NHS Scotland Executive Group Minutes: January 2025

Attendees and apologies

NHS Boards

• Claire Burden, NHS Ayrshire and Arran
• Peter Moore, NHS Borders
• Julie White, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Ross McGuffie, NHS Forth Valley
• Adam Coldwells, NHS Grampian, Interim Chief Executive
• Jane Grant, NHS Greater Glasgow and Clyde
• Fiona Davies, NHS Highland
• Jann Gardner, NHS Lanarkshire
• Caroline Hiscox, NHS Lothian (Vice Chair of CEs)
• Laura Skaife-Knight, NHS Orkney
• Nicky Connor, NHS Tayside

Special Health Boards

• Robbie Pearson, Healthcare Improvement Scotland (Chair of CEs)
• Karen Reid, NHS Education for Scotland
• Gordon James, NHS Golden Jubilee
• Paul Johnston, Public Health Scotland
• Michael Dickson, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• Caroline Lamb, DG HSC/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Alan Gray, Director of Health and Social Care Finance
• Fiona Hogg, Chief People Officer
• Christine McLaughlin, Co-Director of Population Health
• Angie Wood, Director of Social Care Resilience and Improvement
• Anne Armstrong, Interim Chief Nursing Officer
• Gregor Smith, Chief Medical Officer
• Robert Kirkwood, Head of Office of the Chief Executive

Other Attendees

• Jacqui Hepburn, Deputy Chief Executive and Director of Workforce, NHS 24 (for Jim Miller)
• Carolyn Low, Director of Finance, Corporate Governance and Legal Services, NHS National Services Scotland (for Mary Morgan)
• Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship
• Dougie McLaren, Deputy Chief Operating Officer - Performance and Delivery
• John Harden, National Lead for Quality and Safety
• Ed Challis, NHS Scotland Armed Forces Talent Programme (Agenda Item 3)
• Gwen Nicholson, HSCGPIC (Agenda Item 3)
• Nicola Barnstaple, Programme Director Cancer Access (Agenda Item 4)
• Kerry Chalmers, Medical Devices Policy and Legislation Head of Unit (Agenda Item 5)
• Iain Robertson, Medical Devices Professional Adviser (Agenda Item 5)
• Lorraine Cowie, NHS Scotland Professional Lead for Sustainability/Health Planning, NHS Highland (Agenda Item 6 and 9)
• Colin Roddie, Programme Manager, NHSS Acute Reform Programme/Planning & Delivery Board (Agenda Items 6 and 9)
• Tom Steele, Chair, Scottish Ambulance Service (Agenda Item 7)
• Anna Dominiczak, Chief Scientist (Agenda Item 7)
• David Thompson, Head of Innovation Adoption (Agenda Item 7)
• Alan Payne, Board Governance Lead (Observer)
• Aislinn Ní Ghráinne, Strategic Insights and Briefing Unit Head (Observer)

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Sarah Hildersley, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Fraser McJannett, Executive Support Team
• Jenna Stone, Executive Support Team

Apologies

• Brian Chittick, NHS Shetland
• Gordon Jamieson, NHS Western Isles
• Jim Miller, NHS 24 (Jacqui Hepburn attending)
• Mary Morgan, NHS National Services Scotland (Carolyn Low attending)
   

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, NHS Scotland Chief Operating Officer, welcomed everyone to the third meeting of the NHS Scotland Executive Group (Executive Group). Colleagues were reminded of hybrid meeting etiquette.

Caroline reiterated to colleagues that the focus of these meetings was on decision making and giving effect to cooperation between Boards but also between Boards and the Scottish Government Health and Social Care Directorates. 

Caroline advised colleagues that she would need to leave the meeting at 15:00 to attend a meeting with the First Minister at Bute House. 

Caroline thanked Jane Grant for her contribution to NHS Scotland and NHS Greater Glasgow and Clyde, wishing her the best for the future ahead of her retirement at the end of January.  

A list of attendees and apologies for absence is provided at annex a. 

Minutes of previous meeting, actions, matters arising (NHSEG/24/14)

The minutes from the last meeting of the Executive Group held on 13 November 2024 were approved.

A copy of the action tracker was shared, which provided an update on the actions from the last meeting.  Colleagues were invited to provide any further updates on actions not included as part of today’s agenda or noted below.  

