NHS Chairs minutes: February 2024

Attendees and apologies

Health Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders 
• Nick Morris, NHS Dumfries and Galloway
• Patricia Kilpatrick, NHS Fife
• Janie McCusker, NHS Forth Valley
• Alison Evison, NHS Grampian
• Lesley Thomson, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland 
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles
• Linda Semple, NHS Golden Jubilee, Vice Chair (on behalf of Susan Douglas-Scott)
• Carole Wilkinson, Healthcare Improvement Scotland
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Alan Webb, NHS 24 (on behalf of Martin Cheyne)
• Angiolina Foster, Public Health Scotland
• Irene Oldfather, Scottish Ambulance Service (on behalf of Tom Steele)
• Brian Moore, NHS State Hospital for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish Government officials

• Neil Gray. Cabinet Secretary for NHS Recovery, Health and Social Care
• Caroline Lamb, DG HSC/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Richard Foggo, Co-Director of Population Health
• Tim McDonnell, Director Primary Care
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Alison Strath, Chief Pharmaceutical Officer
• John Harden, Deputy National Clinical Director
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Robert Kirkwood, Head of People and Governance Team
• Aislinn Ní Ghráinne, Strategic Briefing and Insights Unit Head

Secretariat 

• Laurie Whyte, Board Governance and Appointments Team
• Hannah Mackay, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team

In attendance 

• Donne Joyce, Deputy Private Secretary to Cabinet Secretary for NHS Recovery, Health and Social Care
• Fraser McJannett, NHS Executive Support to NHS Board Chairs and Chairs

Apologies 

• Susan Douglas-Scott, NHS Golden Jubilee (Linda Semple attending)
• Martin Cheyne, NHS 24 (Alan Webb attending)
• Tom Steele, Scottish Ambulance Service (Irene Oldfather attending)
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Jenni Minto, Minister for Public Health and Women's Health
• Jason Leitch, National Clinical Director
• Donna Bell, Director of Social Care and NCS Development
• Stephen Gallagher, Director for Mental Health
• Andrew Watson, Director for Children and Families

Items and actions

MINUTES

Welcome, apologies for absence and attendees

Neil Gray, recently appointed Cabinet Secretary for NHS Recovery, Health and Social Care welcomed everyone to the meeting. This was his first meeting with the NHS Chairs group, and he thanked Chairs for their attendance. 

Colleagues were reminded of microsoft teams meeting etiquette and invited to participate in discussions by raising their hands.

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 29 January 2024 were approved.

Matters arising

There were no matters raised.

Cabinet Secretary remarks

The Cabinet Secretary opened the meeting by thanking Chairs for their continued support to the NHS at this critical time. He then gave introductory remarks which covered the following:

• NHS recovery
• performance – waiting times, cancer, unscheduled care
• workforce
• finance
• governance

The Cabinet Secretary indicated that he welcomed the recommendations from Audit Scotland’s report on the NHS in 2023 which included a call for investment on preventative work to reduce long-term demand on the NHS. He informed NHS Chairs that he will set out his vision in the coming weeks but that the fundamentals would not change, with a commitment to free access to healthcare.

The Cabinet Secretary was clear that boards need to maintain a clear focus on recovery, with reducing the waiting list backlogs a key priority. He encouraged boards to make use of the facilities at the National Treatment Centres (NTCs) in Fife and Highland, and shortly Forth Valley and Golden Jubilee, as well as core capacity offered though NHS Golden Jubilee. He advised NHS Chairs that boards’ 24/25 plans should detail how new cancer patients would continue to be prioritised, as well as a clear focus on clearing backlogs to bring demand and capacity back into balance.

In addressing the workforce, the Cabinet Secretary stated it was a privilege to take on the responsibility of ensuring that the NHS has a skilled and sustainable workforce for the future, while enabling the current workforce to thrive and feel valued, with a focus on wellbeing. The Cabinet Secretary added that he wanted to ensure that we have the right skills in the workforce and are an attractive employer. He also confirmed that the Scottish Government is committed to implementing the recommendations of the Agenda for Change (AfC) review. 

The Cabinet Secretary acknowledged the significant financial challenges facing boards for the year ahead. He affirmed his expectation was for NHS boards to be working towards recurring savings of at least 3% and it was important that financial reporting was transparent on the actions needed.

