NHS Forth Valley Assurance Board minutes: 9 March 2023

Attendees and apologies

Members

• Christine McLaughlin, Co-Director of Population Health (in-person)

• Alex McMahon, Chief Nursing Officer (virtually)

• Robert Kirkwood, Head of the Office of Chief Executive (virtually)

• Tracy Slater, Head of Performance and Delivery (in-person) 

Attendees – Forth Valley 

• Cathie Cowan, Chief Executive (in-person)

• Janie McCusker, Chair (in-person)

• Andrew Murray, Medical Director (in-person)

• Frances Dodd, Executive Nurse Director (in-person)

• Linda Donaldson, HR Director (in-person)

• Scott Urquhart, Director of Finance (in-person)

• Robert Clark, Employee Director (in-person)

• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP (in-person)

• Gillian Morton, Director of CPMO/Women and Children’s Directorate, Director of Midwifery (in-person)

• Jonathan Proctor, Director of Estates and Infrastructure (virtually)

• Jonathan Best, Interim Director of Acute Services (virtually) 

• Sally McIntosh, Assurance Board Project Manager (virtually) 

Attendees – Scottish Government

• Hazel Borland, Professional Advisor, Chief Operating Officer, SG (virtually)

• [redacted], Head of Workforce Relations (virtually)

• [redacted] (Secretariat), Senior Policy Manager (virtually)

• [redacted] (Secretariat), Policy Adviser (virtually)

Apologies 

• John Brown, Chair of NHSGGC 

• John Harden, Deputy National Clinical Director

• Angie Wood, Director of Social Care Resilience and Improvement

• Gillian Russell,  Director of Health Workforce

• Richard Foggo, Co-Director of Population Health

• Gregor Smith, Chief Medical Officer

• Patricia Cassidy, Chief Officer, Falkirk 

Items and actions

Welcome, apologies and Introduction

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

Forth Valley feedback on papers

The Chair asked the Forth Valley Executive Leadership Team (ELT) to provide a summary of the papers, and agreed to open up the discussion to Assurance Board members when questions arose. 

The ELT summarised the report and appendices, noting that the draft Measurement Framework has only been applied to actions that were agreed in the last iteration of their plan, from December 2022 to February 2023. The latest iteration of their plan is due to be approved by their Board, and the SG External Support Team have reviewed and provided feedback. The SG External Support Team are on hand to provide further support and feedback as it develops.  They outlined programmes of work already underway, including those in the governance, leadership and culture and highlighted the co-produced nature of various workstreams, such as a review of professional leadership structures within the organisation. 

NHS FV acknowledged that whilst the actions in the Improvement Plan related to Integration are now marked as complete, there is still work to embed cultural changes and progress their strategic vision and narrative. 

The Chair of NHS Forth Valley gave an update on the Governance Review and noted that there may be an interim report in April 2023, subject to confirmation from John Brown.  Informal feedback provided is also expected to be provided on an ad-hoc basis. 

The Assurance Board (AB) requested a verbal progress update on leadership and culture in the organisation and how things felt to the team. The general comments suggest consensus that whilst they are not where they should be, they are heading in the right direction. There was also recognition that more needs to be done to working collaboratively to address specific challenges in performance, with everyone playing their part. 

The AB reaffirmed the need to prioritise leadership and cultural change, alongside other key operational performance priorities within the organisation. Co-production and collaboration will be key to success. SG also reaffirmed the need for NHS FV Board involvement in addressing culture and leadership. 

The Chair reiterated to ELT the need to demonstrate real ownership of the Improvement Plan and the actions required to address the issues of escalation.  As part of that discussion ELT were asked to consider the content of updates they wished to bring to the AB and the timing of those.   

The ELT provided an update on performance areas including: out of hours (OOH), Psychological Therapies (PT), Child and Adolescent Mental Health Services (CAMHS), and Unscheduled Care (USC). The ELT noted positive progress in CAMHS and OOH.  Performance has remains challenging in PT, primarily due to workforce recruitment however it was noted that workforce does appear to be in line with other NHS Boards. Chief Officer for Clackmannanshire and Stirling will reconsider workforce capacity in PT to mitigate the impact on services and performance. 

USC progress remains very challenging, with performance in the lower quartile nationally.  The AB asked ELT to consider what more can be done to bring performance in-line with the rest of NHS Scotland. The ELT confirmed that social care capacity is being considered alongside USC programmes of work. The AB requested further detail on performance areas, backed by robust data and intelligence, at the next meeting. 

The ELT also provided an update on positive progress against the actions detailed in the Healthcare Improvement Scotland (HIS) report. 

The ELT thanked the External Support Team for their support and feedback to date, especially on developing the draft Measurement Framework. 

Assurance Board feedback on progress to date

The Chair provided a view of progress to date, including:

• an agreed Improvement Plan in place (developed and agreed by the FV Board), with governance in place to monitor and scrutinise progress

• a simplified single Executive Leadership Team (ELT); a triumvirate is now in place between the Chief Executive Officer (CEO), Medical Director (MD) and Nursing Director (ND)

• encouraging response to the Healthcare Improvement Scotland (HIS) report

• a Governance Review is now in process

• an interim Acute Services Director has been appointed and is working to embed sustainable change, with staff describing signs of improvement in this service area

• a scope has been agreed for a review of integration and

• further Organisational Development (OD) support has been agreed by ELT

The Chair highlighted a number of areas where further work is needed to provide the AB with assurance that sustainable progress is being made, notably: 

• Improved and sustained performance in challenged performance areas, namely USC and PT

• stronger leadership and culture is described and felt throughout the organisation by different groups

• evidence of more effective relationships within the ELT

• papers and evidence provided to the AB should always be a collective effort, whilst being cognisant of the capacity of individuals and 

• following through with further strategic actions on integration (as explored through the deep dive), supported by the integration review

There was recognition and reflection from the Forth Valley ELT that whilst progress on culture and leadership has been made, change will take time to materialise and that further work to maintain momentum is necessary. Once finalised, the Measurement Framework will provide a tool to demonstrate where further work is required in this space. 

The Chair requested, following a number of conversations with SG colleagues and Forth Valley, that a deep dive session on culture and leadership should form the agenda of the next meeting, co-led by the Forth Valley HR Director and Employee Director. The Chair reaffirmed that Forth Valley should pursue programmes of work that will work for them and provide long-term, sustainable change. 

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