Agenda and minutes

Apologies had been received from Cllr Catriona Bhatia, Cllr Frances Renton, Dr Cliff Sharp, Mr John McLaren and Mrs Carol Gillie.

The Chair welcomed Ms Tracey Ball who was deputising for Mr John McLaren.

The Chair advised that this would be the last Board meeting for both Cllr Catriona Bhatia and herself, as they were both stepping down from their positions at Scottish Borders Council and NHS Borders.  The Chair reminded the Board that the Integration Scheme provided for the Chair and Vice Chair positions to alternate on an annual basis with the new chair being provided from NHS Borders.  She further advised that the new chair had been identified as Dr Stephen Mather, subject to final approval from NHS Borders on 6 April 2017.

The Chair confirmed the meeting was quorate.

The Chair welcomed members of the public to the meeting.

The Chair sought any verbal declarations of interest pertaining to items on the agenda.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted there were none.

27 February 2017.

The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 27 February 2017 were approved. 

Action Tracker.

4.1       Minute 15.1: Development Session:  Mrs Elaine Torrance confirmed that the Prof John Bolton session had been confirmed for 4 April 2017.

4.2       Minute 8: Health & Social Care Delivery Plan:  The Chair suggested adding the Live Borders update to the Action Tracker.

The Chair commented that some items had been on the action tracker for some time and she requested assurance that there would be no further slippages on timescales.  Mrs Elaine Torrance provided assurance on timescales.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the action tracker.

Verbal Report by Chief Officer.

Mrs Elaine Torrance updated the Board with progress on the transformational programme through a presentation which also set the context for the financial items later on the agenda.   

Mr Paul McMenamin set the context for the financial challenges for the partnership for 2017/18 and beyond.  He spoke of: initial funding gap; mitigation; £2.6m affordability gap for the partnership for 2017/18 and the need to put in place a medium term transformational plan; seeking efficiencies and savings to contribute to closure of the affordability gap; areas of initial focus included the Prof John Bolton work, care pathways, delayed discharges, sharing buildings, assets, people, IT, data, localities and prescribing.

Mrs Torrance spoke of the shape the transformational programme would take following direction and support from the Executive Management Team.  She emphasised that transformation was about pathways, reducing blockages, redesigning flow, improving outcomes, and making services fit for the future to manage increased demand and affordability. 

Mrs Torrance advised that the next steps were to develop detailed proposals for the transformational programme, identify resources to manage the programme, identify indicative efficiencies and then bring a report back to the next Board meeting. 

Cllr Sandy Aitchison enquired about “realistic medicine”.  Dr Angus McVean explained that it was about providing what was needed and no more.  He commented that there was a tendency for people to receive more and more interventions and at some point a pause needed to be instigated to review if they really required everything that was being provided.

Cllr Sandy Aitchison enquired if the drug and alcohol partnership should be provided through the public sector.  Mrs Torrance commented that services were already commissioned through the third sector and there was an intention to work together differently, more closely and more efficiently.

Discussion focused on several key areas including: prioritisation; pooling resources and funding; culture change; transfer of funds; affordability; indicative costs; timescales; resources in primary care; delivery against the Strategic Plan; and a redesign of services.

Ms Lynn Gallacher enquired about progress in regard to the Carers Legislation as she was aware that there could potentially be increased demand on the third sector if there was less demand on statutory services.  Mrs Torrance advised that further guidance was awaited however a small sum had been set aside to support the formulation of a plan.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the update.

Report by Chief Officer.

Mrs Elaine Torrance gave an overview of the content of the paper and explained each project in turn.

In regard to the GP Clusters proposal, discussion focused on: what could be achieved in 2 hours a week; if the funding level was adequate; good will; intense pressure in GP community services; a move to make the GP a specialist generalist; locum rates; and difficulty in recruiting to GP positions.

Mr John Raine said it was concerning to hear from Dr McVean that there was a general lack of goodwill on the part of GPs.  Primary Care was essential to the effective delivery of integrated services and the pressures faced by GPs were well understood.  However, the Board needed to take serious note of Dr McVean’s statement and ensure action was taken to mitigate the impact.  A focus should be put on building and supporting relationships with GP practices.

