NHS Chairs minutes: October 2022

Attendees and apologies

Health Board Chairs

• Bob Martin, NHS Ayrshire and Arran, Vice Chair (On behalf of Lesley Bowie)
• Karen Hamilton, NHS Borders
• Nick Morris, NHS Dumfries and Galloway (Chair of Chairs Group)
• Tricia Marwick, NHS Fife 
• Janie McCusker, NHS Forth Valley 
• Alison Evison, NHS Grampian
• John Brown, NHS Greater Glasgow and Clyde 
• Boyd Robertson, NHS Highland 
• Martin Hill, NHS Lanarkshire    
• Peter Murray, NHS Lothian, Vice Chair (on behalf of John Connaghan)
• Meghan McEwen, NHS Orkney
• Natasha Cornick, NHS Shetland, Vice Chair (on behalf of Gary Robinson)
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee 
• Carole Wilkinson, Healthcare Improvement Scotland (Vice Chair of Chairs Group)
• 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
• Brian Moore, The State Hospitals Board for Scotland
• Doug Moodie, Care Inspectorate
• Suzanne Dawson, Scottish Health Council

Scottish Government officials

• Humza Yousaf, Cabinet Secretary for Health and Social Care
• Maree Todd, Minister for Public Health, Women’s Health and Sport
• John Burns, NHS Scotland Chief Operating Officer (on behalf of Caroline Lamb too)
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Gordon James, Deputy Chief Operating Officer - Performance and Delivery
• David Miller, Chief People Officer
• John Harden, Deputy National Clinical Director (on behalf of Jason Leitch too)
• Richard McCallum, Director of Health Finance and Governance
• Lorna Gibbs, Deputy Director, Social Care Data and Digital (on behalf of Donna Bell)
• Luska Jerdin, Head of Mental Health Performance and Improvement (on behalf of Hugh McAloon)
• Richard Foggo, Co-Director of Population Health
• Rachel Dunk, Head of Chief Nursing Officer Directorate (on behalf of CNO)

In attendance

• Roslynn Barclay, Executive Support to NHS Board Chairs and Chief Executives
• Angela Constance, Minister for Drugs Policy (for Drugs Policy item)
• Anna Dominiczak, Chief Scientist (Health) (for Innovation Design Authority item)
• Gerald Ellison, Private Secretary to Cabinet Secretary for Health and Social Care
• Louise Dowdles, Private Secretary to Cabinet Secretary for Health and Social Care
• Keegan Schmidt, Assistant Private Secretary to Minister for Drugs Policy
• Orlando Heijmer-Mason, Head of Drugs Policy Division
• Maggie Page, Drugs Policy Unit
• Alison Crocket, Drugs Policy Unit
• Robert Kirkwood, OCENHS Team
• Laurie Whyte, OCENHS Team
• Kat Dobell, OCENHS Team
• Hannah Mackay, OCENHS Team
• Carol Hunter, OCENHS Team

Apologies

• Lesley Bowie, NHS Ayrshire and Arran (Bob Martin attending)
• John Connaghan, NHS Lothian (Peter Murray attending)
• Gary Robinson, NHS Shetland (Natasha Cornick attending)
• Kevin Stewart, Minister for Mental Wellbeing and Social Care
• Caroline Lamb, DG HSC/CE NHS Scotland (John Burns attending)
• Christine McLaughlin, Co-Director of Population Health
• Gillian Russell, Director of Health Workforce
• Jason Leitch, National Clinical Director (John Harden attending)
• Donna Bell, Director of Social Care and NCS Development (Lorna Gibbs attending)
• Tim Mcdonnell, Director of Primary Care
• Stephen Gallagher, Director of Digital Health and Care
• Hugh McAloon, Mental Health Director (Luska Jerdin attending)
• Alex McMahon, Chief Nursing Officer (Rachael Dunk attending)
• Gregor Smith, Chief Medical Officer
• Michael Chalmers, Director for Children and Families    

