NHS Forth Valley Assurance Board update: letter from the Chair to MSPs

Letter from Christine McLaughlin, Chair of the NHS Forth Valley Assurance Board, to members of the Scottish Parliament with an update on NHS Forth Valley against their escalated position.

To: all Members of the Scottish Parliament

From: Christine McLaughlin, Chair of NHS Forth Valley Assurance Board

NHS Forth Valley was escalated to Stage 4 of the NHS Scotland Board Performance Escalation Framework on 23 November 2022 in relation to Governance, Leadership and Culture I was asked by the First Minister and previous Cabinet Secretary for Health and Social Care, Humza Yousaf MSP to establish and chair an Assurance Board to bring direct oversight of the escalation, and to monitor and scrutinise NHS Forth Valley against their agreed Improvement Plan.  

For improvement in NHS Forth Valley to be sustained, the Improvement Plan and the implementation of it must be owned and led locally. The role of the Assurance Board is to scrutinise and challenge and to provide support to enable that change.  The Chair and the Chief Executive of NHS Forth Valley have been fully engaged in this process, along with the senior team. Local governance arrangements are in place within the Board of NHS Forth Valley to ensure local ownership and assurance of delivery. The Assurance Board meets fortnightly to maintain momentum in seeking assurance from the NHS Forth Valley senior leadership team that sufficient progress is being made as set out in the Improvement Plan. As of 31 March 2023, we have convened eight times.

Mr Yousaf last wrote to MSP’s in December.

On 28 March 2023, the Chief Executive of NHS Forth Valley, Cathie Cowan, wrote to me to summarise the progress that has been made so far in implementing the Improvement Plan. I have published that letter on the Scottish Government website.

Links to the following documents, which have been published by NHS Forth Valley

  • NHS Forth Valley Improvement Plan (Revised, including progress update)
  • Measurement Framework

Full details of progress to date is provided in these documents, which have informed the update I have provided below from the Assurance Board:


Professor John Brown, Chair of NHS Greater Glasgow & Clyde, joined the local support team in January 2023, and is in the process of conducting a comprehensive review of NHS Forth Valley’s governance arrangements against the NHS Scotland Blueprint for Good Governance. This involves engagement with a wide range of  stakeholders and observing a full cycle of governance meetings.   

An interim report is expected in early spring 2023 with a final report by June at the latest. The review will provide an assessment of existing governance arrangements against best practice and a set of recommendations for improvement, which will then form part of the Improvement Plan.

Leadership and Culture

The NHS Forth Valley Executive Leadership Team (ELT) led a deep dive into Leadership and Culture at a recent meeting of the Assurance Board. We discussed issues regarding the continued development of the ELT; a review of professional leadership and management arrangements; and work to support equality, diversity, and inclusion across the organisation.

An organisational development programme has been put in place to support the ELT. The programme will commence in early April, and again, I would expect recommendations from this work to feature in the next iteration of the Improvement Plan.

Whilst there are early signs of improvement within the organisation, delivering and sustaining the required changes in governance, leadership and culture will take time and effort to implement and embed throughout the organisation, however the NHS Forth Valley Board and ELT have demonstrated a willingness to affect this change.  

Examples of improvement we have seen to date include the inclusive approach to the response to the most recent HIS report (more detail on this below), implementation of a more streamlined and effective senior leadership team and a ‘triumvirate’ between the Chief Executive, Nurse Director and Medical Director, to support senior decision-making, in line with best practice in NHS leadership.

The Assurance Board has reiterated the importance of evidencing improvements in leadership and culture and NHS Forth Valley has provided a full summary of action taken in their published progress update.


Whilst NHS Forth Valley has not been escalated on the grounds of poor  performance, the concerns related to governance, leadership and culture have been evident in poor performance particularly in relation to unscheduled care, out of hours services, mental health services and Integration.

Unscheduled Care performance in NHS Forth Valley continues to be extremely challenged, with performance consistently in the lower quartile for NHS Scotland. However there is evidence of a significant amount of action being taken to support sustainable change. This includes work on reducing the longest Emergency Department waits and reducing the number of, and reliance on, contingency beds across the system. By putting these foundations in place, the expectation is that this will allow improved whole-system flow and in turn improve the patient and staff experience of Unscheduled Care.

NHS Forth Valley, like all NHS Boards in Scotland, face challenges around how best to balance the delivery of safe and timely care in challenging times, with progressing improvement activity. Officials continue to work with the Board to ensure that improvement actions are safely prioritised and risks mitigated. The expectation of the Assurance Board over the next quarter is therefore that NHS Forth Valley demonstrate a sustained and tangible improvement against the four hour standard as the benefits of this work are realised. This will be a key measure of success.

In relation to out-of-hours services (OOH), Sir Lewis Ritchie, Professor of General Practice at Aberdeen University, has fed back that he is encouraged by the progress made against the recommendations set out in his recent review of OOH services in NHS Forth Valley. I expect this progress to continue under the leadership of the recently appointed interim Director for Acute Services.

In relation to Mental Health, NHS Forth Valley has demonstrated progress in reducing the number of long waits in Children and Adolescent Mental Health Services (CAMHS) and expects to meet the national referral to treatment standard during Q1 of 2023/24. Performance remains more challenged in Psychological Therapies (PT), however NHS Forth Valley have recently recruited to several vacant posts, and expect this to have a significant impact on future performance.

Operational management of Primary Care and Mental Health has now transferred to Integration Authorities and external support to further progress the effectiveness of Integration has also been agreed, with a review of effectiveness beginning in April.

I am pleased to report that NHS Forth Valley has shown an openness to engage with Healthcare Improvement Scotland (HIS) following their inspections and an effective response to the inspection report has been led by the Nurse Director.

Next steps

On behalf of the Assurance Board I would summarise the position to date as one of early signs of improvement since the beginning of escalation and a willingness to engage fully with the process. However substantial further work is required by the NHS Forth Valley leadership team to evidence improvements in governance, leadership and culture; and, in turn, on performance, that can be sustained in the longer term.

During the next quarter (April 2023-June 2023) the Assurance Board will consider the outputs and recommendations from the Governance Review, Integration Review and the Organisational Development Programme and the response of the senior leadership team to these. This will then inform the next iteration of the Improvement Plan.

Finally, having supported NHS Forth Valley to respond to the initial phase of the escalation process, the support team of Professor Hazel Borland and Dr John Harden have now concluded the initial phase of support.  Dr Harden will continue to assist the senior leadership team in the next phase of work, with a focus on locally led improvement.   

Updates from the Assurance Board, including minutes, and other materials associated with the group are available. 


Yours sincerely,

Christine McLaughlin, Chair of NHS Forth Valley Assurance Board

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