NHS Chief Executives minutes: September 2019

Attendees and apologies

NHS Board Chief Executives

• John Burns, NHS Ayrshire and Arran
• Ralph Roberts, NHS Borders
• Jeff Ace, NHS Dumfries and Galloway
• Graham Foster, NHS Forth Valley
• Amanda Croft, NHS Grampian
• Jane Grant, NHS Greater Glasgow and Clyde
• Iain Stewart, NHS Highland
• Calum Campbell, NHS Lanarkshire
• Alex McMahon NHS Lothian
• Gerry O’Brien, NHS Orkney
• Simon Bokor-Ingram, NHS Shetland (by VC)
• Gordon Jamieson, NHS Western Isles (by VC)
• June Rogers, Golden Jubilee Foundation
• Robbie Pearson, Healthcare Improvement Scotland
• Margo McGurk, NHS 24
• Caroline Lamb, 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, State Hospital

Scottish Government

• Malcolm Wright, DG Health and Social Care and Chief Executive NHS Scotland
• Jason Leitch, National Clinical Director Scotland
• Gregor Smith, Deputy Chief Medical Officer
• Richard Foggo, Head of Primary Care Division
• Alison Strath, Principal Pharmaceutical Officer, Chief Medical Officer Directorate
• Richard McCallum, Deputy Director of Health Finance, Corporate Governance and Value
• Hugh McAloon, Head of Fair Work and Skills, Children and Young People’s Mental Health, Directorate for Mental Health
• Jane Hamilton, Head of Business Management and EU Withdrawal, Directorate for Health Workforce, Leadership and Reform
• Tracy Slater, Head of Elective and Unscheduled Care, Directorate for Health Performance and Delivery

In Attendance

• Ken Donaldson, Scottish Association of Medical Directors
• David Williams, Director of Delivery, Health and Social Care Integration
• Jennie Barugh, Director of Performance and Strategic Outcomes (agenda item 2)
• Greig Chalmers, Head of Medicines Policy Team (agenda item 5/6)
• Jacques Kerr, Senior Medical Officer, Directorate for Mental Health (agenda item 7)
• Luska Jerdin, Head of Mental Health Performance and Improvement Unit (agenda item 7)
• Yvonne Summers, Head of Operational Planning, Directorate for Health Performance and Delivery (agenda item 8)
• Gary Mortimer, Operational Planning Team (agenda item 8)

Secretariats

• Robert Kirkwood, Office of the Chief Executive NHSScotland
• Laurie Whyte, Office of the Chief Executive NHSScotland
• Sarah Hildersley, Office of the Chief Executive NHSScotland
• David Bedwell, NHS Scotland Executive Support

Apologies

• Cathie Cowan, NHS Forth Valley
• Tim Davison, NHS Lothian
• Jann Gardner, Golden Jubilee Foundation
• Angiolina Foster, NHS 24
• Gary Jenkins, State Hospital
• Tracy Gillies, Co-Chair of Medical Directors
• Shirley Rogers, Director of EU Exit and Transition, Chief People Officer NHS Scotland and Director of Health Workforce, Leadership and Reform
• John Connaghan, Chief Performance Officer NHS Scotland and Director of Delivery and Resilience
• Christine McLaughlin, Chief Finance Officer NHS Scotland and Director of Health Finance, Corporate Governance and Value
• Donna Bell, Director of Mental Health
• Elinor Mitchell, Director of Community Health and Social Care
• Catherine Calderwood ,Chief Medical Officer Scotland
• Fiona McQueen, Chief Nursing Officer Scotland
• Michael Chalmers, Director of Children and Families
• Gregor Smith, Deputy Chief Medical Officer
• Rose Marie Parr, Chief Pharmaceutical Officer
• Tom Ferris, Chief Dental Officer

Items and actions

Agenda

• Welcome, apologies for absence and attendees
• National Performance Framework – NHSCE/19/20/14
• Minutes of the previous meeting – 12 June 2019 - NHSCE/19/20/12
• Matters arising
• Feedback from the Chief Executives private meeting
• EU withdrawal – NHSCE/19/20/15
• Mental health trajectories – NHSCE/19/20/16
• Transformational AOPs – NHSCE/19/20/17
• Rising unscheduled care attendances – NHSCE/19/20/18
• Any other business
• Date and time of next meeting

Minutes

Welcome, apologies for absence and attendees

Malcolm Wright, Director General Health and Social Care/Chief Executive NHS Scotland welcomed everyone to the meeting. 

Minutes of the previous meeting – NHSCE/19/20/12

The minutes of the meeting held on 12 June 2019 were approved.

Matters arising

There were no matters arising.

Feedback from the Chief Executives private/strategy meeting

Pauline Howie, Chair of the NHS Chief Executives Group gave an update on the discussions from the private/strategy meeting, including:

• finance
• mental health strategy
• workforce
• public health reform
• Crown Office and Procurator Fiscal Service Investigation of Deaths

National Performance Framework – NHSCE/19/20/14

Malcolm Wright welcomed Leslie Evans, the Permanent Secretary of the Scottish Government to the meeting and invited her to give some opening remarks about the National Performance Framework.

The Permanent Secretary thanked Chief Executives for the opportunity to attend the meeting. She outlined some of the key actions that the Scottish Government is taking to make connections across government policy and support the public sector to deliver outcomes and improve wellbeing across Scotland.