Items and actions

Agenda

• welcome, apologies for absence and attendees
• minutes and actions from the previous meeting (5 September 2022)
• matters arising
• Cabinet Secretary remarks 
• standing items:
  • planned care targets (John Burns) (paper no: NHSCH/22/23/04)
  • emergency and unscheduled care (John Burns) (paper no: NHSCH/22/23/05)
  • National Care Service (Lorna Gibbs)
  • staff wellbeing (Nick Morris and Carole Wilkinson)
• emergency budget review (Richard McCallum)
• drugs policy (Ms Constance, Minster for Drugs Policy) (paper no: NHSCH/22/23/06)
• Innovation Design Authority (Tom Steele) (paper no: NHSCH/22/23/07)
• feedback from Chairs private meeting
• any other business
• date and time of next meeting
  • joint Chairs and Chief Executives meeting 9 November 2022
  • NHS Chairs meeting 12 December 2022

Minutes

The Cabinet Secretary for Health and Social Care welcomed everyone to the meeting. A further welcome was extended to Alison Evison, who was appointed as the Chair for NHS Grampian on 10 October 2022. 

NHS Chairs were made aware that Jann Gardner, current Chief Executive at NHS Golden Jubilee, has been appointed as the new Chief Executive of NHS Lanarkshire and that Gordon James, current Deputy Chief Operating Officer will be taking over as Interim Chief Executive of NHS Golden Jubilee, both with effect from 01 December 2022.

The Cabinet Secretary highlighted that he needed to leave the meeting at 15:15 and noted that he would miss the discussion on the Innovation Design Authority (item 8). Maree Todd, Minister for Public Health, Women’s Health and Sport would continue to chair the meeting. 

The Cabinet Secretary noted the apologies and acknowledged the Vice Chairs representing their Boards. A full list of those present and apologies is provided at annex A.

Minutes and actions from the previous meeting

The Cabinet Secretary highlighted the following outstanding action from the previous meeting:

• John Burns, NHS Scotland Chief Operating Officer and Jason Leitch, National Clinical Director to consider a leaflet drop to every household, which details other avenues to seek medical assistance, other than A and E
• John explained that due to current financial challenges, consideration was being given digital alternatives and suggested the NHS 24 app may be better suited to provide this information

Cabinet Secretary’s remarks

The Cabinet Secretary expressed thanks to NHS Chairs for their continued Leadership and acknowledged the significant pressures the system is already facing, entering the winter period. He highlighted the following:

• prioritisation should be given to issues around delayed discharge which affects hospitals, social care, care homes and those providing care at home. The Cabinet Secretary would welcome options going forward if there continues to be little improvement
• the Winter Resilience Overview 2022-23 published on 04 October 2022 set out keys priorities, underpinned by £600 million of investment to guide and focus collective efforts
• on 20 October a full pay offer was made to AfC Unions of an average 7% pay increase to AfC staff, as a flat payment of £2205. This will see the lowest paid receive over an 11% raise, with a Band 5 Staff Nurse receiving up to 8.45%. Unions are now considering and will confirm their positions soon. It was expected that most unions would make their position clear this week, and remain hopeful that most will not proceed to industrial action following this offer
• the Suicide Prevention Strategy was launched on 29 September with the vision of reducing the number of suicide deaths in Scotland, whilst tackling the inequalities which contribute to suicide
• finalists have been announced for the Scottish Health Awards Ceremony on 3 November 2022
• John Swinney, Deputy First Minister and Cabinet Secretary for Covid Recovery, will address the public this week to outline the financial situation

Standing items

Planned care targets (paper no: NHSCH/22/23/04)

John Burns referred to the paper that had been circulated in advance and provided a slide presentation on Planned Care Targets showing ongoing waiting trends for Outpatients and Inpatient/Day cases over 52, 78 and 104 weeks. The effort shown in the last month has started to make a difference with a reduction in numbers. 

The National Planned Care Event will take place in Edinburgh on 23 November 2022. The event is being held in conjunction with the Chief Medical Officer, to bring colleagues together to share practices. John indicated that for 2023/24, it will be important to maximise core capacity and the opportunities that the Centre for Sustainable Delivery (CfSD) are engaged with throughout Scotland. The National Elective Coordination (NECU) is an example which is up and running through CfSD and is having a good impact.

John informed Chairs that the establishment of the four National Treatment Centres is on track. They will form part of the national response, caring for patients in their own and other Health Board areas.

