NHS Chief Executives minutes: June 2019

Minutes of the meeting of the NHS Chief Executives on 12 June 2019.

Attendees and apologies

NHS Board Chief Executives

  • John Burns, NHS Ayrshire and Arran
  • Ralph Roberts, NHS Borders
  • Jeff Ace, NHS Dumfries and Galloway
  • Amanda Croft, NHS Grampian
  • Jane Grant, NHS Greater Glasgow and Clyde
  • Iain Stewart, NHS Highland
  • Calum Campbell, NHS Lanarkshire
  • Gerry O’Brien, NHS Orkney
  • Simon Bokor-Ingram, NHS Shetland
  • Gordon Jamieson, NHS Western Isles (by VC)
  • Jann Gardner, Golden Jubilee Foundation
  • Robbie Pearson, Healthcare Improvement Scotland
  • Angiolina Foster, NHS 24
  • Caroline Lamb, NHS Education for Scotland
  • Gerry McLaughlin, NHS Health Scotland
  • Colin Sinclair, NHS National Services Scotland
  • Pauline Howie, Scottish Ambulance Service (Chair of CEs Group)

Scottish Government

  • Malcolm Wright, DG Health and Social Care and Chief Executive, NHS Scotland
  • Shirley Rogers, Chief People Officer NHS Scotland, and Director of Workforce, Leadership, Reform and EU Exit Preparations
  • Jason Leitch, National Clinical Director Scotland
  • Christine McLaughlin, Chief Finance Officer NHS Scotland and Director of Health Finance, Corporate Governance and Value
  • John Connaghan, Chief Performance Officer NHS Scotland and Director of Delivery and Resilience
  • Donna Bell, Director of Mental Health
  • Fiona McQueen, Chief Nursing Officer Scotland
  • Gregor Smith, Deputy Chief Medical Officer
  • Richard Foggo, Head of Primary Care Division
  • Alison Taylor, Head of Integration Division
  • Rose Marie Parr, Chief Pharmaceutical Officer

In attendance

  • Tracy Gillies, Co-Chair of Medical Directors
  • Alex McMahon, Chair of SEND
  • Alan Morrison, Health Finance and Infrastructure (Item 5)
  • Kathryn Dapré, Head of Energy and Sustainability, NHS National Services Scotland (Item 5)
  • Dave Caesar, Deputy Director and Head of Leadership and Talent Management (Item 6)
  • John Harden, National Clinical Lead for Quality and Safety (Item 7)
  • Jo Matthews, Head of Improvement and Safety, Health Improvement Scotland (Item 7)


  • Stephen Fenning, Scottish Clinical Leadership Fellow
  • Katherina Tober, Scottish Clinical Leadership Fellow
  • Euan Harris, Scottish Clinical Leadership Fellow
  • Chris Sheridan, Scottish Clinical Leadership Fellow
  • Linda Pollock, Deputy Director, Planning and Quality Division
  • David Williams, Director of Delivery, Health and Social Care Integration


  • Laurie Whyte, Office of the Chief Executive NHS Scotland
  • Sarah Hildersley, Office of the Chief Executive NHS Scotland
  • David Bedwell, NHS Scotland Executive Support
  • Chris Campbell, NHS Scotland Executive Support


  • Catherine Calderwood, Chief Medical Officer Scotland
  • Tim Davison, NHS Lothian
  • Michael Chalmers, Director of Children and Families

Items and actions

Welcome, apologies for absence and attendees

1. Malcolm Wright, Director General Health and Social Care/Chief Executive NHS Scotland welcomed everyone to the meeting. A list of attendees and apologies for absence are provided at Annex A.

2. Jason Leitch, National Clinical Director, was congratulated on becoming a Commander of the Order of the British Empire (CBE) in the Queen's Birthday Honours List 2019.

Minutes of the previous meeting: NHSCE/19/20/07

3. The minutes of the meeting held on 8 May 2019 were approved.

Matters arising

4. Chief Executives were encouraged to consider nominations for Honours, at all levels, in their organisations. Chief Executives should see nominations from their Board, prior to them being forwarded to SG Protocol and Honours Team to ensure the range of outstanding work across the health and care system is reflected.

