Stakeholder Advisory Group minutes: Oct 2024

Attendees and apologies

Chairs

• Neil Gray MSP, Cabinet Secretary for Health and Social Care
• Gregor Smith, Chief Medical Officer (CMO)

Members

• Alison Evison, NHS Grampian
• Andrew Moore, NHS 24
• Andy Elder, Royal College of Physicians of Edinburgh
• Benjamin Hannan, NHS Fife
• Carole Wilkinson, Chair, Health Improvement Scotland
• Caroline Hiscox, NHS Lothian Chief Executive
• Chris Provan, Royal College of General Practitioners
• Colin Briggs, NHS Lothian
• Colin Poolman, Royal College of Nursing
• Craig Marriott, Director of Finance rep
• Dr Margot McBride, Allied Health Professions Federation Scotland (AHPFS)
• Eddie Fraser, Solace lead HSC
• Emma Currer, The Royal College of Midwives
• Emma Watson, NSS - Executive Medical Director
• Eric Livingston, Royal College of Physicians and Surgeons of Glasgow
• Heather Cameron, Chair of SDAHP / Director of Allied Health Professions
• Iain Kennedy, British Medical Association
• Iain Morrison, BMA
• Issmael Fergague, Royal College of General Practitioners (Scotland)
• Jacqui Jones, NHS Lanarkshire
• Jann Gardner, NHS Lanarkshire
• Julie Mosgrove, Optometry Scotland
• Karen Reid, NHS Education for Scotland Chief Executive
• Katie MacGregor, Royal College of Occupational Therapists
• Kenryck Lloyd-Jones, Chartered Society of Physiotherapy
• Lee Knifton, Mental Health Foundation
• Malcolm Clubb, NHS Borders
• Matt Barclay, Chartered Society of Physiotherapy
• Moira Mackenzie, Digital Healthcare and Innovation Centre
• Paul Johnston, Public Health Scotland
• Paul Knight, Social Security Scotland
• Rachael King, NHS Orkney
• Ruth Glassborow, Public Health Scotland
• Sara Redmond, Alliance Scotland
• Sharon Hilton-Christie, SAMD rep
• Sharon Wiener-Ogilvie, NHS Fife
• Soumen Sengupta, Director for Health and Social Care South Lanarkshire
• Susan Webb, NHS Grampian

Scottish Government officials

• Alan Gray, Director of Health and Social Care Finance
• Alexa Wall, Principal Pharmaceutical Officer (Workforce Planning)
• Alistair Hodgson, Divisional Head, Strategy, Policy & Corporate Services
• Amy Wilson, Deputy Director of Health Workforce Planning and Development
• Angie Wood, Co-Director, Social Care and NCS Development Directorate
• Anna Dominiczak, Chief Scientific Officer
• Caroline Lamb, Chief Executive NHS Scotland / DG Health & Social Care
• Catherine Aglen, Pharmaceutical Advisor (Community Pharmacy)
• Catherine Labinjoh, Realistic Medicine National Clinical Advisor
• Catherine Ross, Chief Scientific Officer
• Christine McLaughlin, Director of Population Health
• Ellie Crawford, Primary Care Strategy Unit - Unit Head
• Fiona Hogg, Chief People Officer
• Graham Ellis, Deputy Chief Medical Officer
• Helen Moores-poole, Allied Health Professions Officer
• Ian Turner, Adult Social Care Workforce and Fair Work
• John Burns, Chief Operating Officer NHS Scotland
• John Harden, Deputy National Clinical Director
• JohnPaul Liddle, Deputy Director for NCS Development & Delivery
• Julie Dick Chief of Staff, DG HSC Office
• Justine Craig, Chief Midwifery Officer
• Karen Duffy, Delivery Director
• Kim Walker, National Programme Director
• Malcolm Summers, Head of Strategic Reform
• Pamela Joannidis, Pro Nurse Advisor Infection Prevention and Control
• Paula Speirs, Deputy Chief Operating Officer
• Philip Miller, Strategic Briefing and Insight Unit
• Ria Phillips, Strategic Briefing and Insight Unit
• Samantha Burns, Deputy Private Secretary
• Tim Mcdonnell, Director Primary Care

Secretariat

• David Plews, Head of Strategy & Planning
• Caitlin McLaughlin, Health Planning Team

Items and actions

Overview

The inaugural meeting of the Stakeholder Advisory Group heard from the Chief Medical Officer (CMO) on the foundations of reform, followed by the development on the National Clinical Framework from John Harden (National Clinical Lead for Quality and Safety). 

Stakeholders welcomed the opportunity to discuss reform with the Cabinet Secretary, and keen to work with Scottish Government to collectively deliver reform.

Themes from discussion included:

• Whole-system approach must be undertaken for reform: social care, acute and primary care, and links into non-health services.
• The importance of primary care as ‘first line’ approach to improving health outcomes.
• Prevention and early-intervention is paramount to the delivery of improved health outcomes and sustainable services. 
• Implementation of innovation and technology will be critical to delivering reform across services.

Participants were keen to learn more about reform, including national engagement, pace of changes, and long term policy view from Scottish Government on the future of health and social care.

Welcome and update from Chief Medical Officer (CMO)

CMO welcomed members to the first Stakeholder Advisory Group; the group will be chaired by the Cabinet Secretary. 

CMO discussed the background to long term reform across health and social care in Scotland. The focus will be how we deliver the changes that we need to ensure that we begin to see a change in the health outcomes across Scotland.

