Health and Sport Committee

Meeting date: Tuesday, September 26, 2017

Official Report 494KB pdf

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NHS Governance

The third item on the agenda is evidence on national health service staff governance. I welcome to the committee Shona Robison, the Cabinet Secretary for Health and Sport; Paul Gray, who is the director general of health and social care and chief executive of NHS Scotland; and Shirley Rogers, who is the director of health workforce and strategic change in the Scottish Government. I invite the cabinet secretary to make an opening statement.

I welcome the opportunity to give evidence.

Staff governance is a key part of the governance framework for ensuring that NHS Scotland is an exemplar employer and that its diverse workforce is treated and managed well. In 2014, a monitoring framework was agreed in partnership with our trade unions, with the health boards being made responsible for implementation of “Staff Governance Standard” at local level. Boards are also held accountable through a national return and annual review process.

This is about continuous improvement: we are reviewing our approach to ensure that assurance mechanisms are driving any necessary improvements.

We have about 160,000 NHS staff, and we need to listen to them, because the workforce is at the heart of everything that we do. They are our greatest asset, and we need to value, support and motivate them to do the best job that they can do. We need to lead by example. Our values are important and, by our demonstrating and recognising them, our staff feel valued for the great work that they do. We see that daily throughout the NHS.

One of our key achievements has been a transformed approach to staff experience through the iMatter programme. iMatter is a continuous improvement tool for measuring and improving staff experience that has been developed by our staff, for our staff. It has been independently validated. It measures staff experience against the NHS’s “Staff Governance Standard”. Evidence shows that staff who feel valued and engaged provide better health and care.

We have gone from the context being one of poor levels of engagement. As members are aware, previous staff surveys had response rates of around 35 per cent; the current iMatter response rate is over 60 per cent, with an employee engagement index score that is above 70 per cent.

The programme roll-out is nearing completion, and iMatter is engaging individuals and teams in the decisions that affect them. It includes 23 of the 31 health and social care partnerships, which are now using the approach across integrated teams. That means that the programme now involves over 170,000 staff. Figures are indicative at this stage, but show real progress. The full national report will be published in February next year, and will be supplemented by the results of the autumn dignity at work survey.

We are also taking action on pay. We recognise that, at a time of rising inflation, a public sector pay cap becomes increasingly unsustainable, which is why we have announced that we will take account of rising living costs in setting pay for 2018-19, and why we are working in partnership with the trade unions to commission work to develop an evidence base that will help us to assess the impact of pay restraint, which can be used in the next round of submission to the independent NHS pay review bodies.

The committee has heard a lot of evidence on people’s experiences of raising concerns. Concerns are often raised and resolved locally and informally, but where that does not work, staff need to have the confidence that they will be supported, listened to and responded to. In recent years, with our trade union partners we have developed a single national policy, introduced local named policy contacts, non-executive whistleblowing champions and an independent whistleblowing alert and advice service, and introduced a presumption against confidentiality clauses in settlement agreements.

We are committed to adding to the routes that are already in place for raising concerns. We aim to ensure that everyone has a choice about how they do that, and that there is an external route to escalate concerns, if they are not resolved.

We are establishing an independent national whistleblowing officer. The INWO will provide external review, where individuals have legitimate concerns about handling of whistleblowing cases. That is a step further in the development of an open and transparent reporting culture in our NHS. The INWO will complement our approach to whistleblowing, and will provide independent challenge and oversight and should have the powers and functions to do so.

We are in discussions with the Scottish Public Services Ombudsman with a view to the SPSO hosting the role by the end of 2018. I received written consent yesterday from the Scottish Parliamentary Corporate Body for legislation to be introduced. I will announce more details to Parliament in the coming weeks.

We have to listen to concerns, when they are raised, and we value the opportunities that they give us to change. We are clear that it is essential that we have an honest, open and transparent culture in our NHS. We are making good progress, but there is still work to be done. I am happy to take questions.

