NHS Chairs minutes: December 2023

Attendees and apologies

Health Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Fiona Sandford, NHS Borders, Vice Chair (on behalf of Karen Hamilton)
• Nick Morris, NHS Dumfries and Galloway
• Alistair Morris, 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
• Andrew Fleming, NHS Lothian, Vice Chair (attending on behalf of John Connaghan)
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland 
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles    
• Morag Brown, NHS Golden Jubilee, Chair of Clinical Governance (attending on behalf of Susan Douglas-Scott)
• Carole Wilkinson, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Tom Steele, Scottish Ambulance Service
• David McConnell, State Hospitals Board for Scotland, Vice Chair (attending on behalf of Brian Moore)    
• Suzanne Dawson, Scottish Health Council

Scottish Government Officials

• Michael Matheson, Cabinet Secretary for NHS Recovery, Health & Social Care
• Jenni Minto, Minister for Public Health and Women's Health
• John Burns, NHS Scotland Chief Operating Officer
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Saira Kapasi, Head of Support for DG H&SC and CE NHS Scotland
• Jason Leitch, National Clinical Director
• Richard McCallum, Director of Health and Social Care Finance, Digital & Governance
• Christine McLaughlin, Co-Director of Population Health
• Tom Ferris, Chief Dental Officer (on behalf of Tim McDonnell)
• Alex McMahon, Chief Nursing Officer
• Angie Wood, Co-Director, Social Care and NCS Development Directorate

Secretariat    

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

In Attendance

• Stephen Lea-Ross, Deputy Director of Health Workforce, Planning and Development (for Workforce Deep Dive)
• Kirsty Wood, Scottish Clinical Leadership Fellow (Observer)
• Ally Boyle, Non-Executive Director, NHS Lanarkshire (Observer)
• Fraser McJannett, NHS Executive Support to NHS Board Chairs and Chairs

Apologies    

• Karen Hamilton, NHS Borders (Fiona Sandford attending)
• John Connaghan, NHS Lothian (Andrew Fleming attending)
• Susan Douglas-Scott, NHS Golden Jubilee (Morag Brown attending)
• Brian Moore, NHS State Hospital for Scotland (David McConnell attending)
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Caroline Lamb, DG HSC/CE NHS Scotland
• John Harden, Deputy National Clinical Director
• Richard Foggo, Co-Director of Population Health
• Stephen Gallagher, Director for Mental Health
• Gregor Smith, Chief Medical Officer
• Tim McDonnell, Director Primary Care (Tom Ferris attending)
• Andrew Watson, Director for Children and Families
• David Plews, Head of NHS Service Development
• Robert Kirkwood, Head of People and Governance Team    
   

Items and actions

Welcome, apologies for absence and attendees

The Cabinet Secretary welcomed everyone to the meeting, thanked colleagues for accommodating the recent change of date and highlighted the microsoft teams protocol.

The Cabinet Secretary welcomed Lesley Thomson to her first meeting as newly appointed Chair of NHS Greater Glasgow and Clyde.

A welcome was extended to Ally Boyle, Non-Executive Director at NHS Lanarkshire (and part of the Aspiring Chairs programme) who shadowed Carole Wilkinson; and Kirsty Wood, Scottish Clinical Leadership Fellow. Both attended the meeting as observers.

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 23 October 2023 were approved.

Matters arising

There were no matters raised.

The Cabinet Secretary provided updates on the following actions from the previous meeting:

• NHS Chairs to explore with their teams what work was being taken forward and what impact it would have to help and support the unscheduled care and delayed discharge pressures – Chairs have been asked to provide updates on this during NHS recovery and performance item
• secretariat to arrange for Quality Assurance (post Letby) – progress update item to be added as a standing item at future NHS Chairs meetings – This has been added as a standing item and papers (NHSC/23/24/13(A) and NHSC/23/24/13(B)) for noting has been provided for this meeting. 

The following actions were noted as closed items:

• NHS Chairs to ensure they have a trained spokesperson to deal with localised media issues
• NHS Chairs to look at the need for a formal plan to help develop Clinical Leadership skills

Cabinet Secretary remarks

The Cabinet Secretary noted that increasing pressures were affecting performance this winter. Flu and Covid have been tracked against the Public Health Scotland (PHS) model and has fallen short regarding demands. Boards were asked to ensure all arrangements were in place to manage those pressures.

