Health inequalities: Place and Wellbeing Programme Board minutes - December 2024

Attendees and apologies

• Julie Anderson (deputy), Head of Wellbeing and Prevention Unit, Scottish Government
• Linda Bauld, (Chair), Chief Social Policy Advisor, Scottish Government
• Marie Burns, Leader of North Ayrshire Council, North Ayrshire Council
• Neil Cardwell (deputy), Team Lead for Primary Care Strategy unit, Scottish Government
• Chik Collins, Director, The Glasgow Centre for Population Health
• David Cowan, Head of Regeneration, Architecture and Place Unit, Scottish Government
• Eilidh Currie (Speaker), Principal Research Officer, Scottish Government
• Eddie Follan, Chief Officer for Health and Social Care, COSLA
• Brian Jones (deputy), Chair of Population Health Committee, NHS Tayside
• Sam Martens, Policy and Business Analyst, NHS National Services Scotland
• Susan Paxton (Speaker), Director, Scottish Community Development Centre
• Harriet Purbrick, Policy Officer for Health and Social Care, Convention of Scottish Local Authorities
• Kerri Todd, Head of Health Improvement, NHS Lanarkshire

Apologies

• Marion Bain, Deputy Chief Medical Officer, Scottish Government
• Lorna Birse-Stewart, Chair, NHS Tayside
• Ellie Crawford, Director for Primary Care, Scottish Government
• Angela Davidson, Deputy Director for Improving Mental Health and Wellbeing, Scottish Government
• Susan Gallacher, Deputy Director for GP practice, Scottish Government
• Ruth Glassborow, Director for Place and Wellbeing, Public Health Scotland
• Calum Irving, Deputy Director for Strategic Third Sector and Public Service Leadership, Scottish Government
• Lynn MacMillan, Head of Health Inequalities Unit, Scottish Government
• Sheila McCole, Non-Executive Member, NHS Tayside
• Gerard McCormack, Head of Transformation, Performance, and Improvement, Improvement Service
• Dona Milne, Director of Public Health, NHS Lothian
• Lynne Nicol, Deputy Director for Planning and Quality, Scottish Government
• Gordon Paterson, Director of Social Care, NHS Education for Scotland
• Carol Potter, Chief Executive, NHS Fife

Items and actions

Welcome and apologies

Linda Bauld welcomed everyone to the Board and confirmed the slight changes to the agenda. Due to unfortunate last-minute absences from Ruth Glassborow and Lynn MacMillan, Chris Stothart will speak to the Public Health System paper and provide an update on the Population Health Framework. Linda Bauld also made the Board aware that due to a Ministerial meeting, Emma Wylie and Chris Stothart will take over as Chair for the last thirty minutes of the meeting.

Linda Bauld highlighted the two risks that have been increased in the Communities workstream that relate to the capacity of the community and voluntary sector to engage with and support the workstream due to the ongoing funding cuts. There is recognition that the risks need to be managed, particularly bearing in mind the relevance of the sector to the development and implementation of the Population Health Framework.

Minutes from previous Board meeting

No corrections were noted for the minutes from the Place and Wellbeing Programme Board meeting on 3rd October.

Specialist Public Health System Offer to Community Planning Partners

Chris Stothart provided an overview of the Public Health Systems paper which outlines the key activities available from local public health teams and from Public Health Scotland (PHS) to local partners in order to support with activities aimed at improving their populations’ health and wellbeing and addressing inequalities.

The paper highlights key contributions to health improvement that the specialist public health workforce can make, specifically to Community Planning Partnerships. It provides an overview across seven key activities with local examples from practice and links to additional resources.

Kerri Todd provided additional insight to the paper and highlighted that the paper materialised during the recovery from the COVID-19 pandemic due to increased recognition and reignited interest in health inequalities and understanding of local populations’ needs. The paper has been shared through the Community Planning Network with a view that it is shared widely with local partners.

Linda Bauld welcomed comments from the Board

Marie Burns is the chair of her local Community Planning Partnership and welcomed the paper. Marie Burns acknowledged that Community Planning Partnerships operate in different ways across Scotland and saw the paper to be an incredibly useful tool. Marie Burns highlighted the links to the Communities workstream ‘Area for Action’ around the role of Audit Scotland in evaluating Community Planning partners’ roles in improving health and wellbeing.

