HS/S5/21/2/A HEALTH AND SPORT COMMITTEE AGENDA 2nd Meeting, 2021 (Session 5) Tuesday 19 January 2021 The Committee will meet at 9.30 am in a virtual meeting to be broadcast on www.scottishparliament.tv. 1. Scrutiny of NHS Boards - NHS Highland: The Committee will take evidence from— Professor Boyd Robertson, Chair, Pam Dudek, Chief Executive, David Garden, Director of Finance, and Dr Tim Allison, Director of Public Health, NHS Highland. 2. UK Common Frameworks: The Committee will take evidence on the Provisional UK Common Framework on Food and Feed Safety and Hygiene from— Professor Paul Haggarty, Deputy Director, The Rowett Institute of Nutrition and Health, University of Aberdeen, (representing SEFARI - Scottish Environment, Food and Agriculture Research Institutes); David Thomson, Chief Executive Officer, Food and Drink Federation Scotland. 3. Scrutiny of NHS Boards - NHS Highland (in private): The Committee will consider the evidence heard earlier in the meeting. 4. UK Common Frameworks (in private): The Committee will consider the evidence heard earlier in the meeting on the Provisional UK Common Framework on Food and Feed Safety and Hygiene. 5. University of St. Andrews (Degrees in Medicine and Dentistry) Bill (in private): The Committee will consider a draft Stage 1 report. HS/S5/21/2/A David Cullum Clerk to the Health and Sport Committee Room T3.60 The Scottish Parliament Edinburgh Tel: 0131 348 5210 Email: [email protected] HS/S5/21/2/A The papers for this meeting are as follows— Agenda item 1 20201222 Ltr IN from PAPLS Committee re NHS Highland HS/S5/21/2/1 PRIVATE PAPER HS/S5/21/2/2 (P) NHS Highland Executive Summary HS/S5/21/2/3 NHS Highland Operational Plan 2019-2020 HS/S5/21/2/4 NHS Highland Operational Plan 2019-2020 APPENDICES HS/S5/21/2/5 Update on Argyll and Bute Health and Social Care HS/S5/21/2/6 Partnership Update on North Highland Health and Social Care HS/S5/21/2/7 Partnership North Highland Social Care and Health and Wellbeing HS/S5/21/2/8 Indicators NHS Highland Annual Review November 2020 HS/S5/21/2/9 NHS Highland Annual Review Feedback letter HS/S5/21/2/10 NHS Highland Integrated Performance and Quality Report HS/S5/21/2/11 NHS Highland Winter Plan 2020-2021 HS/S5/21/2/12 NHS Highland Winter Preparedness Self-Assessment sign HS/S5/21/2/13 off letter from NHS Scotland NHS Highland Remobilisation Plan 2020 HS/S5/21/2/14 NHS Highland Remobilisation Plan 2020 Appendix 1 HS/S5/21/2/15 NHS Highland Remobilisation Plan 2020 Appendix 2 HS/S5/21/2/16 NHS Highland Remobilisation Plan 2020 Appendix 3 HS/S5/21/2/17 NHS Highland Remobilisation Plan 2020 Appendix 4 HS/S5/21/2/18 Sturrock Review Culture Progress Report December 2020 HS/S5/21/2/19 Agenda item 2 Written submission from Professor Paul Haggarty HS/S5/21/2/20 HS/S5/21/2/A PRIVATE PAPER HS/S5/21/2/21 (P) Agenda item 5 PRIVATE PAPER ISSUED VIA EMAIL HS/S5/21/2/22 HS/S5/21/2/1 Lewis MacDonald Public Audit and Post-legislative Convener Scrutiny Committee Health and Sport Committee Room T3.60 The Scottish Parliament By e-mail only EDINBURGH EH99 1SP Direct Tel: (0131) 348 5390 Email: [email protected] 22 December 2020 Dear Convener, The 2018/19 audit of NHS Highland The Public Audit and Post-legislative Scrutiny understands that the Health and Sport Committee (HSC) is due to take evidence from NHS Highland at its meeting on 19 January 2021. The Committee has considered a series of reports from the Auditor General on NHS Highland during this session and is concerned that there remain significant issues to be addressed. It therefore agreed to write to the HSC on a number of points arising from its recent scrutiny of the section 22 report on the 2018/19 audit of NHS Highland for the HSC to take forward as it considers appropriate. At its meeting on Thursday 8 October, the Committee took evidence from the Chief Executive and Chair of NHS Highland and the Interim Director, Health Finance and Governance at the Scottish Government on the section 22 report. This session had originally been planned to take place in April 2020, but had been postponed due to the Covid-19 pandemic. Following that session, the Committee received correspondence from the NHS Highland which can be found here. Financial sustainability The Committee noted that this was the fourth section 22 report on NHS Highland in six years and second consecutive report highlighting concerns over financial sustainability. This section 22 report indicated that NHS Highland’s financial problems had continued into 2018/19. At the start of the financial year, the board identified that £50.5 million of savings would be required in 2018/19. The report noted that overspends on drugs and adult social care contributed to NHS Highland’s Page 1 of 