NHS Chief Executives Meeting: November 2023

Attendees and apologies

Scottish Government

• Caroline Lamb, DG HSC/CE NHS Scotland 
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Jason Leitch, National Clinical Director
• John Harden, Deputy National Clinical Director
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Donna Bell, Director of Social Care and NCS Development
• Tim McDonnell, Director of Primary Care
• William Findlay, Associate Chief Nursing Officer
• Graham Ellis, Deputy Chief Medical Officer
• Alison Strath, Chief Pharmaceutical Officer
• Kirsty Wood, Scottish Clinical Leadership Fellow (Observer) 

Other Attendees

• Susan Webb, Director of Public Health, NHS Grampian
• Crawford McGuffie, Co-Chair of Medical Directors/Medical Director, NHS Ayrshire and Arran
• Julie Carter, Director of Finance, SAS
• Jacqui Jones, Director of HR, NHS Lanarkshire
• Anne Marie Cavanagh, Executive Nurse Director, NHS Golden Jubilee
• Blaithin Lynch, National Management Trainee, Healthcare Improvement Scotland (Observer)
• Rosemary Agnew, Scottish Public Services Ombudsman 
• Niki Maclean, SPSO Director 

Secretariat

• Laurie Whyte    Board Governance and Appointments Team
• Sarah Hildersley    Board Governance and Appointments Team
• Hannah Mackay    Board Governance and Appointments Team
• Fraser McJannett    Executive Support Team

Apologies

• Calum Campbell, NHS Lothian (Tracey McKigen attending)
• Michael Dickson, Scottish Ambulance Service (Paul Bassett attending)
• Kirstin Dickson, Chair of Directors of Planning/Director of Planning, NHS Ayrshire and Arran
• Claire Pearce, Chair of SEND/NMAHP Director and Deputy Chief Executive, NHS Tayside (Anne Marie Cavanagh attending)
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Douglas McLaren, Deputy Chief Operating Officer – Performance and Delivery
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Angie Wood, Director of Social Care Resilience and Improvement
• Christine McLaughlin, Co-Director of Population Health
• Stephen Gallagher, Director of Mental Health
• Andrew Watson, Director for Children and Families
• David Plews, Head of NHS Service Development
• Robert Kirkwood, Head of the People, Governance and Appointments
• Kat Dobell, Board Governance and Appointments Team

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, DG Health and Social Care and Chief Executive NHS Scotland, welcomed everyone to the meeting. 

A list of attendees and apologies for absence are provided in Annex A. 

Minutes of the previous meeting – 13 September 2023 – NHSCE/23/24/17

The minutes of the meeting held on 13 September 2023 were approved.

Five actions noted from the previous meeting have been completed.

Matters arising

There were no matters arising.

Feedback from Chief Executives private meeting

Robbie Pearson, Chief Executive Healthcare Improvement Scotland (HIS)/Chair of NHS Chief ExecutivesgGroup provided feedback from the private meeting. This included discussion on:

• finance and sustainability
• system balance – how to work across Scottish Government and NHS Boards
• national care service

National care service (NCS) – NHSCE/23/24/18

Donna Bell, Director for Social Care and NCS Development introduced this item to colleagues. A paper had been circulated to colleagues in advance and provided views on outstanding issues:  

•  status of National Care Service board
• powers of intervention within upport and Improvement framework
• independent appointment of care board Chairs
• direct employment of care board staff
• means of strengthening NCS integrated management function
• direct funding of care boards/means of improving funding transparency
• single model of integration
• greater consistency of integrated functions
• what is currently working/not working within community health
• compulsory delegation of prescribed primary and community health functions

The paper circulated included various discussion points and Donna Bell highlighted that it would be helpful to use the time today to discuss these in further detail. Karen Reid, NHS Education for Scotland (NES) and Pam Dudek, NHS Highland provided feedback on behalf of NHS Chief Executives. The following was raised:

• NCS needs to provide simplification and streamline to the system
• clarity was sought on the following:
  • definition of ‘community health.’ An early discussion with Scottish Government colleagues was offered
  • governance around the legal structure
  • direct funding
  • geographic structures
  • Chief Officer employment – who would they be employed by
  • infrastructure estates
• national procurement – how to build on things already in place
• technology and innovation – would be open to investing further into technology

The definition of ‘community health’ was raised by Graham Ellis, Deputy Chief Medical Officer, who described it as covering three key areas: trying to keep ‘families’ together, e.g., mental health, children services etc; accountability; and ensuring services are in-reach. William Findlay, Associate Chief Nursing Officer, added that the definition was more an approach to community health. 

