NHS Scotland Executive Group Minutes: October 2024

Attendees and apologies

NHS Boards

• Claire Burden, NHS Ayrshire and Arran
• Peter Moore, NHS Borders
• Julie White, NHS Dumfries and Galloway
• 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  
• Caroline Hiscox, NHS Lothian
• Laura Skaife-Knigh, NHS Orkney
• Brian Chittick, NHS Shetland
• Nicky Connor, NHS Tayside
• Gordon Jamieson, NHS Western Isles

 
Special Health Boards 

• Robbie Pearson, Healthcare Improvement Scotland (Chair of CEs)
• Jacqui Hepburn, NHS 24, Deputy Chief Executive and Director of Workforce (for Jim Miller)
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Mary Morgan , NHS National Services Scotland
• Michael Dickson, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

 
Scottish Government 

• Caroline Lamb, DG HSC/CE NHS Scotland 
• John Burns, NHS Scotland Chief Operating Officer
• Christine McLaughlin, Co-Director of Population Health
• John Harden, National Lead for Quality and Safety
• Angie Wood, Director of Social Care Resilience and Improvement
• Alan Gray, Director of Health and Social Care Finance
• Fiona Hog, 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 

 

• Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship
• Dougie McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Robert Henderson, Intergovernmental and International Relations Unit Head (agenda Item 3)
• Jonathan Cameron, Deputy Director, Digital Health and Care (agenda Item 7)
• Colin Roddie, Programme Manager, NHSS Acute Reform Programme/Planning and Delivery Board (agenda Item 5)

Secretariat 

• Kat Dobell, Board Governance and Appointments Team 
• Sarah Hildersle, Board Governance and Appointments Team  
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, Executive Support Team
• Jenna Stone, Executive Support Team

Apologies 

• Carol Potter, NHS Fife 
• Jim Miller, NHS 24 (Jacqui Hepburn attending) 
• Paul Johnston, Public Health Scotland 
   

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, DG Health and Social Care and Chief Executive NHS Scotland, welcomed everyone to the meeting, in person and online and colleagues were reminded of hybrid meeting etiquette.

Caroline introduced this as the first meeting of the NHS Scotland Executive Group. This and future meetings will focus on decision making and cooperation between boards but also between boards and the Scottish Government Health and Social Care directorates.

Caroline welcomed two new Chief Executives to their first meeting: Ross McGuffie, NHS Forth Valley and Peter Moore, NHS Borders.

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

NHS Scotland Executive Group terms of reference (ToRS) (NHSEG/24/01) 

Robbie Pearson, Chief Executive Healthcare Improvement Scotland/Chair of Chief Executives group provided introductory remarks on the terms of reference and the group discussed and agreed the ToRs, in principle.

Robbie noted that the current outline for decision making was documented through a high level flow chart (annex a of TORs). It was suggested that recommendations of the group would be recorded in the minutes and a follow up letter, setting out these recommendations, which would then be sent to NHS Chief Executives and copied to NHS Chairs for their consideration and implementation within Boards. Letters would be clear on identifying timescales and programme leads for the work.

In discussion, all agreed the one key thing was how decisions were made on recommendations and how to ensure this is balanced with health board decision making. John Burns, NHS Scotland Chief Operating Officer stated that a narrative was needed around what the key distinguishing features were, as demonstrated through the decision making flow chart (annex a).

Agreed updates to the TORS included:

• risk: it would be the responsibility of health boards to articulate why recommendations were not being taken forward, such as specific risks that were unacceptable and then suggest changes that would allow them to reach a position to implement a recommendation
• roles and responsibilities: these need to be set out clearly for Chief Executives and Chairs. Local engagement with Chairs, Boards and Lead Advisors was crucial
• to be added to the substructure:
  • the concept of pathway development for services needs a single, national, approach
  • workforce development and core activity around training
  • clarity on what financial elements are appropriate for the NHSEG to consider
• communications: the role of Chief Executives to ensure decisions and recommendations are communicated to their Chair and to return to update this group
• within the next month, a definitive version of the ToRs (excluding the sub-structure of groups) would be finalised to engage with Chairs and the Cabinet Secretary for Health and Social Care.

