NHS Forth Valley Assurance Board minutes: 27 June 2024

Attendees and apologies

Members

• Christine McLaughlin, Co-Director of Population Health (Chair)
• Laurie Whyte, Head of Board Governance and Appointments Team (on behalf of Robert Kirkwood) (on Teams)

Attendees – NHS Forth Valley 

• Neena Mahal, Chair (Interim) 
• Amanda Croft, Chief Executive (Interim) (on Teams)
• Frances Dodd, Executive Nurse Director
• Scott Urquhart, Director of Finance
• Garry Fraser, Director of Acute Services

Apologies

• Angie Wood, Co-Director, Social Care and NCS Development Directorate 
• Robert Kirkwood, Head of the Office of Chief Executive NHS Scotland
• Fiona Hogg, Chief People Officer

Attendees – SG

• Tracy Slater, Head of Performance and Delivery

Items and actions

Welcome, apologies, introductions and minutes

The Chair of the Assurance Board (AB) welcomed colleagues to the nineteenth meeting of the AB and outlined the agenda. Attendees and apologies were noted for the minute.

The Chair welcomed Neena Mahal, Interim Chair, NHS Forth Valley, to her first meeting of the AB, since taking up her appointment on 1 April 2024. She also welcomed the appointment of Ross McGuffie as the new Chief Executive of NHS Forth Valley. Ross McGuffie is currently Chief Officer, Health and Social Care, North Lanarkshire.

The Chair advised that her response to public audit committee was published on the Scottish Parliament’s website on 7 June 2024. The response followed a request from public audit committee for the view of the AB on the progress that NHS Forth Valley was making against the actions outlined in the assurance and improvement plan. The response forms part of the committee’s consideration of the Auditor General’s section 22 report, the 2022/23 audit of NHS Forth Valley.

The response outlined four key areas that will be the focus of the AB for the next quarter:

• strengthening governance
• stabilising the executive leadership
• evidence of cultural change throughout the organisation and a longer-term plan
• improvement in unscheduled care performance that can be sustained

The Chair informed colleagues that the Cabinet Secretary was meeting weekly with Councillor Kelly, COSLA’s spokesperson for Health and Social Care to consider what more can be done to reduce the numbers of delayed discharges. She encouraged colleagues to check any outstanding actions against the letter that was issued from the Scottish Government to the Chief Executive of NHS Forth Valley shortly after the board was escalated, which set out six key actions to be progressed to support integration.

The minutes of the previous meeting were approved. These will now be published on the scot.gov. website.

NHS Forth Valley Assurance and improvement plan

Neena Mahal advised that the status of the 103 actions in the original assurance and improvement Plan (the plan) have been reviewed following discussions with internal and external auditors. Actions have been categorised as:

• progressed and complete
• progressed and are being monitored as business-as-usual activities with a focus on continuous learning and improvement
• in Progress

All outstanding actions which have been categorised as ‘in progress’ have been moved to form a new updated plan.

Scott Urquhart provided additional detail on the feedback received from recent internal and external audit reviews about the status of the actions in the plan. Detailed narrative has been provided against each of the actions and there are clear links to the updated plan, which has been approved by NHS Forth Valley’s performance and resources c. He gave assurances that all actions which are being monitored as business-as-usual have been mapped accordingly to the appropriate governance committees. The new plan will go to the full board in July for sign off. 
 
The Chair welcomed the focus on delivery of the outstanding actions that are still ‘in progress’ and agreed that the updated version of the plan should be used by the AB to monitor progress going forward.

Colleagues then provided an update on the outstanding actions in the new plan, against the key improvement themes of culture, leadership, governance, integration, and performance

Culture

The AB noted that substantial progress has been made in this area, with only three outstanding actions remaining. An additional AB meeting has been scheduled for 10 July 2024, which will focus on the outputs of the culture change programme.

It was agreed that colleagues should seek a view from staff side on the status of the culture change work to provide a more rounded perspective.

Action: Seek a view from staff side on the status of the actions relating to the culture change programme.

Leadership

The AB noted that a significant milestone had been achieved with the appointment of a permanent Chief Executive. An official start date has still to be confirmed. Amanda Croft is contracted to the end of September 2024 and plans are being developed to provide a handover to Ross McGuffie, the new Chief Executive.

It was noted that whilst several senior positions have been recruited to – the Director of Acute Services, Chief Officer of Falkirk Health and Social Care Partnership and the Board Secretary – some key posts have been filled on an interim basis. The Chair asked what was being done to mitigate against any risk that further leadership changes may have on progress made.

Amanda Croft agreed to focus on any outstanding HR issues prior to her departure in September 2024. A risk assessment will be conducted against all interim posts and will be considered at the next meeting of the remuneration committee.