Thank you, cabinet secretary.

Are you satisfied with staff governance in the NHS?

I think that we have very well-developed staff governance arrangements, which have been developed in partnership. The partnership arrangements that we have in the NHS are looked on with some envy by other organisations, but we must not be complacent. Partnership requires effort on both sides to make sure that it delivers.

Our staff governance arrangements have evolved over the years. We have good staff governance arrangements, but I am not complacent: there are always improvements that can be made. Some of the areas that I have laid out today show that we are always looking to ensure that we make further progress.

On the back of that, are you satisfied with the progress that has been made towards achieving what is in the “Staff Governance Standard” since monitoring began in 2006 with the staff survey?

Yes. Shirley Rogers will come in with some of the detail. The iMatter development is an important tool in terms of continually getting feedback from staff at a rate and level that are improvements on what we had previously, when rates of return were quite low, and staff feedback was that they did not feel that the survey was a tool that worked for them. iMatter was developed very much in collaboration with the staff side and the unions and has shown itself to be very rooted in being developed by staff, for staff. That bodes well for the returns that we get from it. We need to keep the situation under review as iMatter is taken forward.

I have worked for the NHS for the past 22 years. I recall the introduction of “Staff Governance Standards” when I was working in a board, and I think that its five standards, taken as a package, have moved the agenda forward considerably. They set a benchmark for how the relationship between management, trade unions and staff works across NHS Scotland. The standards are achieved through a number of means, some of which are formal means around partnership working and engagement with the staff side. There is a raft of such things. They also set the tone for industrial relations and employee engagement in NHS Scotland.

The situation is not perfect—we know that we need to do more to make sure that when staff raise concerns they get a better first response from leaders in boards. That has not always been as great as we wished it to be, so we are also spending a lot of time looking at our leadership and management development arrangements, across the NHS. We have worked closely with the staff side to make sure that the five standards of staff governance are achieved as frequently as possible, and the survey results and staff governance audit results have shown considerable improvement in the 10 or 15 years since their introduction. There is, however, more to be done.

The 2015 NHS staff survey showed that 41 per cent of staff would not recommend their workplace as a good place to work. The highest levels of satisfaction were among executive grades and senior management, where satisfaction was at 75 per cent, but the level dipped to 29 per cent among ambulance staff. Has that changed? Are those results illustrative of pressures on the NHS? Why do you think there was such a difference between ambulance staff and executive staff?

I took the annual review for the Scottish Ambulance Service this year, part of which was a good deal of engagement with the staff side and the trade unions. There are still challenges. The Scottish Ambulance Service has changed beyond recognition over the past few years, but staff’s roles are very physically demanding and can be very stressful. Given the pressures, I absolutely understand some of the concerns that have been raised. However, there have been developments. There is the new clinical response model, and rebanding has, I think, resolved a long-standing issue. There are now clearer pathways of employment opportunities for ambulance staff to move from technician to paramedic and to the new specialist roles.

I came away from the annual review very heartened that there have been a number of developments, that morale is improving and that things are in a much better place, but there is still a lot of work to be done. In some ways, the Ambulance Service may be a good litmus test for how things are progressing. You are right to highlight that the service is the area in which most work needs to be done, but I was very heartened by what I heard at the annual review.

11:15  

Thank you.

We discussed whistleblowing champions last week at some length. In a letter, Paul Gray suggested that the role would be best suited to a non-executive director of each board’s staff governance committee. That has raised concerns that have been expressed in written submissions and by individuals whom I have spoken to. I am sure that others have had the same experience. Why does the cabinet secretary wish non-executive directors to be whistleblowing champions? Do you share any concern about potential conflicts of interests?