5. Nomination guidance and forms can be found at www.gov.uk/honours and further advice and guidance on all aspects of the process is available from protocolandhonours@gov.scot.

Action: Chief Executives to consider and submit Honours nominations on an on-going basis.

6. Pauline Howie, Chair of the NHS Chief Executives Group thanked colleagues for the work that has been progressed since the last meeting to collate information on pensions and tax. It was recognised that this is a complex issue and further discussions are required.

Feedback from the Chief Executives' private/strategy meeting

7. Pauline Howie, Chair of the NHS Chief Executives Group gave an update on the discussions from the private/strategy meeting, including:

  • National Cancer Framework
  • Scottish Access Collaborative
  • National Planning Update
  • Safe Staffing Update
  • Brexit
  • Mental Health
  • Capital Investment

8. Malcolm Wright advised that the Cabinet Secretary is keen to come back to a future meeting to discuss Mental Health Trajectories.

9. In relation to Brexit, Shirley Rogers, Chief People Officer NHS Scotland, and Director of Workforce, Leadership, Reform and EU Exit Preparations advised that the SG continue with their preparations. Jeff Ace confirmed that he will continue to act as a liaison for the Chief Executives Group.

10. It was agreed that Brexit would become a standing item at future meetings, until further notice.

Action: SG Secretariat: schedule Brexit as a standing item at future meetings until further notice

11. Christine McLaughlin, Chief Finance Officer NHS Scotland and Director of Health Finance, Corporate Governance and Value advised that work is under way on the Capital and Investment Strategy. The strategy would set out the valuable contribution that health and social care would make towards the outcomes of the National Performance Framework and economic growth.

12. Further discussions on this would take place with Chief Executives over the coming months.

Action: Christine McLaughlin to arrange further discussion on Capital Infrastructure Investment with Chief Executives

NHS Scotland Climate Emergency Response: NHSCE/19/20/08

13. Christine McLaughlin introduced the item and outlined that the discussion would be about our role in climate change and the response to the Climate Emergency declared by the First Minister. She welcomed Alan Morrison from Health Finance and Kathryn Dapré, Head of Energy and Sustainability, NHS National Services Scotland to lead the discussion.

14. The Scottish Government recently declared a Climate Emergency. Independent of that announcement the UK Committee for Climate Change issued a report with recommendations for greenhouse gas emissions reduction across the UK. It recommended that Scotland reduce to ‘net-zero’ emissions by 2045. The NHS is working collabaratively on an NHS Scotland Sustainability Strategy covering 16 areas and supported by an Assessment Tool. This will be published in March 2020. The six initial high-level commitments that will form the basis of the Sustainability Strategy were shared with Chief Executives. These are:

  1. NHS Scotland will be a ‘net-zero’ greenhouse gas emissions organisation by 2045 at the latest
  2. All NHS Scotland new buildings and major refurbishments will be designed to have net-zero greenhouse emissions from April 2020
  3. Each NHS Board should undertake a Climate Change Risk Assessment covering all operational areas and produce a Climate Change Adaptation Plan to ensure resilience of service under changing climate conditions
  4. NHS Scotland transport GHG emissions from its owned fleet (small/ medium vehicles) will be net-zero by 2032
  5. The NHS supply chain will be reviewed to determine the extent of associated greenhouse gas emissions and environmental impacts
  6. Each NHS Scotland Board should establish a Climate Change/ Sustainability Governance group to oversee their transition to a net-zero emissions service

15. Chief Executives asked about discussions with Local Authorities on this. Malcolm Wright agreed to raise this with Sally Louden from COSLA at their next meeting.

Action: Malcolm Wright to raise Climate Change with Sally Louden when they meet

16. Chief Executives endorsed the 6 initial high-level commitments.

Scottish Leaders Forum

17. Dave Caesar, Deputy Director and Head of Leadership and Talent Management provided an update to Chief Executives following the Scottish Leaders Forum on Monday 3 June 2019. Infographics used in the update would be circulated following the meeting.

