Scottish Borders Council

Agenda and minutes

Venue: Committee Room 2, Scottish Borders Council

Contact: Iris Bishop, Board Secretary  Tel: 01896 825525 Email:  iris.bishop@borders.scot.nhs.uk

Items
No. Item

1.

ANNOUNCEMENTS & APOLOGIES

Minutes:

Apologies had been received from Mr John Raine, Mrs Tracey Logan and Mrs Carol Gillie.

 

The Chair confirmed the meeting was quorate.

 

The Chair welcomed Mr Robert McCulloch-Graham, Chief Officer Designate.

 

The Chair welcomed Mrs Susan Swan, Interim Chief Financial Officer.

 

The Chair welcomed Mr Colin McGrath the new Public Partnership Forum representative to the Health & Social Care Integration Joint Board.

 

The Chair welcomed Ms Debbie Rutherford who was deputising for Mrs Lynn Gallacher.

 

The Chair welcomed members of the public to the meeting.

 

2.

Formal Appointment of Chief Officer Health & Social Care pdf icon PDF 123 KB

Minutes:

Mr Robert McCulloch-Graham left the room.

 

The Chair confirmed that the Health & Social Care Integration Joint Board was required to appoint a Chief Officer.  He had received confirmation from the Chief Executive of Scottish Borders Council that she was content for Mr Robert McCulloch-Graham to be seconded from Scottish Borders Council to fulfill the Chief Officer role.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD formally appointed Mr Robert McCulloch-Graham as Chief Officer Health & Social Care.

 

3.

DECLARATIONS OF INTEREST

Minutes:

Mr Robert McCulloch-Graham rejoined 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.

 

4.

MINUTES OF PREVIOUS MEETING pdf icon PDF 201 KB

28 August 2017

Minutes:

The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 28 August 2017 were amended at page 3, paragraph 7, line 1, amend “brining” to “bringing” and again at page 4, paragraph 8, line 4 delete “rotation” and with those amendments the minutes were approved. 

 

5.

MATTERS ARISING pdf icon PDF 75 KB

Action Tracker

Minutes:

5.1         Minute 11: Terms of Reference: Mr Colin McGrath suggested the Terms of Reference might be revisited in light of the Joint Older People’s Services Inspection Report.

 

5.2         Action Tracker:  It was suggested and agreed that the progress box should always be completed.

 

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

 

6.

CHIEF OFFICER'S REPORT

Minutes:

Mr Robert McCulloch-Graham thanked the Board for formalising his appointment.  He advised that this was day 11 of him being in post and had met a range of Board members and officers.   He recognised the difficulties experienced by the partnership in regard to stranded patients and the financial position and intended to work through suggestions and directions with both Chief Executives and officers in the partner organisations.  He commented that there appeared to be strong working relationships between the partnership organisations and he was looking forward to the future.

 

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

 

7.

Commissioning & Implementation Plan 2017 - 2019 pdf icon PDF 221 KB

Additional documents:

Minutes:

Mr Tris Taylor commented that he felt over-all the document that made up the commissioning and implementation plan was good.  He then enquired if the plans within it were prepared sequentially, which he suggested would lead to a delay in their activation given the strategic plan was a 3 year cycle. 

 

Mr Robert McCulloch-Graham advised that it was an iterative process and the partnership would improve its functions and processes as it evolved.  There was a necessity to have different iterations and strategies and he concurred that if they could be pulled together quicker progress should be made.

 

Mr McCulloch-Graham advised that the Commissioning and Implementation Plan would be updated annually, based on the traction received in year, along with cognisance of the Joint Older People’s Services Inspection report.

 

Further discussion highlighted suggested amendments including: “? Palliative”; more detail in the carers sections, especially on support for carers; suggested mention of IT as a key lever to increase efficiency; reducing health inequalities and reference to working with those who are disadvantaged; criteria for critical care needs; transformation programme specifically focusing on IT; increased narrative on carers and eligibility criteria; working with the disadvantaged; locality planning and community involvement; inclusion of a measure around engagement for reducing health and inequalities; and a broad overview of expenditure in the localities including deprived areas.

 

Mrs Jane Davidson suggested that more measures would be helpful, and the Board may also wish to be more sighted on the strategies that were overseen by the Community Planning Partnership.

 

Cllr Shona Haslam reminded the Board of the conversation at the previous meeting where the positive work of the Community Capacity Team had been recognised and discussion had suggested that funding would be concluded in March 2018.  She sought assurance as to whether that work would continue circa March 2018.  Mr Murray Leys advised that an evaluation of the project had been requested by the Executive Management Team before the festive period, so that consideration could be given to the future of the service and a recommendation made to the Integration Joint Board.