3 HS/S5/21/2/1 failure to meet its financial targets. The report also raised concerns about the board’s ability to reach financial balance in 2021/22, stating that: “The board is planning to achieve financial balance over the next three years. It forecasts that brokerage of £11.4 million will be required in 2019/20 and £6.1 million in 2020/21, with financial balance being achieved in 2021/22. I consider these forecasts to be unrealistic given NHS Highland’s poor performance in identifying and achieving savings in recent years.” During the evidence session on 8 October, NHS Highland reported improvements in the financial position in 2019/20. However, NHS Highland still required brokerage from the Scottish Government and, with the pressures of Covid-19, it may become even more challenging for the board to achieve a break-even position in 2021/22. The HSC may wish to seek an update on progress being made to address the financial challenges at NHS Scotland and whether it is on target to achieve financial balance in 2021/22. Workforce challenges The Committee has continued to raise the issue of vacancies and use of locums in its scrutiny of the Auditor General’s reports on NHS Highland. The section 22 report stated that there were high levels of unfilled vacancies in NHS Highland, particularly in key clinical posts in both primary and secondary care, noting that this can affect services and creates a reliance on locum staff. During the session on 8 October, the Chief Executive of NHS Highland indicated that, as of October 2020, the turnover rate was 7.7% and the vacancy rate was 7.9%. NHS Highland also described work being undertaken to encourage newly qualified clinicians to work in NHS Highlands. The HSC may wish to seek an update on the progress being made in reduction of staff turnover and vacancies against NHS Highland’s 2021 target. Governance and leadership Leadership issues have also featured in the audit reports on NHS Highland that the Committee has considered. This section 22 report noted that NHS Highland has faced significant organisational and leadership issues. The chair of the board and the chief executive left the organisation in 2018/19. A new chief executive was appointed, and an interim chair put in place. The Senior Leadership Team has continued to undergo significant change during 2019/20 with several departures. The chief executive appointed in January 2019 left in January 2020 and an interim chief executive was seconded from NHS Fife. A new and permanent chief executive was appointed in August 2020. Further permanent appointments include the Director of Finance in January 2020, the HR Director in July 2019, and the Board Chair in December 2019. During the evidence session on 8 October, the Committee raised concerns about the repeated leadership issues over a number of years in NHS Highland. In October, the board was undertaking recruitment of three non-executive posts on the board. Page 2 of 3 HS/S5/21/2/1 Professor Boyd Robertson, the chair, cited a high level of interest in the posts and was confident that the board would be successful in recruiting individuals with expertise in finance. The HSC may wish to seek an update on the recruitment exercise undertaken in October and whether the appointments will address the skills gap at board level. Raigmore Hospital During the evidence session on 8 October, the Committee raised longstanding concerns regarding the financial management at Raigmore Hospital. Witnesses assured the Committee that the budget has been stabilised through performance recovery work and the board’s remobilisation plan. However, it was noted that the Covid-19 pandemic may have had an impact on the continuation of improvement at Raigmore Hospital. The HSC may wish to examine further whether the budget remains stable in Raigmore Hospital and seek clarification as to whether the impact of Covid-19 has been reflected in the improvement plan going forward. Risk management In follow-up correspondence from NHS Highland, the Board Risk Assurance Framework highlighted a number of risks categorised as “very high” with “extreme” consequence levels as of August 2020. • High number of vacancies in trained mental health nursing (including CAMHS) and psychiatric medical posts with an insufficient level of nurse graduates to meet demand. • There is a risk around the delivery of Financial Targets in 2020/21 and the knock‐on impact on the return to financial balance in 2021/22. • There is a risk that the performance of the health and care system is compromised in remobilisation due to the number of constraints posed by Covid19, winter pressures and those pressures inherent in the system pre- Covid19, NHSH is unable to meet national targets.