Agenda and minutes

Apologies had been received from Dr Jonathan Kirk, Dr Simon Watkin, Mrs Tracey Logan, Mr Andrew Leitch, Mrs Fiona Morrison, Dr Sheena MacDonald and Cllr Sandy Aitchison.

The Chair confirmed the meeting was quorate.

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

The H&SC INTEGRATION SHADOW BOARD noted there were none.

Monday 8 December 2014

The minutes of the previous meeting of the H&SC Integration Shadow Board held on 8 December 2014 were approved. 

Action Tracker

4.1       Newsletter:  Mrs Susan Manion advised that the newsletter was being taken forward with assistance from the Communications group.

4.2       Engagement with Community Councils:  Cllr Catriona Bhatia reminded the Board of the engagement process with Community Councils and confirmed that they had all received the Draft Integration Scheme for comment. 

The H&SC INTEGRATION SHADOW BOARD noted the action tracker.

Mr James Lamb set out the duty under legislation to set up a strategic planning group and gave an overview of the detail of the paper.  

Discussion focused on the size of the group and its decision making status, as well staff representation from health and the council.  Further discussion ensued and encompassed: representation from childrens services; balance of representation; joint staff forum representation; removal of childrens services representation; removal of suggestion that the group is a decision making body and reinforcement that it is influential with linkages.

The H&SC INTEGRATION SHADOW BOARD agreed to remove the reference to childrens services representation.

The H&SC INTEGRATION SHADOW BOARD noted the report subject to amendment. 

The H&SC INTEGRATION SHADOW BOARD agreed that 2 joint staff forum representatives join the Strategic Planning Group.

Mr James Lamb gave an overview of the content of the report highlighting the finalisation of the integration scheme and recruitment to the strategic planning group.  Mr Lamb tabled a paper advising of the details for the February Engagement Events.

Cllr Jim Torrance enquired if AHPs and nursing staff would be invited to the engagement events.  Mr Lamb advised that a series of events for staff had already been undertaken

During discussion several elements were highlighted including: engaging with community pharmacists; broadening the engagement to cover all stakeholders including Learning Disability, Care Homes, etc; an event in the Lauder vicinity; user stories; and the tight timescale for external engagement events.

Cllr Catriona Bhatia commented that all members of the H&SC Integration Shadow Board were welcome to attend any of the engagement events.

The H&SC INTEGRATION SHADOW BOARD noted the report.

The H&SC INTEGRATION SHADOW BOARD agreed that given the tight timeframe for invitations the first 2 events should be repeated at the end of the events cycle.

The H&SC INTEGRATION SHADOW BOARD approved the Business Cycle and Meeting Dates schedule for 2015/16.

Mr David Robertson presented the finance report.  Mr Robertson reported that as at 31 December 2014 the shadow integrated budget was predicting an outturn position of £0.378m overspent.  Managers continued to work on actions to manage the situation and were implementing a number of actions in order to try and ensure a break-even year end position.

Cllr John Mitchell noted that it was taking a while to address the prescribing overspend.  Mr Robertson confirmed that there were improvements in the underlying position and  Mrs Janice Cockburn confirmed that there remained volatility in the drug pricing however she continued to predict a year end break-even position.

Mrs Elaine Torrance noted the current position and enquired about the position once the budget was a single joint budget.  Mr Robertson commented that the detail of a protocol for dealing with overspends, should they arise, was being worked through.

Mrs Jane Davidson advised that the partnership would require clear guidelines around overspends and underspends.  She commented that as the partnership went through the final aligned year it would be good to see what mechanisms were in place and worked to best effect.  Mrs Davidson reminded the Board that Mrs Susan Manion would be a main budget holder for most of the services within the scope and she enquired about the mechanism for having further discussions in regard to disaggregation.

Cllr Catriona Bhatia suggested a Development session be held to look at how anomalies were to be dealt with.  Cllr David Parker agreed that as the Board were to be responsible for the monitoring and managing of budgets then they would need a basic knowledge in that area and supported utilizing a Development session for that purpose.

Susan Manion commented that it was important that during 2015/16 that protocols were established and tested and absolute clarity was in place prior to 1 April 2016.

Mr David Davidson suggested that Finance work up an agreement on contingencies, overspends, underspends, etc, so that a contingency could be available if necessary with strict rules and guidance on how it could be accessed if appropriate.  Cllr Bhatia agreed that this should be reconciled for the future as currently both the Council and the NHS handled this differently.

Cllr Bhatia suggested Councillors might like to attend a future Borders NHS Board meeting.

The H&SC INTEGRATION SHADOW BOARD approved the budget monitoring reports at Appendix 1 and noted the projected outturn position to 31 March 2015 reported at that time.

The H&SC INTEGRATION SHADOW BOARD noted that Budget Holders/Managers continued to work to deliver planned savings measures and bring forward actions to meet both underlying pressures and those currently projected.

Cllr David Parker left the meeting.

Mrs Susan Manion presented the strategic overview of the Integrated Care Fund as submitted to the Scottish Government.   She highlighted a number of pieces of work to take forward and where progress was being made.  She gave an overview of the specific work that had been completed to bring projects to a point of being agreed and the criteria against which they were funded appropriately.

