NHS Chairs Meeting Minutes: December 2024

Attendees and apologies

NHS Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders
• Patricia Kilpatrick, NHS Fife
• Neena Mahal, NHS Forth Valley
• Alison Evison, NHS Grampian
• Lesley Thomso, NHS Greater Glasgow and Clyde
• Sarah Compton-Bisho, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwe, NHS Orkney
• Natasha Cornick, NHS Shetland, Vice Chair, attending for Gary Robinson
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, Golden Jubilee University National Hospital
• Carole Wilkinson, Healthcare Improvement Scotland
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Liz Humphreys, Public Health Scotland, Non-Executive Director and Whistleblowing Champion (for Angiolina Foster)
• Tom Steele, Scottish Ambulance Service
• Brian Moore, The State Hospitals Board for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish Government

• Neil Gray, Cabinet Secretary for NHS Health and Social Care
• Jenni Minto, Minister for Public Health and Women’s Health
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Christina McKelvi, Minister for Drugs and Alcohol Policy
• Caroline Lam, DG HSC/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Amy Wilson, Director of Health Workforce
• Fiona Hog, Chief People Officer
• Alan Gray, Director of Health and Social Care Finance
• Fiona Bennett, Interim Deputy Director NHS Scotland Finance
• Stephen Gallagher, Director of Mental Health
• Richard Foggo, Co-Director of Population Health
• Christine McLaughlin, Co-Director of Population Health
• Tim Mcdonnell, Director of Primary Care
• Anne Armstrong, Deputy Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Angie Wood, Interim Director, Social Care Resilience and Improvement
• Robert Kirkwoo, Head of Office – OCENHS Team

Other Attendees - Observers

• Paul Ryan, Aspiring Chairs Prog. – NHS Greater Glasgow and Clyde
• Greg Black, Aspiring Chairs Prog. – NHS Dumfries and Galloway
• Carron McDiarmid, Aspiring Chairs Prog. – Public Health Scotland
• Catherine Labinjoh, Scottish Government - Senior Medical Officer for Realistic Medicine and Value Based Health and Care to the CMO

Secretariat

• Kat Dobell, OCENHS Team
• Carol Hunter, OCENHS Team

Apologies

• Marsali Caig, NHS Dumfries and Galloway
• Gary Robinson, NHS Shetland
• Angiolina Foster, Public Health Scotland
• Martin Cheyne, NHS 24
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gregor Smith, Chief Medical Officer
• John Harden, Deputy National Clinical Director
• Andrew Watson, Director for Children and Families
• Donna Bell, Director of Social Care and NCS Development
   

Items and actions

Minutes

Welcome, apologies for absence and attendees

Neil Gray, Cabinet Secretary for Health and Social Care welcomed the group, thanking everyone for attending the meeting.

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

Cabinet Secretary’s Opening Remarks

The Cabinet Secretary acknowledged the pressures NHS services face, in particular the challenges during winter. While there were no indications currently that services would halt entirely, a winter surge period is anticipated which would reduce capacity in some areas. 

It was noted that delayed discharge continued to be a significant issue. The Cabinet Secretary advised that the First Minister’s plan to deliver whole system collaboration and improvement would drive down waiting times and it highlighted delayed discharges as a top priority. Work had begun with health boards to develop improvement with a whole system approach to reducing high levels of delayed discharge and improving hospital occupancy flow. Work would continue with COSLA, local councils and health and social care system leaders this year and into 2025-26, to see our reform agenda deliver real improvements. Subject to budget approval, a suite of funding and new measures to provide national support has been announced. 

The Cabinet secretary highlighted the importance of reducing the number of people in hospital and the work of boards in regards to acute frailty services and the variation across Scotland. Every mainland health board had a frailty service and, through NHS Healthcare Improvement Scotland (HIS), five frailty units have been set up during the focus on frailty programme led across Ayrshire and Arran, Lanarkshire, Tayside, Glasgow and Dumfries and Galloway. 

He encouraged all boards to engage with this opportunity to enhance, develop and deploy units/pathways that have a specific focus and a link to community re-enablement. Boards were asked to look at how they utilise the NHS HIS frailty network and engage with this work to reduce unnecessary admissions to acute settings and increase the level of support in the community, which will be both cost effective and better for the patient and their family. 

The Cabinet Secretary reflected on their recent visit to the frailty unit at NHS Ayrshire and Arran and of the positive impact this unit was having in the local area. Launched in October 2024 within the first week of zones being in place 30% of patients were turned around within 48 hours against a target of 40%. While there remains opportunity to scale this up, the Cabinet Secretary saw this as a great opportunity for productive change for local communities. 

The Cabinet Secretary reported that On 28 October 2024, a 5.5% pay uplift was approved for 2024/25 for executive and senior manager (ESM) staff. This was notified to the service by a pay circular issued on 8 November 2024. Officials have been asked to carry out a scoping exercise around ESM remuneration and to conduct some internal research for Ministerial consideration. Work would be informed by initial research as well as evidence submitted by Chief Executives as part of their own review. Once further scoping work has been completed, we would be engaging fully with employers and staff side. 