I understand the concern. The idea was to have leadership from within boards that was non-executive: the champions would be a step removed from executive responsibility and would drive and champion the whole area of trust, of being able to speak out and of whistleblowing policies. I still think that that is the right thing to do, but it is not the only thing. It is one element of a range of measures that have been taken to change the culture and to provide a clear way for staff to raise concerns, in addition to the helpline and—of course—the independent national whistleblowing officer. It is probably fair to say that it has been working better in some boards than others, so perhaps we need to learn some lessons from that, but there are some very proactive non-execs who have gone around the wards and other areas in our NHS a lot to speak to staff directly to promote that culture.

It might help if I gave a couple of examples. In NHS Greater Glasgow and Clyde, the whistleblowing champion asked the board to upgrade the level of investigation in a case because the champion felt that that was appropriate in the specific circumstances, so that was done. Also in NHS Greater Glasgow and Clyde, in another case the whistleblowing champion was not satisfied that it had been investigated properly and asked for it to be reinvestigated.

In NHS Lothian, the whistleblowing champion was asked indirectly to become involved in an individual case, but the internal processes had not been exhausted, so the champion ensured that they were. The champion also ensured that the board took all appropriate actions and received written monthly updates on that and all other live cases. I can give other examples which, in view of the time, I can share later, if the committee wishes.

I think that we have evidence that the whistleblowing champions are being proactive and are making a difference. It is important, as the cabinet secretary said, to set them in the context of the other avenues for staff to raise concerns, whether through their line manager or, ultimately, the employee director, who also sits on the board, or through Public Concern at Work.

The whistleblowing champion is a component, not a panacea. The fact that we are proceeding, as the cabinet secretary said, with the establishment of an independent national whistleblowing officer—which, of course, Parliament will have the opportunity to consider—is evidence that we continue to build on what we already have in this area.

Is that something that the cabinet secretary would keep under review? It might become apparent that an individual is not independent or impartial enough, or the perception might simply always be that “one step removed” is still a step too close to being actively involved in other aspects of a board’s governance.

Yes. Be assured that I keep everything under review; I absolutely will keep that under review. I can perhaps learn from best practice where the system has worked well and has the confidence of staff, and from issues in boards where, perhaps, that is not as strongly the case. I do not see anything wrong with the system, in principle. It is about its execution and making sure that the person, as in the cases that Paul Gray highlighted, is shown to be driving improvement and benefiting the system. Of course, I will be happy to come back to the committee if developments are taken forward.

I was going to ask about best practice, but I am interested in following up quickly on Alison Johnstone’s comment. During the recess, the deputy convener and I visited the ambulance control centre in Glasgow. That visit was, to some extent, on the back of the results that we had seen. It is fair to say that, when we went in, we were expecting problems, but we had quite a good chat with management. We were very open—we spoke with the union representatives and we spent quite a bit of time talking with the staff in the call centre. To be frank, it was quite different to what we had expected. It was a much more positive environment, so perhaps the survey did its job in highlighting a problem that was then dealt with.

My question is about sharing of best practice, which you touched on. There will be health boards, or parts of the NHS in Scotland, that use maybe not best, but better practice in staff governance. What mechanisms are in place to identify that and then to share best practice and facilitate that between the health boards?

In the NHS, we are driving more and more towards our approach being that, if there is best practice in one area that works well, there has to be a pretty good reason why it is not happening everywhere, and towards holding boards to account for making sure that they employ best practice in whatever area, not least in staff governance. Given the good practice that has been highlighted in some cases, we want to make sure that boards see the benefit of that culture and of having non-execs in the role of champions who effect change.

There are formal and informal ways to gain an understanding of best practice in staff governance. My team works closely with the boards. I am from a board, and I work closely with our trade union partners and with staff; I spend quite a lot of time out and about in the service.

To come back to the Ambulance Service staff example, I am pleased that you have seen that evolution. The service is different in some respects to the rest of the health service. It has 150 locations across Scotland. Having worked in the service for a number of years, I can say that one of the issues that it wrestles with is leadership visibility, in terms of leadership being able to get out to the small pockets—largely, ambulance crews or control rooms.

