Health and Social Care Delivery Plan: National Programme Board minutes, April 2019

Attendees and apologies

Members

• Shirley Rogers, Chair and Director of Health Workforce, Leadership and Service Reform
• Phil Raines, representing Donna Bell Director of Mental Health
• Jason Leitch, Director for Health Care Quality and Improvement
• Derek Grieve, representing Richard Foggo  Representing Director of Population Health
• Alison Taylor, Head of Health and Social Care Integration
• Caroline Lamb, National Implementation Lead
• Angiolina Foster, National Implementation Lead
• Tim Davison, Regional Implementation Lead for the East
• Gerry O’Brian (VC), representing Amanda Croft  Representative Implementation Lead for the North
• Sharon Adamson, representing John Burns Regional Implementation Lead for the West
• Vicky Irons, Chair of the Chief Officers’ Group
• Andrew Kerr, SOLACE, CE Edinburgh City Council
• Elizabeth Ireland, Chair NSS
• Norman Provan, Representing Theresa Fyffe, Staff Representation

Apologies

• Christine McLaughlin, Director of Health Finance
• John Burns, Regional Implementation Lead for the West
• Donna Bell, Director for Mental Health
• John Wood, CoSLA
• David Garbutt, Chair NHS National Education for Scotland
• Amanda Croft, Representative Implementation Lead for the North
• Richard Foggo, Interim Director for Population Health

Attendees

• Rachel Jenkinson, Head of Service Reform Division
• Anne Aitken, Head of Directorate Support and Delivery 
• Justine Westwood, Head of Strategic Change
• Syed Kerbalai, Secretariat, Strategic Change
• Robert Spratt, Secretariat, Strategic Change
• Paige McNicol, Service Reform
• John Connaghan, Chief Performance Officer
• Malcolm Summers, Head of Future Vision Unit
• Rona Watters, Future Vision Unit
• Isabella De Wit, Head of Board Reform
• Sean Neill, Head of Workforce 

Items and actions

Welcome and apologies

1. Shirley Rogers welcomed Members to the fourteenth meeting of the Programme Board. 

2. The Chair welcomed:

• Vicky Irons, replacing David Williams as the new chair of Chief Officers and representative on the group. Shirley noted David’s input to the group and his continued dedication to improve health and social care integration, and that she look forward to working with him in his new role
• joining by VC from Orkney Gerry O`Brien representing Amanda Croft
• John Connaghan for the unscheduled care and waiting times improvement updates
• Malcolm Summers and Rona Watters for the Future Vision item
• Paige McNicol, new member of the Board Reform team and observing today
• Derek Grieve representing Richard Foggo
• Phil Raines representing Donna Bell
• Sharon Adamson representing John Burns

3. A full list of attendees and apologies is at the top of this page. 

Matters arising

4. The minutes of 1 March 2019 were agreed without amendment.

5. All the remaining actions from the Actions Log were either covered by the agenda, or will be brought forward to future meetings. 

Progress report

6. Justine Westwood introduced paper NPB/2019/29-04/01 providing the Board with a progress update on the key programmes within the Delivery Plan. In consideration of the progress report, the board agreed to consider the following in more detail at the next meeting:

• establishment of the new national public health body
• realistic medicine
• digital health and social care integration

7. The Board recognised the overall assessment for the programme had risen from ‘amber’ to ‘amber / green’ for the first time.  The board agreed to consider more detailed analysis, including risks and impacts, on programmes from the Delivery Plan that had longer-term slippage; and to consider a written update following the Delivery Plan Modelling workshop. 

8. The Board:

• noted the progress of the underlying programmes and the update on the risks and issues
• agreed the revised milestone dates and follow-up requirements

Action 88:  Secretariat to arrange for detailed analysis on programmes that have slipped from their original timeline in the Delivery Plan.

Action 89:  Secretariat to provide a written update on the Delivery Plan Modelling work (see attachments issued with Minutes).

Unscheduled care and Waiting Times Improvement Plan

9. John Connaghan introduced paper NPB/2019/29-04/02 providing separate updates on unscheduled care and the waiting times improvement plan.  

10. Unscheduled care. There are six essential actions to improve unscheduled care at a whole system level.  Significant progress has been made implementing the actions, resulting in performance in Scotland being the best in the UK for almost four years running.  However, unexplained performance variations remains across health boards in Scotland. 

11. The Waiting Times Improvement Plan (WTIP) was launched in October 2018 and directs over £850 million of investment to substantially and sustainably improving waiting times by 2021.  The WTIP is in the early stages of implementation  and waiting times have been observed, but more time and further information is required to assess this robustly as a trend.   

