Agenda and minutes

Apologies had been received from Cllr Shona Haslam, Mr Tris Taylor, Mr John Raine, Dr Cliff Sharp, Mr Stuart Easingwood, Cllr John Greenwell, Miss Iris Bishop and Mrs J Davidson.

The Chair confirmed the meeting was quorate.

The Chair welcomed Mrs Nicky Berry, Interim Director of Nursing, Midwifery & Acute Services to the meeting.

The Chair advised of the now vacant Service User Representative position on the Integrated Joint Board. The position was previously held by Mr Colin McGrath, from the Public Participation Forum, and a new representative was being sought from the locality groups.

The Chair welcomed members of the public to the meeting.

Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest.

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

Cllr Elaine Thornton-Nicol advised she was a patient at Eildon Medical Practice.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the verbal declaration of interest.

The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 22 October 2018 were approved.

Action Tracker

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

Mrs Karen Hamilton sought assurance that actions which had extended deadlines were picked up and allocated in the 2019 Integrated Joint Board workplan.  Mr Robert McCulloch-Graham advised the themes of many of those actions would be covered at the upcoming Integrated Joint Board Development Session, currently being arranged.

4.1       Action 29: Dr Angus McVean asked if the action could be rescheduled for March 2019 or April 2019 to take into account the Quality & Governance for the previous and forthcoming years. The Chair agreed the action should be amended and therefore added to the April 2019 agenda.

4.2       Action 31: The Chair advised the action could be closed.

4.3       Action 32: The Chair advised the action could be closed.

4.4       Action 33: The Chair advised the action could be closed.

Mr Robert McCulloch-Graham gave an overview of the content of the report and highlighted the finalised agreement with Queen’s House on the Murray House specialist dementia care beds; mental health Day of Care Audit Plus (DoCA Plus) results; Chief Officer conference and the proposed clinical productivity work through Meridian.

Mrs Karen Hamilton enquired in regard to the cost associated with the newly proposed clinical productivity projects. Mr Robert McCulloch-Graham advised the costs were covered in the existing three year contract with Meridian that NHS Borders held.

Mr John McLaren enquired in regard to the responsibility to ensure patients had the right level of clinical input and how assurance was secured on the care provided at Murray House. Mr Robert McCulloch-Graham advised that Queen’s House retained ultimate responsibility to provide the standard of care required and NHS Borders retained the responsibility for selecting and placing the patients within appropriate care providers. Assurance on the quality

of care was gained through the monitoring of Care Inspectorate reviews, staffing skill mixes and the continual review of patient’s care.

Mr John McLaren raised concerns over the proposed Meridian clinical productivity projects, echoed by the Trade Unions, as it was felt a satisfactory level of engagement with Partnership had not yet been met. Additionally, Hospital to Home remained a project funded by the Integrated Joint Board and therefore discussions ensued around the potential distortion of the

project with the involvement of Meridian. Mr Robert McCulloch-Graham advised of the rationale for the inclusion of Hospital to Home, covering the essential support required to scale up the development of systems.

Mr Robert McCulloch-Graham assured the Board that engagement would continue and this was addressed with Scottish Borders Council Trade Unions on 13 December 2018.

Mrs Nicky Berry advised the Royal College of Nursing had been informed of the Meridian clinical productivity proposal. Mr John McLaren asked if Partnership could also be approached as early as possible.

Mrs Lynn Gallagher enquired in regard to the involvement of carers in the Meridian clinical productivity, due to their close links with SBCares staff. Mr Robert McCulloch-Graham advised the involvement of carers was not detailed in the scope of the project; however that element could be developed after the findings were issued in the initial weeks of the project.

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

Mr Mike Porteous gave an overview of the report and the Chair advised that it had been circulated electronically for comment, following the cancellation of the November Integrated Joint Board meeting due to non quoracy. Therefore, through Chair’s action, the Chair had approved the recommendations set out in the report.

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

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the direction of the remaining balance of £0.512m of Social Care funding.

Mr Mike Porteous gave an overview of the report and the Chair advised that it had been circulated electronically for comment, following the cancellation of the November Integrated Joint Board meeting due non quoracy. Therefore, through Chair’s action, the Chair had approved the recommendations set out in the report.

Mrs Karen Hamilton enquired in regard to the evidence of Garden View reducing delayed discharges. Mrs Nicky Berry advised that the information gathered on patient stays was now more robust with additional categories taken into account when reviewing the type of delay.  The numbers of delayed discharges continued to vary, however reassurance was given that

performance indicators were continually monitored to alert any pressure points and therefore the system was in a good state. Mrs Tracey Logan added the evidence from Garden View was compelling and a worthwhile project to continue.

Discussions ensued regarding the positive impact of Craw Wood last year; rationale of opening extra beds; and operational model of fluctuating SBCares and agency staffing. Mr Mike Porteous advised an Integrated Care Fund update report would be brought to the Integrated Joint Board January meeting, giving an overview of all of the projects currently

operating with Integrated Care funding.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the allocation of Integrated Care Funding to date, as detailed in the report.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the direction of the sum of £100,000 to Scottish Borders Council from NHS Borders.

Mr Rob McCulloch-Graham gave an overview of the report to highlight the two points which had been amended in the scheme of Integration; the inclusion of the Carers Scotland Act 2016 and the proposed extension of the Chair’s term.