Action: SG Secretariat to circulate SLF infographics to Chief Executives

18. Chief Executives welcomed the update. There was agreement that the day went well, although a very full agenda. There were some helpful presentations which showed current alignment and also where the focus needs to move to in relation to the national outcomes. It was recognised that SOLACE and other sectors should be involved in future discussions.

19. Colleagues agreed that they should work collectively across systems and consider how they link with the wider public sector. Chief Executives were keen to undertake further work on this and report back at a future meeting. Malcolm Wright agreed to speak with Paul Johnston, Director General, Education, Communities and Justice about what the immediate ask is of Chief Executives.

Action: Malcolm Wright to speak with Paul Johnston to ascertain the immediate ask of Chief Executives following the SLF meeting on 3 June 2019

Scottish Patient Safety Programme, including Hospital Standardised Mortality Ratios: NHSCE/19/20/09

20. Jason Leitch, National Clinical Director thanked everyone for their engagement around the 2019 NHS Event. He introduced the Scottish Patient Safety Programme (SPSP), including Hospital Standardised Mortality Ratios (HSMR) item thanking Chief Executives for the work undertaken since the Programme was launched in 2007.

21. Jo Matthews, Head of Improvement and Safety in Healthcare Improvement Scotland and John Harden, National Clinical Lead for Quality and Safety then led a discussion with Chief Executives.

22. Since August 2016, the HSMR has been used to monitor progress towards the Scottish Patient Safety Programme aim of reducing mortality by a further 10% by end December 2018. Across NHS Scotland a reduction of 14% has been achieved. The work of teams and adoption of improvement methodologies across the service has helped drive down standardised mortality across the system as a whole.

23. The end of the current phase of the SPSP provided the opportunity to review the model methodology for a second time, and subsequently update and refine it. The main changes proposed to be made to the HSMR methodology from August 2019 are:

  • move to a dynamic three-year base period, advanced by three months with each reporting period, this will ensure that the Scottish HSMR is always representative of current outcomes and reflective of changing case-mix and provision of services
  • move to a twelve month reporting period - rather than three months - when drawing comparisons against the national average, smoothing out seasonal variation and reducing variation for smaller hospitals
  • use less aggregated specialty groupings to improve performance of the model and allow more in-depth analysis

24. Chief Executives were asked to:

  • Celebrate – share the latest HSMR information with their teams and celebrate the success
  • Coverage – check the coverage of the Scottish Patient Safety Programme in their Boards
  • Connect – connect with the next stage of the Programme

Action: Chief Executives to ensure sharing of HSMR information locally, check local involvement in the SPSP and engage in the next stage of the Programme

Annual reviews: NHSCE/19/20/10

25. John Connaghan, Chief Performance Officer, NHS Scotland, and Director of Delivery and Resilience led the discussion with Chief Executives on the paper that had been circulated in relation to Annual Reviews. The paper shared the background to annual reviews, reflections from the most recent round, why change can be a challenge and integration. He advised that stocktakes would take place in the autumn. These would not only review the mid-year point, but would include a forward look to the year ahead.

26. Chief Executives were in agreement that Annual Reviews should have a whole system component including primary care, mental health, third sector and integration. They were mindful of other stakeholder groups opinions.

27. Malcolm Wright thanked John Connaghan for the update and invited a further discussion on the Annual Review process after the stocktakes have been completed.

Action: SG Secretariat to schedule Annual Reviews at a future meeting in liaison with John Connaghan

28. John Connaghan also provided Chief Executives with an update on Annual Operating Plans (AOPs). Malcolm Wright will be writing to individual Boards shortly setting out terms following receipt of the plans.

Any other business

29. Malcolm Wright asked that 'Day of Care' be discussed at a future meeting.

Action: SG Secretariat to schedule 'Day of Care' at a future meeting

Date and time of next meeting

30. The next NHS Chief Executives Business Meeting will take place on 11 September 2019 at 13:00, in the Fettes Suite, Scottish Health Service Centre, Edinburgh EH4 2LF.

Office of the Chief Executive for NHS Scotland
14 June 2019


NHS Chief Executives minutes: June 2019


Corporate Business Management Team: cbmt@gov.scot

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