Preventative and Proactive Care Programme Board: 18 March 2024

Attendees and apologies

• Donna Bell, Director of Social Care and National Care Service, Scottish Government
• Tim McDonnell, Director of Primary Care, Scottish Government
• Karen Duffy, Delivery Director, Preventative and Proactive Care, Deputy Chair, Scottish Government
• Ann Gow, Director of Nursing and Deputy Chief Executive, Health Improvement Scotland
• Anne Leitch, Value Based Health and Care Programme Lead, Scottish Government
• Cat Macaulay, Chief Design Officer, Scottish Government
• Elaine McMenemie, Project Manager, Care and Wellbeing Portfolio, NHS National Services Scotland
• Ellie Crawford, Unit Head leading for Primary Care link with Preventative and Procative Care, Scottish Government
• Gordon Paterson, Director of Social Care, NHS Education for Scotland 
• Jennifer Champion, Deputy Director of Public Health, NHS Forth Valley
• Joanna MacDonald, Deputy Chief Social Work Adviser, Scottish Government
• Katie Morris, Getting It Right For Everyone Lead, Scottish Government
• Kim Walker, Programme Director, Care and Wellbeing Portfolio, NHS National Services Scotland
• Lynn MacMillan, Head of Health Inequalities Unit, Health Improvement Division, Scottish Government
• Lorna Kelly, National Lead, Primary Care, Health and Social Care Scotland
• Manira Ahmad, Chief Officer, Public Health Scotland
• Sammi Allan, Project Manager, Social Care and Telecare, NHS National Services Scotland
• Rishma Maini, Consultant Public Health Medicine, Public Health Scotland
• Eddie Fraser, Council Chief Executive, SOLACE
• Nicola Edge, Head of Health and Social Care Analysis, Scottish Government

Apologies

• Karen Reid, Chief Executive NHS Education for Scotland / NHS Board Chief Executive
• Paula Speirs, Deputy Chief Operating Officer, Scottish Government
• Julie Murray, Chief Officer, East Renfrewshire Health and Social Care Scotland
• Anne Armstrong, Deputy Chief Nursing Officer, Scottish Government
• Rikke Iversholt, Programme Lead for Social Care and Telecare, Scottish Government
   

Items and actions

Welcome and apologies, Donna Bell 

Donna Bell, Director of Social Care and National Care Service and Chair, welcomed all to the meeting and noted apologies received prior to the meeting. 

There was a request for any comments on the minutes from the previous meeting, none were noted at this point but the Chair welcomed feedback later if applicable. 

PPC Status Report – Katie Clayton 

Katie Clayton, Programme Manager for Primary and Proactive Care (PPC), reported that the RAG status for the programme is Green for this period despite some delays in Digital and Primary Care projects which are reporting Amber at a project level. Cardiovascular Disease will commence reporting in the next period but is progressing well with the second Steering Group taking place this week. 

Key points to note include a red milestone for Primary Care roll out of Community Glaucoma Service due to four locations being delayed. This is being escalated to senior leadership in the four boards. All other areas of Primary Care are progressing on track.

Katie Clayton pointed members towards an escalation report included in the papers relating to the withdrawal of two pathfinders and partners for the Getting It Right For Everyone design school process. It does not impact overall delivery, or timescales for the remaining partners and mitigating actions are in place to provide support and flexibility to all other pathfinders. This is also being monitored as a risk. 

There is a ‘Very High’ risk recorded under Waiting Well (WW) due to an SBAR regarding improving communication to patients while they are waiting that has not progressed since submission to the Digital Leads group. This is not impacting any other key initiatives within WW. 

Highlight Reports

Getting it Right for Everyone (GIRFE) – Katie Morris 

Katie Morris, GIRFE Lead, presented the Highlight Report for GIRFE. 

GIRFE partners and pathfinder teams are currently working on 18 prototype areas associated with “The Team around the Person”. Several workshop sessions have been held for GIRFE prototyping and have been well attended. Five storyboards are now complete which are aligned to GIRFE thematic areas. 

Katie Morris reported that two GIRFE pathfinder teams (Edinburgh and Angus) and two GIRFE partner teams (Dumfries and Galloway and East Renfrewshire) have withdrawn from this work due to resourcing restraints and capacity issues. GIRFE leads have agreed to meet with these teams at the end of summer 2024. The project is still able to fulfil all obligations around the different thematic areas.

A benefits review has been completed and a new GIRFE policy advisor has been recruited. The team also met with Maree Todd, Minister for Social Care, in March to present GIRFE progress and forward plan. Ms Todd agreed with direction of travel. 

The next phase of work includes developing prototypes which will be tested from April to June and regular meetings with partners and pathfinders are ongoing to monitor progress. From the summer onwards the work will also focus on connecting the dots to ensure enabling areas support the team around the person. 

Katie Morris presented the GIRFE storyboards and explained to the group how these have been developed.