On the specifics of the question, we have some formal mechanisms. I meet the boards’ human resources directors every month. We meet our trade union partners regularly, we meet the employee directors and we meet the whistleblowing champions formally to share good practice.

We also have a number of informal means to share that stuff. For example, the whistleblowing champion in Dumfries and Galloway has started to blog and has found—surprise, surprise—that people have started to see that as a less formal means of communicating, and it is benefiting that system. Sharing that kind of good practice formally and informally is something that we do.

Of course, we still have a particular interest where there is a potential for dispute. When concerns are raised or—as a previous question suggested—some stats make us look at something in a bit more detail, we have formal interventions that we can bring to bear, and we can ask boards to give particular consideration to a particular strategy.

Can you outline to the committee your role as a prescribed person in the Public Interest Disclosure Act 1998?

Paul, can you—

I think that it is the cabinet secretary specifically who is the prescribed person in the act.

Yes. I suggest that we write to the committee about that, given that it is a legal provision in the act. We have had to answer questions about that recently, and we got substantial briefing on the matter. It would be more straightforward if we were to write to the committee and describe that, because it is a technical legal matter. It would be better if the committee had the formal advice.

Is there a particular concern that you have?

My question was about suspension of members of NHS staff, especially when a complaint is escalated to one of the prescribed people, including you. How many people have you met to discuss such concerns? Specifically, do you think that it is effective for someone to be suspended when there is a non-medical complaint and for them to perhaps not return to work in the NHS?

Let me answer that carefully. Obviously, such issues are very complex and sensitive, and it would be wrong of me to discuss individual cases. However, I have met individuals who have asked to meet me, many of whom—as you can imagine—have been through a very long process. You will not be surprised to hear that what we find is that a complex set of relationships will have got the person to that position, whether in relation to their management team or, in some cases, other colleagues. I always make it clear that my powers of intervention in such cases are very limited, because it is really an employee-employer matter.

In those particular cases, I thought that it would be helpful for me to hear the concerns that were being raised by the person, but it is tricky territory for me, as cabinet secretary. As I think you will accept, it would be wrong of me to intervene in a process that has had a long and complicated route and which concerns an employee-employer relationship. Quite often, there are very sensitive issues. I tread carefully, and I take careful advice before meeting people, which I have done for particular reasons, on occasion. Obviously, it would be wrong to share specific details of those meetings.

When the committee has done work in the area, we have found that there are real difficulties for some members of NHS staff, who have gone through the complaints procedures and have reached a point at which they cannot go back to their work. In a non-medical complaint case, retaining those people is something that we need to look at reforming.

I can think—again, I am not going to get into the specifics, because it would be wrong to do so—of at least one case in which the person ended up working in another board after a long and difficult process. That person was redeployed, if you like. You make an important point: where possible, we do not want to lose skills. Sometimes, when we boil it down, we find that there has been a breakdown in the relationship with a colleague or a line manager. Things are never black and white; they are usually very much in the grey area of responsibility.

We always take the view—and would expect management in boards to take the view—that the last thing that we want is lose skills. If the person wants to continue working in the NHS—sometimes they do not; let us be honest about that—efforts should be made to find a resolution, and that has happened in at least one case that I can think of.

The relationship that we have with the management of the boards must also be taken into account, in that respect. There are numerous occasions on which I would intervene to ask the management of a board to pay particular attention to something or, if there is a matter that I think has not been appropriately resolved, I will intervene to make sure that it is resolved, as best it can be.

Is that wholly a matter for employees and employers? Would the cabinet secretary intervene and force an investigation if it was a patient safety issue rather than an employee issue?

