NHS Chairs minutes: August 2023

Attendees and apologies

Health board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Fiona Sanford, NHS Borders, Vice Chair (on behalf of Karen Hamilton) 
• Nick Morris, NHS Dumfries and Galloway
• Alistair Morris, NHS Fife
• Alison Evison, NHS Grampian
• Ian Ritchie, NHS Greater Glasgow and Clyde, Vice Chair (on behalf of John Brown)
• Sarah Compton-Bishop, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Gary Robinson, NHS Shetland 
• Lorna Birse-Stewart, NHS TaysideGillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee 
• Carole Wilkinson, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Tom Steele, Scottish Ambulance Service
• Brian Moore, State Hospitals Board for Scotland
• Doug Moodie, Care Inspectorate
• Suzanne Dawson, Scottish Health Council

Scottish government officials

• Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Elena Whitham, Minister for Drugs and Alcohol Polic
• Caroline Lamb, DG HSC/CE NHS Scotland
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gillian Russell, Director of Health Workforce 
• Fiona Hogg, Chief People Officer
• John Harden, Deputy National Clinical Director 
• Hugh McAloon, Interim Director of Mental Health 
• Alex McMaho, Chief Nursing Officer 
• Tim McDonnell, Director Primary Care 
• Alison Strath, Chief Pharmaceutical Officer 
• Angie Wood, Interim Director of Social Care Resilience and Improvement 
• Robert Kirkwood, Head of People and Governance Team

In attendance

• Pat Kilpatrick, NHS Tayside, Aspiring Chairs Programme (Observer)
• Orlando Heijmer-Mason, Head of Drugs Policy Division (For Deep Dive Item)
• Martin Shanahan, Drugs Policy - Policy Manager (For Deep Dive Item) 
• Maggie Page, Unit Head - National Mission on Drugs (For Deep Dive Item)
• Aime Jaffeno, Children, Families and Complex Needs Team Leader (For Deep Dive Item)
• Alexander Stannard, Head of Clinical Care (For Deep Dive Item)
• Alison Crocke, Whole Systems Unit Head - National Mission on Drugs (For Deep Dive Item)
• Louise Dowdles, Private Secretary, Cabinet Secretary for NHS Health and Social Care
• Madeleine Fleming, Private Secretary, Minister for Drugs and Alcohol Policy

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team 
• Hannah Mackay, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, NHS Executive Support to NHS Chairs and Chief Executives

Apologies

• Karen Hamilton, NHS Borders (Fiona Sanford attending)
• Janie McCusker, NHS Forth Valley
• John Brown, NHS Greater Glasgow and Clyde (Ian Ritchie attending)
• Meghan McEwen, NHS Orkney
• Jenni Minto, Minister for Public Health and Women's Health
• John Burns, NHS Scotland Chief Operating Officer (Douglas McLaren attending)
• Saira Kapasi, Head of Support for DG HSC and CE NHS Scotland
• Jason Leitch, National Clinical Director 
• Richard McCallum, Director of Health and Social Care Finance and Governance
• Richard Foggo, Co-Director of Population Health
• Christine McLaughlin, Co-Director of Population Health
• Donna Bell, Director of Social Care and NCS Development
• Stephen Gallagher, Director of Digital Health and Care
• Gregor Smith, Chief Medical Officer
• Andrew Watson, Director for Children and Families
• David Plews, Head of NHS Service Development

 

Items and actions

Welcome, apologies for absence and attendees

The Cabinet Secretary welcomed everyone to the meeting and thanked colleagues for their attendance.

The Cabinet Secretary welcomed Elena Whitham, Minister for Drugs and Alcohol Policy who joined the meeting for the Deep Dive item on Mental Health and Drug Deaths.

Welcome was extended to Pat Kilpatrick, Vice Chair from NHS Tayside, who attended the meeting in person to observe, as a member of the Aspiring Chairs programme.

To help with inclusivity with those attending virtually, the Cabinet Secretary reminded in-person attendees to also join the meeting from their laptop, as it is more visible as to who is speaking in the room. 

A full list of attendees and apologies is noted in annex A.

Minutes and actions from the previous meeting 

The minutes of the meeting held on 26 June 2023 were approved.

The Cabinet Secretary advised the actions from the previous meeting were complete and closed.

Matters arising

There were no matters arising raised.