Governance

Neena Mahal described the work that she has progressed to strengthen governance, since taking up post. This has been focussed on three key areas:

• developing a strategic space for the board to influence leadership work
• developing the assurance framework and collaborating with non-executive members to support their development through attendance at governance committees of other boards and benchmarking workplans
• development of a new skills matrix to identify gaps in relation to the board’s strategic priorities. This will inform the development of a business case for replacing and recruiting additional members as part of the succession planning process

Scott Urquhart highlighted that both internal and external auditors gave positive feedback about the level of scrutiny and challenge of board papers that is now being provided by non-executive members.

Laurie Whyte confirmed that she had had discussions with Neena Mahal about the governance work and around succession planning.

The development of the five-year Healthcare Strategy was highlighted by internal audit as an action which was still ‘in progress’ and so was included in the plan. Amanda Croft gave assurances that work is underway against this action, but that the timeline and approach were being reviewed so that it better aligns with the national population health strategy and the appointment of the next Chief Executive who will start in the autumn. Therefore the indicative timeline will be determined once the new Chief Executive starts.

Integration

Amanda Croft confirmed that a review of the integration schemes is being progressed on a Forth Valley wide basis and work is on track for completion in October/November 2024.

The Chair asked colleagues to seek feedback from their partners on whether they agree with the narrative about improvements in collaborative working.

Performance

The only action outstanding in this area relates to work to improve the emergency four-hour access standard through the delivery of the urgent and unscheduled care programme. This work was discussed further under a separate agenda item on urgent and unscheduled care.

The Chair commented on the improved format of the updated plan and confirmed that going forward, the AB would focus on the delivery of the outstanding actions which have been recorded as ‘in progress.’

The AB was satisfied that sufficient monitoring processes were in place for all outstanding actions on governance and integration to be removed from the new plan and reflected as ‘progressed and being monitored as business-as-usual activities with a focus on continuous learning and improvement.’ The Chair asked colleagues to ensure that the accompanying narrative was updated to clearly explain the change in status and detail the monitoring process.

The new plan should be updated before the next AB meeting to reflect the agreed changes to the status of the actions and it was agreed that the focus for delivery going forward would be on culture, leadership, and performance.

Action: Update the plan to reflect changes agreed to the status of ‘governance and integration’ actions so that they move to become business-as-usual and the plan going forward focuses on the delivery of the culture, leadership and performance action that are outstanding.

Healthcare improvement Scotland report

Frances Dodd gave a progress update against the findings of the Healthcare Improvement Scotland (HIS) unannounced follow up inspection visit which took place between 22nd and 24th of January 2024. 

The Chair welcomed the update and thanked Frances for relating the findings of the report to the improvement plan under leadership, culture, and governance. It was agreed that further updates would be progressed through business as usual reporting to the clinical governance committee, but that the AB should receive a copy of the next update for information. 

Urgent and unscheduled care 

Garry Fraser summarised the key points from the paper which was circulated in advance of the meeting. The paper aimed to provide additional assurances of the whole-system working that is being undertaken to improve patient experience and performance in urgent and unscheduled care.

It was noted that whilst there is evidence of whole-system working and a satisfactory framework of key controls in place, there had been limited sustained improvement with the four-hour ED performance.

The Chair welcomed the update and acknowledged the work streams underway to improve the four-hour ED access standard and the multiple factors which can impact ED performance. She encouraged colleagues to ensure that targets set in their Improvement Plan are realistic and achievable.

Tracy Slater highlighted the work that is being progressed on quality improvement at a national level and encouraged colleagues to ensure that this is linked into the support already provided by the Centre for Sustainable Delivery (CfSD) and HIS. Amanda Croft advised that she was a member of the Chief Executive led portfolio group tasked with considering sustainability of improvements on a national basis. 

Tracy Slater confirmed that the Scottish Government was proposing to change the way that data was reported to include planned attendances and minor injuries data in overall ED performance reports – this approach has not yet been formally signed off, but assuming they are, will lead to a modest improvement in FV performance, due to the high volumes of planned attendances. 

The Chair advised that Caroline Lamb, DG Health, and Social Care/Chief Executive NHS Scotland had asked for general information about recruitment to key positions and asked if additional data could be built into the culture work, for example, numbers of applicants for senior positions and leavers rates.

Action: additional information on recruitment to be included in the culture work programme.

AOB/Prep for next meeting

The performance paper which was circulated was highlighted, with particular attention to the performance improvements that have been sustained since January 2024 within Child and Adolescent Mental Health Services (CAMHS). 

The next meeting of the AB will be on 10 July 2024, with a specific focus on the culture change programme.

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