NHS Forth Valley Assurance Board minutes: 24 January 2023

Attendees and apologies

Members

• Christine McLaughlin (Chair), Co-Director of Population Health (virtually) 
• Alex McMahon, Chief Nursing Officer (virtually)
• Graham Ellis, Deputy Chief Medical Officer (virtually) (substituting for Gregor Smith)
• Angie Wood, Director of Social Care Resilience and Improvement (virtually)
• Robert Kirkwood, Head of the Office of Chief Executive (in-person)
• Tracy Slater, Head of Performance and Delivery (virtually)

Attendees – Forth Valley (in-person)

• Cathie Cowan, Chief Executive 
• Andrew Murray, Medical Director 
• Frances Dodd, Executive Nurse Director
• Scott Urquhart, Finance Director
• Robert Clark, Employee Director 
• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP

Attendees - Scottish Government/external

• Hazel Borland, Professional Advisor and External Support (in-person)
• John Harden, Deputy National Clinical Director and External Support (in-person)
• John Brown, Chair of NHS Greater Glasgow and Clyde and External Support Team (virtually)
• [redacted], Head of Workforce Practice Unit (virtually) (substituting for David Miller and Gillian Russell) 
• [redacted],  Head of Workforce Relations (virtually) (substituting for David Miller and Gillian Russell)
• [redacted] (Secretariat), Senior Policy Manager (virtually)
• [redacted] (Secretariat), Policy Adviser (virtually)

Apologies 

• Gregor Smith, Chief Medical Officer, Scottish Government
• Richard Foggo,  Co-Director of Population Health, Scottish Government
• Gillian Russell, Director of Health Workforce, Scottish Government
• Linda Donaldson, HR Director, NHS Forth Valley 
• Patricia Cassidy, Chief Officer, Falkirk HSCP
• Janie McCusker, Chair, NHS Forth Valley 
• Allan Rennie, Vice Chair, NHS Forth Valley 

Items and actions

Welcome, apologies and introduction

The Chair welcomed members to the fourth meeting of the Assurance Board, and noted apologies. She summarised the structure of meetings going forward and asked the Assurance Board (AB) and NHS Forth Valley Executive Leadership Team (ELT) to confirm approval of the meeting note from 10 January 2023. The note was approved and it will be uploaded onto the Scottish Government (SG) website. 

Scottish Government external support team update

The External Support team provided an update on their work, referencing the report shared with ELT. They will provide written reports on the same schedule as NHS Forth Valley and to maintain transparency, will be sharing the report with both the AB and ELT ahead of the meeting. The reports will be organised in terms of the agreed role and remit of the External Support. 

The External Support team continue to regularly meet with colleagues across NHS Forth Valley, including the recently appointed interim Director of Acute Services, who they believe has been providing strong leadership to the service. During these conversations they have encouraged better use of their Quality Improvement (QI) Fellows. 

The Assurance Board considered progress on NHS Forth Valley’s Measurement Framework, including timeframes, engagement with governance structures and the collation of various pieces of work under the Improvement Plan. Further detail will be provided in the next written update. 

Members commented on progress and reaffirmed the need for a strong Measurement Framework to support progress against the Forth Valley Improvement Plan, especially around immediate and short-term actions. Work to support strong governance should not be put on hold as the Governance Review takes place. The SG External Support Team offered to work with the Forth Valley ELT to identify potential success indicators, particularly around their Governance work. 

Members reaffirmed the need to develop an open and transparent culture within the ELT to provide space for challenge, otherwise progress cannot be made, understood and sustained.  

The Chair thanked everyone for their updates and comments and closed this item. 

Governance review

Prof John Brown provided a brief update on the Governance Review, whilst outlining the three strands of work that will be undertaken through this review: 1-to-1 interviews; observations; and, a desk-based review, namely of the operating guidance. 

The Governance Review will be baselined against the Blueprint for Good Governance, which recognises the role of positive culture and leadership and the need for active and collaborative governance. Work will begin in late January and the final report will shared in late June.  

A brief update was also provided on the Terms of Reference (ToR), and Prof Brown committed to a development session with NHS Forth Valley to walkthrough the review, the ToR and to hear any concerns from the ELT. Prof John Brown will work with the Chief Executive to arrange this.  

The output of the review will be to have a governance development programme in place, which is an expectation from all NHS Boards. 

Members of the ELT raised questions in relation to how far the review will venture into the leadership and culture space, and the role of internal audit. 

The Chair thanked colleagues for their comments and reiterated the need for the governance review to align with the work being undertaken by the rest of the External Support Team.  

Verbal progress update

The Chair asked the Chief Nursing Officer to take over chairing this agenda item. 

NHS Forth Valley provided a verbal progress update against the actions within the Improvement Plan and focused on key activities that have progressed over the previous month, including: leadership and culture; progressing a decision-making matrix; and conducting directorate performance reviews. The ELT consider this decision-making matrix as an improvement tool to support their journey in delivering improved governance, leadership and culture. NHS Forth Valley will provide a written update against the published Improvement Plan on 7 February 2023 supplemented by a performance report (also provided by Forth Valley) demonstrating the performance trajectory since the decision to escalate in November.

The ELT described the need for the Directorate Performance Review as a means to build accountability through organisation-wide, team and individual objectives. There was a recognition that these objectives would create a wider understanding amongst the team. Learning has also been taken from other Boards, particularly on the establishment of diversity and inclusion networks. The Employee Director reaffirmed the need for further comms and staffside consideration, including giving staff the tools to lead these networks.

The ELT also updated on challenged performance areas including: out of hours (OOH), Psychological Therapies (PT), Child and Adolescent Mental Health Services (CAMHS), and Unscheduled Care (USC). An update was also provided on progress against Healthcare Improvement Scotland’s (HIS) recommendations following the recent Safe Delivery of Care report.

Members noted the need for cross-workforce support, beyond ELT level. 

An update was provided on the transfer of Integration services, noting the recent engagement between SG and Forth Valley on a request for support around capacity. The Director of Social Care Resilience and Improvement is due to meet the ELT in person on 7 February, following the Assurance Board meeting, to consider the request. She asked for further consideration to be made to refine the request, ensuring it is an ask on behalf of the whole ELT, including IJB Chief Officers. 

Members acknowledged the amount of work underway and the self-reflection from members of the ELT evidenced by the tone and content of the discussion.

Members of NHS Forth Valley ELT left the meeting.

Review and next steps 

Members of the Assurance Board and External Support Team reflected on the discussion with NHS Forth Valley ELT. 

The External Support Team will provide a short bullet point list of feedback to NHS Forth Valley following this meeting. 

The Chair will engage further with Director of Social Care Resilience and Improvement on Integration actions.

The Chair thanked members and attendees for their time and closed the meeting.