Action NHSEG21

• A paper was shared setting out the high-level purpose of the Chief Executive Co-ordination Group on reform, and how it supported the single coherent approach to health and care reform
• Christine McLaughlin, Co-Director of Population Health, was invited to give a brief update on this item ahead of a substantive item scheduled for the next meeting on 5 March 2025

Action NHSEG24

• A paper was shared setting out the proposed sub-committee structure as one of the actions from the previous meeting.  This set out the initial consideration and sought approval to conduct further work in advance of a substantive item scheduled for the next meeting on 5 March 2025. It was noted that further work was required to ensure that the arrangements were aligned to the reform programme and demonstrated the opportunities to streamline and simplify structures.  

Items for adoption

Armed forces talent programme (AFTP) and military covenant (NHSEG/25/01)

Ed Challis, NHS Scotland Armed Forces Talent Programme introduced the paper that had been shared in advance of the meeting and gave a presentation which highlighted the recent signing of the covenant between NHS Scotland and the military at Edinburgh Castle.  He also highlighted the significance of boards maintaining defence employer recognition scheme gold awards and proactively embracing the opportunities this provides, both for service personnel and the NHS.  Chief Executives were recommended to watch the short video on the AFTP website following today’s meeting.

Chief Executives were supportive of the programme. There was a discussion about communications and Fiona Hogg suggested working with HR directors and recruitment leads to support the programme at local level, so that connections could be made through appropriate groups. 

Action no/ action lead/ timescale

• NHSEG25/01 - Chief Executives consider what more NHS Scotland could be doing to support links with the military, veterans and their families - NHS Chief Executives/by end February 2025
• NHSEG25/02 - Fiona Hogg to work with HRDs and recruitment leads to support communications at local level - Fiona Hogg/by end February 2025
• NHSEG25/03 - Chief Executives ensure within boards that the opportunities and support provided through the AFTP is being utilised - NHS Chief Executives/by end March 2025

Cancer delivery (NHSEG/25/02)

Dougie McLaren, DCOO (Performance and Delivery) and Adam Coldwells, Chief Executive NHS Grampian introduced this agenda item and gave a short presentation. A paper was circulated in advance of the meeting. 

Colleagues were made aware that the NHS Scotland cancer performance and delivery board had agreed a prioritised set of actions to support improvement and that a letter had issued to Chief Executives on 5 December seeking support to enable cancer management teams to participate in this work. The cancer improvement and early diagnosis team at CfSD are also leading on several workstreams that support earlier and faster cancer diagnosis.

There was a discussion about the actions in the paper and the work that NHS Lanarkshire have carried out in relation to cancer pathways. The Executive Group indicated that it would be helpful to see the blueprint for the pathways and agreed that work should be taken forward to embed learning points with clinicians and recognise and adopt systems. 

The executive group agreed to consider benchmarking and how digital technology can help in this area, to review their own systems and identify barriers to change. Caroline Lamb asked NHS boards to examine existing referral pathways and where how learning from NHS Lanarkshire could be adopted within the context of their local systems.   It was agreed that this would need to be carried out before colleagues would agree to all the actions presented in the paper.

Action no/ action lead/ timescale

• NHSEG25/04 - NHS Lanarkshire cancer pathways to be shared with colleagues - Jann Gardner/by 31 January 2025
• NHSEG25/05 - Consider benchmarking and how digital technology can help and review their own systems and identify barriers to change - NHS Chief Executives/NHS Executive support team/to be agreed and advised and return to executive group 5 March 2025 meeting

Scan for safety (NHSEG/25/03)

Kerry Chalmers, Medical Devices Policy and Legislation Head of Unit introduced this agenda item. A paper had been shared in advance of the meeting.

The paper outlined that the scan for safety (SfS) programme is focused on 4 specialties (orthopaedics, ophthalmology, interventional radiology and cardiac) which covers approximately 75% of high-risk implants in NHS Scotland. It noted that a directors letter (DL (2024)3) was issued to remind Boards of the regulatory requirement and the need for engagement and implementation of the programme.

The executive group agreed an extension of the programme until March 2027, to allow sufficient time to achieve core objectives The legislative requirement will mandate traceability of all implantable medical devices and the group highlighted the need for boards to continue implementation beyond the initial four key specialties to ensure full compliance. Colleagues agreed to provide a national reporting dashboard that provided an overview of progress to 100% compliance by board. NHS executive support team will liaise with Kerry Chalmers regarding next steps. 

