NHS Forth Valley Assurance Board minutes: 27 October 2023

Attendees and apologies

Members

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

Attendees – Forth Valley 

• Amanda Croft, Interim Chief Executive (in-person)
• Janie McCusker, Chair (in-person)

Attendees – SG/Other 

• [redacted] (Secretariat), Executive Support Officer (in-person)

Items and actions

Welcome, apologies and introductions

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

NHS Forth Valley improvement plan

Amanda Croft (interim Chief Executive) provided a progress update on the escalation and improvement plan and advised that the version 2 close-out report had now been approved by the Performance and Resource Committee (P and R). The report will be presented to the NHS Forth Valley board at the end of November. 3 key areas were highlighted:

Organisational design

Version 3 of the assurance and improvement plan is now in draft and highlights organisational development (OD), using feedback from work undertaken by Jenny Copeland. The close of this work will be done once evaluation conversations are completed and progression can be made into the implementation phase.

Culture

Culture work has been undertaken around a compassionate leadership programme using feedback from staff, including via iMatter. Feedback suggests common themes to those already identified e.g. colleagues not feeling listened to. Development is ongoing in this area, drawn from work undertaken by Michael West, and an action plan produced. The importance of having colleagues feel ownership of this work was highlighted and nominated Executive Leadership Team (ELT) members would help take this forward. The plan, along with progress already made, will be presented to the NHS Forth Valley board in January 2024. 

In addition, there was recognition that the work previously undertaken around leadership now needs to be consolidated. The importance of demonstrating positive behaviours and role modelling had been highlighted, with middle managers key to this. 

Integration

As already noted, a number of practical steps have been taken around integration in transferal of services, budget alignment and recruitment. The focus is now on the impact of those changes, specifically in delivery and improvement. Version 3 of the Improvement Plan will set out the key actions to be undertaken. 

In discussion, it was noted that progress is being made in the groundwork for improvement, but the focus must remain on the key issues that had led to escalation. The importance of engaging and involving colleagues across the organisation in the work, particularly around culture, was emphasised as was the opportunity to utilise the wealth of data gained through staff surveys and iMatter. This will help to increase the opportunities to listen and respond to the opportunities and concerns identified by colleagues across the organisation.

All actions in version 2 of the improvement plan have been taken forward but it was recognised that there was a need to be able to evidence and quantify the improvements that were now being made. That evidence base would be required to support to begin to plot a trajectory for de-escalation. As well as a factual update on the actions completed, it would be helpful to have a narrative that clearly sets out progress that has been made to date.

Action: Amanda Croft to review and update the plan summary to describe the amount of work already done. 

Version 3 improvement plan

Amanda Croft described the role of the established Corporate Programme Management Office established to oversee the plan, as well as the processes and governance that would be in place to monitor and manage implementation. An update was given on the content of the plan, which included:

• the plan will be submitted to the next AB on 22 November then to the NHS Forth Valley board on 28 November
• other updates included:
  • recruitment to Deputy Chief Executive role
  • transfer of prisoner healthcare to the Chief Officer of Falkirk IJB
  • planned care performance remains strong and NHS Forth Valley are liaising with other boards including NHS Greater Glasgow and Clyde to offer support
  • the Whole System Leadership Team (previously named CMT) will be involved in the implementation of the plan going forward to embed the work across the organisation
  • the importance of engaging and listening to the range of reflections from staff side was essential, particularly as the organisation continued to recover
  • Amanda Croft added that work is being done on getting a more readable plan/action plan and getting the public version of the plan on the website with the main copy being made available on request

Action: feedback from the 4-weekly staff side meetings to be sought to ensure colleagues are confident in engagement being sought. 

Governance report

A draft copy of the report, commissioned by NHS Forth Valley on their governance arrangements, had been received from John Brown (Chair of NHS Greater Glasgow and Clyde and member of the External Support Team). The Chair updated on the steps to review the report, including a facilitated development session on 7 November, before going to the formal board meeting at the end of November. The self-assessment work, previously commissioned, would be paused to allow this. The process of considering that report and how the recent work on the self-assessment against the Blueprint for Good Governance would be brought together into the improvement plan was queried. The Chair undertook to set out the process that would bring this work together.

Action: detail to be provided to the AB on how consideration of the Report on NHS Forth Valley governance would be brought together with the governance self-assessment to provide input to version 3 of the improvement plan. 

NHS Forth Valley performance update

Amanda Croft highlighted the on-going focus of addressing unscheduled care performance. Use of the well led framework would be made in the acute sector and key recruitment would take place, while issues with the structure were addressed. It was acknowledged that more work on culture within the acute sector was also required and it was hoped that improved resourcing in the structure and resilience would enable that to happen.

AOB/prep for next meeting

The next meeting of the AB would be held on 22 November. At that, it was expected that a complete version of the assurance and improvement plan would be considered along with an update on the progress regarding work on governance. The plan would then go to the board the following week for approval.

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