Recommendation, lead and timescale:

• ToR agreed in principle noting the below updates;
  • annex a to include a narrative description of how recommendations are communicated to boards and expectations on how boards will feedback into the NHS Scotland Executive Group (NHSEG) - Robbie Pearson/Secretariat (by 18 October 2024)
  • annex c to be taken out of the ToR while extensive work is undertaken on the supporting structures that feed into the NHSEG - Robbie Pearson / secretariat (by 31 Octpber 2024)
• final version to be agreed before 31 October and then shared with NHS Chairs (with Robbie Pearson and Caroline Lamb to present) and the Cabinet Secretary for Health and Social Care. Robbie Pearson/ secretariat (by 31 October 2024)

Darzi review (NHSEG/24/02) 

Caroline invited Robert Henderson, Unit Head, Intergovernmental and International Relations to update on the Darzi review. A paper was circulated to attendees in advance of the meeting outlining the of work being undertaken in response to the themes highlighted below:

UK Government’s 3 pillars to health missions:

• health and Ccre services there when people need it
• fewer lives lost to the biggest killers (cancer, CVD, suicide)
• a fairer Britain where everyone lives well for longer: focused on prevention, addressing the behavioural and social determinants of health

The Darzi review is published at a time when consideration is also being given to the future of the NHS within Scotland. As the Cabinet Secretary set out in Parliament on 4 June, there is an urgent need to reform how health and social care services operate in Scotland.

A range of work has been taken forward already which addresses themes highlighted in the Darzi review. To deliver the HSC vision and provide a strong contribution to the FM’s 4 Scottish Government priorities and package of public service reform, the following is underway:

• developing a national clinical framework to reform and improve NHS acute services across Scotland
• supporting primary care to deliver high quality preventative health and care services 
• developing a mental health transformation programme to deliver the implementation of a number of related transformation projects 
• Wwrk to better integrate health and social care
• building on the positive and innovative actions we are already taking across areas including tobacco and alcohol control to improve population health and reduce health inequalities
• Scottish Government officials would continue to engage with DHSC as they develop plans in response to the Darzi review. Ministerial engagement is also being planned to enable shared learning and collaboration

In discussion, it was noted that the message the Darzi review gave was that the NHS was no longer fit for purpose and there was concern that this could demoralise staff. While the NHS in Scotland faced significant challenge, the focus should be on engaging staff and ensuring a positive culture. There would be a need for boards to focus on the positive opportunities afforded by reform, putting patients and staff at the centre of that work, with the ongoing work around digital and innovation in support. It was agreed that this group would look at prioritisation of opportunities and align it with learning from the Darzi review.

Colleagues highlighted the need for greater consideration on ESM and the importance of the managerial profession in the health service. Focussed management training should be looked at to ensure people are appropriately supported for management in an acute/operational setting. Fiona Hogg, Chief People Officer and Karen Reid, NHS Education for Scotland, were looking at what existing resources could be utilised to support that work, as well as how the university sector could be involved.

Recommendation, lead and timescale

• prioritisation options for development and implementation to be brought to the next NHSEG meeting - John Burns, Robbie Pearson, Caroline Hiscox (by 13 November 2024)

Quality and safety (NHSEG/24/25/03)

John Harden, National Lead for Quality and Safety introduced this item. The paper proposed additional governance and oversight arrangements to provide assurance and improve safety and quality in health and social care for the future.