Mrs Tracey Logan commented that the Executive management Team were supportive of the proposal and of building bridges and relationships with the GP community and were engaging with them.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the utilisation of ICF funding to establish the Cluster Quality Lead posts at 2 hours per week per post and to assess capacity levels against their remit and the outcomes delivered over the initial 12 month period at a cost of circa £50k over one year.

In regard to the Domestic Abuse Service Pathway proposal, discussion focused on: big lottery and match funding; redesign of the pathway; well established and well recognised service in the Scottish Borders; and sharing services more effectively with the third sector.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the request for £120k total funding over 3 years, and a further update on the redesign of the service at the next meeting.

In regard to the Alcohol & Drug Partnership (ADP) Transitional Funding proposal, discussion focused on: redesigned service proposals; reduced expenditure profile; Executive Management Team support for the proposal; future funding requests; and effects on childrens education in closing the attainment gap.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the request for £46k of transitional funding from the Integrated Care Fund to allow further work to be taken forward by the ADP.

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

Report by Chief Officer.

Mrs Elaine Torrance presented the draft performance report and sought feedback on the content.  She drew attention to pages 51, 52 and 53 which set out the priorities for the next year and commented on the performance data. 

Comments received included: good layout; comparison to the scottish average for population; intended audience; acronyms and language; simplified easy read version; photographs of the Board members; and local objectives to the local geographical area or borders wide.

Mrs Torrance confirmed that the timeline for publication was by the end of July and that a final version would be brought to the next meeting of the Board and would include tracked changes and version control.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD commented on the content, structure and format of the draft Annual Performance Report.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the timeline for the development and publication of the report.

Report by Chief Officer.

Mrs Elaine Torrance introduced the NHS Borders draft Local Delivery Plan (LDP) and welcomed Ms Meriel Smith who was present to answer any technical questions.

Comments received included: additional information required for the suicide prevention section; public involvement and the community engagement strategy; feedback from the results of the information gathered from patients and carers – published - information on ward boards; difficulties in engaging with the public through the Public Participation Forum (PPF); challenges of engagement with the wider public; attendance at Area Forums; attendance at the PPF; and production of an easy read version.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the draft LDP and provided feedback and comments on the draft.

Verbal Report by Chief Social Work Officer.

Mr Murray Leys gave feedback to the Board following the recent joint inspection.  He confirmed that the inspectors had provided initial feedback which had focused on anticipated areas of improvement, key processes, and work with communities and localities.  Evaluation scores were expected on the 28^th April and formal feedback was expected around the 11^th May.  The final report was expected to be available in late June, early July.  He further advised that the final report would be brought to the Board post publication for consideration.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the update and that the final report would be brought to the Board for consideration.

Report by Chief Officer.

Mrs Elaine Torrance spoke of the reasons for refocusing the role and function of the Strategic Planning Group (SPG).  

Mrs Angela Trueman commented that she was concerned there was only one representative on the SPG as a user of health care and one community council network representative for the whole of the Scottish Borders.  She enquired if the membership was prescribed or could be expanded?  Mrs Torrance advised that the membership was prescribed in Scottish Government guidance and conversations had taken place in regard to the substantial size of the group.

Cllr Sandy Aitchison left the room.

The meeting was not quorate.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the progress made in reviewing the role, function and membership of the SPG.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD endorsed the revised Terms of Reference.

Report by Interim Chief Financial Officer.

Mr Paul McMenamin presented the report and highlighted the work that had been undertaken in regard to the NHS Borders recovery plan and the continued work that was underway to deliver financial balance at the year end.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and the monitoring position on the partnership’s 2016/17 revenue budget at 31^st January 2017.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD supported the management teams within both organisations as they continue to make every effort to ensure the IJB returns a balanced position for 2016/17.

Cllr Sandy Aitchison returned to the meeting.

The meeting was quorate.

Report by Interim Chief Financial Officer.

