NHS Forth Valley Assurance Board minutes: 11 April 2023

Attendees and apologies

Members

• Christine McLaughlin (Chair), Co-Director of Population Health (virtually) 

• Alex McMahon, Chief Nursing Officer (virtually) 

• Gregor Smith, Chief Medical Officer (virtually) 

• Angie Wood, Director of Social Care Resilience and Improvement (virtually)

• Robert Kirkwood, Head of the Office of Chief Executive (virtually)

• Tracy Slater, Head of Performance and Delivery (virtually)

Attendees – Forth Valley (in-person)

• Cathie Cowan, Chief Executive 

• Janie McCusker, Chair, NHS Forth Valley 

• Frances Dodd, Executive Nurse Director

• Scott Urquhart, Finance Director

• Robert Clark, Employee Director 

• Linda Donaldson, HR Director, NHS Forth Valley 

• Sally Mcintosh, Project Manager

Attendees – Forth Valley (virtually)

• Andrew Murray, Medical Director 

• Jonathan Best, Acting Director of Acute Services

• Ewan Murray, Clackmannanshire and Stirling HSCP

• Elaine Kettings, Nurse Director, Falkirk HSCP 

Attendees - Scottish Government/External

• John Harden, Deputy National Clinical Director and External Support (virtually)

• [redacted], Head of Workforce Practice Unit (virtually)

• [redacted], Head of Workforce Relations (virtually)

• [redacted] (Secretariat), Senior Policy Manager (virtually)

• [redacted] (Secretariat), Policy Adviser (virtually)

Apologies 

• Gillian Russell, Director of Health Workforce, Scottish Government 

• Richard Foggo, Co-Director of Population Health, Scottish Government

• John Brown, Chair of NHS Greater Glasgow and Clyde and External Support Team

• Patricia Cassidy, Chief Officer, Falkirk HSCP

• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP

• Gillian Morton, Director of CPMO/Women and Children’s Directorate, Director of Midwifer, NHS Forth Valley 

Items and actions

Welcome, Apologies and Introductions

The Chair welcomed members to the ninth meeting of the Assurance Board (AB), noted apologies and outlined the agenda.

The Chair briefly updated on the letter issued to MSP’s on 31 March, providing them with a progress update on NHS Forth Valley’s escalated position. 

NHS Forth Valley Performance Update

The Forth Valley Executive Leadership Team (ELT) provided an update on the challenged performances areas: Children and Adolescent Mental Health Services (CAMHS), Psychological Therapies (PT), Urgent and Unscheduled Care (USC) and Out of Hours (OOH). 

Work is progressing in CAMHS, and Forth Valley (FV) is confident of meeting the standard in Quarter 1 of 2023-2024. In PT, FV is focused on reducing the longest waits, after reviewing all patients on their list. FV have introduced group therapy and will utilise agency staff, where needed, until permanent staffing is in place. The OOH action plan is progressing as expected. 

USC remains to be extremely challenged. However, there has been some progress made in reducing the longest waits and in closing contingency beds. The ELT is due to consider what further whole-system changes they can make to improve their performance. The FV ELT will provide the Assurance Board (AB) with any an update on actions related to performance in unscheduled care, flowing from the follow up discussion at ELT and the NHS FV Board later in the week.   

The ELT provided an update on the Healthcare Improvement Scotland (HIS) action plan and how they intend to embed learning throughout the organisation. They are engaging with a patient forum to better understand the immediate needs of patients in Forth Valley. 

The AB recommended that FV continue to progress their work on self-assessment, following the departure of the HIS improvement team. 

NHS Forth Valley Improvement Plan

The ELT updated on the latest iteration of the Improvement Plan, including recent outputs, notably a self-facilitated Organisational Development (OD) session aimed at improving working leadership and culture within the ELT. Members of the ELT in attendance described a better working environment and a more collaborative approach. 

The ELT recognised that further work is still required, including consideration how to operationalise their strategic aspirations, and understand individual roles and responsibilities in resolving issues in leadership and culture as well as challenged performance areas. Work to improve the ELT has been supported by engagement with staff working elsewhere in Forth Valley, including the Clinical Management Team. 

The AB reaffirmed the need for the ELT to understand how issues materialised in the past, and how to overcome them in the present. The AB queried the pace of this work and asked for clarity on timescales.   

Work on Integration is also progressing, as is the ongoing Governance Review led by Prof John Brown, and further development of an iterative Measurement Framework (MF). The AB reaffirmed the need for the MF to focus on the reasons for escalation: governance, leadership and culture, and for the whole ELT, and the FV Board, to be comfortable with and own it.  Demonstrating real and sustained progress in the quarter to June 2023 will be critical.

The Chair noted that the next meeting will centre around a deep dive on Whole System Flow, with a focus on the approach to leadership, governance and culture within the system.

The Chair thanked everyone for their contributions and closed the meeting.