NHS Forth Valley Assurance Board minutes: 26 January 2024

NHS Forth Valley Assurance Board

Attendees and apologies

Members

• Christine McLaughlin, Co-Director of Population Health (Chair) (in person)
• Fiona Hogg, Chief People Officer (in person)
• Angie Wood, Co-Director, Social Care and NCS Development Directorate (in person)
• Robert Kirkwood, Head of the Office of Chief Executive NHS Scotland (in person)

Attendees – Forth Valley 

• Janie McCusker, Chair (in person)
• Amanda Croft, Interim Chief Executive (in person)
• Andrew Murray, Medical Director (in person)
• Frances Dodd, Executive Nurse Director (in person)
• Patricia Cassidy, Chief Officer, Falkirk HSCP (in person)
• David Williams, Interim Chief Officer, Clackmannanshire & Stirling HSCP (virtual)
• Garry Fraser, Interim Director of Acute Services (in person)

Attendees – SG/other 

• (redacted), Executive Support Officer (Secretariat)
• (redacted), Support Officer (Secretariat)

Items and actions

Welcome, apologies and introductions

The Chair of the Assurance Board (AB) welcomed members to the seventeenth meeting and outlined the agenda.

A welcome was extended to additional colleagues attending from NHS Forth Valley who were in attendance to support the discussion on ontegration and unscheduled care.

The AB Chair highlighted that the minutes from the previous meeting were circulated with meeting papers and would be published on scot.gov website.

The Chair referred to the follow up inspection by Healthcare Improvement Scotland (HIS) which took place earlier in the week. There were a number of points worth noting and these would be discussed within the meeting. 

NHS Forth Valley improvement plan

Amanda Croft, interim Chief Executive, provided an overview of the latest NHS Forth Valley assurance and improvement plan. The updated plan reflected the recommendations from the corporate governance review report and board self-assessment, to ensure that any further actions are addressed. The plan was approved by the escalation committee on Friday 19 January and would be presented to the full board for approval on Tuesday 30 January. A session on prioritising actions would be facilitated by an external governance consultant, on 01 February.

A ‘firebreak’ has increased the understanding of system constraints and an action plan has been created for cnscheduled Care. Key colleagues have been exploring and working through issues and recommendations have been incorporated in the action plan. NHS Forth Valley highlighted the benefits of adopting this process and would look to share it with other health boards experiencing challenges. The following points were noted:

Leadership

• the Executive Leadership team (ELT) are developing well and have already commenced discussions around next year’s financial situation. Work has begun on how to develop systems leaders within the NHS and community partnerships. A consultation process would be set up to start discussions on whole system issues. Initial pilot work has also taken place using the ‘Well Led’ framework to support continuous improvement approaches in governance, leadership, and culture. The plan is to roll this out further following initial evaluation in a number of service areas. There is a risk relating to the high number of interim postholders in senior management positions and this remains as a key priority for Amanda Croft

Culture

• Amanda Croft, noted the findings from the culture change and compassionate leadership programme were given to the ELT, who listened to powerful feedback from focus groups, interviews and surveys. This was shared with staff side colleagues who are collaborating with ELT to develop a plan, which should be completed by the end of March. The team have increased visibility and have been on the hospital site, engaging with staff. Three videos have been produced, receiving good feedback from staff. Actions from the governance report around recruitment, equality and diversity, have also been added into the improvement plan, ensuring appropriate connections are made to other actions.

The first phase of the culture journey was looking into issues and creating diagnostics. NHS Forth Valley have moved into the second phase which will provide the opportunity to see visible evidence of improvement. Succession planning has been looked at within the board and nationally, which has helped to frame the performance and development process. 

Frances Dodd, Executive Nurse Director, reflected on the recent return Health Improvement Scotland (HIS) inspection. The board had continued to focus on a whole system approach to the points identified in the previous inspections and significant improvement work was continuing. The final report from the most recent inspection is expected to be published in the Spring, however, the board will look for any early feedback and use this to continue to drive improvement. 

The Chair of AB queried some of the delivery dates included in the plan. It was suggested that it may be helpful to include how much progress has been made towards each action, which would better display the range of work underway and the progress being made, rather than simply stating a completion date. It was also highlighted that the plan should better reflect the number of actions crossing over the different headings and causing duplication. Discussions with colleagues in NHS Education for Scotland (NES) have begun around how to share lessons learned from the Governance Report with other Boards. All agreed, that progress had been made and that momentum was continuing to build, particularly around communication and how decisions were being made.

AB members highlighted that they were assured by the content of the plan and asked the Board to focus on delivery. It is not therefore expected that there will be further versions of the plan. 

Integration and unscheduled care

Patricia Cassidy, Chief Officer, Falkirk HSCP, provided an update on the review of the Forth Valley wide integration schemes via the NHS and councils. The first meeting with key stakeholders will take place this week, with a draft plan being shared with councils by June. Following on from that, a public consultation will be organised and the NHS Forth Valley board and councils will meet to discuss findings in September. The health board has an important role around assurance and whilst all acknowledged the challenge ahead in working on a whole systems approach, this was an opportunity to pursue productive and positive conversations with all partners.

David Williams, Interim Chief Officer, Clackmannanshire and Stirling HSCP, and Patricia shared a paper on whole system working. The ‘firebreak’ proved to be a pivotal diagnostic tool for a whole range of matters and the team are now doing a review to identify what actions remain. Through this, good relationships have been developed with a positive effect on partnerships and delivery of their services. It was recognised that there remained work to do but there was now a better focus on necessary activity across all partners. 

The Chair of AB noted this would be a chance to build on any positive reflections from the HIS report, as well as the broader improvement work that was underway. The assurance board highlighted that the focus should now shift to be less on what is being done and more on what difference is being made. There will be on-going scrutiny on how this will be delivered and there remains a need for clear governance and assurance processes to support and evidence the work. The assurance board also acknowledged the volume of work undertaken by colleagues across the organisation, despite the current winter pressures. It was clear that good progress is being made but momentum would need to be maintained.

AOB/prep for next meeting

The performance paper which was circulated for noting was highlighted and the improvements made within Child and Adolescent Mental Health Services (CAMHS) were noted.

The next meeting of the AB will be on 26 February 2024, however it was noted that this may be rescheduled until after public audit committee on 29 February. Consideration will be given to the next meeting regarding areas of focus.

The AB Chair thanked colleagues for their contributions and closed the meeting. 

26 January 2024