The Cabinet Secretary was impressed with how the system has managed to turn scheduled care round and added that although the focus is on delayed discharges with other partners, more can still be done within NHS Boards to drive improvement. 

Emergency and unscheduled care (paper no: NHSCH/22/23/05)

John Burns referred to the paper that had been circulated in advance on Emergency and Unscheduled Care. Data shows that attendance at Accident and Emergency was down by 9%; minor injuries down by 13% with no change in the level of admission. Whilst it was important to focus on reducing delayed discharges, he explained that it was also essential that we focussed improvement on the high impact changes in local plans to ensure we are addressing every opportunity for betterment. 

National Care Service (NCS) 

Lorna Gibbs, Deputy Director, Social Care Data and Digital provided an update on the NCS:

• Parliament is moving into the evidence sessions for Stage 1 of the Bill and this will continue for the rest of the year. Finance colleagues before parliament currently outlining costs associated with the NCS
• the first NCS National Forum took place on 03 October 2022 which brought together people across the sector and those with lived experiences of social care. It is proposed that this will be an annual event
• the co-design process has been launched, starting with the Charter of Rights and Responsibilities 
• Nick Morris stated the Chairs would welcome a focus on the development of standards for care and the development of integrated inspection regimes. He mentioned that Donna Bell, Director of Social Care and NCS Development was working on Multi-Disciplinary Teams in her engagement with the Care and Wellbeing portfolio Boards and it would be helpful to understand how this work would be brought into the development of the NCS (as regards integrated community teams across health and social care)
• Paula Speirs, Deputy Chief Operating Officer - There is a specific workstream on Community Health currently looking at the synergies in terms of Multidisciplinary Teams (MDT). This work stream is looking at the definition of “Community Health” There is opportunity for Chairs to engage with this work
• the NCS will have a national framework but will look different in local areas as appropriate

Staff wellbeing

Nick Morris and Carole Wilkinson provided an update on staff wellbeing. The NHS Chairs identified workforce as the top priority in its assessment presented to this group in February. The Chairs focused considerable time to this at the September away days recognising their leadership on culture would support a focus on wellbeing, recruitment and retention. 

Discussions centred around:

• new staff hubs, including outdoor spaces have been opened to help with staff wellbeing
• finding appropriate accommodation for staff in Boards outside central belt is vital for recruiting and retaining the workforce. Initial discussions have taken place with Local Authorities and Housing Associations in some areas on how this could be improved
• the complex and fragile nature of remote and rural service provision. Resilience issues for single practitioners and implementing a resilience tool to prevent staff feeling isolated

The Cabinet Secretary thanked NHS Chairs for the amount of effort on trying to alleviate the pressure on wards which will make an impact on staff wellbeing through the coming challenging winter months. 

Emergency Budget Review (EBR) 

Richard McCallum, Director of Health Finance and Governance, stated that the Scottish Government were working towards the emergency budget provision and were looking to set out more details around the funding decisions that will need to be made. Assumptions will have to be adjusted after the mini budget and the changes made by the Chancellor last week. He noted that discussions were ongoing this week with Unions around staff pay. 

Looking forward to 2023/24 Scottish Government will ensure a stronger integrated approach with workforce, performance and finance colleagues. 

There was a discussion about bank and agency staff. There is a shortfall in permanent and bank staff across NHS Boards which has created a high dependence on the use of agency staff. Work is underway to explore options for this nationally through the Sustainability and Value Group. The first meeting was held on Friday co-chaired by Alex McMahon, Chief Nursing Officer and Calum Campbell with Bank Managers, Nurse Directors and Directors of Finance with 10 options to look at. There will be fortnightly meetings to ensure this is progressed quickly and an update will be provided at the next NHS Chairs meeting in December. 

A note of the Sustainability and Value Group paper which was prepared for the NHS Chief Executives meeting on 12 October, would be sent out following this meeting to allow NHS Chairs to see what plans are being made.