CMO presented the content and approach to population health challenges as set out in his recent Realistic Medicine - Taking Care: Chief Medical Officer for Scotland annual report 2023 to 2024:

The continuing threat posed by infectious diseases. 

1. Improving life expectancy, healthy life expectancy and reducing inequalities. 
2. Sustainability of our health and care services.
3. Sustainable use of resources to maintain planetary health. 

• Prevention is a crucial component to all reform. 
• Recent improvements showing in life expectancy are partly due to the recovery of the NHS after the pandemic but these have still not returned to pre-pandemic levels. 
• CMO outlined some of the challenges in healthcare services, e.g. over diagnosis and over-provision alongside significant increase in diseases burden. 
• Delivering consistent ‘person centered’ services is a priority for Scottish Government, starting with primary care and community health which will see the strongest impact on health outcomes. 
• CMO outlined the challenges of over industrialisation of care which fails to deliver the Kind and Careful, holistic approach desired by patients and staff alike. 
• Realistic Medicine allows us to maximise the resources we have across services and communities. 

Comments from the wider group included:

• Healthy life expectancy are crucial in thinking about keeping people healthy. 
• Concerns raised about the sustainability of General Practice; need to invest in continuity relationship-based care. Current model of care is not optimally supported. Reference was made to the recent work coming out of Denmark on reform.
• Highlighting the right investment and measuring the right things –  this requires direction to put it into practice. 
• Question about if the Government have evaluated all the work that has been done in the past 10 years on reform, need to be clear on that work in order to move forward.
• On engagement, how do we manage public expectations and support greater public involvement?
• Interested in how we use the various functions of government e.g. housing, transport, social security, education etc. and how we can work together. There may be a risk that this is seen as a ‘health only’ issue.
• Reference was made to the latest Citizens' Panel survey (CP14) regarding use of resources, and reducing waste and harm. This included views on shared decision making and use of decision making tools. Results to be published soon but preliminary results appear very supportive of a Realistic Medicine and Value Based Health Care approach. 

National Clinical Framework (NCF)

John Harden presented on the National Clinical Framework (NCF):

• Set out the development of the NCF as the collaborative reform planning function of the National Clinical Strategy (2016), which remains the strategic foundations for Scottish Government’s NHS reform. The principles of the National Clinical Strategy will further set out in the health and social care vision, which the Cabinet Secretary outlined to Parliament in June.
• The National Clinical strategy set out the need to reconfigure our hospital network and the pace of digital adoption.  
• The NCF will further develop the complex challenge profile facing NHS Scotland over the next decade. 
• Moving the strategy into collaborative working groups to build long term delivery planning will be the next phase of the work, with more details to follow in the new year.
• The Cabinet Secretary has been clear, we need to have greater level of proactive development on our long term plan for the NHS, and to put into practice the principles of the National Clinical Strategy. 
• Engagement, both with service and the public, will be critical in the development of this work. 

Comments from the wider group included: 

• Broad level agreement with direction of travel; noted the need for greater investment, and direction on what can be done differently from previous years. 
• Highlighted the scale of the challenge. Discussed systems and overwhelming demands, need to consider a different way for investing.
• An outline of how we will engage the public on this work will be important.
• The need to recognise administration efficiencies, the systems behind the scenes are important i.e. digital innovations. 
• Keeping social care on the agenda at all times. Highlighted the impact of austerity and reform needs to consider seriously, the significant input of third sector. 
• In addition, John Harden discussed how we can optimise the use of current resources in order to meet near-term demand.  

Reform update – Cabinet Secretary Neil Gray

• Cabinet Secretary highlighted the positive response to reform and welcomed the commitment people had shown to working together. 
• On this, he emphasised that reform will require a cross-sector level of working in addition to the work of Government to develop the transformation and improvement plans. There is recognition and willingness from across services for this greater collaboration. 
• The purpose of this Advisory Group is to focus on what we actually need in order to improve the health and wellbeing of people in Scotland. 
• Cabinet Secretary raised the importance of front line workers and patient voices being heard which will be part of the wider national engagement. 
• We must deliver on the commitment to embracing innovation and digital technologies in how we organise and deliver services. 
• Grateful for Advisory Group members’ time and drive for reform, plus the incredible improvements we witness across the system. 
• The Cabinet Secretary re-stated the importance of this Group to discuss reform collectively.  

The conversation was opened to the group and the following points were discussed:

• On digital innovations: the key challenge is how we fundamentally embed these innovations i.e. Accelerated National Innovation Adoption pathway and other elements to shift these services forward. 
• Important to ensure that there is an alignment with Realistic Medicine. 
• Request for more information on how the Stakeholder Advisory Group will function.
• The Audit Scotland report was concerning, regarding a ‘whole system’ approach; finance and leadership are critical themes that require further support.
• Importance of driving prevention. Primary Care provides critical vehicle for prevention.  

Cabinet Secretary closing remarks

• The Cabinet Secretary noted the need for a culture shift with new technologies and ways to implement these. 
• For this group to be successful, we need to work together and have leadership capabilities take them back to your forums.
• The Cabinet Secretary highlighted that wide structural reform is not the priority at the moment because there is a great deal that can be done by re-thinking how we work within the current boundaries to deliver an NHS Scotland approach to our health service. 
• Our focus will be on reconfiguring our services to meet the needs of people in communities while taking seriously the wider challenges in terms of finance, infrastructure and workforce. 
• Cabinet Secretary thanked all participants for their contributions today.
• Highlighting that this is the start of a new process together on reform.