Health and care reform: Stakeholder Advisory Group minutes - April 2025

Attendees and apologies

• Neil Gray MSP, Cabinet Secretary for Health and Social Care
• Caroline Lamb, Chief Executive NHS Scotland / DG Health & Social Care
• Matt McLaughlin, UNISON
• Rachel Cackett, Coalition of Care and Support Providers
• Ben Hannan, NHS Fife
• Eric Livingston, Royal College of Physicians and Surgeons of Glasgow
• Sharon Wiener-Ogilvie, AHPF Scotland
• Katie MacGregor, Royal College of Occupational Therapists
• Kenryck Lloyd-Jones, Chartered Society of Physiotherapy
• Emma Currer, The Royal College of Midwives
• Jaki Lambert, RCM
• Julie Mosgrove, Optometry Scotland
• John McAnaw, NHS 24
• Iain Kennedy, BMA Scotland
• Andrew Elder, Royal College of Physicians of Edinburgh
• Kirstin Dickson, NHS Ayrshire & Arran
• Alison Evison, NHS Board Chairs Group
• Heather Cameron, NHS
• Susan Webb, NHS Grampian
• Moira Mackenzie, Digital Health & Care Innovation Centre (DHI)
• Jennifer Champion, NHS Forth Valley
• Charlotte Waite, British Dental Association
• Carole Wilkinson, NHS Board Chairs Group
• Chris Provan, Royal College of General Practitioners Scotland
• Robbie Pearson, Healthcare Improvement Scotland
• John Robertson, BMA Scotland
• Carol Harris, Royal College of Nursing Scotland
• Soumen Sengupta, South Lanarkshire Council
• Eddie Follan, COSLA
• James O’Connell, Unite the Union
• Caroline Hichling, Royal College of General Practitioners Scotland
• George Dodds, Public Health Scotland
• Iain Morrison, British Medical Association (Scotland)
• Sara Conroy, Allied Health Professions Federation Scotland
• Tom Steele, NHS Grampian
• Sara Redmont, The Health and Social Care Alliance Scotland

 

Items and actions

Welcome and update on reform - Neil Gray MSP, Cabinet Secretary for Health and Social Care and Caroline Lamb.

The Director General welcomed members to the fourth Stakeholder Advisory Group (StAG). 

The Cabinet Secretary:

• thanked those present for attendance
• noted that since the last STAG, the Operational Improvement Plan (OIP) had been published, which sets out a clear trajectory for where we want to go
• he noted that the Population Health Framework (PHF) will also be published soon, which is part of the whole government and societal response to long term population health issues.
• PHF will be followed, before the summer recess, by the Service Renewal Framework (SRF).
• all three publications need to be seen together as a package to meet demand, prevention, and longer term sustainability. 

Update on Operational Improvement Plan (OIP) - Douglas McLaren, Deputy Chief Operating Officer NHS Scotland

• an outline of the OIP was provided, and the factors that went into its publication. The ethos that we are trying to deliver is one of collaboration and alignment across the whole of NHS Scotland, and has led to new and enhanced collective working on flow and capacity and Hospital at Home and frailty services
• in our interactions with stakeholders we have been struck by the consistent message that we need to empower the workforce
• the tracking of the work in OIP is ongoing, we know where the pressures and issues are – progress reports will be brought to future meetings.
• comments from the wider group included: there needs to be a link-up between the work of the OIP and social care. Cabinet Secretary said he was aware of the linkages present and the work required, and is looking to make sure the Service Renewal Framework (SRF) reflects that. He also responded to a comment on the need to assess the impact of the reform work on carers, especially women, and whether an EQIA has been prepared to support this work. The Cabinet Secretary gave assurance that all new policies will have impact assessments, and what the Government could do for unpaid carers is being looked at
• another comment was that the group should take note of the findings of the King’s Fund, south of the border, and how the lessons learned from this work can be noted in Scotland

HSC Service Renewal Framework (SRF) -  John Burns, Chief Operating Officer (COO)

• the COO outlined the SRF, with its focus on community healthcare and Primary Care, population planning instead of territories or geographical models, and collaboration across the NHS
• the Framework would be published in June, between 21 to 24 June, and it was not another strategy – it is about delivery
• COO outlined areas that can be built on, including flow navigation, virtual wards, and said that the SRF will include consideration of how we prioritise resource and how we think about system measures, to ensure outcomes are measured
• there is thinking on the expanded community model, and what delivering more healthcare in the community means
• it was noted that the work needs to be done on a one for Scotland basis: we are good at trialling new methods locally, but the challenge is about scaling it on a national level
• comments from the wider group included: that the focus on principles is welcome, and that the third sector sees itself as a bit part of delivering healthcare in the community. There is huge potential in the involvement of the third sector, and how we can redesign models. There is a question of how we implement principles in a consistent way, and how we think about groups whose rights are most at risk. Another comment noted that governance and prioritisation is key to the process, how do we co-ordinate and implement all the reforms, and what is the most efficient way of doing this
• the Director of Primary Care noted that that is part of our thinking; any planning must consider the base, enablers and conditions needed to effect change. The model described allows for that broad thinking and draws from many sources, including Audit Scotland, extant delivery, data and known pressures (and benefits)
• another member cautioned the language around rehabilitation: rehabilitation is not always appropriate in a community setting – sometimes it has to be done in hospital. Community and Secondary Care has been better integrated but sometimes there are gaps between Primary and Secondary Care, they noted, and was eager to see how this would develop going forward
• Cabinet Secretary noted that governance was important in making sure there were not gaps as the contributor outlined
• DG said we were empowering leaders to have initiative into how these changes look in practice. Central to this work is how we manage change with governance, methodology and resources, and more fundamentally, how we approach the data

Update on Population Health Framework (PHF) – Niamh O’Connor , Deputy Director for Population Health & Improvement and Eddie Follan of COSLA

• the purpose, intended audience, and development of the PHF was outlined
• it will be published at the end of May 2025
• Mr Follan noted that the whole health system is less siloed than it used to be – the pandemic forged better partnership working, and we wanted to build on that. We are now in a better place on this than we have ever been. There are challenges on resources, and there is not an easy fix, but the PHF also includes non-fiscal levers. We are confident it can be delivered and the PHF has been a solid exercise in national and local level co-operation
• the Cabinet Secretary highlighted that key to the Population Health Framework is energising society to support a healthier more active lifestyle.
• comments from the wider group highlighted that capacity in local systems for preventative activity is not in as much as a positive place as presumed, for reasons including years of underinvestment, and that position should be appropriately acknowledged in the PHF. Officials agreed to take this point away and consider how best to address this in the framework document

Next steps and closing remarks

• the Cabinet Secretary closed the meeting, advising that the next formal meeting of STAG is scheduled for September
• the next Stakeholder Advisory Group meeting will take place on 3 September