The Cabinet Secretary thanked Chairs for letter he had received from the collective group and welcomed the opportunity to join one of the NHS Chairs private meetings to further discuss transformation and the vision for health and care. 

Update from NHS Chairs private meeting

Carole Wilkinson, Chair of Health Improvement Scotland and Chair of the NHS Chairs Group fed back from the Chairs private meeting, noting discussions around:

• November 2024
  • value based care focus with Chief Medical Officer including input from the Golden Jubilee, Scottish Ambulance Service and NHS24. CMO highlighted national work on training of clinicians and the need for further discussion on primary care and community planning partnerships. Winter pressures and challenges
• December 2024
  • integration and joint working focus, looking at what is working well, learning and key issues. The Chairs group agreed to take on further work to include IJB partners looking at accountability and shared risk
  • the 3rd aspiring chairs programme was also discussed and will be launched in January 2025

Carole Wilkinson noted that the NHS Chairs had taken away an action to ensure good practice case studies were shared at their private meetings on delayed discharge as recorded in the October minutes and indicated that through there discussion it was noted that social care does not have the same level of improvement support as the NHS and that this could greatly support in addressing delayed discharge. 

Action: Angie Wood to engage with NHS Chairs to discuss how to provide support around improvement for social care services.

The Cabinet Secretary concluded that the issue around delayed discharge needed a collaborative approach and he was interested in how to discuss permutations of disparity around mainland and single island authority models.

Finance and Budget 2025/26 

Programme for Government and Health and Care Priorities 

The Cabinet Secretary invited Alan Gray, Director of Health and Social Care Finance and John Burns, Chief Operating Officer to provide a short presentation on Finance and Programme for Government which outlined:

• revenue - £2.1bn package – building a future together with:
  • baseline uplift in 2025-26 for all NHS boards
  • additional funding for improvement and reform
  • all prior year commitments funded
  • significant funding moved to baseline
• capital - £139m increase
  • progressing capital programme and planning for further investment
  • 5% uplift in capital allocation
  • funding legal and IFRS 16 commitments
• programme for government:
  • primary care reform
  • reducing alcohol and drugs deaths – national mission
  • reducing waiting list backlogs in planned care 
  • reducing the number of people remaining too long in hospital
  • improvements to mental health services and treatments
• planning and finance guidance
• delivery plans

Chairs were asked to progress development of delivery plans and three year finance plans and to focus on key priorities and optimising use of resources. John Burns advised his team would be taking this forward in the next few weeks. John reiterated the importance of clearing the wait list backlogs and also minimising delay and hospital stay. The budget set out additional funding for 2025/26 for performance improvement which will be linked to delivery plans and achievement of outcomes. John Burns also emphasised the good work with the centre for sustainable delivery (CfSD) and the importance of local data with the focus on assessment and short stay for people to be able to go home. 

Discussion was opened up to the group and the following points were highlighted:

• Chairs welcomed the cohesion in policy directions and clear alignment between funding and priorities
• access to primary care is highly variable across Scotland and the Scottish Ambulance Service (SAS) are now responding to this demand across the system. The Cabinet Secretary acknowledged it was difficult in some areas to access primary care, depending on investment, however noted more data was required to understand the complexity surrounding this. The Cabinet Secretary is in discussion with the BMA Chair on capacity and output and how to measure to ensure funding is given appropriately. It was agreed that SAS share data captured to understand key pressure points in the system
• national communication is required to support local work about access to care. In particular demonstrating that traveling for a specialist will not only give a high level of care but address long waits as specialist centres can work more efficiently due to a single focus. 
• all national treatment centres are asked to run as close to 100% as possible, in particular NHS Golden Jubilee. Additional funding would be welcomed to enable work to be done on maximising resources across Scotland. Support from the Scottish Government looking at the staff and clinical governance issues on this would be helpful to address this
• ensuring appropriate transport links for remote and rural boards was highlighted, with the need to travel it was noted that this is becoming increasingly difficult for some island boards
• the recent Human Rights Commission has also raised issues surrounding a lack of access for health in rural localities
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport highlighted the commitment to increase spending on mental health

The Cabinet Secretary thanked colleagues for their reflections and reiterated the importance that funding is aligned to the core priorities of the programme for government.

Action: Tom Steele to share Scottish Ambulance Service data relating to responding to cases due to lack of primary care options.

Minutes from the previous meeting 

Approval of the minutes of the meeting held on 30 October 2024 would be sought following this meeting via correspondence.

Any other business

There was no other business raised.

The Cabinet Secretary thanked Colleagues for their dedication this year. Wished them a safe and happy new year, asking that they recognise their staff over the festive period. Supporting staff is paramount to ensure delivery of safe and effective care.

Date and time of next meeting

Wednesday 29 January 2025 – 10:00 – 12:00.

People, Governance and Appointments Team