I would expect that that would already have happened before a case came anywhere near me. Where there are patient safety concerns, there are clear procedures for investigation. The culture in the NHS—the duty of candour that is being introduced next year is really important and pertinent in this context—should be that staff feel able to give an honest and open account of what has happened when something has gone wrong. That is really important. Ultimately, the regulators might take disciplinary or registration action if something is found to have been absolutely wrong in terms of the person’s capability, actions and culpability, but it is often not as straightforward as that. It tends to be more about whether the best judgment call was made at the time.

The issues would have to be separated out, but before anything came anywhere near me, I would certainly expect all the processes and procedures to have been gone through and any adverse-event reviews to have been carried out. Obviously, a fair bit of attention has been paid to that over recent months—rightly so. When anything comes to me, it is usually at the end of a long process.

11:30  

Would an employee be able to access support throughout that process from, say, a trade union or another supportive element of the organisation?

Yes. When something has gone wrong with patient safety, it can be a stressful time for the staff member, who will often be very distraught, so it is important that they are supported. Again, there are clear procedures for that. When a significant adverse-event review takes place, it is important that staff members are supported and that the process is carried out in an atmosphere of learning from what has happened, training and change. If, at that stage, we enter into the territory of disciplinary or registration matters, that is a different sphere, but the processes are clearly laid out.

It is also the case that anybody who is suspended from the NHS should have somebody allocated through their HR department as a contact person who can provide such support whether or not they are a member of a trade union or a professionally regulated body.

I would like to ask about the national confidential whistleblowing helpline. I have asked the cabinet secretary about this in the chamber and in committee. Recently, a constituent came to see me about concerns that they had in the NHS—the person was NHS staff. I mentioned the helpline, which the person was unaware of. They expressed a degree of disbelief about what might happen if they were to phone it, and a lack of confidence that their call would be taken seriously or acted on.

Will you give us an idea of how the situation is improving—if it is—in terms of call volumes, how calls are dealt with and what feedback people who make calls to the helpline receive in respect of the complaints or concerns that they have raised?

Since its establishment in 2013, the line has received 309 calls from staff, which suggests that there is a demand for the service. There is always room for improvement, and I would be concerned if staff did not know about the helpline. It is pretty well advertised everywhere. I would be happy to look at the specifics; if more needs to be done to promote the service in the locality, we will certainly make sure that that happens.

We have just been talking about resolving matters before they escalate and early intervention. Often, encouragement would be given to the person to raise concerns with their employer in the first instance, because that would give the employer a chance to respond to those concerns. Of course, if the person feels uncomfortable about doing that, Public Concern at Work’s staff, who are legally trained advisers, can do so on their behalf.

I hope, given that the helpline is now in its fourth year of operation, that people would have confidence that it is a professional service that offers a wealth of advice. We have had pretty good feedback from those who have used it, but as I have said in answer to previous questions, there is always room for improvement. I would be particularly concerned if staff do not know of the helpline’s existence or how to access it. We would take that seriously and look to do something about it.

You mentioned that there had been 309 calls. You might not have this information in front of you, but what is the profile of those calls? Was there a glut at the start when the helpline was first launched? Has there been a creeping incremental uptake?

I think that uptake has been pretty consistent. Shirley Rogers may have the figures.

I do not have the precise figures, although I can get them for you. In the first year of the helpline’s operation, the calls largely fell into three categories. The first was calls from other parts of the UK, the second was people who were ringing to see whether the helpline was actually there, which is interesting, and the third was calls from NHS Scotland itself. Thereafter, the numbers have been quite high but quite consistent.

I would like to come back to the point that Alex Cole-Hamilton raised about communications, which is very important. There are two specifics that I want to draw the committee’s attention to. The first is that we have had a stall for Public Concern at Work at the NHS event for several years, so people have had the opportunity to have dialogue and to put a face to something. That is in addition to the poster campaigns and the other things that the cabinet secretary has referred to. That has put a human face on the work, and people seem to respond well to the opportunity to ask people what will happen if there is a concern, whatever it might be.

