NHS Forth Valley Assurance Board minutes: 18 July 2023

Attendees and apologies

Members

• Christine McLaughlin, Co-Director of Population Health (Chair) (in-person) 
• Fiona Hogg, Chief People Officer (in-person)
• Robert Kirkwood, Head of the Office of Chief Executive (in-person)
• Tracy Slater, Head of Performance and Delivery (virtually)
• John Harden, Deputy National Clinical Director (virtually)

Attendees – Forth Valley 

• Cathie Cowan, Chief Executive (in-person)
• Janie McCusker, Chair (in-person)
• Frances Dodd, Executive Nurse Director (in-person)
• Scott Urquhart, Finance Director (in-person)
• Annemargaret Black, Chief Officer, Clackmannanshire and Stirling HSCP (in-person)
• Patricia Cassidy, Chief Officer, Falkirk HSCP (in-person)
• Robert Clark, Employee Director (in-person)
• Sally McIntosh, Project Manager (in-person)
• Elaine Bell, HR Manager (in-person)
• Gillian Morton, Director of CPMO/Women and Children’s Directorate, Director of Midwifery

Attendees – SG/Other 

• [redacted] (Secretariat), Head of Board Governance and Appointments (in-person)
• [redacted] (Secretariat), Executive Support Officer (virtually)

Apologies

•  Alex McMahon, Chief Nursing Officer 
• Angie Wood, Director of Social Care Resilience and Improvement 
• Gregor Smith, Chief Medical Officer 
• John Brown, Chair of NHSGGC 
• Linda Donaldson, HR Director
• Jonathan Best, Interim Director of Acute Services
• Jonathan Proctor, Director of Estates and Infrastructure
• Andrew Murray, Medical Director (in-person)

Items and actions

Welcome, apologies and antroductions

​​​​​​The Chair welcomed members to the twelfth meeting of the Assurance Board (AB), noted apologies and outlined the agenda.

It was noted before receiving a progress update that there had been a longer period since the last meeting, compared to previous meetings, and it was hoped that this would have provided sufficient time for colleagues to update and make significant progress to the next iteration of the improvement plan.

NHS Forth Valley improvement plan

• The NHS Forth Valley Executive Leadership Team (ELT) shared the latest iteration of the improvement plan and highlighted that strengthening leadership across NHS Forth Valley, supported by effective governance and cultural improvement, continues to progress with a focus on three key priority areas:
• putting patients first
• supporting our staff
• working in partnership

In relation to supporting our staff, close attention has been paid to iMatter ‘employee engagement index’ score and the feedback the Board receives from staff. In the most recent iMatter staff survey, the Board saw their response rate increase from 56% (2022) to 61% (2023) with an employee engagement index rate of 76%.

Putting patients first and patient feedback remains important to the Board and the use of Care Opinion is promoted, which enables people to share the story of their care, with the majority of feedback being positive.

In terms of working in partnership, a major recruitment event, supported by both the University of Stirling and Forth Valley College, took place at Forth Valley Royal Hospital at the end of June 2023. The event was well attended, with many attendees now joining the board’s staff bank or  signalling interest in applying for a number of permanent roles. 

Fiona Hogg added that it was good to see trends over time, including for individual Directorates and evidence that progress was being made as a result of the actions taken. The challenges that exist around data collection were recognised..

Action - The next version of the Improvement Plan will be reviewed at the next meeting.

Measurement framework

There were a number of metrics which were measured against supporting staff, which included attendance management and staff turnover. The data provided in absence rates was highlighted as being challenging due to not being able to breakdown the reason for an individual’s reason for absence where stress was identified e.g. if it was work related or personal. Staffside highlighted that they were supportive of staff coming back to work but recognised that options needed to be explored for members of staff who were fit to return but not to their normal role, due to injury. In addition, there was a peer support programme in place, which appeared to have received a positive reaction. A formal evaluation would take place in the coming months.

The Chair and AB commented on the real progress that had been made on the development of the measurement framework. While this had taken some considerable time to achieve, the framework enabled measurement of progress against the improvement plan, as well as assisting in the understanding of the impacts made by the improvements.

Integration update

A paper was provided, which included an update on progress against each of the actions in relation to integration. The additional work being supported by David Williams, Professional Advisor, was also highlighted as it attempted to support partners in their review and update of the Integration Schemes. That work was based on the Ministerial Strategic Group (MSG) for Health and Community Care proposals, adopted from the Audit Scotland report, published in November 2018.

​​​​​​​​​​​​​​These focus on:

• collaborative leadership and building relationships;
• integrated finances and financial planning;
• effective strategic planning for improvement;
• agreed governance and accountability arrangements;
• ability and willingness to share information; and
• meaningful sustained engagement

​​​​​​​The Chair asked that further work took place to clarify what the outstanding actions are to ensure the actions set out in the letter from John Burns are addressed. Additionally, the Forth Valley team would wish to seek further feedback from Angie Woods on the content of the integration paper, when she returns from leave.

​​​​​​​​​​​​​​All members of the ELT commented on the positive experience of the recent ELT session. The session allowed colleagues to share how this situation has impacted on them which allowed them to connect on a personal level. In addition to this, it was a positive experience with discussing and agreeing actions where they would hold each other to account in a collegiate way.

​​​​​​​AB reflected that the board were at a crucial point and it was important to keep up momentum before winter approaches.

NHS Forth Valley performance update

​​​​​​​The ELT provided an update on the challenging performance areas: Children and Adolescent Mental Health Services (CAMHS); Psychological Therapies (PT); Urgent and Unscheduled Care (USC); and, Out of Hours (OOH).

​​​​​​​CAMHS activity has significantly increased and long waits are reduced compared to the same quarter a year ago. There is a similar picture for PT. CAMHS, in June, saw 107 patients and in July have the target of 120 which is more challenging but currently on track. Sickness and absence rate fell below 4%, however maternity leave rate was higher which was more challenging to plan for.

​​​​​​​​​​​​​​The Board are not an outlier for PT. They are in line with the majority of Boards across Scotland. Concerns were raised, however, on meeting the waiting time target due to workforce capacity and funding constraints, predominantly within PT services.

 ​​​​​USC saw some improvements in data around the 4 hour target, however it had not been consistent. 12 hour waits had improved significantly. Positively, there had been key recruitment to leadership roles. Winter planning work was ongoing, with  engagement taking place with councils and other partners on preventative work.

​​​​​​​In OOH, a recent OOH review meeting indicated that progress, in some areas, had stalled. This would be kept under review.

​​​​​​​The Chair highlighted that it would be useful to see how the Board’s position compares to other Boards in Scotland as well as the expected trend for entering winter, not just an update on the current position.

​​​​​​​Scott Urquhart noted that the Board had undertaken early discussions with an external consultant in relation to carrying out their self-assessment against the revised Blueprint for Good Governance. John Brown has organised a session with the Board to go over his review of governance for 7 August (subsequently postponed due to leave).

​​​​​​​In summing up, the Chair recognised the quality of the papers that had been presented to the AB and that NHS Forth Valley was now well placed to take forward the implementation of the next version of the improvement plan, which would be reviewed at the next meeting.

​​​​​​The Chair thanked everyone for their contributions and closed the meeting.