Cabinet Secretary remarks 

The Cabinet Secretary spoke of the tragic circumstance in the case of the current trial involving a neonatal nurse in England. The nature of the incidents has demonstrated the risks within the system and although there are additional safeguards in Scotland, it is important to ensure nothing like this occurs in future. NHS Chairs should ensure that the appropriate processes are in place and that there is a culture that supports those raising issues. The Cabinet Secretary will issue a letter, formally requesting that all health boards reassure themselves that existing processes for the “early identification, reporting and robust investigation of patient safety concerns in NHS Scotland are fully effective.”

Action: NHS Chairs to review current governing processes on whistle blowing and ensure a culture of accountability and action within the organisation to assure the public and ministers that issues are appropriately managed. 

The Cabinet Secretary stated that there continues to be an increase in outpatient and inpatient waiting lists and noted the following:

• management information shows the total waiting list size remains on an upward trajectory, an increase of 259 in the last four weeks.

The Cabinet Secretary advised that a review of the current NHS Scotland waiting times guidance was complete. The final draft of the guidance was circulated on Friday 18 August to allow for final review and comments with the view of publishing late September.

The Cabinet Secretary indicated that winter planning would be included as part of the performance update at the October meeting. He added that a winter summit was to be held on Tuesday 22 August with approximately 300 colleagues from health, (including NHS Chairs), social care, COSLA and Scottish Government. The aim of the summit is to ensure that there is collaboration across all sectors in advance of preparing for winter.

The Cabinet Secretary stated that there has been a positive outcome for the junior doctors ballot and the risk of industrial action has been removed for the near future. NHS Education for Scotland (NES) is leading the work on the contract reform aspect of the agreement which will take place over an extended period. 

The Cabinet Secretary advised Chairs that Scottish Ministers set out the NHS dental reform position publicly to the sector on Thursday 27 July 2023.

Standing item

NHS recovery and performance - NHSC/23/24/06 

Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery, provided a presentation on NHS recovery and performance. A paper was circulated in advance and slides were displayed during the meeting which covered the following points:

Planned care:
New outpatients and inpatients / day cases

• planned care flows
• diagnostics
• strategic recovery

Cancer

• cncer performance – June 2023
• cancer patient flow (referrals; breaches and backlogs; treated)
• urgent and unscheduled are
• decline of performance in last few weeks
• demand and capacity
• transforming urgent and unscheduled care
  • urgent and unscheduled care collaborative
  • next steps

Delayed discharge

• delayed discharge sitRep – Scotland headlines – 07 August 2003
• delayed discharge actions

Douglas McLaren explained that further work is required to support NHS boards to meet waiting times, whilst maintaining focus on long waits. Waiting lists were stabilising to a degree but diagnostics still have long lists. With no additional funding for diagnostics this year, the focus is on what can be done for next year 2024-2025. Douglas offered to provide trend slides around demand and capacity for future meetings, which was welcomed.

Action: NHS recovery and performance item to include trend slides on demand and capacity for future NHS Chairs meetings.

Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship, advised through teams chat function that winter self-assessment and assurance checklists will be issued early September for return around end of the month. For the first time, this will be issued jointly to boards and health and social care partnerships reflecting a whole system approach.

The Cabinet Secretary opened the item to Chairs to provide their experiences around challenges in their local areas and the processes used to manage them.

John Connaghan, NHS Lothian, asked for additional data to be shared on cancer waiting times beyond the targets set to see the full picture of longer waits, i.e., 70/75/80 day waits. 

Action: Directorate of the Chief Operating Officer to consider the management data available with a view to including data on longer cancer waiting times for future NHS Chairs meetings.

Lesley Bowie, NHS Ayrshire and Arran noted an issue within social care due to the lack of staffing at care homes included private homes. A whole system meeting with council members to discuss long term regeneration plans would be held and ongoing meetings with care home providers were taking place around empty care home facilities. The reduction of palliative care while finding alternative ways of rehabilitating those patients, would be considered. 

Brian Moore, State Hospitals Board for Scotland, commented that having more analysis of data would help to understand the extent of issues which contribute to the overall problem of delayed discharge. There is a need for a more detailed breakdown of the reasons which can be supported from a local perspective.

Alison Evison, NHS Grampian added that workforce and recruitment is a huge issue and there is a drive to get senior nurse practitioners through the NHS Academy, as part of the focus on workforce planning. Different areas were doing things differently to tackle waiting lists. This could be improved with the cooperation of Integration Joint Boards (IJB). 

