NHS Forth Valley Assurance Board minutes: 8 March 2024

Attendees and apologies

Members

• Christine McLaughlin, Co-Director of Population Health (Chair)
• Fiona Hogg, Chief People Officer

Attendees – Forth Valley 

• Allan Rennie, Chair (acting)
• Amanda CroftIn ,terim Chief Executive

Apologies

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

Attendees – SG/Other 

Laurie Whyte, Head of Board Governance, Appointments and Development Team

 

Items and actions

Welcome, apologies and introductions

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

There were no amendments to the minutes of the previous meeting. These will now be published on scot.gov website.

The Chair advised that the Cabinet Secretary, NHS Recovery, Health, and Social Care had decided to appoint Neena Mahal as Interim Chair to the Board of NHS Forth Valley, for a maximum of one year, from the 1 April 2024. 

NHS Forth Valley improvement plan

Amanda Croft provided an update on progress against the NHS Forth Valley assurance and improvement plan. She summarised outstanding actions and gave an overview of key areas where improvements have been realised since the last meeting. 

It was noted that 31 out of 35 high-level actions in the plan are now complete (89%), with the remaining actions sitting across the domains of culture and governance. Key points included:

Leadership

• the Executive Leadership Team (ELT) continues to develop and evolve as a team, membership has been broadened to ensure all organisational functionalities are represented. Agreed values and behaviours are being promoted and role modelled
• the continued development of the senior leadership team is being progressed on a whole system basis with a formal programme led by an external facilitator, beginning in March 2024. This will be cascaded across the system through the creation of a leadership development plan
• ensuring the stability of the ELT to deliver organisational priorities, was raised by Audit Scotland in their Section 22 Report and has been a key element of this work. The associated risk has been assessed and will be presented to the remuneration committee in March. The appointment of a permanent Director of Acute services has been a positive step in delivering sustainable leadership arrangements

Culture

• work is underway to share feedback on key themes from the culture change and compassionate leadership programme, identify priority actions and discuss how these should be addressed. This has informed the development of a culture change plan
• the only outstanding action around culture relates to progress on the recommendations outlined in the Sturrock Report. The recommendations need to be captured in the assurance and improvement plan and aligned with the culture change plan. This has been agreed through the area partnership forum and staff governance committee and is expected to be completed by the end of March 2024

Governance

• All 51 recommendations from the external erview of governance received in October 2023 have been mapped against outputs from the board self-assessment survey and factored into the assurance and improvement plan, with 3 outstanding:
  • a board assurance framework has been developed using the model set out in the blueprint for good governance and will be finalised by end March 2024
  • production of a strategic planning framework
  • review of annual appraisal process of Chief Executive will be presented to remuneration committee on 19 March 2024 for approval
• NHS Forth Valley internal control vealuation 2023/24, highlighted better organisation of the board assurance committees, the use of standard committee templates and improved quality of minutes

Fiona Hogg queried some of the actions on the plan which were not yet marked as complete, but are ongoing, for example, 3.6 which relates to diversity of the population and how this is reflected in senior management and board level roles. Consideration needs to be given as to work that is ongoing is captured in the plan going forward and as it becomes business as usual.

The Chair commented on the improved format of the report and asked whether evidence was still being recorded in the project plan. It was confirmed that the project plan was still in use, but that the feedback from the escalation performance and resource committee and staff has been that the new format makes information more accessible. It was agreed that this current version should now be published on both the internet and NHS Forth Valley’s intranet.

The Chair asked what internal validation processes were in place to provide assurances that the actions in the plan have been completed. Confirmation was given that the plan is scrutinised at the escalation performance and resource committee. The board has also asked internal audit to include the plan as part of their review for 2024-25.

The Chair asked about any further correspondence following NHS Forth Valley’s appearance at public audit committee on 29 February 2024 to give evidence following the publication of Audit Scotland’s section 22 Report. The board has been asked to provide follow up information in writing to public audit committee on some of the data presented, by April 2024. 

De-escalation: key milestones and support

The Chair provided an overview of the escalation process and set out for discussion some of the key components that would need to be in place to support consideration of de-escalation from Level 4 by Scottish Government. 

It was recognised that good progress has been made against completion of the actions in the issurance and Improvement plan across leadership, culture, and governance. There was a discussion about how the board could evidence sustainable improvements in the specific areas of performance identified as part of the escalation of NHS Forth Valley, namely: out of hours, unscheduled care, mental health, and integration. It was agreed that Scottish Government policy colleagues should be consulted and asked for their assessment of improvement in each of these areas.

It was agreed that the discussion paper should be developed further to incorporate key deliverables for integration, as outlined in a letter from Caroline Lamb, DG Health and Social Care/Chief Executive NHS Scotland to local authority Chief Executives on 22 December 2022. These were then incorporated into earlier versions of the assurance and improvement plan. Laurie Whyte will take on board these comments and work with relevant colleagues to develop the paper further in advance of the next AB meeting.

It was agreed that for future meetings, the Chair of the AB will provide an indication of the priorities that NHS Forth Valley should focus on to enable the board to move towards de-escalation. This would be based on information provided by NHS Forth Valley to the AB in preparation for the meeting and is aimed at providing a clear focus on the outstanding actions, whilst also recognising where improvements have been made.

AOB/Prep for next meeting

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

Amanda Croft updated the AB on recent actions taken to address unscheduled care performance. The board is meeting with SG policy officials on a weekly basis to discuss key performance indicators. This was highlighted as a key area of focus. 

The Chair indicated that it would be helpful, for the next AB meeting, if the board could include metrics on other areas of performance to provide more context, including on planned care and productivity. 

The next meeting of the AB will be on 9 April 2024. 

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

8 March 2024