The Cabinet Secretary noted concerns about turnaround times for ambulances which have caused difficulties in the community. Boards should focus on addressing issues when they arise. John Burns and boards would be engaging to discuss issues in detail. 

The Cabinet Secretary added that the budget would be announced in Parliament on Tuesday 19 December, which is expected to bring further challenges across the public sector. The next financial year would be difficult with austerity continuing and further cuts in budget allocations in Scotland. SG officials are meeting with NHS Chairs, NHS Chief Executives, Directors of Finance, IJB Chief Officers and Chief Finance Officers at 4pm on Tuesday 19 December. The focus of the meeting is on what the announcement means for health boards and the expectation of collaboration to meet challenging circumstances.

Action: NHS Chairs to ensure all arrangements are in place to manage increasing winter pressures particularly on ambulance turnaround times. 

NHS recovery and performance - NHSC/23/24/11 (John Burns)

John Burns, NHS Scotland Chief Operating Officer provided a summary of progress from the last meeting via a slide presentation. This covered:

• whole system data dashboard.
• planned care:
  • whole system modelling – winter pressure acute adult inpatient scenarios
  • seasonal respiratory illness
  • planned care activity
  • new outpatients and inpatient / day-cases (TTG)
  • cancer performance
  • cancer waiting times – improvement work 
• urgent & unscheduled care:
  • NHS 24
  • Scottish ambulance service
  • accident and emergency core sites weekly unplanned attendances
  • emergency admissions and average length of stays
  • CfsD discovery sessions
• delayed discharges sitrep

The whole system dashboard summary, updated weekly, provides a good insight into where the system is. The whole system modelling, updated fortnightly, highlights an uptick in seasonal impacts such as flu and covid. RSV had been climbing but fewer admissions were now being seen. 

Latest figures showed a reduction in new outpatient waiting lists indicating Endoscopy remained stable; radiology showed some reduction over the last few weeks and TTG continued to grow. There was slight concern about the dip in the 31 day target for cancer as all trajectories had indicated the 95% target would be maintained. Improvement work is being undertaken to address this. John Burns advised NHS24 data showed a call volume increase. The Scottish Ambulance Service (SAS) have maintained a high level of non-conveyancing and continue to develop professional to professional calls through flow navigation centres.  

A detailed set of national centre for sustainable delivery (CfSD) discovery sessions were undertaken and looked at board data and analysis. CfSD would speak to boards about improvement plans informed by the discovery analysis. A new unscheduled care clinical lead role is being implemented in CfSD which will engage with clinical teams regarding the approach for improvement.

Nick Morris, NHS Dumfries and Galloway, noted that the percentage of people being admitted was relative to pre-pandemic admissions. Jason Leitch, National Clinical Director, added that the data shows people had delayed presentation for the past 4 years and lengths of stay were longer however there was nothing to suggest there had been sudden increased acuity.

Alison Evison, NHS Grampian, raised the question if people utilising short term pathways had an increased re-admission rate. The Cabinet Secretary noted that the percentage re-admissions had not considerably changed. He asked Angie Wood, Co-Director, Social Care and NCS Development, to share the re-admission numbers. These were shared in the meeting chat for Chairs to note and confirmed that readmission remained consistent between September 2022 - August 2023. 

Martin Hill, NHS Lanarkshire, noted that the Minor Injuries Department at University Hospital, Wishaw had been expanded and had an increase in staff. Advantages would be seen in the next few weeks. In addition, work was being done to understand why the number of people being referred for social care are significantly higher in Lanarkshire than the neighbouring board of Glasgow. 

Nick Morris added that key issues for NHS Dumfries and Galloway are bed occupancy, the inefficiency of releasing beds, capacity in the social care / care at home sectors, and lack of workforce. There is a potential announcement for an increase in care pay and there needs to be an awareness, more so in rural areas and the Islands. 

