Preventative and Proactive Care (PPC) Programme Board: June 2024

Attendees and apologies

• Tim McDonnell (TM), Director of Primary Care (PC), Co-Chair PPCPB, Scottish Government
• Karen Duffy (KD), Delivery Director, PPC, Deputy Chair, Scottish Government
• Ann Gow (AG), Health Improvement Scotland (HIS) Director of Nursing and Deputy Chief Executive, HIS
• Angella Fulton (AF), Associate Director, Social Care, NHS Education for Scotland (NES)
• Cat Macaulay (CM), Chief Design Officer, Scottish Government
• Professor Carolyn McDonald (CMcD), Chief Allied Health Professions Officer, Scottish Government
• Craig Tomlinson (CT), Engagement Lead for Person-Centred Care, Scottish Government
• Ellie Crawford (EC), Unit Head leading for Primary Care (PC) link with PPC, Scottish Government
• Gregor Boyd (GB), Senior Statistician in Health and Social Care Analysis (HSCA), Scottish Government
• Jennifer Champion (JC), Acting Director of Public Health (PHS), NHS Forth Valley
• Katie Morris (KM), GIRFE Lead, Scottish Government
• Laura Kerr (LaK), Head of Policy and Workforce, Social Work Scotland
• Lorna Kelly (LoK), National Lead, Primary Care for HSCS, HSCS
• Lorraine Cowie (LC), Head of Strategy, NHS Highland
• Malcolm Summers (MS), Head of Strategic Reform, Scottish Government
• Rikke Iversholt (RI), Programme Lead for Social Care and Telecare, Scottish Government
• Rishma Maini (RM), Consultant Public Health Medicine (PHS), Public Health Scotland
• Sara Redmond (SR), Chief Officer, ALLIANCE Scotland

Apologies

• Donna Bell (DB), Director of Social Care, Co-Chair PPCPB, Scottish Government
• Anne Leitch (AL), Value Based Health and Care Programme Lead (VBHC), Scottish Government
• Manira Ahmad (MA), Chief Officer, PHS
• Joanna Macdonald (JM), Deputy Chief Social Work Adviser, Social Work
• Suzi Macpherson (SM), Person-Centred Design Policy Lead, Scottish Government
• Katie Clayton (KC), Programme Manager PPC, NHS NSS
• Nicola Edge (NE), Head of Health and Social Care Analysis (HSCA), Scottish Government
• Anita Morrison (AM), Head of Health and Social Care Analysis, Scottish Government
• Gordon Paterson (GP), Director of Social Care, NES
• Stephen Gallagher (SG), Director of Mental Health, Scottish Government
• Graham Ellis (GE), Deputy Chief Medical Officer, Scottish Government
• Paula Speirs (PS), Deputy Chief Operating Officer, Scottish Government
• Julie Murray (JM), Chief Officer, East Renfrewshire, HSCP Representative
• Anne Armstrong (AA), Deputy Chief Nursing Officer, Scottish Government
• Kim Walker (KW), Programme Director, Care and Wellbeing Portfolio (CWP), NHS NSS

 

Items and actions

Welcome and apologies – Tim McDonnell (TM) 

Tim McDonnell, Director of Primary Care and Chair, welcomed all to the meeting and noted apologies received. 

There was a request for any comments on the minutes from the previous meeting, none were noted.

 

PPC Status Report – Rosemary Otieno (RO)

Rosemary Otieno, Project Manager for Preventative and Proactive Care (PPC), reported that the overall RAG status for the programme is Green for this period. An adjustment has been made to the Getting it Right for Everyone (GIRFE) milestone for the ‘Team around the person’ impacting on the toolkit delivery. 
Further scoping is taking place to agree what aspects of Primary Care and Community Health reform will be delivered within PPC. Cardiovascular Disease (CVD) is progressing well with two pathway workshops held and ideas generated for consideration by the group.
There was a very high risk on the Community Glaucoma Service (CGS) which has now been reduced due to 10 out of the 14 boards being on track to complete by April 2025, with discussions taking place with the remaining boards. 
It was recommended at the PPC workshop that there is no requirement for Digital PPC to report further as a stand-alone workstream and necessary change controls are in process. 

 

Highlight Reports

Getting it Right for Everyone (GIRFE) – Katie Morris (KM) 

Katie Morris, GIRFE Lead gave an update on progress. The board had reviewed the highlight report, which showed progress as green, with attention drawn to the adjusted milestone timeline. This is to allow the version 1 of the ‘Team around the person’ toolkit to be live tested further with pathfinders. The version 2 will then be made ready for national publication, after the Programme of Government is published in the Autumn.

Actions:
•    KM to look at revising the communication and messaging for GIRFE for this next stage of the work
•    as the work progresses, to look at widening out of the dependencies and accurately define these along with actions to Senior Responsible Officers (SROs) outwith of the programme so this can help to enable some of the work

Cardiovascular Disease (CVD) - Karen Duffy (KD)

Karen Duffy, Delivery Director for PPC, gave an overview on CVD which is reporting green. Two workstreams sit under the CVD Steering Group chaired by CMO.
Workstream 1 focusses on public facing information and communication to support the understanding of ‘CVD’ terminology and risk factors awareness. A YouGov poll was undertaken for ethnic groups and other groups that looked at higher CVD risk factors. Evidence from other countries have also been reviewed to understand their efforts to make a shift in secondary prevention. 
Workstream 2 is around transforming models of care and case finding for those people at most risk of CVD. Two workshops have been held and the outcomes will be presented at the CVD Steering Group on 26 June. The CVD team are also looking to hold a session with the Cabinet Secretary to update him on the work.  
There is also scope to align with other policy areas to maximise impact.