The Cabinet Secretary highlighted that the discussion has emphasised the need for the national care service to have a consistent approach to social care across Scotland. 

Deep dive 

Mental health and drugs deaths - NHSC/23/24/07 

Maree Todd, Minister for Social Care, Mental Wellbeing and Sport, thanked the NHS Chairs and their teams for their continued work in supporting people, families, and carers, but stressed that more needs to be done. She was encouraged by the whole system approach and widening the scope of mental health, to include wellbeing and prevention. Three areas of focus are:

• promote tackling stigma and inequality
• prevent mental health issues by tackling underlying causes
• provide mental health support and care, giving right skills and opportunities at the right time

Elena Whitham, Minister for Drugs and Alcohol Policy noted the significant work being undertaken to reduce stigma and offer holistic support to meet individual’s needs. This should be a collaboration between central government, local community, and all services. She thanked NHS Chairs for driving this work forward and noted that whilst there has been some encouraging progress over the last year, there was still a lot to be done to maintain high standards.

The Minister had three request of NHS Chairs: 

• consider what they were doing to raise awareness of MAT standards and encourage further accountability
• ensure maximisation of resources in relation to mental health and substance use services
• as leaders, consider how they could better support to deliver better outcomes for people with co-occurring conditions

Action: NHS Chairs to consider what they are doing to raise awareness of the MAT standards in their Board, and how to encourage accountability for delivery, particularly in supporting services, such as primary care, mental health, and beyond.

Action: NHS Chairs to consider the level of funding available, and the information available to them, and consider whether the board is truly maximising the resources they have or whether more needs to be done to make full use.

Action: NHS Chairs to consider how, as leaders, they can support mental health and substance use services to participate in this work and deliver better outcomes for people with co-occurring conditions. 

It was highlighted that Scottish Government would send an update on oversight arrangements for MAT. 

Gary Robinson, NHS Shetland and Lorna Birse-Stewart, NHS Tayside expressed the importance of the integration of mental health and substance misuse services. They outlined some of the areas their boards were supporting to meet the Medical Appraisal Guidance Scotland (MAGs) while focusing on being people centred to address stigma. Gary Robinson highlighted the challenges on recruitment to the mental health team in Shetland. 

Lorna Birse-Stewart, NHS Tayside advised in addition to the work on the MAGs a mental health strategy has been developed and signed off by the board. In addition, two mental health hubs have been opened in Dundee which are open 24/7, 365 days a year. 

Orlando Heijmer-Mason, Head of Drugs Policy Division, advised a lot of good work was ongoing with the 3rd sector but it may take a long time. It was highlighted that the annual drug deaths statistics would be published the following day and encouraged Chairs to look at local performance and give assurance to have an annual drugs death review.

Brian Moore spoke of prisoner healthcare and deaths in custody. In prisons, there are several drug related deaths and suicides due to poor mental health. He highlighted that there is huge potential for the use of digital services to support prisoner healthcare. Nick Morris, Chair, NHS Dumfries and Galloway added that poverty in communities needs to be tackled with better intelligence sharing.

Tom Steele, Chair, Scottish Ambulance Service (SAS) advised that SAS attend a high number of overdoses cases each month: 40% are not connected with healthcare in any way. The Naloxone Programme, also administered by Police, has a significant impact in saving lives.

Hugh McAloon, Interim Director of Mental Health, added work was still being progressed on the delivery plan that supports the mental health strategy. This plan will be realistic, aligned with current resource and will build on the progress already made by boards. He welcomed the input from Chairs and will share the draft delivery plan for an opportunity for them to feed into the final plan.

Action: Hugh McAloon to share mental health delivery plan with NHS Chairs for feedback.

Feedback from NHS Chairs private meeting

Nick Morris provided feedback from the NHS Chairs private meeting which took place in the morning and included:

• capital funding process
• planned care
• system model of health and care post pandemic
• deep dive into primary care at next meeting in October

Any other business

The Cabinet Secretary thanked Nick Morris for his work within the role of Chair of the Chairs group as this was his last meeting in this capacity. Carole Wilkinson (current Vice-Chair) takes on the role as Chair and Alison Evison will be taking on the role as Vice-Chair.

Date and time of next meeting

The next NHS Chairs Meeting will take place on 23 October 2023. 

Office of the Chief Executive for NHS Scotland