Action 24 

• Chris Stothart to feedback to Ruth Glassborow and Marie Burns on the Board noting the paper.

Programme update

Emma Wylie provided a programme update on each of the workstreams and programme risks.

Population Health Framework – the recent phase of engagement has been completed, and the team are working with partners to identify the actions. The publication of the Framework is scheduled for early 2025.

Anchors – overall the outputs for the workstream are on track although the procurement strand could see changes to the agreed outputs and timescales due to the reduced capacity within boards including within procurement teams due to financial constraints. The stage two deliverables of the workforce strand are due to be signed off by the Anchors Delivery Group in January 2025.

Enabling Local Change – there has been limited workstream lead and partner resource capacity to progress the key deliverables and timescales continue to be reviewed to reflect this.

Communities – the development of the communications strategy is now likely to be completed in March 2025 due to delays in drafting the evidence review and the team focusing its resource on engaging with the community and voluntary sector around the Population Health Framework. A second grant managers workshop was held this quarter, focused on fairer funding and SG-wide developments around grant management.

The overall RAG status for the programme is sitting at Amber as it was during the last reporting period. Details on risks for each workstream are available in the workstream highlight reports.

Evidence review – role of the community and voluntary sector in improving health and wellbeing and reducing health inequalities

Susan Paxton and Eilidh Currie provided the Board with a summary of the review that has pulled together evidence of the role that the community and voluntary sector plays in supporting health and wellbeing. The findings will form the basis of a communications strategy that will be developed through the Communities workstream.

Susan Paxton provided context on the importance of the work in terms of capturing the existing evidence base for community led health approaches to improving health and tackling health inequalities in one central place.

Susan Paxton noted that the role of sector is often overlooked within the wider health system and a perceived lack of credible evidence can be a barrier to understanding their role. Having a single, up-to-date source of evidence that demonstrates the impact, and the value of community led health will help raise awareness across sectors of their role. The team has been working closely with the Common Health Assets research team at Glasgow Caledonian University, which will publish further relevant evidence in the new year.

Eilidh Currie explained the eligibility criteria for the review focused on English language research from Scotland and the wider UK. The search for evidence was carried out by the Scottish Government Library service initially followed by additional manual searches of relevant databases and websites.

There are further studies which set out the ways in which community organisations have can contribute to improvements in health and reductions in inequalities, however there is a gap in robust evaluation research on what works for whom and under what circumstances. This gap is being explored through the Common Health Assets project.

Next steps are to finalise the paper by early 2025, following feedback from colleagues at Glasgow Centre for Population Health. Key messages will then be incorporated into the communications strategy that is being currently being developed.

Linda Bauld welcomed comments from the Board.

Marie Burns commented on the importance of the role of local community-based organisations and noted is that the role of Community Learning and Development is missing from the review, highlighting that a national review of Community Learning and Development revealed their growing contribution to community development.

Eddie Follan noted that from a social care perspective in particular, the increase in employers’ National Insurance contributions will be very difficult for third sector organisations to absorb, which will pose a risk to local services.

Kerri Todd expressed the importance of the work, and how helpful it is to have the evidence in one document for those at a local level who are trying to support the community and voluntary sector. Kerri Todd also asked whether there are any thoughts on the communications strategy going wider than internal colleagues within Scottish Government as it is important to share the evidence.

Chik Collins congratulated the team for the work on the evidence review. Chik Collins referred to the caveats in the report around the lack of robust evidence on the role of the sector in supporting health and wellbeing and questioned whether there was a need for such strong caveats, as the sector’s role in supporting health and wellbeing should be common sense. Chik Collins also raised points around the need to note the current economic context, the obvious value for money offered by the sector, and the disproportionate burden placed on the sector to evidence their contribution compared to other sectors, and the fact that often community organisations are plugging ’chasms’ in public sector services, rather than complementing them.

Linda Bauld suggested that the independent Board members could also use this evidence in their own context to evidence the role of the sector.

David Cowan supported the comments raised by the Board and highlighted the struggle to evaluate the impact of the community and voluntary sector’s work on the social determinants of health, and how vulnerable the sector currently is. David Cowan also highlighted the domino effect that can take place when one organisation withdraws funding. David Cowan suggested liaising with Gill Gunn who may be able to suggest some organisations that could support with the messaging.

