NHS Scotland Executive Group Minutes: November 2024

Attendees and apologies

NHS Boards

• Claire Burden, NHS Ayrshire and Arran
• Peter Moore , NHS Borders
• Julie White, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Ross McGuffie, NHS Forth Valley
• Adam Coldwells, NHS Grampian, Interim Chief Executive
• Jane Grant , NHS Greater Glasgow and Clyde
• Fiona Davies, NHS Highland
• Jann Gardner, NHS Lanarkshire
• Laura Skaife-Knight, NHS Orkney
• Brian Chittick, NHS Shetland
• Nicky Connor, NHS Tayside

Special Health Boards

• Robbie Pearson, Healthcare Improvement Scotland (Chair of CEs
• Jim Miller, NHS 24
• Paul Johnston, Public Health Scotland
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotlan
• Michael Dickson, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• John Burns, NHS Scotland Chief Operating Officer
• Christine McLaughlin, Co-Director of Population Health
• Alan Gray, Director of Health and Social Care Finance
• Fiona Hogg, Chief People Officer
• Anne Armstrong, Interim Chief Nursing Officer
• Gregor Smith, Chief Medical Officer
• Robert Kirkwood, Head of Office of the Chief Executive

Other Attendees

• Susi Buchanan, Director, NSD (Agenda Item 5) (V)
• Kathryn Brechin, Professional Nurse Advisor, Nursing and Midwifery, Health, and Care (Agenda Item 6)
• Lorraine Cowie, NHS Scotland Professional Lead for Sustainability/Health Planning (on behalf of Paula Speirs) (Agenda Item 6)
• Colin Roddie, Programme Manager, NHSS Acute Reform Programme/Planning and Delivery Board (Agenda Item 5 and 6)

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hildersley, Board Governance and Appointments Team
• Fraser McJannett, Executive Support Team

Apologies

• Caroline Hiscox, NHS Lothian
• Caroline Lamb, DG HSC/CE NHS Scotland (John Burns deputising)
• Angie Wood, Director of Social Care Resilience and Improvement
• Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship (Lorraine Cowie deputising)
• Dougie McLaren, Deputy Chief Operating Officer - Performance and Delivery
   

Items and actions

Welcome, apologies for absence and attendees

John Burns, NHS Scotland Chief Operating Officer, welcomed everyone to the second meeting of the NHS Scotland executive group (executive group). Colleagues were reminded of hybrid meeting etiquette.

John positively reflected on the first meeting of the NHS Scotland executive group and encouraged colleagues to continue this momentum with productive exchanges and action focus.

John reminded colleagues that it was Jane Grants last meeting as Chief xecutive of NHS Greater Glasgow and Clyde. He reflected on her 40 years of service to the NHS and wished her well in her retirement at the end of this year.

John congratulated Jann Gardner, Chief Executive NHS Lanarkshire on being the successful candidate who will take over from Jane Grant on 1 February 2025.

A list of attendees and apologies for absence is provided at annex a.

Minutes of previous meeting, actions, matters arising (NHSEG/24/07)

The minutes from the first meeting of the Executive Group held on 9 October 2024 were approved.

Colleagues confirmed they were content with the format of the action tracker and updates provided. The action tracker should be seen as usual business rhythm and action owners were asked to be pro active regarding, providing updates to the secretariat, and not relying on the secretariat to chase.

The updated Terms of Reference (ToR)document was approved by the NHS Scotland executive group and will now be shared with colleagues and the Cabinet Secretary for Health and Social Care.

Action, lead and timescale

• Finalise ToR document and share as final with colleagues and the Cabinet Secretary for Health and Social Care - SG secretariat (4 December 2024)

Darzi – reforming our services and reforming the way we work together (NHSEG/24/08)

John Burns introduced the paper that had been circulated to attendees in advance of the meeting which set out the Scottish position in relation to the Darzi report. The paper was co-produced with the Chair of the Board Chief Executives’ group and drew out relevant recommendations for development and implementation for NHS Scotland.

The executive group were asked to consider:

• what role the executive group could play in helping to shape a multi-year plan that is a single proposition and draws in reform, population health, finance, and the national clinical framework
• NHS Scotland productivity – bench marking, unwarranted variation and system efficiency including modernisation, equipment, and digitisation
• the creation of a productivity and efficiency task and finish group to report to the executive group

In discussion, colleagues highlighted other areas in Scotland that should be considered as part of wider system reform following the prioritisation areas set out in the Darzi paper. These included primary care, mental health, health of the nation, social care, and workforce (staff, behaviour, and cultures). This work would be taken forward under the umbrella of the reform executive, drawing from collective expertise and knowledge to shape a single multiyear paper/plan with clear outcomes for 12 months, 24 months etc. This should be produced and return for further discussion at the March 2025 meeting.