Summary of board discussion on this item: 

• there will be an opportunity to engage differently during the implementation stage for the partners and pathfinders who had to withdraw from the process. These teams may have opportunity to implement as early adopters, conversations are in progress
• GIRFE should gain insights from the Black and Minority Ethnic community and consider this during the gap analysis and Equalities Impact Assessment work
• all colleagues involved in this work have been offered continued support form local and national trauma informed teams due to the subject matter which could be triggering for individuals
• due to cross overs between work carried out with GIRFE and the National Care Service collaboration the teams are meeting regularly to ensure these are joined up

Cardiovascular Disease (CVD), Karen Duffy 

Karen Duffy, Delivery Director for PPC, gave the group an overview of CVD workstream including progress so far, governance structure and alignment with other groups. The group was set up to develop and coordinate delivery of a programme to improve the identification and management of clinical risk factors for cardiovascular disease (CVD) in Scotland. The first CVD Steering Group was held end of January, with the second meeting scheduled for Thursday 21st March.

Aims, primary and secondary drivers have been developed to guide our hypothesis about what could make a difference. Karen Duffy provided overview of key actions under each established driver and advised that short, medium, and long term aims have been set out. A meeting is scheduled with Health and Social Care Management Board on 20th March to discuss how this can be a joint priority across the system. 

Summary of board discussion on this item: 

• Karen Duffy has reached out to Public Health Scotland burden of disease team who are working on whole systems modelling and burden of disease down to locality level as there is opportunity to share and repurpose information
• community focus important, everyone is under pressure so using community planning partners could help to promote risk factors
• links should be made with NES to support service moving from a reactive to a more proactive space - to ensure training is aligned

Digital, Sammi Allan 

Sammi Allan, Project Manager for Social Care and Telecare, provided an update on the Digital workstreams. 

Proactive Telecare will soon be running 3 consecutive testing phases. The first is a traditional person to person model with Alarm Receiving Centre Operators making regular phone calls to service users at a time that’s suitable for the customer. The second is Yokeru, a proactive AI solution which sends automated calls to a customer’s telephone (mobile or landline) at a set time with tailored messaging and the third, Alertacall, which is a touchscreen device working off a 4g multi-network SIM or Wi-Fi. The device can increase with two-way conversations, giving residents the ability to send messages to Hanover, and to push multimedia messages out to residents. Alertacall’s ‘OKEachDay’ button on the touchscreen device provides an opportunity for residents to check in to say they are OK, negating the need for a morning call.Sammi Allan suggested that the leads on each could present at a future PPC board. 

PainChek will run until December 2024 at which point a decision will be made about whether to scale up nationally based on the benefits and impact of the current phase. 

Hypertension currently has more than 100k users. There are ongoing discussions about where Connect Me will be managed from and its priority pathways. DanceSing is now live in 65 care homes and a meeting will be held on 19th March to establish how to increase engagement in the service. Surveying and analysis are ongoing. 

SEM Scanner work is currently on hold due to lack of funding but may be funded in 24/25 FY, an update is pending. 

RAG status is currently Amber but will move to Green if SEM Scanners are removed from project plan until a final decision is made as it is the only factor delaying progress.

Summary of board discussion on this item: 

• there was a suggestion to conduct a programme needs assessment around digital and sharing consistent messages about the importance of access to digital information services
• comments were received on the importance of care homes and this should also be brought into the GIRFE work
• Sammi Allan advised that the previous focus on digital inclusion for care homes had been to issue devices and ensure they had internet connection which most care homes now have. Those who do not have internet access due to poor connection or building incompatibility are still being supported by the digital team

Action: Sammi Allan to invite leads for Proactive Telecare to future PPC Programme Board to report on progress.

Primary Care, Ellie Crawford 

Ellie Crawford, Unit Head leading for Primary Care link with PPC, provided an update on Primary Care noting the RAG status for each workstream and key points to note in progress.
All workstreams are reporting as Green except for Whole Family Support through GP which is reporting as Amber. EC advised that this will move to Green when the grant has been accepted and recruitment is underway.

Analysis on Inclusion Health in Action in General Practice across 70 practices has shown this has had a positive impact on patients, staff and systems. An external evaluation is now underway and findings are due in April ’24, the results will inform decisions for future years.

Monitoring is ongoing for Dental Payment Reform but initial feedback is positive with general consensus from dentistry being that it is a major improvement for practices who provide NHS dentistry. 

Community Glaucoma Service (CGS) is proving a success and is anticipated to meet target dates however EC noted that it has stalled in some areas and showing less progress in others which are reporting as Amber or Red.  

Recommendations/Decisions Required from Programme Board: CGS prioritisation is escalated to a senior level in those Boards where progress has stalled – NHS Ayrshire and Arran, NHS Fife and NHS Lothian.