A discussion ensued which focused on: the potential to pump prime a single initiative; child to adult partnerships; recognition of the different outcomes for those utilising Learning Disability and Mental Health services; early interventions to release funds upstream; and new services to be developed to be self sustaining.

Cllr Catriona Bhatia reminded the Board that it was not within their gift to decide how the monies were to be spent.  Dr Eric Baijal confirmed that technically the Board should note that various projects were being worked up and that the detailed business case for each project would be submitted to the H&SC Integration Shadow Board for approval.

Mrs Jane Davidson enquired how long the Integrated Care Fund was to run and it was confirmed as one year.

Mrs Pat Alexander suggested the Learning Disability and Mental Health services should be able to access the fund given the equalities agenda.

Mrs Elaine Torrance provided an assurance on child to adult transition.

Mr David Davidson suggested a future agenda item be outcomes and projected financial spend for all project choices.

The H&SC INTEGRATION SHADOW BOARD noted the report.

The H&SC INTEGRATION SHADOW BOARD agreed to receive a report on outcomes and projected financial spend for all project choices.

Mr Simon Burt informed the Board of the issues regarding the transition process for young people with additional support needs.  He spoke of the current services provided and the further work that could be taken forward to improve the outcome for service users. 

Cllr Jim Torrance questioned the need for a project person to provide guidance.  Mr Burt commented that the resource was not in the right place to support people through to adult services, currently people with needs fitted to the service instead of the service fitting into peoples needs. 

Mr Burt advised the requirement for the additional resource was to take a more objective look at what was currently being provided by who, where.  Mrs Evelyn Rodger commented that transitions were not easy, however, to put in place a project post ran the risk of the service becoming dependent upon that individual and she suggested using the various initiatives that were available such as LEAN methodology and improvement facilitators.  Mrs Rodger explained that the NHS funded a significant resource around improvement and redesign.  Mr Burt suggested those resources would be helpful however the Steering Group were of the opinion that expertise in transitions was also required. 

Mrs Rodger sought assurance that the project post would not become a one person dependent post.  Mr Burt responded that the post would be to use what was available in a more coherent way with a clear remit to work within the resources that existed to ensure the right people were in the right areas.  Mrs Rodger reiterated that the improvement teams could assist in that work.   

Dr Stephen Mather enquired if support for the project had already been agreed given the wording in the Integrated Care Fund paper on this matter.  Mrs Susan Manion advised that support would be sought from the Integrated Care Fund and specific costings would be brought to the H&SC Integration Shadow Board for approval with a recognition that the project post would need to be self funding. 

Mrs Jane Davidson reminded the Board that the Integrated Care Fund sat within the remit of the NHS and advised that it was essential to have a multi agency decision making group to ensure the fund was utilised to best effect.  Whilst the fund sat with the NHS and the NHS would be audited on it she was keen to make it as multi agency as possible and she suggested the multi agency mechanism for decisions could be discussed at a future H&SC Integration Shadow Board. 

Mrs Manion advised that the guidance set out that the Chief Officer would establish an Integrated Care Fund which would report through the H&SC Integration Shadow Board who would submit recommendations to the NHS Board for approval. 

Mrs Rodger enquired about the numbers of young people involved.  Mr Burt advised it was 10-12 as the principles applied to groups other than just Learning Disability services.  Mrs Rodger suggested drawing in child protection and being clear on numbers and links  ...  view the full minutes text for item 13.

Mr Alasdair Pattinson gave an informative presentation to the Board which focused on providing a seamless package of care from multi agency services to a single patient/service user.  He highlighted the work of the Kings Fund in examining seamless multi agency care provisions and spoke at length on the learning from the Torbay approach around achieving benefits for service users; reduction in communication failures; Torbay integration results; planning for change; firm foundations of joint working; data sharing; and a shift towards prevention and pro active care.

During discussion several issues were highlighted including: the barriers to progressing the Torbay approach and how they would be addressed; staff attitude to change; exchanging information; care planning and integrated resources; interaction with connected care project learning; evaluation of cost and benefits of a care coordinator role; organizational development plan and entire transformation plan; involvement of the voluntary sector seen as crucial to success; and re-enablement of community services.

In summing up the discussion Cllr Bhatia suggested taking the principles of the Torbay model and empowering the staff to change a patient journey in the current year and to provide feedback to the Board on the trials and tribulations of such a transformation.

The  H&SCINTEGRATION SHADOW BOARD noted the presentation.

The H&SC INTEGRATION SHADOW BOARD agreed to receive a story on a patient in Borders whose care had been transformed as a consequence of following the Connected Care/Torbay principles.

12.1     CH&CP:  Mr David Davidson enquired about how the work of the Community Health & Community Partnership (CH&CP) would be taken forward post April 2015 given that Housing and Childrens Services would not be within the remit of the H&SC Integration Shadow Board.  Mrs Jeanette McDiarmid advised that a paper was being worked up for the Board which would discuss the governance arrangements for those services.

The H&AC INTEGRATION SHADOW BOARD noted the update.

Monday 9 March 2015 at 2.00 pm in Scottish Borders Council.

The Chair confirmed that the next meeting of H&SC Integration Shadow Board would take place on Monday 9 March 2015 at 2pm in the Council Chamber, Scottish Borders Council.

The meeting concluded at 4.10pm.