Chief Executives were invited to approve the following:

• To agree the strategic approach to quality and safety using a quality management system, informed by quality and safety metrics, to be implemented across NHS Scotland
• To agree a quality and safety sub-group of the new NHS Scotland Executive Group should be established. The sub-group should have representation from NHS Board chief executives, medical and nurse directors, and others across the healthcare professions. This sub-group, chaired by the National Clinical Lead for Quality and Safety, John Harden, will make recommendations to the Executive Group for action within the boards and be focused on driving improvement

A range of comments were made on a number of aspects of the paper. This included: seeking a stronger focus in the SBAR on the delivery of quality and safety rather than the governance mechanism; ensuring a strong emphasis on outcomes; providing clarity on the link to education and training; explicit mention of value; delivering a balanced approach to risk; and, delivery of a consistent approach across Scotland.

It was also highlighted that any subgroup must not interfere with the governance arrangements of health boards. A co-design approach would be essential.

Recommendation, lead and timescale

• to rework the proposal for the quality and qafety group and outline key priorities and issues that would be taken forward. Codesigning with input from professional groups including SEND and SAMD - John Harden (by 22 January 2024)

NHS Scotland Planning and Delivery Board Items

Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship provided an update on the following:

• sustainable services (NHSEG/24/25/04a)
  • vascular
  • oncology
• national programmes (NHSEG/24/25/04b)
  • business Services
  • e-rostering

The discussion summarised work underway to address sustainability of identified services. The paper asked the NHSEG to endorse and commission the PDB to continue the work on vascular and oncology.

The group was assured that issues raised over the last year are collectively addressed through collaboration including engagement across the system with clinical and planning colleagues. The PDB is seeking to deliver a coherent approach to service reviews that can be adapted to support sustaining services, as the current use of urgent mutual aid is no longer viable.

John Burns confirmed there were no current mutual aid requests, however, raised concerns about how quickly mutual aid could be enacted. All agreed they would be happy to work with colleagues to take steps to deliver long term sustainability of services and that this would require multidisciplinary emphasis.

It was vital that the group fully understood the current challenges around vascular services. To enable that, it was recommended that boards providing vascular services, Medical Directors and Chief Executives meet to ensure a collective situational awareness - and this conversation should be prioritised soon. The focus would not just be about developing a plan but a focus on implementation. Sustainable solutions will need to come with appropriate assurance before going to the Cabinet Secretary.

The planning and delivery board have discussed a single service for Scotland and recommend to the NHSEG that this is an agreed approach to all national programmes. A short paper will be sent to NHSEG regarding this approach.

The NHSEG agreed to commission the planning and delivery board to take forward the work proposed on e-rostering. Risks were highlighted around working in a new way, looking at the governance to support the change on a national basis and resourcing required for effective implementation of e-rostering and payroll.

The NHSEG agreed to commission the planning and delivery board to take forward the work proposed on payroll. Noting that payroll and e-rostering are considered to be a part of service redesign and that the planning and delivery board are commissioned to lead on this with the extant portfolio board.

On moving to a single payroll, it was agreed this should be jointly overseen by finance and HR leads. E-rostering would improve insights into productivity in the system, which was currently challenging to understand. Risks associated with the local impact of changes also needed to be fully understood and mitigated if a change was to be successfully implemented – this included delivering change with no clearly identified resourcing to support implementation.

Recommendation, lead and timescale

• PDB to ensure collaborative working across the service on sustainable services and to focus on the practicalities of implementation - Paula Speirs (update to be provided at 13 November 2024)
• Medical Directors and Chief Executives meet to ensure a collective situational awareness relating to vascular services - and this conversation should be prioritised soon - Fiona Davies   (update to be provided at 13 November 2024)
• NHSSEG endorsed that the PDB should take a one Scotland approach to national programmes - Paula Speirs (ongoing)
• PDB commissioned to continue work on e-rostering - Paula Speirs (update to be provided at 13 November 2024)
• PDB commissioned to continue work on payroll - Paula Speirs (update to be provided at 13 November 2024)
• payroll work to ensure adequate input from HR and Finance colleagues including risk assessment on local impact of national implementation - Carol Potter (update to be provided at 13 November 2024)