Action: Ellie Crawford to share learnings from the Primary Care Inclusion Health in Action in GP workstream with colleagues from PHS (Manira Ahmad and Rishma Maini) as it may be helpful to the work being done around racialised health inequality and anti-racism. Ellie Crawford to meet with Manira Ahmad to discuss this further and coordinate introduction with leads.

Waiting Well, Karen Duffy 

Karen Duffy, Delivery Director of PPC, provided an overview of progress on Waiting Well (WW). 

The Public Information Subgroup has been instrumental in setting up the WW Hub on NHS Inform which has been live since October 2023. Posters and leaflets have been distributed to GP practices and outpatient departments, with help from Public Health Scotland, to promote the hub and direct people to the site. The team have also requested that a link to the WW Hub can be added to GP practice websites. The WW team are also working with National Elective Coordination Unit and DrDoctor SMS to promote the WW Hub through SMS. 

Health and Wellbeing Plans for People Subgroup has been developing a toolkit which is now in final development. This will help people create a plan on how to wait well, showing what support is available, what they need to manage their health and wellbeing whilst waiting, and what resources local boards offer. A PDF version will be shared with boards initially, and a comprehensive version developed in collaboration with Healthcare Improvement Scotland to publish on the Right Decision Scotland website.
PPC Delivery Director’s Update, Karen Duffy 

Karen Duffy provided an overview of the PPC programme outlining key opportunities and challenges. Reform is an opportunity to achieve better outcomes for people in Scotland but it must be done in bite sized steps across three key areas; Path to Balance, Immediate Reform, and Longer-Term Reform. 
A population health plan is currently being developed with the group being chaired by Linda Bauld with support from Richard Foggo and Christine McLaughlan, Population Health Directors. There has also been a COSLA leaders agreement for the PHP to be developed together with partners. This will be the primary prevention and reduction of health harms space.

An Acute Services Reform programme is being prepared, which aims to look at the design of acute services using population health level needs assessment. This will focus on the number of people who need acute care in Scotland and how this can happen with best quality of care. The charter for this is in development stage. Other reform planning includes Primary Care Reform, Mental Health Strategy, and Social Care and the NCS development. 

The key aim is “a Scotland where people live longer, healthier and fulfilling lives” but it should also incorporate ageing well and having better health overall. 
An early benefits review for PPC workstreams has been carried out which outlines the benefits of each programme output and how they align to the strategic objectives and Care and Wellbeing Portfolio aims. Karen Duffy highlighted that Digital has been included in the benefit review but posed a question to the group about whether this should remain as a standalone workstream or if Digital should act as an enabler that runs through all future workstreams. 

The PPC team have been revisiting the original charter and aims and looking at the current state to understand if there are any improvements which could be made and how the programme can be optimised. Karen Duffy proposed that draft ideas of a new and improved driver and structure be brought to PPC Programme Board members, perhaps holding a workshop in May, to focus on this in a logical way. 

The PPC Programme Board is asked to:

• review the benefits and look at contributions to date
• decide what needs to be carried forward and what new areas of work should be considered
• review how the workstreams are themed and where they sit

Summary of Board discussion on this item:

• digital is a component of all workstreams and we need to understand the needs of digital across them to ensure we rationalise where possible and prioritise what can and needs to be delivered
• timelines should be reviewed in line with current financial and infrastructure restraints within Scotland as we work towards the aim of the programme to live longer, healthier lives
• it was agreed that a review of the PPC programme would be advantageous as finance, resources and capabilities have changed since the beginning 
• due to similarities in work across organisations, general consensus was that ongoing collaboration is required to mitigate duplication, identify risks and identify any corresponding or opposing workstreams

Action: PPC Project Management Office to plan and invite Programme Board members to a workshop in May to review the original PPC programme charter.

Final comments from the Co-Chairs

Donna Bell agreed that it is a time for consolidation in terms of PPC but also in terms of collaborative work with Place and Wellbeing and Acute Transformation. The opportunity for true collaborative space within government but also with other partners is really important. We are at a point where PPC is well established and lots of activity is underway but the portfolio programmes need to become more than the sum of its parts and this gives us opportunity to do this. 

Tim McDonnell, Director of PC, added that the whole point in the programme is the dependencies we know and understand in the preventative space and are born out in everything discussed in this meeting. The strength of this programme, and its iterative development, and the importance of our work to systems sustainability means we have all the foundation elements to guide acute reform, and wider system reform in the right way. The more that this programme develops, and the stronger connections it makes with detailed and directive work that it helps to inspire and to draw from, the more we will get this right.

Donna Bell thanked PPC board members for their input. 

Any Other Business

Donna Bell informed the group for transparency that the minutes from this board will now be published on SG website, requesting that members to pay close attention to the detail of minutes when they are circulated for accuracy and submit any comments or corrections. 

Karen Duffy assured the group that future dates for 2024 meetings and workshop in May will follow. 

Donna Bell thanked the group and closed the meeting.