 

The Chair commented that he was pleased that Cllr David Parker, Vice Chair, would be the new Chair of the Strategic Planning Group and would be injecting a new pace and urgency and identity to that Group.  Cllr Parker commented that it was early days and at the last meeting the Strategic Planning Group had agreed to refresh the plan and he would ensure that was actioned. 

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the Commissioning and Implementation Plan.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the Commissioning and Implementation Plan 2017-2019 subject to the amendments suggested.

 

8.

Issuing of Formal Directions

Minutes:

Mr Robert McCulloch-Graham commented that he had discussed with the Chief Executives the subject of stranded patients and significant pressures on the systems.  He was aware that there were people who were medically fit for discharge and awaiting assessment.  He was keen to move the assessment process into the community, people’s homes or other appropriate facilities.  He suggested the assessments would be more accurate if undertaken in those environments, however it would require a Direction to be issued from the Integration Joint Board to the Health Board and Local Authority.  He suggested an Extra Ordinary meeting of the Integration Joint Board be held within the next 2 weeks to agree the content of such a direction, given there would be a significant amount of work to be done by both partners to be able to enact the direction.  There would also be a cost implication for such a change.

 

He further suggested that a paper on emergency procedures be brought to the Integration Joint Board for consideration to enable emergency decisions to be made quickly outwith the usual meeting cycle, when required.

 

Further discussion included: comments from those unable to attend the Extra Ordinary meeting, being received in advance; potential of movement of people from the acute sector to primary care services would potentially place a significant amount of work on community staff; recognition of the significant costs of stranded patients to both the Health Board and Local Authority; and urgent identification of a date for the Extra Ordinary meeting.

 

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

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed to hold an Extra Ordinary meeting to discuss and agree the issue of a Direction to the Health Board and Local Authority on a change in policy to move to discharge to assess.

 

9.

Statutory Requirements: Climate Change, Model Publication Scheme, Complaints Scheme pdf icon PDF 67 KB

Additional documents:

Minutes:

Mrs Jill Stacey confirmed that as a public authority and under the local code of corporate governance the Integration Joint Board was required to produce a number of integrated public reports as per those submitted for noting.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the requirements of the Integration Joint Board as a public authority to produce a Climate Change Report, an Integrated Complaints Handling Procedure and a Model Publication Scheme.

 

10.

Joint Winter Plan 2017/18 pdf icon PDF 94 KB

Additional documents:

Minutes:

Mr Philip Lunts presented the final version of the joint winter plan for the partnership and advised that the majority of actions within the plan had been addressed.  He emphasised the criticality of the plan, additional staffing in key areas, management of the anticipated additional activity generated by the winter period, and the ability to have capacity and resource available within the community. 

 

Mr David Davidson sought assurance in regard to staff and capacity to address anticipated additional surge activity.  Mr Lunts assured the Integration Joint Board that plans were in place to address additional activity over the winter period as well as more creative options around alternatives to traditional staffing. 

 

Mr Davidson enquired if funding was available.  Mr Lunts advised that the majority of the proposals in the winter plan were funded.  Each action that was identified had been required to include a funding source. 

 

Mr Davidson enquired who would be undertaking the external review of Community Hospitals.  Dr Cliff Sharp advised that Mrs Anne Hendry has been asked to undertake an external review of community hospitals.  She had agreed to undertake the review over 10 days to analyse what they do, options for how they could be used taking into consideration the Prof John Bolton work, and how they could be shaped for the best outcomes for the Scottish Borders population.

 

Cllr Shona Haslam noted the slippage in commencing the external review of community hospitals and requested that the document be updated.

 

Cllr Helen Laing enquired if the 50% target rate for flu vaccination of staff should be higher.  Dr Cliff Sharp advised that the Public Health Department were well sighted on the issue and were working on the winter flu plan given the flu epidemic currently being experienced in Australia.  Publicity and open sessions had been organised for staff across the Scottish Borders to take up the flu vaccination, especially for those working with the most vulnerable in society, and whilst the target was set at 50% there was an expectation that it would be surpassed.

 

Mrs Karen Hamilton enquired about transport and discussions that were due to take place with the Red Cross during September.  Mr Lunts advised that discussions were on going with the Scottish Ambulance Service and the voluntary and third sector in regard to transport issues.

 

Mrs Jane Davidson commented that the joint winter plan was for health and partners to have in place.  It was an operational plan that had been tried and tested over the years and was reviewed and revised on a weekly basis, and was a mechanism well used by both the Health Board and the Local Authority.  She suggested that the Integration Joint Board should be assured that the plan was robust and would address the winter period.  She further commented that the impact of stranded patients would affect its operational value and therefore the suggestion of moving to a discharge to assess arrangement should strengthen the plan further.

 

The Chair commented that stranded patients had been at  ...  view the full minutes text for item 10.

11.