To provide clarity around the legal structure, Donna Bell was clear that form should follow function. 

Chief Executives also raised during discussion that they were finding it challenging to see how NCS would simplify the system and that clarity was needed on whether the local care board would be a commissioning or delivery body.

Donna Bell highlighted that going forward they should strive to learn from the Public Bodies (Joint Working) (Scotland) Act 2014 which established integration authorities and indicated that she was keen to hear from boards about this.

Donna Bell expressed that Ministers have been clear that this change to the system needs to make improvements. The Cabinet sub-committee meeting which is due to take place at the end of the month would guide the next phase. Stage one of the bill is due to take place early next year.

Caroline Lamb noted that Karen Reid and Pam Dudek were drafting a response, on behalf of Chief Executives about the NCS proposals and it was highlighted that the deadline for this was Monday 20 November 2023. Chief Executives were asked to start thinking through real life scenarios so that this could be evaluated against proposals. 

Donna Bell thanked Chief Executives for their input and advised that her team will set up meetings with individuals to follow up on all points raised. It was expressed that she was keen to discuss in detail what works in the integrated space currently and highlighted that children’s services and the justice system were still to be considered.

Action: Karen Reid and Pam Dudek to provide a written response, on behalf of Chief Executives, on NCS proposals, by Monday 20 November 2023

Action: Chief Executives to start thinking through real life scenarios so that this could be evaluated against NCS proposals

Action: Donna Bell to set up meeting with individuals to follow up on points raised by Chief Executives in relation to NCS

Independent National Whistleblowing Officer (INWO) – NHSCE/23/24/19

Rosemary Agnew, Scottish Public Services Ombudsman provided colleagues with an update on INWOs. She highlighted that it had been a while since engaging with NHS Chief Executives as a collective group and was keen for an open discussion. The update covered:

• a brief overview of the background and establishment of the INWO
• an overview of INWO case volumes
• implementation challenges and learning in respect of investigations by INWO and at local level
• emerging themes with a focus on
• concerns and complaints relating to senior staff
• speak-up culture
• action plans
• capturing and sharing lessons learned, and confidentiality
• contractors, and relationship with primary care
• governance and annual reporting 

Discussion included:

• in response to Rosemary and colleagues looking at creating guidance on handling of issues regarding HR, Jacqui Jones, Director of HR, NHS Lanarkshire, highlighted that that would be very valuable and an invite was extended to SPSO colleagues to attend a human resources directors meeting;
• John Harden, Deputy National Clinical Director, expressed he was keen to make connections with INWO regarding the concerns/complaints about patient safety and discuss any key themes emerging to ensure not missing anything for the future
• Paul Johnston, Public Health Scotland, commented that he found speak-up week helpful with the events which were offered to staff. It was expressed that it was good to feel as if getting ahead of the curve and being pro-active. Rosemary highlighted that hold the dates for next year’s speak-up week would be issued shortly.

Caroline Lamb indicated that this was a timely issue due to the current climate on clinical governance and assurances regarding complaints procedure and whistleblowing. She thanked Rosemary for the helpful conversation and asked that the colleagues who wanted to engage further should take forward offline. 

Action: Jacqui Jones and John Harden to take forward engagement separately with Rosemary Agnew, SPSO colleague.

Any other business

Caroline Lamb shared the following details from policy colleagues on consumer duty:

Consumer duty

• Chief Executives have received an email from Wendy McCutcheon of the consumer policy team in the Scottish Government informing you that the coming into force date of the consumer duty is being delayed slightly, and likely to 1 April 2024. This is to allow further consultation with public bodies. Please do engage with the consumer policy team to find out how the duty will apply to health bodies
• The Consumer Scotland Act 2020 established a consumer duty on public bodies to improve the extent to which consumers are considered in strategic policy and decision-making.  A key principle of the duty will be to ensure all public bodies are working towards improving outcomes for consumers as part of their strategic decision-making process. However, the Scottish Government will work to ensure that the principle of proportionality is reflected in the administrative requirements placed upon organisations.  Consumer Scotland, as stated in the Act, will develop guidance to support the delivery of the duty
• Chief Executives highlighted it would be helpful if a joint response could be provided rather than an individual response from each health board

Date and time of next meeting

NHS Chief Executives business meeting – Wednesday 17 January 2024 at 14:00 which will take place virtually.