Agenda item

Mrs Elaine Torrance provided an overview of the content of the paper.  She highlighted the range of projects that had been approved and their projected costs.  She advised that the Executive Management Team had taken forward work to review the projected pathway and part of that review had led to a closing of the fund to new bids to enable more substantial planning work to take place to speed up the process and eliminate blockages in the system.  

A discussion ensued which highlighted several key points including: development of ideas to prioritise pathways for delivery in the community setting; Rapid Assessment and Discharge (RAD) Team six day cover; the pause providing the ability to focus on the gaps in the system on admission and discharge; further opportunities to look at projects contributing to an integrated approach; and the timetabling of projects requiring approval by the Health & Social Care Integration Joint Board that might already be underway.

Mr John Raine enquired to what extent it represented additionality and whether the timeline for completion of the RAD project was realistic.  Mrs Torrance confirmed that it was likely the timeline would be extended.  In terms of additionality, she advised that one of the issues was how much the fund could be used for transformation.  One of the learning elements was around the bids and how realistic it was to do shorter pieces of work which would lead to rapid change. 

Mr Raine suggested it would be helpful to see if the Integrated Care Fund (ICF) was being used as additional money and to what extent against posts already funded by both Scottish Borders Council and NHS Borders. 

Dr Angus McVean welcomed the RAD project but cautioned that the frail elderly would be admitted with a range of issues and potentially the target might miss a bit of the problem as there would be some who might not fit the medical model however the hospital might actually be the safest place for them at that specific point in time.  He suggested undertaking audits on what was required at admission and on discharge. 

Mr Andrew Murray agreed with Dr McVean’s concerns and urged that the focus be person centred with the individual being the key component.  Mrs Jane Davidson suggested collecting the data on what would have prevented the admission as it might give a slightly different picture and more insight into preventing admissions or enabling timely discharge.

Mrs Jenny Smith reflected that the RAD projects felt process orientated as opposed to person centred and she noted that whilst some pieces of work would be about getting the system right there was a need to think about what that change in process would make for the person using the service. 

Mrs Lynn Gallacher suggested strengthening the references to carers, signposting and the Carers Act.

Cllr Graham Garvie suggested a future development session be organised to understand what the projects actually implied.

Dr Stephen Mather reminded the Health & Social Care Integration Joint Board (IJB) that it had discussed quick wins at the start of its formation back in 2015 and one of those targets suggested had been delayed discharges.  He suggested the IJB should be disappointed that limited progress had been made since that time.  Mrs Tracey Logan commented that more recently work had been undertaken on delayed discharges and change had now been effected with some success being seen.  The matter was being tackled jointly at a senior level. 

Mrs Davidson commented that over the previous 6-8 weeks there had been a cultural shift in addressing delayed discharges with both herself and Tracey Logan meeting and empowering their staff to make decisions to prevent delays, such as employing health care support workers instead of home carers, working with district nurses and attending GP Practices.  She agreed that whilst progress had been limited in the past the new joint approach was focused on addressing the pathway to reduce and ultimately end delayed discharges. 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the position of the Integrated Care Fund.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD supported the closing of the fund to new bids, until further planning work was undertaken.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD ratified the recommendations of the Executive Management Team to approve 3 new projects detailed in 4.1 of the report.