Pauline Howie, Chair of NHS Board Chief Executives Group then invited some of the other Chief Executives to share some examples of good practice of where NHS Boards were already contributing to outcomes. This included:

• national digital platform (Caroline Lamb, NHS Education for Scotland)
• Dundee Drugs Commission Report (Grant Archibald, NHS Tayside)
• collaborative working across bodies in Orkney (Gerry O’Brien, NHS Orkney)
• leadership and planning (John Burns, NHS Ayrshire and Arran)
• transformational planning (Jane Grant, NHS Greater Glasgow and Clyde)
• maternity review (Jane Grant, NHS Greater Glasgow and Clyde)
• the Place Standard Tool (Gerry McLaughlin, NHS Health Scotland)
• national services (Colin Sinclair, NHS National Services Scotland)
• community engagement (John Burns, NHS Ayrshire and Arran and Grant Archibald, NHS Tayside)

The Permanent Secretary welcomed the update and encouraged Chief Executives to ensure that the pivotal role of the NHS was represented on the Scottish Leaders Forum. The Permanent Secretary also indicated that she would welcome the opportunity to return to a future meeting.

Action:

• Secretariat – invite Permanent Secretary to a future Chief Executives meeting

EU Withdrawal - NHSCE/19/20/15

Malcolm Wright invited Jane Hamilton, Head of Business Management and EU Withdrawal to lead the discussion on operational readiness for EU Withdrawal. A short update paper was circulated to Chief Executives in advance of the meeting.

The Scottish Government to prepare on the assumption of a “No Deal” EU Exit. Shirley Rogers, Director of EU Exit and Transition, Chief People Officer NHS Scotland and Director of Health Workforce, Leadership and Reform wrote to Chief Executives in August requesting that they review their preparations and readiness for EU exit and to submit responses by 20 September. Responses will then be reviewed to inform discussions and workshops with Chief Executives in early October.

Ministers are holding meetings on a weekly basis to scrutinise the Scottish Government’s readiness preparations. The EU Exit Health and Social Care Network met twice in August and are holding ‘deep dive’ meetings on a weekly basis from September. These sessions will look at issues in detail and talk through/identify outstanding risks and mitigating actions. Further resilience preparations are taking place in concert with the broader SG approach.

Chief Executives noted the update in relation to their organisations being as operationally prepared as possible for EU Exit, in particular a potential ‘No Deal’ Exit at the end of October. They reflected that it would be helpful to have official Scottish Government communications for Boards to advise the public of any likely impact on services.

Action:

• NHS Board Chief Executives to submit a response by 20 September in relation to Shirley Rogers letter, if they haven’t already done so

Mental Health Trajectories – NHSCE/19/20/16

Malcolm Wright invited Hugh McAloon, Head of Fair Work and Skills, Children and Young People’s Mental Health and Jacques Kerr, Senior Medical Officer to give the presentation to Chief Executives on mental health performance and improvement. Scottish Government officials will work directly with Chief Executives in NHS Boards that have not yet agreed their trajectories to facilitate sign-off.

The presentation shared with Chief Executives:

• performance against waiting time standards for CAMHS and adult Psychological Therapies in Scotland
• the wider context in relation to the sustained increase in demand for CAMHS and adult Psychological Therapies in Scotland
• trajectories
• future investment
• ongoing Ministerial prioritisation of mental health services
• the wider reform of the approach to mental health
• the Distress Intervention Group

Chief Executives noted the presentation. There was a discussion about the ‘Distress Intervention Group’ work. Jacques Kerr indicated that he would be happy to attend a future meeting to provide an update on the Group’s work.

Action:

• Scottish Government colleagues to liaise with 3 NHS Boards who have not yet signed-off their trajectories
• Secretariat – invite update on Distress Intervention Group to a future meeting

Transformational AOPs – NHSCE/19/20/17

Malcolm Wright welcomed Yvonne Summers, Head of Operational Planning to the meeting who then gave a presentation to Chief Executives on transformational Annual Operating Plans (AOPs).

Chief Executives noted the presentation which outlined the planned timescales and arrangements for the development and submission of the next round of AOPs. There was a discussion about the level of detail required in the AOPs and how they linked to other Board plans, for example, workforce plans.

Chief Executives welcomed the change in timescale, but raised highlighted the tight timeline to allow whole system dialogue and agreement.

Rising unscheduled care attendances – NHSCE/19/20/18

Malcolm Wright invited Tracy Slater, Head of Elective and Unscheduled Care to lead a discussion with Chief Executives on rising unscheduled care attendances.

The rise in attendances at A&E is a result of numerous whole system and behavioural changes and cannot be attributed to one particular issue. The response to reducing attendances will require a whole system and comprehensive approach across primary care and community services, integration, acute services and communication with the public to address the trend and promote a multi-disciplinary health and social care approach to urgent and emergency assessment.

Various discussions are taking place and Tracy Slater will write out to Chief Executives electronically seeking their views. This feedback will then be collated and submitted to the Cabinet Secretary by the end of October.

Action:

• Tracy Slater to write out to Chief Executives seeking their views on rising unscheduled care attendances
• SG Secretariat – bring item back for further discussion at a future meeting

Any other business

Malcolm Wright provided Chief Executives with an update on:

•  Medical Foundation Posts
•  redress scheme for survivors of child abuse in care

Jason Leitch advised colleagues that next Tuesday, 17 September 2019, is the first Global Patient Safety Day. To mark this occasion buildings are being turned orange, including Scottish Government buildings, and invited NHS Boards to participate.

Date and time of next meeting

The next NHS Chief Executives Business Meeting will take place on 13 November 2019 at 13:00, in the Fettes Suite, Scottish Health Service Centre, Edinburgh EH4 2LF.

Office of the Chief Executive for NHSScotland
18 September 2019

NHSCE/19/20/19 – An update from St Andrew’s House was circulated to Chief Executives for information.