Action no/ action lead/ timescale

• NHSEG25/06 - colleagues to develop a national reporting dashboard to show NHS board compliance to 100% traceability of implantable  medical devices in line  with the regulatory requirement - NHS Chief Executives/by 4 April 2025 
• NHSEG25/07 - once national reporting dashboard developed Chief Executives engage with Kerry Chalmers and Nicky Waters, scan for safety programme director regarding next steps -    NHS executive support team,Kerry Chalmers/by 4 April 2025

Strategic direction required

Prioritisation (NHSEG/25/04)

Paula Speirs, DCOO Planning and Sponsorship and Lorraine Cowie, NHS Scotland Professional Lead for Sustainability/Health Planning provided an update on prioritisation. A paper had been shared in advance of the meeting. 

The executive group previously reviewed the 2025/26 approach for prioritisation which focused on the areas where national financial challenges were known or where increased spend was predicted in areas such as new medicines.  It was noted that further engagement had taken place with policy colleagues from across NHS Scotland to develop areas for further consideration. This paper provided an update of the position.  Robbie Pearson reported that the NHS board Chief Executives had agreed the funding of the NSSC pressures at its meeting on 21 January 2024.  

Caroline Lamb advised that additional work was being done on areas where there were significant existing cost pressures. There was a discussion about the need for boards who were experiencing different issues to understand options and align priorities. Colleagues agreed there was a need to reframe the language with regard to the positioning of the paper being described as ‘prioritisation’.  It was acknowledged that the paper was more accurately described as a range of cost pressures and that there was a need to be explicit that funding of individual pressures would have consequences for the availability of resourcing other pressures or priorities. John Burns and Paula Speirs would work on putting the paper into that context, with the Cabinet Secretary having an overview.

Action no/ action lead/ timescale

NHSEG25/08 - John Burns and Paula Speirs to undertake work on knowing what to measure to get a better sense of whether we are delivering on a reformed modelling - John Burns,Paula Speirs/by executive group 5 March 2025 meeting

Innovation (NHSEG/25/05)

Tom Steele, Chair, Scottish Ambulance Service, Christine McLaughlin, Co-Director of Population Health and Anna Dominiczak, Chief Scientist talked to the paper that had been circulated in advance of this meeting. 

The paper set out the strategic context, current policy response, role of the NHS executive group, recent achievements and sought support for the prioritisation of innovation activity and views on the next accelerated national innovation adoption (ANIA) pathway proposal.   

Discussion then followed around the need to:

• ensure innovation is at the heart of reform
• have appropriate technology investment
• have national and local training of workforce around innovation
• have a closer alignment with life sciences industries
• work through barriers to implementation
• ensure best value decisions are being made
• strategically look at where potential areas of gain are and how can we actively identify innovations to pull into this work
• consider using horizon scanning to evidence where we are

The executive group agreed to continue support for the prioritisation of a national approach to innovation adoption and agreed in principle to the pharmacogenetics value case.  The group emphasised the importance of the work in delivering better outcomes for patients.  

The NHS Board Chief Executives agreed to discuss the next steps with regard to this at its meeting in February and to report back to the meeting in March 2024.  

Action no/ action lead/ timescale

NHSEG25/09 -NHS Chief Executives to discuss next steps regarding the prioritisation of a national approach to innovation adoption and the pharmacogenetics value case - Robbie Pearson/ NHS Executive Support Team/bce February meeting/by executive group 5 March meeting

Productivity and efficiency (NHSEG/25/06)

An update was provided by Lorraine Cowie, NHS Scotland Professional Lead for Sustainability/Health Planning. They advised that an NHS Scotland productivity and efficiency group has been established to consider and provide a view on the existing arrangements and mechanisms in place that ensure and support improving NHS productivity and efficiency across NHS Scotland.

There was a discussion about how to measure productivity as there was no single method used within the NHS. It was acknowledged that mental health should be prioritised. It was agreed that further work was required on this, and it should be brought back to the group for decision later.  The meeting also highlighted the need for evidence to be drawn from an international as well as UK perspective.   