Primary Care (PC) - Ellie Crawford (EC)

Ellie Crawford, Unit Head, Primary Care gave an update on PC PPC which is reporting amber. The Primary Care and Community Health Steering Group had its first meeting on the 15th May and the focus was on the vision for PC in the context of wider reform and the collaborative development of a route map to set out how the sector should best operate in the future.
Good progress has been made within the MDT through the PC Phased Improvement collaborative which launched in April. Some good evidence of progress is also emerging in Dental Payment Reform, where there is substantial improvement for Dental Practices through the Payment Reform Programme.
The PC team continues to develop proposals for contribution to the new CWP reform and PPC. They are also looking to finalise the measurement framework for the Multidisciplinary teams (MDT) demonstrator sites.

Community Glaucoma Service (CGS) rollout and prioritisation needs to be escalated to the Senior Management Board where progress has stalled. 

Action: EC to provide an update on the next PC highlight report on the outcome of discussions on CGS rollout within the remaining health boards

Waiting Well (WW) - Carolyn McDonald (CMcD)

Carolyn McDonald provided an overview of progress on Waiting Well (WW). 
A WW abstract poster was displayed at the NHS Scotland Event in June which was well received. The campaign to promote the WW hub through partnership with the National Elective Coordination Unit, Orthopaedic Validation programme is under way. Further work to analyse usefulness of information on the WW Hub is under discussion, including exploration of a self-assessment tool that direct people to specific resources. The National Waiting Well Toolkit was published in pdf format to all boards in May. A learning network of WW Champions to share initiatives and collaborate has recently been established. Work with HIS Right Decision (RDS) knowledge services continues to develop an electronic version of the toolkit. 

Actions:

• information of RAIDR to be shared with LK – video of online demonstration and meeting with RAIDR was shared in meeting sidebar for LK
• JC to provide an update paper on the outcomes from the Prioritisation Investment Framework workshop at the PPC Programme Board in September

 

Digital - Rikke Iversholt (RI)

Rikke Iversholt, Portfolio Director, Social Care, Digital Health and Care provided an update on the Digital workstream, which is its last report to the PPC Programme Board. Work will continue as an enabler, with links to GIRFE pathfinders, Digital Front Door and Health and Care Integrated Record work. 
Proactive Telecare led by Hanover Housing is going well. A report looking at using technology to ascertain people's early indications of an additional need when they live independently in the Community will be available in November.
PainChek using an AI on mobile phones to identify people's pain levels is also progressing well. Work is mostly with older adults in the initial stages but have been branching out into adults with learning disability across the age range, and adults that are using drugs or have alcohol dependency. 
Connect Me with Hypertension Pathway was recently covered in the media and is showing strong examples of how to reduce the need for ATP appointments, saving money and time. 
The Healthcare Framework DanceSing focuses on getting people moving in care homes, is currently active across sixty-four care homes to help ensure that people become stronger physically and are socially active, preventing some of the decline that is commonly seen in care homes. A report will be available in October.

Action: KD/PPC PMO to consider the initiatives being delivered in Digital Health & Care Strategy (DHAC) Portfolio in relation to the critical dependencies for PPC deliverable

 

PPC Delivery Director’s Update - Karen Duffy (KD)

KD provided an update on the PPC Programme outlining key opportunities and challenges for the Programme’s future. At the last meeting, it was noted that there would be a look back on the PPC programme, to see what has worked well and what the focus should be in the next two years and how that would fit within the ever-changing reform landscape.
A PPC workshop held on the 13 May 2024 identified several challenges and potential interventions to support the health of Scotland’s population. The high burden of disease, different demographics and high demand on health and social care services are all key drivers of reform. 
The Cabinet Secretary for Health and Social Care presented at the NHS Scotland Event and in response to his question of which single word is most prevalent for the reform of the NHS, an overwhelming majority responded ‘Prevention’. There is strong support for the need for shift to a more preventative approach. 
The four quadrants of the reform vision are focused around 4 elements of access, prevention, quality, and people and place. We need to influence and be part of that change, not only from the side but to influence from within and be part of the solution ourselves.
Within the CWP, the primary prevention space is led by Place and Wellbeing programme (Population Health Framework). The PPC programme is addressing individual health, secondary prevention and transforming models of care (GIRFE and PC and Community health). 
KD discussed the work on the new programme draft mission, aims, drivers. At present this will most likely focus around: Leading the improvement of the individual level secondary prevention space; continued design, introduction and spread the GIRFE national practice model and approach; and ensuring that primary care and community healthcare reform is at the heart of CB Portfolio and integrated reform. 
At present in the secondary prevention space, PPC has been focusing on the CVD risk factor programme and waiting well, but is having preliminary explorations around the area of musculoskeletal (MSK) health – as this remains in the top burden of disease and does not have a clear policy home of connected prevention plan. 
There was support for the revised Charter and the new strategic direction. Noted that the themes being discussed at this board are similar at Portfolio level and how to oversee progress. Board members asked the PPC team to consider how to take learning from the PPC Programme’s delivery so far and understand what the common threads are, where the dependencies lie and how to influence the system to support in achieving the programme’s aims.
The proposal to be brought back for sign off at the next PPC Programme Board will include: 

• revised charter 
• a workplan for 2024/25 to allow us to continue work whilst navigating the changing reform space

Actions:

• PPC PMO to share the slide deck with members 
• KD to review the comments and revise the programme charter and workplan

 

Any Other Business

TM thanked PPC Board members for their contributions and comments. 
TM noted that the next Programme Board is scheduled on 9 September and encouraged members to connect outside of the board meetings on some of the ongoing work and to feedback on some of the individual projects.