The Cabinet Secretary broadly agreed that there was variation across health and social care partnerships, however it wasn’t all about workforce or available placements. It was confirmed that social care staff will receive a pay increase with payment coming from the health portfolio budget allocation. Working with local authorities could make a difference but the key aspect to dealing with delayed discharges is demonstrating strong leadership.

Gary Robinson, NHS Shetland, reiterated the variation of the challenge across the country in particular for Islands it is not only recruitment but housing that poses a challenge to the delivery of service. 

Deep dive

Workforce - NHSC/23/24/12 (jointly led by SG officials and Chairs)

Carole Wilkinson thanked SG colleagues for their attendance at the Chairs meeting and for their advice and support, the slides were made available to the Chairs meeting as background reading and included today for reference.

Martin Hill, NHS Lanarkshire, contributed the following regarding workforce at NHS Lanarkshire:

• education and development are key to innovation in workforce. Working with universitys and NHS Scotland academy to increase development opportunities
• there is a strong partnership with SAS working as integral team in the accident and emergency department and has proved fruitful
• the board has agreed to convert £5m on temporary and fixed term staff appointments to permanent positions and are actively recruiting
• focused quality reporting has been introduced and leadership skills management development has been widened
• NHS Lanarkshire – “The Big Shout Out” publication focusses on different teams each month, promoting their service and is shared with MSPs and MPs. This is crucial to staff feeling confident and supported to face choices and decisions especially workforce
• workforce policy plans need to focus on service design. Reduction in working week is not affordable and staff will work excessive overtime which is unsustainable, therefore rostering must be modernised and streamlined
• difficult conversations are needed and there is a need for no blame culture where people can freely express what is not working and help shape the future

Tom Steele, Scottish ambulance service, commented that the innovation and change is about utilising people to do things differently and education/development is needed to develop existing capabilities. Artificial intelligence (AI) is already used but not to massive effect in healthcare as it is intrinsically face to face interaction. Tom is working with NHS Education for Scotland which will look at training people to do things differently as people are the change drivers but AI needs to be taken seriously as it is tied to future workforce. 

Alison Evison, NHS Grampian, advised that their AI research project has the potential to make a great impact for patients in Grampian in relation to chest Xray and the board will be looking at other areas AI can be utilised. Shared services could benefit from support around national systems and data systems to have an understanding of the workforce for the future.

The Cabinet Secretary added that there was an opportunity to look at non-patient facing services which could be brought together. Technology should be utilised effectively in shared services and there is a potential to automate where we can. A different mind-set is needed for this change and reassure people that they won’t lose their jobs. Chairs need to collaborate outwith their boards and to look at data and modelling no the burden of disease.  The Chief Medical Officer (CMO) is currently progressing work on modelling for the future. The Cabinet Secretary requested that this item is placed on the Chairs agenda for future discussions and CMO to prepare a briefing.

Action: Chief Medical Officer to bring an item to NHS Chairs meeting on data and modelling.

The Cabinet Secretary noted the workforce challenges and the financial difficulties in the next year. He encouraged Chairs to be innovative to deliver and improve services. Diagnostic capacity can improve productivity in staff with the technology currently used. CfSD will continue to support innovation but staff and boards need to ensure consistent engagement. Boards need to engage their workforce, capitalise on the skills and help them to work more efficiently and use technology as appropriate to support them. The Cabinet Secretary noted a number of comments regarding innovation in different board areas that are improving productivity and the way things are delivered to patients. He reiterated the importance of sharing best practice and for boards to question if these practices are suitable for their board. It is important that there is constructive challenge and consistency with boards working collaboratively together to ensure cross-board learning is put into practice across Scotland.

John Burns noted the planning and delivery board last week agreed to take forward, business services transformation on an NHS Scotland basis. Work is being done on scoping for the correct technical support.

Feedback from NHS Chairs private meeting

Carole Wilkinson provided a brief updated from the Chairs private meeting, held on Monday 11 December:

• workforce discussions on scale and spread/good practice on a regional and national basis
• finances for deep dive in January
• sponsorship of territorial boards

Any other business

There was no other business raised.

Date and time of next meeting

The next NHS Chairs meeting will take place virtually on 29 January 2024.