Action no/ action lead/ timescale

NHSEG25/10 - further work on how to measure productivity to be done and return to a future meeting - Dougie McLaren,Lorraine Cowie/executive group 16 April 2025 meeting
NHSEG25/11 - mental health should be prioritised -Dougie McLaren, Lorraine Cowie/immediate

Business systems and business services (NHSEG/25/07)

An update was provided by Paula Speirs and Lorraine Cowie. A paper was circulated prior to this meeting, which set out the task and finish group’s approach to considering the initial steps in developing single business services and how best to progress development of a single payroll service.

Paula noted that the main task and finish group had been looking at benefits and outcomes and were keen to look at communications. She outlined that it was the expectation of ministers that NHS Scotland move towards single services, but that engagement with the service would be key, particularly those with responsibility for procurement, payroll and other transactional services. It was noted that this would be a longer-term piece of work, with the executive group commissioning the task and finish group. 

Specifically in relation to e-rostering, Paula requested that the group consider approving the following recommendations as set out in the e-rostering paper:

1. Continuation of a -rostering programme structure, with a refreshed scope to focus on delivery of business change and a single “to be” process beyond technical implementation
2. Implementation of the interim ‘adapt’ solution for the direct to payroll interface by RLDatix as the first phase to enable the ‘adopt’ approach in subesquent phases. Anne Armstrong noted her support for the interim solution.
3. Standing up of two further task and finish groups:

• A pay sub group to quantify identified variation at a local level with boards concerned via payroll leads.
• Commission HRDs to establish a variations reference group to assess remedy options for each type of variation then work with DoFs on the impact assessment and range of potential costs. As no objections were noted, the recommendations were taken as approved.

Peter Moore, NHS Borders, provided a short presentation on mandate: delivering a successful business services programme. An event has been organised for 29 January 2025 to empower key stakeholders to influence the vision, approach and strategic case for systems transformation. 

It was highlighted that there was a need to be explicit about the governance of each approach.  This included ensuring that the task and finish group had the close involvement of NHS boards and sufficient resource and capability to proceed whilst being mindful of the inter-dependency with the work on business systems.   It was agreed that there was an opportunity to revise the governance arrangements to bring appropriate clarity to this portfolio and the inter-connectedness between the work on business systems and business services.  

Action no/ action lead/ timescale

NHSEG25/12 - Commission HRDs to establish a variations reference group to assess remedy options for each type of variation then work with DoFs on the impact assessment and range of potential costs - Paula Speirs/by 14 February 2025
NHSEG25/13 - Task and finish group work with the systems program and produce a single roadmap/timeline for the next Eexecutives group meeting - Paula Speirs,Carol Potter,Peter Moore/ by executive group 5 March 2025 meeting

Quality and safety proposal (NHSEG/25/08)

John Harden, National Clinical Lead for Quality and Safety gave a presentation, noting that there would be a more in-depth discussion at the March meeting. He confirmed that discussions have taken place with Chief Executives and other colleagues and further work will now be undertaken to consider the purpose and function of the sub-group.

Planned care (NHSEG/25/09)

A paper was shared in advance of the meeting and Dougie McLaren provided an update. The centre for sustainable delivery was commissioned by the Scottish Government performance and delivery division to develop specialty level national plans to support sustainable improvements in planned care performance and delivery. While the national plans align broadly with board priorities, significant concerns around funding, workforce sustainability, and technological readiness persist. It was noted that Scottish Government colleagues recognised these challenges and will work with NHS colleagues to deliver the actions and aims of the plans.

The original modelling was for a 3-year backlog clearance plan at £100m for 3 years. This is now a single year centre for sustainable delivery.

Unscheduled care (NHSEG/25/10)

Dougie McLaren provided an updated in addition to the paper which was circulated prior to the meeting which set out the existing improvement activity for acute sites that were expected to continue to be delivered as part of core funding.  He indicated that the outputs from this paper would inform a broader NHS delivery plan for ministers to consider.

The Chief Executives were given the opportunity to share their experiences/views at the end of the meeting. All agreed that changes were needed to optimise capacity. There were lots of opportunities available and all boards should support the work going forward.

Any other business

Caroline Hiscox raised obesity drugs with colleagues and asked for a discussion about this at their next board Chief Executives meeting in February 2025.

Action no/ action lead/ timescale

NHSEG25/14 - obesity drugs to be discussed at the February board Chief Executives meeting - NHS executive support/by board Chief Executives February 2025 meeting

Date and time of next meeting

The next meeting will take place on Wednesday 5 March 2025 at 13:00.