The other thing is that is really important for credibility is our being able to tell appropriately anonymised stories of what has happened when people have raised concerns. We know that there have been issues that have been raised through Public Concern at Work on which action has been taken; it is important for people to have confidence that that is the case. I know of at least a couple of cases in which people have expressed concerns about a particular clinical service that have resulted in further investigation and further work and, in one case, in some remedial action. We are working with Public Concern at Work to find a way to anonymise stories appropriately and to put them into the NHS domain so that people can see that it is not a pointless exercise and that things actually happen as a result. Most people who raise concerns through the line do so because they want something to be fixed, not because they want to moan about something. It is important that those things are fixed.

I have a specific question about the duty of candour. I am a member of a regulated profession—as a pharmacist, I am regulated by the General Pharmaceutical Council, and I already have a duty of candour. What will be added by the duty of candour that comes in in April next year?

I think that the duty of candour will be an attempt to drive culture change. It will explicitly say that, by law, there is a duty on staff members—members of the NHS—to give a full, frank and honest account of anything that is of concern. I guess that it is part of a basket of measures to drive cultural change. Rightly or wrongly, there is a perception—I sometimes hear this from patients who are making complaints—that when something happens, the barriers go up and an attempt is made to circle the wagons. I do not think that that is always the case, but I can see why it is a perception.

The duty of candour says that there is a duty on everyone in the organisation to be honest and open—that is an expectation and a legal requirement. It has that sharp point: no one should feel that they have to be part of a circling of wagons, because there is a legal duty for them not to be. That provides an incentive for cultural change but it also provides protection in that everyone is under a duty to give an honest and frank account. It is part of a drive to improve the culture in the NHS. It is not the only solution, but it brings with it a sharp point that will provide clarity about expectations. We will need to monitor the duty of candour’s implementation and make sure that it leads to more transparency and openness in how the NHS operates.

Thank you. A slightly or tenuously related topic is the question of regulating managerial professionals. The British Medical Association’s submission suggests that it might be a good idea to have regulation of management in the same way as there is regulation of the professions, so that there is parity. What are your thoughts on that?

Have you any thoughts on that, Shirley? Obviously, there would not be a clinical regulator; regulation would be more around performance. I guess that performance management should be done within the NHS rather than by a regulator, but it is an interesting concept.

The question has been raised over probably the past 20 years. One thing that the duty of candour brings is a requirement on everybody, whether or not they are in a regulated profession: that is important. Many of the managerial responses from boards are beyond where clinical processes take us—they might be on resolution of a financial claim or a range of other matters.

The approach that has been taken so far has been about ensuring that we make appointments that comply with the standards that we expect in public life, and the cultural and values-based recruitment that we are increasingly moving towards, which gives us a particular cadre of managers. As an NHS manager, I think that professionalism and standards are good, but that is something that we will continue to wrestle with as we develop that professional management and leadership cadre. I have no doubt that we will come back to that question.

There are clinical managers as well, so managers from the clinical community will still be regulated. That clinical leadership is really important.

A practising lawyer, accountant or quantity surveyor in the NHS is regulated by their professional body. I would go so far as to say that I would welcome proposals for the regulation of managers and leaders in the NHS because it would bring parity. We would have to think about the risks and opportunities of that, but I certainly would not fear it: quite the opposite—I would welcome it. If there were sensible propositions that could be taken forward, I would be happy with that.

In gathering evidence around governance, we have seen a growing perception that there is a disconnection between front-line NHS staff and NHS managers. Are you aware of that? What are you doing to combat that and break down those barriers?

I suspect that one will always get a sense that there is in some workplaces a better connection and a more positive feeling towards managers than there is in others. Where there is good leadership, whether it is by a senior charge nurse on a ward or a member of the senior management team, it is respected. Staff might not always agree with them, but that leadership is respected. Likewise, where there are strong partnership arrangements, managers find that to be an easier environment in which to operate, because through those clear, good and strong partnership arrangements concerns and problems can be resolved in a spirit of partnership.

