcome, apologies for absence and attendees

John Burns, NHS Scotland Chief Operating Officer welcomed everyone to the meeting. A slight change to the running order was noted.

Minutes of the previous meeting – 10 November 2021 - NHSCE/21/22/2

The minutes of the meeting held on 10 November 2021 were approved. 

Matters arising

There were no matters arising.

Feedback from Chief Executives private meeting

Ralph Roberts, Chief Executive NHS Borders/Chair of NHS Chief Executives group provided an update on discussions from the private and strategic meetings that would link into today’s agenda items. These were:

• governance
• finance
• deep dives on
  • mental health
  • workforce
  • digital delivery plan
  • unscheduled and urgent care
• national care service

Today’s meeting would focus on the challenges going forward in the current financial position and look at how to proceed in returning to financial sustainability. 

Collaboration between the NHS Boards and Scottish Government colleagues will be essential in this process.

Climate change and decarbonisation

Alan Morrison, Interim Deputy Director Health Infrastructure, Investment and PPE advised that the draft strategy consultation closed on 10 March 2022. Responses to the consultation would then be considered and a further discussion on proposed changes would be scheduled for a future meeting.

Phillip McLean presented a slide pack on the sources of greenhouse gas emissions from the health system, including:

• explanation of tCO2e
• sources of NHS greenhouse gases
• main sources of NHS emissions. (tCO2e 20/21)
• medical gas emissions (tCO2e)

 It was noted that we have moved on since the strategy was written for COP26. The current situation in the Ukraine is causing price rises around oil and gas and possible shortages in the future, which could impact plans. Suggestion was for a “once for Scotland” policy for NHS boards to work collaboratively on a national level and move quickly to reconnect with digital and redesigning polices while factoring in net zero. As fuel costs increase this will impact on staff as well as patients and future plans will need to factor this in.

Various issues that impacted climate change were highlighted:

• pharmaceuticals and over prescribing
• net zero buildings and travel to work
• the need to reduce the number of cars/medium vehicles by 2025
• funding from Transport Scotland to support the NHS in terms of electric vehicles and EV charging
• whole charging infrastructure to support this

There was a reflection over the skills needed to address these challenges and the need to ensure that these skills are available at local and national level.

Action: Executive Support team/Alan Morrison - deep dive discussion to take place with Chief Executives to explore “once for Scotland” approach on de-carbonisation and climate change. 

Finance planning – 2023 and beyond

Richard McCallum, Director of Health Finance and Governance presented slides covering:

• 2022 to 2023 financial outlook
• work underway to address this challenge which can be considered in three parts:
  • underlying challenge
  • COVID-19 pressures
  • reform and recovery
• 2022 to 2023 NHS Scotland financial challenge and actions to address, sharing a comparison between pre and post pandemic).
• COVID-19 Financial challenge 2022 to 2023 and beyond:
  • Situation summary
  • COVID-19 cost improvement – no more COVID-19 money from UKG
  • vaccinations
  • PPE
  • other costs
  • next Steps

A framework around financial planning looking at the longer term picture and what would be sustainable would be worked up. Regarding reform and recovery, the onus will be on health boards and whilst challenges have been significant, there has been additional resource provided. It is therefore important to maximise the impact of this additional funding. Consistent messaging on how the financial position would align with the challenges faced by the system was essential.

It was noted that the (RSR) would be published at the end of May 2022 and decisions would need to be made quickly. Richard McCallum added that input would be needed from everyone and discussions are already taking place through the Care and Wellbeing portfolio and would also take place in the Horizon Scanning meetings.

Action: Executive Support team/Richard McCallum – a session at Strategic Co-ordination group to get views from the wider system in advance of the spending review.

Healthy life expectancy and health inequalities pose significant challenges. There are also broader societal issues and there would be a need to re-evaluate the scale of the challenge in terms of finance and the communication with the public. Focus would be on identifying priorities, looking at funding and supporting the RSR discussions. The Care and Wellbeing portfolio will consider the longer term population health landscape. An additional pressure will be coming out of the pandemic with increased ill health in communities. It will be challenging to both deal with the immediate issues faced by the system while also considering the bigger opportunities to transform the system.

Actions: Executive Support team/John Burns and Richard McCallum – future discussion around population health to be arranged.

Colleagues raised the issue of touchpoint cleaning requirements and the resource implications involved. They asked for this to be reviewed. 

Action: Chief Nursing Officer to review touchpoint cleaning

National Care Service – update

Donna Bell, Director of Social Care and NCS Development provided an update on ongoing discussions with ministers in preparation of plans for the national care service. More work is required on preparing the bill following the public consultation. Discussions with key stakeholders on understanding the current operating model would continue.

Colleagues were keen to understand the timetable for the work as well as the infrastructure and workstreams that were being established. It would also be helpful to have clarity on what consultation would take place with staff.

Action: NHS boards to explore with Scottish Government on how to improve engagement on the range of work that is under way.

Any other business

John Burns advised colleagues that the Scottish Government ethnic pay gap strategy will now be published in Autumn 2022, centred around the Scottish Government’s Fair Work Policy.

Date and time of next meeting

The next NHS Chief Executives business meeting will take place on Wednesday 11 May 2022 at 14:00.

Office of the Chief Executive NHS Scotland