In summary, colleagues were supportive of the need for a single plan with the new reform executive group taking this forward and look at how the executive group can contribute to discussion.

John Burns and Robbie Pearson would put together a representative group to discuss next steps.

Action, lead and timescale

• reform executive shape multiyear paper/plan covering the prioritisation areas set out in the Darzi paper considering other areas highlighted by colleagues ahead of further discussion at March 2025 meeting - Christine McLaughlin/John Burns (5 March 2025)
• representative group to discuss next steps to be set up on a short-term basis - John Burns/Robbie Pearson (6 December 2024)
• productivity and efficiency group to be established and report to executive group - John Burns (6 December 2024)

Informing service priorities in 2025-26 (NHSEG/24/09)

Robbie Pearson, Chief Executive Healthcare Improvement Scotland/Chair of Board Chief Executives Group introduced the paper that had been shared with colleagues to start a discussion on the scope, parameters and outcomes of healthcare reform in Scotland and agree a set of priority areas for action in 2025 26, aligned to Darzi and the wider reform agenda.

The executive group were asked to:

• consider the paper and endorse the principles set out paragraph 6
• consider the ways in which we can develop expected outcomes of healthcare reform
• consider the ways in which SG and health board representatives can work together to set out agreed priorities for subsequent executive group review and approval

In discussion colleagues discussed the current portfolio roles of NHS Chief Executives. It was agreed that further work was required to ensure that they align with reform priorities. Colleagues endorsed the principles set out in the paper and agreed with the development of single plan, with shared outcomes which link to the work outlined under the Darzi agenda item above, and that this should be taken forward by the reform executive group.

It was noted that the reform executive group would need to ensure participation from clinical colleagues around the evidence base for reform.

It was agreed that the role of the NHS Scotland executive group would be to simplify the governance of this work and streamline the meetings landscape to focus on priorities.

Action, lead and timescale

To ensure alignment with NHS Chief Executive Portfolio roles and Reform priority areas - Robbie Pearson/ NSS Secretariat (22 January 2025)
Work to continue on understanding the meeting landscape for Chief Executives and take out duplication/merge groups as appropriate - NSS secretariat to review John Burns/
Robbie Pearson to then discuss (22 January 2025)

Prioritisation (NHSEG/24/10)

John Burns introduced this item. A paper and presentation for decision was shared with the group in advance of the meeting, which covered the following areas:

• national services – NSS
• Scottish medicines consortium
• other demands
• innovation design authority
• non-clinical

 John highlighted that the decisions that needed input from the executive group related to areas where funding had not yet been agreed/confirmed. This included decisions to be made against proposed areas for prioritisation in 2025/26 but also what could be de-prioritised. He noted that further work was required to evaluate areas for de-prioritisation to provide an initial view on scale of opportunity and ease of implementation.

The NHS Scotland executive group were asked to:

• identify if any further areas should be included in both prioritisation and de-prioritisation
• have a discussion on indicative prioritisation and further information required to support further discussion
• determine the key lens to prioritise the list of current service pressures, with higher priority given to those pressures that will support prevention and value-based health and care
• support further iteration of this list, engage with SAMD, and SEND executive groups to further consider the list from a clinical perspective and DoPH from a preventative aspect
• agree that a commission is developed for an exploratory review to agree a national approach to medicines
• identify if any additional information is required to support further discussion

In discussion colleagues reflected that learning should be taken from the production of this paper to understand where links and connections need to be strengthened going into 2025/26 and future years. Colleagues discussed how to take on views from local systems and that the efficiency and productivity task and finish group would take this forward.

Colleagues highlighted other pressures that were not reflected in the paper, including, mental health services, hospice fragility. It was agreed that there should be an evidence-based approach to prioritisation, as carried out by national specialist services committee.

It was agreed that de-prioritisation should be considered on a one Scotland basis, drawing on the approach of value-based health and care and realistic medicine eg addressing low clinical value and how/when to intervene.

In summary, the priorities identified in the paper were noted, but that this should be further refined and brought back for decision at the next NHS Scotland executive group meeting in January 2025.

It was noted that a separate piece of work in relation to Scottish Medicines Consortium was commissioned at the board Chief Executives (BCE) Meeting and BCE colleagues would link in with SG colleagues regarding this.

Action, lead and timescale

• further discussion regarding areas of opportunity to take place at efficiency and productivity group - John Burns/Robbie Pearson (6 December 2024
• refined prioritisation paper to be brought back to next executive group meeting - John Burns/ Paula Speirs (22 January 2025)
• Scottish Medicines Consortium – BCE and SG colleagues to liaise regarding this - Mary Morgan/ Jann Gardner/Paula Speirs/ Lorraine Cowie (13 December 2024)

Business systems, e-rostering and payroll (NHSEG/24/11)

John Burns introduced this item and referenced the paper that had been circulated in advance. At the October meeting the executive group agreed that there should be a one Scotland approach to business systems and a single services model. The paper set out an assessment of related programmes and proposed actions to move in the direction of single corporate services. 