There are difficulties where that partnership is not as strong and relationships have broken down. I do not think that that characterises the whole NHS. In an organisation that is the size of the NHS there are, undoubtedly, areas where relationships between staff and management are not as good as they need to be. The issue is what is done about that. There is a responsibility on both sides to improve the partnership arrangements to make sure that issues of concern can be worked through and that staff concerns are listened to and addressed. It is a mixed picture in an organisation of that size, as you would imagine.

11:45  

On a subject that is tenuously linked to the NHS being a positive place to work, there is concern about the health of our healthcare professionals. They are the front-line staff who give health advice, and there is a feeling that the NHS is not currently a place that is conducive to a healthy active lifestyle, especially among front-line nurses and midwives. Are you aware of that? What can we do to make it a better place for health and wellbeing?

You touch on an important point. The physical health and wellbeing and the mental wellbeing of staff are equally important. Our NHS and care staff work hard, sometimes in very stressful situations. Therefore, the occupational health support in the system is important. A lot of effort has been made to intervene early so that there are clearer pathways. For example, when someone who works in a physically demanding job reaches a certain age, it is important that that has been planned for well in advance, whether that means giving them lighter duties or a different role. Parts of the service are getting better at that because we want to hold on to staff. We do not want to lose staff through ill-health retirement before their time if they can give more years of service. We need to get better at that.

There are well-documented, regular surveys that show that there is work to be done regarding the general health of our health service staff and that we need to lead by example. The chief nursing officer for Scotland—I hope that I am not going to embarrass her—has done a lot around the system in terms of nursing staff and the need to lead by example. The system needs to support people’s physical and mental health. It is getting better at doing that and recognises that early intervention is best.

Thank you. I will ask the panel a final question. You will be aware that we have taken lots of evidence from the integration joint boards and have looked not just at health staff but at social care staff. Are there any plans to have a single governance standard for health and social care staff?

I will let Shirley Rogers say a bit more about that in a second. There is potential there, and a number of IJBs have already taken on the staff governance principles of the NHS. At the start, there were sensitivities about one system being seen to impose its way of doing things on another, but staff and unions in local authorities and the care sector quite like the NHS staff governance principles. We have seen gradual adoption of some of the staff governance principles across the IJBs, and we will probably see more of that direction of travel. Shirley Rogers is closer to the detail.

The committee may be aware that the NHS Scotland workforce strategy “Everyone Matters: 2020 Workforce Vision” was launched about five years ago as a health and NHS Scotland-specific document. We have started to work on the next iteration of that strategy with colleagues from across the health and social care platform. Our intention is to have the “Everyone Matters” strategy for the NHS in Scotland and some of its principles being considered across the wider health and social care agenda. Indeed, the “Everyone Matters” implementation group contains representation from people across wider areas than the NHS in Scotland.

The cabinet secretary has pointed to the success of iMatter in its being considered as an appropriate tool for wider implementation; indeed, it is providing benefit and generating good results where it is used in integration joint boards. iMatter is an organisational development based product, so it allows people to work together instead of having them just fill out a survey or answer some questions. It is about people working together, and it is generating some good results in that respect.

The fundamental issue in IJB-land has been the need to ensure that the standards of staff governance that apply to the NHS in Scotland are not diminished in that space. Although we are content that other people have different arrangements at this stage, as they would in bringing those organisations together, people who are employed by the NHS continue to have the rights and terms and conditions of the NHS workforce. That has been the most persuasive tool of all, because people are working next to each other, seeing what somebody else has and thinking, “I like that.” The health service will need to learn from that. There are things in local authorities and the third sector that will be useful and with which it will be important that the NHS engage, but if the staff governance standards that have been achieved in the NHS in Scotland are the best, we will want to share them across the piece.

I thank the panel for coming along this morning. We now move into private session, as was previously agreed.

11:51 Meeting continued in private until 12:21.