Susan Paxton noted that Board members have a good understanding of the issues faced by the sector including the likely increase in demand on public services of cutting investment to the sector. She reiterated that that the team’s aim is to communicate these messages to those with less understanding of the sector’s role. The team will also highlight that community-led approaches to health should not be about  ‘firefighting’ but supporting primary prevention.

Caitlin Frickleton noted the work taking place with fairer funding colleagues within Scottish Government on grants and that the comments raised by the Board were also reflective of feedback from the Communities Core Group.

Action 25

• Eilidh Currie and Caitlin Frickleton to share the slides with the Board and the report with members once it has been finalised.

Enabling Local Change – progress update

Chris Stothart provided an update on Enabling Local Change.

Chris Stothart highlighted that delays to the workstream have primarily been due to capacity and resources being allocated to support the Population Health Framework and as a result the timescales have been adjusted.

Progress has been made with Public Health Scotland partners on one of the key deliverables, the Enabling Local Change stocktake report. The report is exploring local public health teams’ contribution to Community Planning Partnerships and seeks to identify opportunities, barriers, and areas for improvement. A first draft of that report has been produced and is being reviewed  with PHS colleagues. There is an expectation that the paper will be completed within this financial year.

Next steps are to reconvene the delivery group in early 2025. Following this will be wider engagement with the Community Planning Network and Community Planning Improvement Board to discuss stocktake report findings and future workstream activities.

Population Health Framework update

Linda Bauld noted that she would be attending a meeting this afternoon with Ms Minto, Minister for Public Health and Women’s Health, and Mr Gray, Cabinet Secretary for Health and Social Care. Linda Bauld explained that the Population Health Framework is potentially going to be part of a wider suite of health and social care reform outputs, which is contributing to uncertainty around the exact  timing of publication. Linda Bauld indicated that the Board will be kept updated on the progress of the Population Health Framework.

Chris Stothart reminded the Board of the wider stakeholder engagement which took place throughout September and October. Chris Stothart noted that the focus of this update is to provide both details on the stakeholder engagements and to summarise the key feedback received.

Chris Stothart described how there was overwhelming agreement from stakeholders for a renewed focus on prevention and taking a whole system approach to this work. There were wide-ranging views on what actions should be taken forward, with several stakeholders asking for only a small  number of key priorities to be identified, whilst others called for actions to be taken forward across all five described drivers of population health. Variable support was also received for setting a new national target, with some suggesting alignment with existing targets such as child poverty targets.

A number of stakeholders spoke positively about how the Population Health Framework is already proving to be a catalyst for local collaborative working. Other stakeholders voiced concerns about taking work forward this work at this time given existing pressures on public services and fiscal challenges.

Specific feedback was  also received on the content and proposed next steps for each of the five drivers which is being shared with relevant policy teams. A number of potential gaps were also identified by stakeholders which are being considered. Chris Stothart reflected on an ongoing tension with the potential for the Population Health Framework to cover a broad range of areas that impact population health, but an ask from some stakeholders for it to add value and be specific rather than a narrative on everything.

Chris Stothart walked through a Population Health Framework overview slide of the potential structure for the Framework using the five drivers and tiers of priorities and actions. Consideration is needed on how to identify a few overarching priorities and supporting actions that the whole system can focus on in the coming years.

Next steps are to develop advice for Convention of Scottish Local Authorities and Ministers in the new year to support publication early 2025.

Chris Stothart welcomed comments from the Board.

Chik Collins found the update very useful and asked about the drivers and enablers of change and the scale of innovation required. Chik Collins also cautioned if the methods adopted reflect what was used previously that it may slow down progress. There is a need for people to be aware that we don't really have the answers right now on how to best address many of the complex issues surrounding population health and inequalities within existing budgetary constraints.

Kerri Todd is keen to understand what the process will be to consider the wide range of feedback received from stakeholders and the decision making criteria to generate actions.

Chris Stothart noted that the team is still in discussions on how to work through reviewing and using the feedback received in a constructive manner and will work with key partners to identify potential actions.

AOB

Marie Burns (North Ayrshire Council) and Kerri Todd (NHS Lanarkshire Council) announced that their Councils were both chosen for the Marmot Places work described at the previous board.

Emma Wylie concluded the meeting and thanked the Board and speakers for their contributions and noted that next meeting is scheduled on Tuesday 18th March 2025.