Setting out how he wanted to work with NHS Chairs going forward, he highlighted the importance of NHS Chairs working co-operatively across boards and boundaries to deliver the transformation and innovation required. He praised the great work taken forward around implementing the learning from the revised edition of the Blueprint for Good Governance, published in December 2022, and indicated that there would be a discussion on improvement plans in due course. 

Future Meetings

The Cabinet Secretary added he was looking forward to continuing to have open and constructive dialogue with Chairs and intended on meeting with them individually over the coming months. He emphasised that it would be essential to retain a focus on priority areas for delivery and performance and recovery would remain a standing item. 

Over the coming weeks, the Cabinet Secretary would be working closely with officials and SG Directors to review priorities for discussion. Caroline Lamb and John Burns will also have a follow up discussion with Carole Wilkinson, Chair and Alison Evison, Vice Chair of Chairs Group in advance of the next meeting on 17 April, to discuss the format of the meeting and plan future agenda items.

Discussion 

Carole Wilkinson Healthcare Improvement Scotland (HIS) thanked the Cabinet Secretary, on behalf of Chairs, for the opportunity to have this meeting and highlighted the following:

• the importance of leadership across the system and building partnerships 
• boards’ commitment to the focus on wellbeing
• work needed around reform and the challenging issues in communities ensuring people understand the situation. National communications would be helpful
• issues around workforce retention, recruitment and motivation remain. Require discussion around skill mix which could potentially have more resources and efficiency if worked differently
• concerns re executive pay given the recent Agenda for Change settlement and the impact on morale, retention and recruitment of staff in the executive cohort

There was a discussion about some of the points made by the Cabinet Secretary in his opening remarks as well as some of the challenges and opportunities facing the health service in Scotland.

John Connaghan, NHS Lothian raised the importance of partnership working, for example with universities to attract capital and the potential to work with Scottish Government colleagues on developing a model for capital investment through partnerships. 

David Garbutt, NHS Education for Scotland (NES), indicated that he would welcome a future discussion on the reform agenda and whether it would support the re-balance of training from secondary to primary care, and reform of medical training to ensure that we are producing people with the right skills. He also emphasised the importance of innovation and asked that a future conversation be had around agreeing a national approach to implementation.

Nick Morris, NHS Dumfries and Galloway reflected some of the challenges around the workforce within remote and rural areas and made a plea for national communications from government, including a national framework for decision making.

Gillian McCannon, NHS Western Isles noted that she sits on a culture and leadership group which incorporates a listening project taskforce - to hear direct from staff what is happening. She added that to get a diverse workforce, system leaders need to support ideas coming from different groups as it was important that people understood what our expectations were, to be able to deliver.

Alison Evison, NHS Grampian, shared challenges around recruitment in remote areas and welcomed the development of an asset strategy to alleviate concerns about sustainability with regards to buildings and equipment. 

Irene Oldfather, Vice Chair Scottish Ambulance Service (SAS) added that SAS was grateful for monies given through demand and capacity and innovation which has made significant benefits to patient care through “see and treat,” “hear and treat” and flow navigation. She stated that short term changes could be implemented but this needed consistency in innovation in Scotland.

The Cabinet Secretary agreed with Chairs, noting the opportunities available for reform to ensure we get back to why we value the NHS and Health and Social Care services and the people who work in them. He added that he would welcome ideas from Chairs around areas of duplication in productivity and efficiency. Collaboration would be crucial to implement innovative practices, treatments and devices on a national basis and was happy for discussion to continue.

The Cabinet Secretary understood the different challenges and economy of scale in operating and delivering a service for a smaller, more spread-out population. He stated he would be keen for collaboration at all levels to ensure that patients’ and staff voices are heard when it comes to decisions around policy change, redesign, and reform.

The Cabinet Secretary emphasised the need to provide honest, but positive and consistent communications with the staff and public, which was cognisant of the situation that boards were operating in. He ended by re-affirming his commitment to continuing to work with Chairs on these decisions and he expressed his gratitude to everyone for their efforts and support.

Any other business

There was no other business raised.

Date and time of next meeting

The next NHS Chairs meeting will take place on 17 April 2024.

Office of the Chief Executive for NHS Scotland