Quarterly Performance Report pdf icon PDF 89 KB

Additional documents:

Minutes:

Mr Robert McCulloch-Graham gave an overview of the content of the report and drew the Integration Joint Board’s attention to the schematic that had been tabled.

 

Cllr Helen Laing enquired if the Falls Strategy had been finalised.  Mr Murray Leys commented that he would find out and advise outwith the meeting.

 

Several issues were raised during discussion including: page 12 update required on delayed discharges; page 23 carers section confirmation required that there were just 2 exceptions as opposed to 4; preference for run rates against the previous year and the Scottish average and the inclusion of RAG rates within the next quarterly report instead of legends; anomaly of the Margaret Care Unit being included within the Borders General Hospital end of life care statistics instead of the community based statistics; inclusion of narratives; immenseness of the issue of combining stranded patients with care closer to home; performance in community spend and receipt of the anticipated figures for 2015/16.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the additional themes and measures for reporting.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the key performance issues highlighted.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD advised of changes to be included in future quarterly performance reports.

 

12.

Locality Plan Consultation Update pdf icon PDF 133 KB

Additional documents:

Minutes:

Mr David Davidson commented on the low number of responses received across the Borders.  Mr Murray Leys assured the Integration Joint Board that the plans had been produced by communities through community involvement.  Engagement sessions had been held across the localities on a regular basis and given the input that had been received to the locality plans, he had been surprised at the low consultation response rates.

 

Mr John McLaren commented that Berwickshire had a higher response rate than the other localities and he enquired if equality impact assessments had been carried out to evidence engagement from older people, those with disabilities and those identifying as carers.  Cllr John Greenwell suggested that the higher response rate for Berwickshire could have been due to the Area Forum in that area which was always well attended.

 

Mr Colin McGrath suggested that from his perspective and as part of the Cheviot Locality Planning Group, that group had not engaged well with the public and volunteering groups.  He suggested the process should be run again and issues of GP clusters should be looked. 

 

Dr Angus McVean reminded the Integration Joint Board that when GP clusters were set up it was for GP Practices to group themselves with the colleagues that they thought they could have the best working relationship with in their close area.  It was apparent that 5 GP clusters to mirror the 5 localities would not work for GPs and whilst 4 GP clusters created an overlap it was not viewed as an issue by GPs either then or now.

 

Cllr Greenwell commented that as the Local Authority Equality & Diversity champion he had been pleased to see that equality impact assessments had been completed on the plans and he expected impact assessments to be undertaken on the responses received.  He enquired if the positive and negative responses had been separated in the numbers reported.  Mr Leys advised that he was unaware of how the responses had been analysed but would seek confirmation from the locality coordinators and provide assurance to the Integration Joint Board on the process that had been followed to bring together the views of the communities. 

 

During further discussion various views were expressed in regard to: engagement and consultation processes; refresh of the communication and stakeholder plan; engagement processes to reflect partnership working; pick up concerns under the actions within each plan; and include the process of engagement with the public on a future Integration Joint Board Development session agenda.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the number of questionnaires returned and the key themes emerging from feedback received and sought further information on the community engagement process.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD endorsed the proposals to revise the plans based on feedback received and sought to further encourage the public to engage with the proposals.

 

13.

Update on Buurtzorg in the Borders pdf icon PDF 73 KB

Additional documents:

Minutes:

Mrs Claire Pearce gave an update on the Buurtzorg project and explained the key principles of the initiative and the progress that had taken place to date. 

 

Mrs Jane Davidson advised that whilst the project might seem miniscule it was a huge step forward in enabling integrated care to be delivered to people in the community.  She suggested the pilot would assist in the cultural change required and be the first step in making real change happen on the front line in the community.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the progress to date and welcomed hearing more at a later date.

 

14.

Inspections Update

Minutes:

Mr Murray Leys gave an update on the Joint Older People’s Services Inspection report had had been published on 28 September.  He advised that discussions continued with colleagues in the Care Inspectorate and Healthcare Improvement Scotland and an action plan had been produced following publication of the report, which would be shared with the Integration Joint Board once finalised.

 

Discussion ensued which focused on: the media response issued in regard to the publication of the Inspection report; differences between the positive verbal feedback received during the inspection and the negative written feedback contained within the actual report; improvements to the process of producing the inspection report; perspectives from the Chief Executives of the Health Board and Local Authority; a review of the report; adult protection seen as an area of weakness; and improvement work to be undertaken.

 

Cllr Tom Weatherston commented that one of the criticisms within the report related to a facility within his constituency and when he had spoken to the public and users of the facility within his ward area they had been shocked at the report content as they viewed the facility as well run and a positive service.

 

The Chair asked for assurance that the matters that had been brought up in the report pertaining to adult care in both secondary and primary care were being addressed.  Mrs Davidson suggested the Integration Joint Board receive the action plan once finalised by the Health Board and Local Authority.

