NHS Chief Executives minutes: May 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
• Anne Macpherson, NHS Greater Glasgow and Clyde (for Jane Grant)
• 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
• Robbie Pearson, Healthcare Improvement Scotland
• Karen Reid, NHS Education for Scotland
• Jann Gardner, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Angela Leitch, Public Health Scotland
• Pauline Howie, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• Caroline Lamb, DG Health and Social Care/Chief Executive NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Jason Leitch, National Clinical Director
• John Harden, Deputy National Clinical Director
• Richard McCallum, Director of Health Finance and Governance and Value
• Stephen Lea-Ross, Director of Health Workforce
• Richard Foggo, Covid-19 Director
• Christine McLaughlin, Director of Testing
• Michael Kellet, Director of Population Health
• Jonathan Cameron, Interim Director for Digital Health and Care
• Alex McMahon, Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Tom Ferris , Chief Dental Officer
• Robert Kirkwood, Head of the Office of the Chief Executive
• Sarah Hildersley, OCENHS Team
• Carol Hunter, OCENHS Team

In attendance

• Kenneth Donaldson , Medical Director/Co-Chair of SAMD
• Jacqui Jone, Director of HR
• Ann Gow, NMAHP Director and Deputy Chief Executive/Chair of SEND
• Roslynn Barclay, Executive Support to NHS Board Chairs and Chief Executives
• Nicola Gordon, Executive Support to NHS Board Chairs and Chief Executives 

Apologies

• Jane Grant, NHS Greater Glasgow and Clyde
• Gillian Russell, Director of Health Workforce
• Donna Bell, Director of Social Care and NCS Development
• Gregor Smith,  Chief Medical Officer
• Graham Ellis, Deputy Chief Medical Officer
• Michael Chalmers, Director for Children and Families

Items and actions

Welcome, apologies for absence and attendees

John Burns, NHS Scotland Chief Operating Officer welcomed everyone to the meeting. This was the first hybrid meeting to take place since the beginning of the COVID-19 pandemic.

Minutes of the previous meeting on 9 March 2022

The minutes of the meeting held on 9 March 2022 were approved. 

Matters arising

John Burns, NHS Scotland Chief Operating Officer opened the meeting by giving feedback on the NHS Chief Executives private session with its focus on finance which would be taken as part of today’s discussion. 

Financial challenge in 2022 to 2023 and beyond 

Richard McCallum, Director of Health Finance and Governance noted that good discussions have taken place around issues and challenges and how to make collaborative decisions. Looking ahead to 2022 to 2023, the immediate challenge is around COVID-19 costs and pressures, whilst recognising the continuing financial challenges for health boards. Directors of finance are meeting next week and will then expect to work through any required changes with Chief Executives, focussing on fixed commitments.

There is likely to be significant financial challenge across all boards and government over the Resource Spending Review period. There should be an open discussion about the best approach to take this forward. 

A two day session was suggested to give colleagues appropriate time to fully engage and re-evaluate the current approach, using as examples, the improvements and efficiencies achieved during COVID-19, with a view to developing a new strategic plan. The Care and Wellbeing Portfolio approach recognises the need for the reform and refocussing of services, the implications and opportunities and the need to align funding. Given the scale and pace of change required, it was agreed that taking an incremental approach would not deliver the reforms required. A step change was required and this must be taken forward on a “Once for Scotland” basis where appropriate. 

Climate change and workforce sustainability are a fundamental part of the required changes. Conversations would also be welcome on the contribution that could be made through community planning and public health issues, recognising that not all of the answers to the challenges faced are within the remit of health and the NHS. Plans need to be produced for the future that focus on improving services and taking staff and professional bodies along with the change.

Colleagues noted that:

• recovery in the past significant choices, not just general efficiencies
• recovery now needs to be large scale, at pace and have a national level of focus, with different system options modelled
• there needs to be openness about what should be on the table in order to assess the financial impact
• there needs to be collaborative working across NHS Scotland and cross government around the challenges the system is facing
• the need to be clear with staff if the messages were now to pivot away from wellbeing and toward sustainability

Action: two day session to be arranged to have an open discussion regarding moving forward (14 and 15 June) – Secretariats.

Action: Conversation to take place around sustainability and value and how to establish this approach and to include Finance Directors and other contributors – Executive Support Team/Richard McCallum.

National care service

In Donna Bell’s absence, John Burns provided a short update on the National Care Service (NCS). The Parliamentary Bill is a key step in the process and plans are proceeding. There is work to do around the policy and financial memorandum to align with Ministerial requirements. The bill is an enabling one, with an opportunity to contribute to the details of delivery as policy develops. A Cabinet sub‑committee meeting is arranged for next week to discuss the next phase. The Strategy Board met for the first time and will be a collective forum to keep engagement and open conversation.

Care and wellbeing portfolio

Christine McLaughlin shared led the discussion which included the following:

• structure of the Care and Wellbeing portfolio
• horizon 1- managing the current system
• horizon 2 - innovating to sustain current system and bridge to new world
• horizon 3 – Creating the Conditions for a New World
• key priorities – Our Starting point for 2022 to 2023
• draft Care and Wellbeing portfolio governance structure

Discussion centred focussed on the approach not being additional or new to what was already underway but it provided a framework on how we approached our priorities for the future. The importance of focussing on and addressing inequalities was highlighted, as was the clear ambition of improving healthy life expectancy using all the information and data already available.

Work on all three horizons needs to start now, so not just immediate pressures (H1) and reform of current system (H2) but also developing radical sustainable options (H3). This work needs to be fully partnership based and recognise the need to develop capabilities rather than see this as one-off work. The importance of including Children’s Health and Mental Health were highlighted for the portfolio approach. Chief Executives were also keen to understand the funding that would support this approach.

Chief Executives highlighted the importance of co-design and common purpose with delivery partners around the portfolio approach, as well as the need to draw out the culture and behaviours required to ensure there is a focus on the approach. The links to the wider wellbeing economy were also suggested and that it would be helpful to have further detail on that. A community planning approach was vital to ensure appropriate inputs to this work as not all the levers lay with health boards.

Feedback from Chief Executives private meeting

Ralph Roberts, Chief Executive NHS Borders/Chair of NHS Chief Executives Group reflected the benefits of being able to meet up with colleagues in person. He provided feedback from the private meeting and strategic session. These focussed on:

• resource spending review
• care and wellbeing
• climate emergency
• sustainable development
• succession planning
• escalation
• eobotics
• child health system

Any other business

There were no items of other business.

Date and time of next meeting

The next NHS Chief Executives business meeting will be a two day strategic session that will take place on 14 and 15 June 2022. 

Office of the Chief Executive NHS Scotland