Given the upcoming year was crucial for the Integrated Joint Board to continue to evolve and mature, the collective view from the Chief Executives, NHS Borders Chairman and Council Convener was to maintain consistency of the Integrated Joint Board Chair and Vice Chair.  Therefore, the proposed increase to a three year tenure for those positions was recommended.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the term of office extension.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the amendments to the Scheme of Integration in regard to the Carers Act 2016 and the term of office extension.

Papers to follow – Appendix 2018-54

Mr Mike Porteous gave an overview of the content of the report and advised of the ongoing joint working between Scottish Borders Council and NHS Borders finance departments to progress this important piece of work.

Cllr Tom Weatherston asked for an amendment to be made in section 5.1 to ensure the commitment to fund additional expenditure should be done proportionately rather than equitably.

Mr Malcolm Dickson asked if any releasable savings had been identified from the Hospital to Home project. Mrs Carol Gillie advised NHS Borders Board had requested a business case to detail the Hospital to Home savings plan. Mr Robert McCulloch-Graham advised that the business case was being prepared, however a portion of releasable savings would only be

realised by the reduction of investment in other service areas.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the Financial Plan funding of £168.4m as the base budget for the Integrated Joint Board for 2018/19.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD delegated revenue resources of £45.829m to Scottish Borders Council and £122.528m (including Set Aside) to NHS Borders to deliver services in 2018/19 in line with the strategic plan.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that any expenditure in excess of these delegated budgets in 2018/19 will be funded by additional contributions from the partners in line with the approved scheme of integration.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the commitment to producing a Financial Recovery Plan and the work being done to progress developments to deliver efficiency schemes.

The Chair asked for comments on the revised Terms of Reference as proposed by the Strategic Planning Group.

The Chair agreed to amend an expectation of the Strategic Planning Group members to ‘Contribute to the ongoing development of the Strategic Plan’ on page one of the document.

Mrs Karen Hamilton advised the appendix containing the group members would change quite frequently due to staff turnover and moving to different roles in the organisations. The Chair agreed the membership should be updated by the administration lead for the Strategic Planning Group whenever a change arose, to keep the document factually accurate.

The Chair also agreed for a second appendix to be added containing the contact details for each group member.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the revised Terms of Reference for the Strategic Planning Group, based on the above amendments.

Mr Robert McCulloch-Graham gave an overview of the report and highlighted the next steps to be carried out in the option appraisal process.

Dr Angus McVean advised he had spoken to the GPs at Eildon Medical Practice who had reviewed and agreed the report. It was advised the GPs were looking to withdraw from the practice by October 2019 and therefore a contingency plan for service level provision was required until a solution was in place.

Mrs Carol Gillie advised there were a number of contingency options being considered and Dr Cliff Sharp would be discussing those with the Eildon Medical Practice Partners on 18 December 2018.

Cllr Elaine Thornton-Nicol advised a petition from patients of Eildon Medical Practice had been presented to Dr Cliff Sharp following the Integrated Joint Board Meeting on 22 October 2018. The Chair advised the petition was technically received by NHS Borders and therefore should be noted as such.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the work undertaken to date.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the further development of the financial appraisal to determine a final preferred option.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted receipt of a Petition.

Papers to follow – Appendix 2018-60

Mr Mike Porteous gave an overview of the content of the report and highlighted the forecast year end position.

Dr Angus McVean asked for the term ‘GP Prescribing’ to be renamed to ‘Prescribing’.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the forecast financial position for the Partnership for the year to 31 March 2018/19, based on available information.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the progress in securing brokerage which provides assurance that in year overspends will be covered.

Mr Robert McCulloch–Graham gave an overview of the content of the report and highlighted the proposal for Locality Working group administration support; Healthy Lives week and the Carer’s Strategy.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the Strategic Planning Group Report.

Cllr Tom Weatherston provided an update on the involvement of Integrated Joint Board members in the annual review 2018/19 of the Local Code of Corporate Governance, further to the discussion at the Integration Joint Board Audit Committee held that morning. That engagement could be tied in with a future Board Development Session.

Mr Malcolm Dickson provided an update on NHS Borders internal audit of unscheduled care flow, further to the discussion at the NHS Borders Audit Committee on 11 December 2018.

Mrs Jill Stacey advised a paper would be brought to a future Integration Joint Board meeting on the Accounts Commission Report November 2018: Health and Social Care Integration update on progress.

The Chair advised the Integration Joint Board Development Session was being rescheduled from November 2018, with the date of 14 January 2019 in mind but yet to be confirmed. Mr Robert McCulloch-Graham gave an overview of the intentioned aims of that session.

Mrs Carol Gillie advised that the NHS Borders Endowment Fund Board of Trustees meeting was scheduled for 14 January 2019 and therefore many NHS Borders representatives would be unable to attend. Dr Angus McVean also advised it would be difficult to ensure sufficient clinical and GP attendance on that date, due to the lack of notice and the busy period of time.

The Chair agreed that new dates in March 2019 should be sought for the development session and advised further information would be circulated in due course.

Mrs Karen Hamilton gave her apologies for the January Integration Joint Board meeting.

Monday 28 January 2019 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 28 January 2019 at 2.00pm in Committee Room 2, Scottish Borders Council.