 

Mr Robert McCulloch-Graham commented that the judgements published within the report, were not supported by details of the evidence used by the inspectorate, to reach their conclusions. He was seeking a meeting with the Care Inspectorate to examine their evidence base. In this way the partnership’s improvement action plan would be better informed, and appropriate actions put in place to address concerns.  The meeting would also seek to reach agreement with the inspectorate on the evidence to be collated which would demonstrate improvement.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the update and agreed to receive the Action Plan at the next meeting.

 

15.

IJB Business Cycle 2018 pdf icon PDF 31 KB

Additional documents:

Minutes:

Dr Angus McVean left the meeting.

Mr David Bell left the meeting.

 

Miss Iris Bishop gave a brief overview of the content of the paper.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the proposed meeting dates and business cycle for 2018.

 

16.

IJB Annual Accounts pdf icon PDF 135 KB

Additional documents:

Minutes:

Mrs Susan Swan gave an overview of the content of the Annual Accounts and advised that they had been presented to and endorsed by the Integration Joint Board Audit Committee in September 2017.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the report and the 2016/17 Annual Accounts as endorsed by the Integration Joint Board Audit Committee.

 

17.

Interim Transformation and Efficiencies Programme Tracker pdf icon PDF 86 KB

Additional documents:

Minutes:

Mr Tris Taylor left the meeting.

 

Mrs Susan Swan provided the Integration Joint Board with an update to the presentation received at the previous meeting in August.  She highlighted the detail in regard to the financial gap in terms of recurring efficiency savings, the review to be undertaken over the next 2 accounting cycles and aligning the financial plans of the partnership to the transformational programme projects to fill the financial gap.

 

Mr John McLaren suggested staff side representation could be offered to the programme leads and also enquired if there were any funds to work with the locality groups.  Mrs Swan advised she would find out and advise outwith the meeting.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and requested an update on the delivery of efficiencies in 2017/18 and future years from the Transformation Programme.

 

18.

Monitoring of the Health & Social Care Partnership Budget 2017/18 pdf icon PDF 104 KB

Additional documents:

Minutes:

Mrs Susan Swan gave an overview of the content of the report.  She advised that future iterations of the report would be revised to be more user friendly and less technical in terms of accountancy speak.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and the monitoring position on the partnership’s 2017/18 revenue budget at 31st August 2017 and requested details of the financial recovery plan for 2017/18 at the next meeting.

 

19.

Ring Fenced Resources - Update on Social Care Fund, Integrated Care Fund and Change Fund pdf icon PDF 135 KB

Additional documents:

Minutes:

Cllr David Parker left the meeting.

Cllr Shona Haslam left the meeting.

 

Mrs Susan Swan gave an overview of the content of the report.  She highlighted the request to direct £1m of resources as discussed earlier in the meeting to assist in addressing the surge bed situation linked to stranded patients.  She further explained the background to the request to direct £0.285m to the Border Ability Store equipment budget.

 

Cllr John Greenwell asked that the financial discussions be moved earlier up the meeting agenda given the current financial pressures facing the partnership.

 

Cllr Tom Weatherston noted the potential for adverse publicity given the content of the papers and that their status as public documents.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and the status of resources on the Social Care Fund, the Integrated Care Fund and the Change Fund. 

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the recommendation by the Executive Management Team to direct £1m of Social Care Fund resources on a non recurring basis for 2017/18 to NHS Borders to cover the costs of surge bed capacity used across the health system linked to the level of delayed discharges.

 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the recommendation by the Executive Management Team to direct £0.285m of Social Care Fund resources on a non recurring basis for 2017/18 to the Borders Ability Store - equipment budget.

 

20.

Committee Minutes pdf icon PDF 33 KB

Additional documents:

Minutes:

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

 

21.

ANY OTHER BUSINESS

Minutes:

21.1     Health & Social Care Integration Joint Board Development Session: 27 November 2017:  The Chair highlighted the subject matter for the next Development session to be held on 27 November.

 

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

 

21.2     Transformation Programme:  Mr Colin McGrath suggested inviting Mr Grant Laidlaw, Programme Manager for Planned Care and Commissioning to a future Development session to talk about patient optimisation.  Mrs Susan Swan reminded the Integration Joint Board that the subject matter was operational and was being picked up under the Transformation Programme.

 

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

 

22.

DATE AND TIME OF NEXT MEETING

Monday 18 December 2017 at 2.00pm in Committee Room 2, Scottish Borders Council

Minutes:

The Chair confirmed that the next meeting of Health & Social Care Integration Joint Board would take place on Monday 18 December 2017 at 2.00pm in Committee Room 2, Scottish Borders Council.

 

 

 

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