Planned care (NHSEG/24/25/05)

Gordon James, NHS Golden Jubilee provided a paper on planned care and presentation on productivity. He gave an update on the progress to date in key areas and reiterated actions required by health boards. The presentation covered:

• update on theatre scheduling implementation
• update on community glaucoma services
• deep dive on productivity
• agreement of the planned care transformation board workplan
• agreement of the commission to establish an NTC forum

John Burns emphasised the importance of the planned care transformation and delivery board in demonstrating a more collective approach, vital in driving the pace of change. The need for theatre scheduling information to be returned by boards was highlighted.

The meeting was also updated on the productivity work taking place around ophthalmology with the Minister for Public Finance. Targeted action was sought around this and Chief Executives were asked to engage with their clinical leads on the clinically agreed blueprint developed by CfSD, to increase throughput on single cataract lists.

Chief Executives were asked to assess where their Board was utilising the opportunities available through the National Elective Coordination Unit (NECU) as this is an important building block to assist with waiting list reduction.

Recommendation, lead and timescale

• outstanding theatre scheduling readiness assessments to be completed for the following health boards. (NHS Fife, NHS Grampian, NHS Orkney, NHS Shetland, NHS Tayside, NHS Western Isles) - Carol Potter, Adam Coldwell, Laura Skaife-Knight, Brian Chittick, Nicky Connor, Gordon Jamieson - (by 31 October 2024)
• Chief Executives to engage with local clinical leads to increase throughput on single cataract lists - all Chief Executives (report back by 13 November 2024)
• to share the productivity presentation within their local teams - all Chief Executives (by 13 November 2024)
• Chief Executives were asked to assess where their board was utilising the opportunities available through the National Elective Coordination Unit (NECU) - all Chief Executives (update by 13 November 2024)

Digital reform (NHSEG/24/25/06)

Jann Gardner reminded colleagues of the discussion in September and the commitment by Chief Executives to making digital a priority. This includes the three key areas for digital enablement of reform: digital front door; integrated health and social care record; and the national digital platform.

Colleagues were asked to agree to commission a landscape review into digital to determine the optimum roles and responsibilities for national and local work. It was also agreed that this work should clearly support the sustainable services work being taken forward by the PDB. This has been a co-produced approach. Chief Executives endorsed the delivery of a landscape review.

Colleagues agreed to the recommendations to commission the strategic leadership board for digital and data transformation to finalise a shared narrative and vision for digitally enabled reform alongside a stronger articulation of benefits, impacts and outcomes. They also discussed NHS Scotland’s immediate priorities for information sharing and agreed to commission the BCE digital and innovation portfolio to set out scope and parameters of the resultant work on information sharing.

 Recommendation, lead and timescale

• approved the delivery of a landscape review on digital and agree to ongoing engagement with the resultant review - Christine McLaughlin (procurement to begin late October  subject to SG approval
• work to be linked with the sustainable services work of the planning and delivery board - Christine McLaughlin / Paula Speirs (to go back to planning and delivery board on 14 December 2024)
• commission the strategic leadership board for digital and data transformation to finalise a shared narrative and vision for digitally enabled reform alongside a stronger articulation of benefits, impacts and outcomes - Christine McLaughlin (report back by 22 January 2024)
• commission the digital and innovation portfolio to set out scope and parameters on information sharing - Christine McLaughlin (report back by 22 January 2024)

Any other business

Caroline Hiscox advised colleagues that she would be writing to boards shortly for mutual aid as NHS Lothian moves services out of the Eye Pavilion. The Eye Pavilion is estimated to be closed for 6 months with services dispersed during that time. It was recognised that this will have an impact on the national position around ophthalmology.

John Burns reminded colleagues of the ask from the First Minister and Cabinet Secretary on the implementation of pre-eclampsia and placental growth factor (PIGF) Testing. Chief Executives were reminded to provide implementation plans to Scottish Government as soon as possible, recognising the financial challenge.

