NHS Forth Valley Assurance Board minutes: 7 February 2023

Attendees and apologies

Members

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

Attendees – Forth Valley (in-person)

• Cathie Cowan, Chief Executive (in-person)
• Janie McCusker, Chair (in-person)
• Andrew Murray, Medical Director (in-person)
• Frances Dodd, Executive Nurse Director (in-person)
• Scott Urquhart, Finance Director (in-person)
• Robert Clark, Employee Director (in-person)
• Linda Donaldson, HR Director (in-person)
• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP (virtually)
• Patricia Cassidy, Chief Officer, Falkirk HSCP (virtually)

Attendees - Scottish Government/external

• Hazel Borland, Professional Advisor and External Support (in-person)
• John Harden, Deputy National Clinical Director and External Support (in-person)
• [redacted], Head of Workforce Practice Unit (virtually) 
• [redacted], Head of Workforce Relations (virtually) 
• [redacted] (Secretariat), Policy Adviser (virtually)

Apologies 

• Gregor Smith, Chief Medical Officer, Scottish Government
• Richard Foggo, Co-Director of Population Health, Scottish Government
• John Brown, Chair of NHS Greater Glasgow and Clyde and External Support 

Items and actions

Welcome, apologies and introduction

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

Feedback from External Support Team

Leadership and Culture 

The External Support team provided an update on their work. They continue to meet with key stakeholders and provide support and guidance in line with their agreed remit. Forth Valley (FV) provided positive feedback on the engagement with the SG External Support Team. 

The Chair reaffirmed that the External Support Team is there to provide FV with support and should utilise them to the best of their abilities. AB members can also provide guidance if required. 

Governance Review 

The Chair provided a short update on the Governance Review, including timelines for completion by end of June 2023. Prof John Brown will provide feedback as it arises to FV and the AB, and expect the Executive Leadership Team (ELT) to implement improvements on an ongoing basis throughout the review. 

The importance of strong audit processes within the Board, and aligned with the Integration Joint Board's, was also noted. The ELT agreed to consider their audit actions at the next ELT meeting. 

Progress against Improvement Plan

The Chair outlined that this agenda item would be considered in four parts: Measurement Framework; Integration; Organisational Development Support; and Performance. 

Measurement Framework 

The ELT updated on progress and expected timelines for completion. The SG External Support Team have been providing support where appropriate, recognising that this is for the ELT and Board to undertake and own. The SG External Support Team agreed to provide feedback on further drafts. AB members requested to review a draft at the earliest opportunity. 

FV ELT stressed the need to take their time to get this work right. AB members reaffirmed that cultural change needs to impact the top of the organisation to benefit staff at all levels. The Measurement Framework should recognise this, and can be further developed as the Board progresses with their work.

Integration

Chief Officers updated on the transfer of services to their respective IJB’s. This included operational management of specialist mental health and learning disability services, staff and budget responsibility and corporate support including due diligence (staff, budget alignment and staff and staff side engagement). Their update included where further work is required, both practically and culturally. The Chief Officers meet with the FV Chief Executive regularly to agree actions required to support integration. 

AB members highlighted the cultural aspect of integration, including the need for a shared strategic narrative, developed in collaboration with the Local Authority (LA) Chief Executives. 

The AB reaffirmed that the transfer of services is a significant milestone but that strong leadership is required to ensure integration is successful in the long term. Effective governance and strong relationships will be crucial.

Director of Social Care Resilience and Improvement will meet with the ELT to consider capacity and capability issues in this space, including ensuring that the entire ELT take ownership of the work required on integration. 

Organisational Development (OD) Support

The Director of Health Workforce asked the ELT to summarise progress in the leadership and culture space, including any reflections the Board has made, and in turn, what assurances can be provided to the AB. 

FV ELT is confident that the work they are progressing will create the conditions for success, whilst recognising the need for strengthening relationships at a senior level.  AB members made the following observations: 

• Forth Valley should incorporate additional actions relating to leadership and culture into their Improvement Plan and consider how best to report against them; 
• the importance of the FV Board taking ownership of this escalation; and
• the importance of linking with staffside colleagues and others in the organisation to understand the impact of culture and leadership issues.

Performance 

The ELT provided an update on challenged performance areas including: out of hours (OOH), Psychological Therapies (PT), Child and Adolescent Mental Health Services (CAMHS), and Unscheduled Care (USC). 

Members reaffirmed the need for a Measurement Framework to demonstrate progress against the individual improvement plans within these service areas. By demonstrating progress in performance areas, further assurance would be provided to the AB. For example, acute services performance has stabilised, supported by an effective response to the Healthcare

Improvement Scotland (HIS) inspection led by the Nurse Director. It is crucial that FV develop a focused, robust, and reliable performance report which can demonstrate this. 

The Chair confirmed the timeline for updating the Director-General Health and Social Care, Chief Operating Officer of NHS Scotland and the Cabinet Secretary for Health and Social Care. 

The Chair thanked everyone for their contributions and noted the need to focus on the following progress in Integration and the Measurement Framework, alongside challenged performance areas. The Chair reaffirmed that NHS FV should provide the Measurement Framework to the AB for scrutiny at the earliest opportunity. 

FV attendees left the meeting. 

Review & Next Steps

Members of the Assurance Board and External Support Team reflected on the discussion with NHS FV, reaffirming the need for the Board to own the Improvement Plan, reflect on their escalated position, and demonstrate sustained change. 

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