NHS Forth Valley Assurance Board minutes: 16 May 2023

Attendees and apologies

Members

• Christine McLaughlin (Chair), Co-Director of Population Health (in-person) 
• Gregor Smith, Chief Medical Officer (virtually)
• Fiona Hogg, Chief People Officer (in-person)
• Angie Wood, Director of Social Care Resilience and Improvement (virtually)
• Robert Kirkwood, Head of the Office of Chief Executive (in-person)

Attendees – Forth Valley (in-person)

• Cathie Cowan, Chief Executive 
• Janie McCusker, Chair
• Andrew Murray, Medical Director 
• Frances Dodd, Executive Nurse Director
• Linda Donaldson, HR Director
• Scott Urquhart, Finance Director
• Robert Clark, Employee Director 
• Gillian Morton, Director of CPMO/Women and Children's Directorate, Director of Midwifery
• Sally Mcintosh - Programme Manager 
• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP
• Gail Woodcock, Acting Chief Officer, Falkirk HSCP

Attendees - Scottish Government/External

• John Harden, Deputy National Clinical Director (virtually)
• John Brown, Chair of NHS Greater Glasgow and Clyde (virtually)
• [redacted] (Secretariat), Senior Policy Manager (virtually)
• [redacted] (Secretariat), Policy Adviser (virtually)

Apologies 

• Alex McMahon, Chief Nursing Officer, Scottish Government 
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Patricia Cassidy, Chief Officer, Falkirk HSCP
• Jonathan Best, Acting Director of Acute Services, NHS Forth Valley
• Jonathan Proctor, Director of Estates and Infrastructure, NHS Forth Valley

Items and actions

Welcome, apologies and introductions

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

The Chair welcomed Fiona Hogg, newly appointed Chief People Officer at the Scottish Government. Fiona Hogg joins the Assurance Board and replaces Gillian Russell, Director of Health Workforce.  Richard Foggo, Director of Population Health, has stepped down from the Assurance Board as part of a review of members. 

Performance update 

The Chair offered the executive leadership team (ELT) the opportunity to update on challenged performance areas by exception.

The ELT updated on concerns in CAMHS performance. Following an increase in referrals and complex cases, NHS FV is not tracking against the agreed improvement trajectory. The ELT highlighted the range of actions being undertaken to support the service, which is expected to improve over the summer months. The ELT were asked to engage with colleagues in Scottish Government (SG) to remodel against the SG trajectory, and provide an update to the Assurance Board on proposed actions. 

The ELT also provided a brief update on OOH and USC, noting that pressure had eased in A&E and that Forth Valley were no longer relying on contingency beds. 

The Chair of the AB noted that tackling performance challenges as a whole system is an opportunity to demonstrate sustainable change in leadership and culture, therefore the way in which these challenges are being addressed is the focus of the AB. 

Members of the AB also queried evidence of improvement in staff morale.  ELT  will work with colleagues to provide data from staff and patient experiences surveys, and incorporate these measures into the Measurement Framework ahead of the next meeting. 

Improvement plan and measurement framework 

The Chair stressed the need for the ELT to agree and provide evidenced based indicators to demonstrate where progress has been made; and what impact it has had on governance, leadership and culture in the organisation.   Without evidence, it is not possible to determine progress against the plan.

Governance 

The ELT outlined various activities underway to improve governance in the organisation, with reference to the Governance Review led by Prof Brown. There has been some difficulty in agreeing success indicators, although the work is still in progress, with further learnings to be captured. 

The Chair reaffirmed the need for a single report which provides appropriate key performance indicators (KPIs) and explains the difference this is having on governance in the organisation. The focus of the AB is on the evidence of improvement, rather than on the activities underway to achieve those.

Prof John Brown provided a short update on the Governance Review and shared some reflections on a number governance workstreams being progressed.

To support next steps, Prof Brown will meet with the Finance Director to provide feedback on processes and observations made as part of the Review.

Prof Brown will also engage with Scottish Government colleagues to secure NHS Forth Valley access to the self-assessment pilot programme. 

Leadership and culture 

The ELT provided an update on a range of workstreams, including the Organisational Development (OD) Programme. Whilst the majority of the ELT spoke positively about the session, some members expressed concern that it was a missed opportunity to begin to resolve long-standing issues. The next session is not expected to take place until July, due to diary conflicts. 

The Assurance Board reflected on the conversation and asked NHS FV to consider what progress can be made outside of the OD sessions, including agreeing specific actions and making intentional changes to demonstrate their commitments to change. There is a frustration at the time taken to progress this work, which is fundamental in tackling the issues in leadership and culture. The AB asked the ELT to agree the purpose and outcomes expected of the next structured OD session as a collective, and to work to ensure full team attendance. This work should be evidenced and shared with the Assurance Board. 

The ELT highlighted the whole system approach taken in Unscheduled Care as evidence that progress is being made, and agreed to ensure they capture and evidence improvement more effectively. Work is underway with staff, including promoting the completion of iMatter surveys, engagement with staffside, and conducting interviews.

The Chair of the AB acknowledged the amount of activity underway, but expressed frustration that there is no clear picture of progress. This work is critical following six months of escalation. 

The AB reaffirmed the ask of the ELT to populate the measurement framework with simple, clear metrics that already exist, to provide both a baseline position and a means of showing future progress.  Dr John Harden offered to provide support. 

The Chair thanked everyone for their reflections and asked the ELT to reflect on how they can provide the AB with assurance that there are tangible and sustainable improvements, and asked the Chair of NHS FV to ensure sufficient challenge is provided from the FV Board. 

Integration

The ELT provided an update on the work being progressed on integration, in conjunction with local authorities, referencing the support that will be provided by SG Professional Adviser, David Williams. 

The SG Director of Social Care Resilience and Improvement provided challenge to the ELT and asked them to define more tangible actions and outcomes,  and to reassess timescales. 

The ELT confirmed that this information would be provided to the Assurance Board. NHS Forth Valley Chief Executive will follow up on the points raised by the Director of Social Care Resilience and Improvement. 

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