Recommendation, lead and timescale

• pre-eclampsia and placental growth factor (PIGF) testing implementation plans submitted to Scottish Government - NHS Chief Executives to John Burns (25 October 2024)

Date and time of next meeting

The next meeting will take place on 13 November 2024 and will focus on prioritisation and the planning and delivery board endorsed framework. This would be the last meeting scheduled for this year utilising the current planned Chief Executive business meeting dates. Next years proposed dates are included in the draft TORs.

Recommendation, lead and timescale

• ToR agreed in principle noting the below updates;
  • annex a to include a narrative description of how recommendations are communicated to boards and expectations on how boards will feedback into the NHS Scotland Executive Group (NHSEG) (by 18 October 2024)
  • annex c to be taken out of the ToR while extensive work is undertaken on the supporting structures that feed into the NHSEG - Robbie Pearson / secretariat (draft by 31 October but ongoing)
• final version to be agreed before 31 October and then shared with NHS Chairs (with Robbie Pearson and Caroline Lamb to present) and the Cabinet Secretary for Health and Social Care - Robbie Pearson/ Secretariat (31 October 2024)
• prioritisation options for development and implementation to be brought to the next NHSEG meeting. - John Burns, Robbie Pearson, Caroline Hiscox (by 13 November 2024)
• to rework the proposal for the quality and safety group and outline key priorities and issues that would be taken forward. Codesigning with input from professional groups including SEND and SAMD - John Harden (22 January 2024)
• PDB to ensure collaborative working across the service on sustainable services and to focus on the practicalities of implementation - Paula Speirs (update to be provided at 13 November 2004)
• Medical Directors and Chief Executives meet to ensure a collective situational awareness - and this conversation should be prioritised soon - Paula Speirs    Update to be provided at 13 Nov 2004
• NHSSEG endorsed that the PDB should take a one Scotland approach to national programmes - Paula Speirs (ongoing)
• PDB commissioned to continue work on e-rostering - Paula Speirs (update to be provided at 13 November 2004)
• PDB commissioned to continue work on Payroll - Paula Speirs (update to be provided at 13 November 2004)
• payroll work to ensure adequate input from HR and Finance colleagues including risk assessment on local impact of national implementation - Paula Speirs (update to be provided at 13 November 2004)
• outstanding theatre scheduling readiness assessments to be completed for the following health boards. (NHS Fife, NHS Grampian, NHS Orkney, NHS Shetland, NHS Tayside, NHS Western Isles) - Carol Potter, Adam Coldwell, Laura Skaife-Knight, Brian Chittick, Nicky Connor, Gordon Jamieson (31 October 2024)
• Chief Executives to engage with local clinical leads to increase throughput on single cataract lists - all Chief Executives (report back by 13 November 2024)
• to share the productivity presentation within their local teams - all Chief Executives (by 13 November 2024)
• Chief Executives were asked to assess where their board was utilising the opportunities available through the National Elective Coordination Unit (NECU) - all Chief Executives (update by 13 November 2024)
• approved the delivery of a landscape review on digital and agree to ongoing engagement with the resultant review - Christine McLaughlin (procurement to begin late October subject to SG approval)
• work to be linked with the sustainable services work of the planning and delivery board - Christine McLaughlin / Paula Speirs (to go back to PDB on 14 December 2024)
• commission the strategic leadership board for Ddgital and data transformation to finalise a shared narrative and vision for digitally enabled reform alongside a stronger articulation of benefits, impacts and outcomes - Christine McLaughlin (report back by 22 January 2024)
• commission the Digital and Innovation Portfolio to set out scope and parameters on information sharing - Christine McLaughlin (report back by 22 January 2024)
• pre-eclampsia and placental growth factor (PIGF) testing implementation plans submitted to Scottish Government - NHS Chief Executives to John Burns (25 October 2024)