The executive group were asked to commission a task and finish group to:

• consider the key issues and variations highlighted in the e-rostering discovery report and set out an initial approach to addressing issues highlighted
• rapid consideration of next steps for further implementation of e-rostering, reviewing initial options
• consider the initial steps in progressing the development of single services for NHS Scotland, as agreed by the executive group on 9 October 2024
• consider how best to progress development of a single payroll service, and key next steps, as agreed by the executive group on 9 October 2024
• mobilises with the members as set out in the paper.

A review of where we are with these strands of work needs to be undertaken quickly and it should set out interconnected benefits from various system changes. Current business systems need to be replaced along with the whole platform underneath while recognising this is a multi-year piece of work with significant challenges and risks. In discussion, colleagues highlighted that current business systems cannot be put at risk during the transition to a single system.

A paper informing next steps on how we do this as part of a significant programme of transformation/reform should be brought back to the January 2025 executive group meeting, considering financial costs.

Colleagues agreed that a task and finish group should be mobilised with membership as set out in the paper.

Action, lead and timescale

New task and finish group to be established to review business systems, e-rostering and payroll - Paula Speirs/Lorraine Cowie (6 December 2024)

Thwe task and finishing group review current processes including using benchmarking from Police Scotland/Fire and Safety Scotland and prepare a paper setting out next steps for decision - Paula Speirs/Lorraine Cowie (22 January 2025)

Unscheduled care (NHSEG/24/12)

Robbie Pearson invited Jim Miller, Chief Executive NHS 24 and Jann Gardner, Chief Executive NHS Lanarkshire to speak to this item.

The executive group were asked to:

• note that boards’ ongoing focus on improving unscheduled care performance will be augmented by a focussed two phase ‘once Scotland’ approach, led by CfSD, to identify productive opportunities and areas for improvement in each territorial board
• phase 1 will provide an objective view of the shorter-term actions boards can take within their sphere of influence to improve unscheduled care, whilst phase 2 will provide more insight into the more systemic underlying issues that may require national support beyond 2024

Jim Miller highlighted that this work has clinical buy in, and the consistency of data has much improved however unscheduled care improvements still tend to focus on local level rather than whole system level.

Jann Gardner advised CfSD is mapping out opportunities for shared learning and what will make an impact in phase 1 and phase 2. Data packs will be made available to territorial boards through CfSD, and colleagues are asked to engage with this work.

Unscheduled care and access to services is a key priority for the First Minister and have raised questions on the variation across the country on delivery of unscheduled care services. While some variation is understandable there needs to be more consistency across Scotland. The ambition is there, and colleagues need to engage with the work to ensure that data driven improvement opportunities are utilised.

It was agreed that the unscheduled care transformation board would bring back data driven improvement opportunities, outlining a timetable with CfSD.

Action, lead and timescale

Unscheduled care transformation board would bring back data driven improvement opportunities, outlining a timetable with CfSD - Jim Miller/ Jann Gardener(January/March 2025)

Planned care (NHSEG/24/13)

John Burns provided the executive group with a verbal update on planned care. He indicated that the centre for sustainable delivery (CfSD) is playing a lead role in developing a number of national plans as per the workplan of the planned care transformation board. The initial focus will be on:

• ophthalmology
• imaging
• orthopaedics

CfSD will reach out to examine opportunities for capacity building, look at theatre scheduling and the use of national treatment centres. Colleagues asked for clearly described parameters for patient lists based on complexity rather than a single parameter for patient lists.

CfSD is currently finalising national plans on planned care with a view to circulating to boards in due course, colleagues agreed that CfSD could share board-level information from each board to ensure we have a shared understanding and can agree the delivery of national plans. CEOs also agreed that boards data used to develop other plans through CfSD can be shared.

CMO offered support to CfSD regarding Patient Initiated Reviews due to low uptake.

Action, lead and timescale

• CfSD to outline parameters for patient lists based on clinical difficulty - Gordon James (22 January 2025)
• CfSD to prepare national plans on planned care and bring these back to the January 2025 meeting - Gordon James (22 January 2025)
• CfSD link with CMO regarding Patient Initiated Review - Gordon James/CMO (13 December 2024)

Any other business

Paul Johnston, Chief Executive, Public Health Scotland, reflected on a recent meeting with the First Minister where he highlighted the challenge on bodies providing joined up support to those in deep poverty. Paul would share reflections with the executive group.

Action, lead and timescale

Share reflections regarding the challenge on bodies providing joined up support to those in deep poverty - Paul Johnston (13 December 2024)

Date and time of next meeting

The next meeting will take place on 22 January 2025.