12. In the detailed discussions that followed the Board noted:

• the need to recognise the increase in attendances to hospital
• care of the elderly is well understood but the middle-aged population with complex co-morbidities is a concern and there needs to be further focus on younger peoples services
• important to keep public health prevention and improvement in mind
• larger central belt hospitals are importers of elective and unscheduled care, leading to problems with waiting times / patient flow
• important to recognise difference between operational plans and the NPB’s responsibility for service transformation. Transformation / reform is captured by the Delivery Plan refresh to include a focus on transformational horizon scanning / forward look
• there is a continued challenge of delayed discharge which, in most instances, reflects the challenges being experienced locally before integration of health and social care. Delayed discharge is always unacceptable. Unscheduled care  and reduced occupied bed days have improved but we have not observed funding move away from acute
• the September meeting of the Board is to consider performance colleagues’ review and analysis of Annual Operating Plans (AOPs) including, areas of good practice, transformational aspects and areas where improvement and support was needed. It will also be important to receive an update on similar national boards plans, to ensure consistency and coordination
• AOPs provide an opportunity to identify whole system unwarranted variation and address this through programmes such as the Access Collaborative and Quality Improvement initiatives

Cancer programme

13. Jason Leitch introduced paper NPB/2019/29-04/03 providing an update on the cancer programme:  Beating Cancer – Ambition and Action. The 5 year (2016-2021) Cancer Strategy was published in 2016 with a £100 million commitment and 53 recommendations aimed at - more people surviving cancer, closing the gap in survival rates, reducing inequalities, better patient experience and reduction in the growth in the number of people diagnosed.

14. To date, £59 million (£33 million capital + £26 million revenue) has been invested and 26 of the 53 recommendations have been completed (48%).

15. Key achievements to date include:

• a new Scottish Cancer Patient Experience Survey to determine what matters to cancer patients
• 7 out of 10 women were more encouraged to attend cervical screening in deprived areas following targeted campaigns
• £33m on radiotherapy equipment to ensure delivery of safe, effective and modern radiotherapy treatments

16. In the detailed discussion that followed the Board noted:

• the successful progress in a range of areas should be recognised and celebrated more – for example the improvements as a result of the Detect Cancer Early Programme.  
• cancer requires a true multi agency approach incorporating, public, charitable and private sector expertise
• John Connaghan has approached the Cancer Access Group to address performance concerns around urological and colorectal
• the Board recognised that a commitment from the Cancer Programme in Delivery Plan will slip into 2022 and agreed to consider the risks and impacts of this, at a future meeting
• Justine Westwood and Marianne Barker are to work together to identify success stories and areas for inclusion in the refreshed Delivery Plan

Action 90:  Marianne Barker and Justine Westwood to consider how best to recognise and celebrate successes from the cancer programme to date and programme areas to include in the refreshed Delivery Plan.

Action 91:  Secretariat to arrange consideration at a future meeting of the risks and impacts as result of the delay to one of the cancer programme commitments from the Delivery Plan. 

Workforce planning

17. Sean Neil introduced paper NPB/2019/29-04/04 providing an update on workforce planning activity.    The National Health and Social Care Workforce Plan was published in three Parts between June 2017 and April 2018.  Part 1 of the workforce plan focused on the acute NHS and was published in June 2017. Part 2, covering workforce planning in social care, was published jointly with COSLA in December 2017. Part 3 of the National Health and Social Care Workforce Plan was published on Monday 30 April 2018, setting out our strategy to recruit new and retain existing GPs, along with our plans for the wider primary care workforce.

18. The next iteration of this work is the production of a fully integrated health and social care workforce plan, which is due to be published in late Spring 2019, with annual iterations being published thereafter.  Key recommendations from the National Workforce Plan parts 1, 2 and 3 have been taken forward through a number of projects and business as usual processes.

19. During the detailed discussions that followed, the Board noted:

• the workforce programme governance was noted and it was agreed regular updates on progress should be provided to the National Programme Board
• there is a limited supply of health and social care workforce, coupled with an increasing trend for health staff opting to work and train part time – national and local policies had to recognise this when considering / delivering new policies 
• TURAS workforce data platform was rolled out on 1 April to provide NHS workforce data to support and improve workforce planning and scenario planning capabilities  
• Scottish Government officials have spoken to HMRC colleagues about impacts on workforce of top rate tax changes
• need to consider how we make a job in health and social care the career of choice.  Similar skills and knowledge needed for wide range of health and social care roles – need to work together to attract staff from the same limited supply pool

Action 92:  Secretariat to arranged periodic updates for NPB on the workforce planning progress. 

Future vision

20. Malcolm Summers and Rona Watters introduced paper NPB/2019/29-04/05.  This work recognises as we approach 2020, there is a need to set our future direction of travel to 2035.  The vision will build on the work of the Health and Social Care Delivery Plan, and provide the future overarching policy framework for Health and Social Care.  Its outcomes will contribute directly to the National Performance Framework, and the United Nations Sustainable Development Goals.

21. During the discussion that followed the Board agreed:

• subject to a review of any required additional membership, NPB should act as the oversight sponsor group for the future vision work
• the Board recognise the proposed co-productive approach for developing this work, but noted it was important to be clear with the public what is and isn’t included in the future vision work
• Vision Team to provide a more detailed work programme, refined options and proposed membership additions to the Board at its meeting scheduled for 26 June 2019

Action 93: Vision Team to meet with Andrew Kerr, SOLACE on the vision development approach.

Action 95: Vision Team to provide a more detailed work programme, refined options and proposed membership additions to the Board at its meeting scheduled for 26 June 2019. 

AOB and next neeting

22.  The next meeting is arranged for 26 June 2019, 13.00 – 15.30 at 4.ER, St Andrew's House.  

Secretariat
10 May 2019