NHS Forth Valley update: letter

This letter provides an update in relation to the recent escalation of NHS Forth Valley on the NHS Board Performance Escalation Framework. 

The Scottish Government escalated NHS Forth Valley to Stage 4 on 23 November 2022 and I asked Christine McLaughlin, Director of Population Health, to establish an Assurance Board to bring direct oversight of the escalation. The Assurance Board met for the first time on Thursday 1 December 2022, subsequently on Tuesday 13 December 2022, and will meet fortnightly to maintain ongoing engagement and assurance from the NHS Forth Valley senior leadership team.  The Terms of Reference (ToR) and other material relating to the escalation and the Assurance Board have been published on the Scottish Government website. 

I asked Professor Hazel Borland, former Nurse Director and interim Chief Executive of NHS Ayrshire & Arran, and Dr John Harden, Deputy National Clinical Director, to lead the senior level external support to the Board, and they have been engaging with NHS Forth Valley since the escalation came into effect. I can also confirm that Professor John Brown, Chair of NHS Greater Glasgow and Clyde, will formally join the external support team in January 2023 to conduct a review of the effectiveness of the governance arrangements within the Board. 

In my statement, I outlined my expectation that NHS Forth Valley should produce a coordinated Improvement Plan and demonstrate clear progress by the end of the calendar year.  Scottish Government Directors have continued to work with NHS Forth Valley on service level Improvement Plans for Unscheduled Care, Child and Adolescent Mental Health services (CAMHS), Psychological Therapies (PT), and Out of Hours (OOH) services. The overarching Improvement Plan, published today, relates to Governance, Leadership and Culture; and whilst service performance is not within the remit of the Assurance Board, improved performance is an important indication of change. 

The Improvement Plan has been approved by the NHS Forth Valley Board and reviewed by the Assurance Board.  Whilst the Assurance Board is providing direct monitoring and support to NHS Forth Valley, the onus remains on the NHS Board to commit to, and deliver on, improvement.   The role of the Assurance Board, following acceptance of the plan, is to ensure local delivery of the plan, leading to sustained improvement in performance.  The Chair of the Assurance Board will update the Director General for Health and Social Care and myself as Cabinet Secretary on a regular basis. 

Healthcare Improvement Scotland (HIS)

Healthcare Improvement Scotland (HIS) will provide support from January to the end of March 2023 and is currently in discussion with NHS Forth Valley in relation to the focus and form of that support. NHS Forth Valley and HIS have already met to enable the transfer of key learning from the improvement support recently offered by HIS to NHS Ayrshire and Arran. 

It is important that we respect the independent role and remit of HIS to provide public assurance about the quality and safety of healthcare through the scrutiny of NHS hospitals and services in Forth Valley. After eighteen weeks, the inspection team will request an update on the Improvement Plan produced by NHS Forth Valley in response to the recent inspection; and will return to Forth Valley Royal Hospital to undertake a further unannounced inspection in 2023, to assess and provide assurance on progress. 

Unscheduled care 

Following the decision to escalate, the Scottish Government tasked the NHS Forth Valley senior leadership with urgently reviewing existing plans; and convened a meeting of key stakeholders to streamline activities, and provide increased focus on the priority actions that are most likely to have a positive effect on performance over the winter period. 

The national Unscheduled Care team have agreed to provide leadership support, and improvement advisor resource, to support the delivery of key initiatives within this rapid recovery plan. Commensurate resource from NHS Forth Valley leadership, quality improvement (QI), and clinical will be identified, and week by week activities set out in a programme plan. 

In order to govern and oversee this work and increase accountability and risk identification and management, the national Unscheduled Care programme will make arrangements for additional programme management resource to be contracted from National Services Scotland (NSS) until the end of this financial year. The Programme Manager will support increased scrutiny and provide output reports to the Assurance Board where required. 

Mental health 

Following my statement to Parliament, officials also asked NHS Forth Valley to submit updated local improvement plans and trajectories to provide assurance that the Board is doing all it can to improve performance in mental health. 

Officials have recently received plans for Child and Adolescent Mental Health services (CAMHS) and Psychological Therapies (PT) and are in the process of reviewing the actions and trajectories before providing feedback to the Board. We continue to provide tailored support to NHS Forth Valley, as well as access to professional advice and regular board engagement calls.

Performance is still not where it needs to be in NHS Forth Valley. However, there has been an agreed focus on clearing the backlog in treatment due to the pandemic; and, although this may have a short term negative impact on performance against the standard, it is a necessary step to ensure that those who have waited longest are seen first. It will also support NHS Forth Valley to build sustainable foundations on which to achieve the standard in the longer term. 

NHS Forth Valley achieved a 23.4% reduction in the number of children and young people waiting to begin treatment between June and September 2022; and a 4.9% decrease on the same time last year. Equally, the number of people waiting to start PT treatment at the end of September 2022 was 3.1% lower than in June and 19.5% lower than at the same time last year. 

Out of hours

The Scottish Government provided the Chief Executive of NHS Forth Valley with Sir Lewis Ritchie’s preliminary feedback on their Improvement Plan developed on the basis of his recommendations. Unfortunately, the initial Plan was not to the standard Sir Lewis would have expected and he was unable to determine substantive progress on his recommendations. 

My officials requested a further updated Improvement Plan to be submitted by Friday 16 December and NHS Forth Valley submitted their revised Plan by the agreed date. I have been advised by Sir Lewis and my officials that while these remain early days, NHS Forth Valley is making satisfactory progress in defining and beginning to implement a robust action plan.   

Conclusion 

I set out in my statement that escalation is a last resort, and a decision taken following a consistent demonstration that the NHS Forth Valley leadership team is unable to follow through with the transformational change required without additional formal support and monitoring.

I have received assurance that the leadership within NHS Forth Valley is committed to delivering the required change, and it is important that this is achieved within the timeframes set out in the Improvement Plan.  

The Improvement Plan provided by NHS Forth Valley is now published and the Assurance Board will hold them to account on delivery over the coming weeks and months. 

I committed to regular progress updates and can confirm that I will provide a further update to Parliament by no later than the beginning of the next financial year. 

Yours sincerely

Humza Yousaf MSP
Cabinet Secretary for Health and Social Care