Mr Paul McMenamin introduced the paper and highlighted the future work required in terms of due diligence, refining how the budget is allocated, savings targets and also presented the provisional budget.  He emphasised that both partners had committed to deliver a flat cash budget to the Integration Joint Board and that the transformational programme would be utilised to bring forward other efficiency and savings measures to help address the unmitigated pressures. 

Mr David Davidson advised that if both Chief Executives were satisfied with the content of the paper, then he had confidence in them and would be supportive of the paper.

Cllr Graham Garvie suggested a budget should never be approved unless it was balanced and on the advice of the Finance Officer that the budget was 95% balanced and the other 5% would be worked on he was supportive of the paper.

Mrs Jane Davidson commented that for the Health Board it would provide the resource that it had been asked to provide and could not provide any additional funding.  She suggested the challenge would be for the partnership to deliver on the transformational agenda and she assured the Board that partners were working better behind the scenes to reduce the gap.

Mrs Tracey Logan commented that for the Local Authority it would be looking to deliver efficiencies in the same way as the NHS and she expected delivery of transformational change programme to be fundamental to deliver on budgets.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the report and the provisional 2017/18 Health and Social Care Financial Plan.

Mr Paul McMenamin gave a brief presentation which encapsulated an overview of the content of the paper.  He highlighted the additional funding from the Scottish Government that had been routed through the NHS to the partnership to support social care and the direction of that funding by the Board during the previous year. 

Cllr Sandy Aitchison sought clarification of the additional support to integration authorities.  Mr McMenamin explained that the Scottish Government had advised Health Boards that they must provide the same amount of funding to the partnership as they had provided in 2016/17 and that Local Authorities had the ability to reduce their share of funding to the partnership.  Mr McMenamin confirmed that the Local Authority had agreed not to reduce its funding to the partnership. 

Mr McMenamin explained the social care new commitments and sustainability and advised that COSLA and the Scottish Government had reached agreement with residential care home providers to agree an uplift of 2.6%.  As agreement had been reached he was now able to build that into the direction of funding of the living wage.  Mr McMenamin further spoke of the pressures on the system of catering for those with complex needs, those transitioning into adulthood and older peoples care requirements.

Karen Hamilton left the meeting.

Mrs Tracey Logan suggested the Board may wish to consider deferring the allocation of funding until further clarity of detail was provided, apart from the uplift to the living wage element which was payable from 1 April 2017.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the uplift in the living wage allocation and deferred any further allocations until the next meeting in June.

Mr John Raine wished to record thanks to the Council for choosing not reduce their financial allocation to the partnership in line with the discretion given to Local Authorities to make reductions.

Verbal report by Chief Officer.

Mrs Elaine Torrance advised that the Integration Joint Board’s Audit Committee had been held earlier that morning and that the Prof John Bolton event had been confirmed for 4 April.

Cllr John Mitchell advised that the Audit Committee had agreed to recommend to the Health & Social Care Integration Joint Board that it issue a direction to both partner organisations to direct them to undertake a refresh of financial regulations across partnership resources.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the update.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD issued the direction to partner organisations to undertake a refresh of their financial regulations across the partnership resources.

15.1     Mrs Evelyn Rodger:  The Chair advised that this was the last meeting of the Board for Mrs Evelyn Rodger, Director of Nursing, Midwifery and Acute Services, in her capacity as a professional advisor to the partnership.  Mrs Rodger was retiring to pursue other interests beyond nursing and the Board wished her well for the future.

15.2     Mrs Pat Alexander:  Mr David Davidson thanked Mrs Pat Alexander for chairing her last meeting of the Board and recorded the thanks of the Board to her for being the vice chair for the past two years and wished her well for the future.

15.3     Cllr Catriona Bhatia:  Mr David Davidson also recorded the thanks of the Board to Cllr Catriona Bhatia for chairing the Board for the past two years and wished her well for the future.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the updates. 

Verbal Report by the Chief Officer.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that an alternative date was being sought. 

Monday 26 June 2017 at 2.00pm in Committee Room 2, Scottish Borders Council.

The Chair confirmed that the next meeting of Health & Social Care Integration Joint Board would take place on Monday 26 June at 2.00pm in the Committee Room 2, Scottish Borders Council.