Actions:  

• Richard McCallum to return to NHS Chairs meeting in December with an item on Sustainability and Value Group discussion on staffing and costs
• Richard McCallum to issue Sustainability and Value paper to NHS Chairs for information

(The Cabinet Secretary left the meeting at 15:15. Maree Todd, Minister for Public Health, Women’s Health and Sport took over as Chair)

Drugs policy 

Angela Constance, Minister for Drugs Policy, highlighted that Scotland still have a drug deaths crisis and therefore we still have a public health emergency. The Annual Report on Drug Deaths for 2021 showed a marginal decrease but the second highest number of drug related deaths in Scotland on record, and we continue to have the highest drug death rate in Europe. Suspected drug deaths information for the first half of 2022 is showing a decrease but there are a number of important caveats to this information.

The key ask of NHS Chairs included the following:

• use their skills and position to ensure Chief Executives and Boards were doing everything possible to reduce drugs deaths
• ensure that there is sufficient support and scrutiny of implementation of Medication Assisted Treatment (MAT) standards and use of rehabilitation
• to understand and challenge the pace of work – there are things that can be and should be done quicker but it’s also important to think of the longer term picture
• money allocated appropriately for the delivery of services
• alcohol and drug partnerships should be better supported to implement changes
• help reduce the stigma and challenge the culture around Drug and Alcohol related issues. A Stigma Action plan is currently in development

Discussion was focused around the need to remove stigma and inequalities. It can difficult to get sympathy from the general acute NHS environment and there is a need for cultural change to remind staff of peoples’ vulnerability. It is important to work with all local recovery communities and partners in the acute sector and mental health to get an understanding of the needs of the patient. There needs to be clear pathways to improve the patient’s journey. Ms Todd added that there is a huge amount of empathy from staff however the system is difficult to navigate. 

Tom Steele, Chair, Scottish Ambulance Service (SAS) noted that SAS are in a unique position of accessing patients who can be difficult to reach and are able to sign-post these patients to relevant health care. SAS also work closely with Police Scotland (PS) on overdose incident response, with PS officers now carrying naloxone nasal spray and SAS distributing take-home naloxone kits to anyone at risk of, or likely to witness, an opiate overdose. Naloxone reverses the effects an opiate overdose. 

Innovation Design Authority 

Tom Steele, Scottish Ambulance Service and Innovation Design Authority (IDA) co-chair with Professor Dame Anna Dominiczak noted innovation is a key enabler of change of both scheduled care and unscheduled care. The IDA is a new board set up to provide leadership, coordination and decision-making on the development and adoption of innovation. The IDA will oversee the work of the Accelerated National Innovation Adoption (ANIA) collaboration between NHS Boards working with academia and industry to offer innovative solutions to Territorial Boards and other agencies.

Professor Dame Anna Dominiczak, Chief Scientist (Health) gave a slide presentation which included points on:

• the opportunity and challenge in the service of Scotland
• research and development
• current investment - £2m over 2023/24 into Accelerated National Innovation Adoption Pathway
• leadership and coordination, delivering:
  • system leadership and co-ordination
  • delegated decision making on a “Once for Scotland” approach
  • identification, assessment and national adoption of innovation

ANIA Pathway – gateway stages for large projects including: 

• triage
• full strategic assessment
• value case development

National adoption at scale

Innovations in the ANIA Pathway – three examples are:

• digitally enabled once for Scotland dermatology referral and triage pathway
• technology enabled theatre scheduling tool
• diabetes closed loop system for diabetic patients 

Due to time constraints, it was agreed this item will come to the December meeting for further discussion. Jann Gardner, Chief Executive, NHS Golden Jubilee will be invited to this discussion. 

Actions:

• Secretariat to add discussion on Innovation Design Authority item to the agenda for the next NHS Chairs meeting in December
• Secretariat to extend invitation for the December NHS Chairs meeting to Jann Gardner, Chief Executive, NHS Golden Jubilee for participation in the Innovation Design Authority item

Feedback from Chairs private meeting

Nick Morris provided feedback from this morning’s Private Chairs meeting. Discussion was focused on key issues raised in this meeting with an additional item on how the NHS supports ex-military personal. The work is being taken forward with Chief Executives and Directors of HR.

Date and time of next meeting

The next NHS Chairs Meeting will be held on Monday 12 December 2022.