Agenda and minutes

Apologies had been received from Mrs Karen Hamilton, Dr Sheena MacDonald, Mrs Evelyn Rodger, Mr David Bell, Mr James Lamb, Dr Eric Baijal and Miss Iris Bishop.

The Chair confirmed the meeting was quorate.

The Chair welcomed Mr Simon Burt, Interim General Manager Mental Health and Learning Disabilities Services and Ms Carin Petterson, Communications Officer to the meeting. The Chair also welcomed Mrs Marie Briggs, Administrative Assistant who minuted the meeting in Miss Bishop’s absence.

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.

Monday 22 June 2015 (Appendix-2015-38)

Mr David Robertson requested that the following changes be made to the minutes of the previous meeting:

The minute reads “Mr Robertson confirmed that volatility in prescribing would continue…”  It should read “The board were advised that volatility in prescribing would continue…”

Following this change, the minutes of the previous meeting of the Health and Social Care Integration Board held on 22 June 2015 were approved.

Action Tracker (Appendix-2015-39)

4.1          Action Register: Integrated Care Fund Proposed Governance

Mrs Susan Manion stated that the note of when the Torbay model would be going live would be absorbed in the ICF six monthly report scheduled for 12 October 2015.

Director of Strategy (Appendix-2015-40)

Mrs Susan Manion gave an overview of the content of the report.  She reminded the Integration Joint Board that the final draft for formal consultation would be presented to Borders NHS Board on 1 October 2015 and to Scottish Borders Council on 8 October 2015, before being presented at the Integration Joint Board meeting on 12 October 2015.

Cllr Catriona Bhatia confirmed that as part of the process she and Mrs Pat Alexander would be meeting with the management team to request any further input. 

There were no further questions in relation to the report.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the draft Strategic Plan.

Programme Manager (Appendix-2015-41)

Mrs Susan Manion gave an overview of the content of the report. She highlighted that the status of the Scheme of Integration was currently “Amber” however it was still within the broad national timescales.  She also noted that the status of the Strategic Planning Framework was currently “Red”, however with the revised timescale the status had reduced to “Amber” and therefore was well within the broad national timescales.

Mrs Manion confirmed that the report would be redrafted and would be presented at the Integration Joint Board meeting on 12 October 2015.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed that a revised version of the Programme Highlight Report be presented to the next meeting on 12 October 2015.

Chief Officer (Appendix-2015-42)

Ms Susan Manion highlighted the changes to the meeting in terms of the minimum amount of meetings that should take place. The Standing Orders reflected that the Integration Joint Board would meet no less than four times per year on the basis that six formal meetings were held.

Mr John Raine felt that it was difficult to combine the standing orders of two organisations and requested clarification of the membership of the Integration Joint Board; voting members, non-voting members, others invited to attend.  Mr Raine stated that the Standing Orders should be clear as to how the Board was constituted as the current explanation could be misleading. Mrs Manion stated that the Board constitution could be verified in the legislative requirements.

MrRaine queried whether members who had pecuniary interests should be asked to leave the meeting rather than there be a restriction on participating in the debate. Mr David Robertson believed this to already be the case.  Mr Raine felt that this should be clearer in the Standing Orders.

Mr David Davidson noted that it stated clearly in the Standing Orders that “every question at a meeting should be determined by a majority of votes of the members present and who were entitled to vote on the question.”  Mr Davidson queried the outcome if two partner agencies disagreed.  Mrs Manion explained that this was highlighted in the Integration Scheme.  She confirmed that once the Integration Scheme was agreed this point could be added to the Standing Orders.

A discussion ensued relating to the circulation of all Integration Joint Board, Committee and Sub-Committee papers and whether they should be published seven days prior to the meeting or after the meeting.  The meeting agreed that the papers should be published seven days before any given meeting. It was also agreed that members of the Integration Joint Board should receive a copy of the papers seven days in advance of any given meeting. Cllr Bhatia confirmed that subject to amendments the Integration Joint Board agreed to operate the changes from that point of the meeting.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed the Standing Orders subject to amendments highlighted.

Chief Officer (Appendix-2015-43)

Mrs Susan Manion provided the meeting with a brief update on the development of the Integration Scheme.  The first draft was submitted at the end of March 2015 and comments were returned at the end of May 2015. Taking those comments into consideration a redraft was completed at the end of July 2015 and was submitted to Scottish Government on an informal basis for any further comment prior to formal submission by NHS Borders and Scottish Borders Council.

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

Communications Officer (Appendix-2015-44)

MsCarin Petterson advised the meeting that the Scottish Borders Health and Social Care partnership attended the Border Union Show in July 2015. The purpose of attendance was to gain feedback from the public on what was most important to them. The results indicated that ‘improved support for unpaid carers’ was marked as the most important, followed by 24/7 services and early intervention.

Mrs Elaine Torrance added that as an incentive to provide feedback the public were encouraged to enter a competition with the chance to win an IPad mini.  Entrants were asked to list ‘the top tip to improve health and social care services’.  Ms Torrance confirmed she would confirm what the top tip was when this information was available.

The meeting discussed the overview of the feedback received at the Border Union Show and it was noted that the location of where the feedback was gained should be taken into consideration when analysing the results.  For example; ‘transport links’ was not considered of high importance, however in some areas of the Scottish Borders transport links was an issue. This feedback was gained at a show where 90% of those attending came by car.  Mrs Jane Davidson felt it would be helpful to have information on where and from whom (staff or service users) the contributions were received.

MsPetterson confirmed that contributors were encouraged to mention any other additions they wanted to add if this was something that was missing from the list.

MsPetterson stated that a newsletter was under development with a focus on both staff and public engagement and a second draft of the communication plan would be completed.

MsPetterson confirmed that the Integration Joint Board had been presented with the new logo for the partnership which had been well received.

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

Interim General Manager MH&LD (Appendix-2015-45)

Mr Simon Burt provided the meeting with an overview of the Joint Mental Health Service and noted that the development of the Borders Mental Health Service had been in process since 2006.  The service had a clear focus on the principle that integration aimed to improve the service for service users.  Mr Burt highlighted the strategic direction of the service, the operational issues and the challenges faced by the service. He also explained the further developments to improve the service.

Dr Cliff Sharp referred to the separation and re-amalgamation of the Joint Mental Health Service from past to present. He noted that full integration was underway.  Considering that he highlighted the importance that joint integration set a positive example to frontline staff allowing them to fulfill their roles and responsibilities to meet the needs of the service.  Dr Sharp recognised that there were differences in the employing organizations policies which could cause issues, however highlighted the importance of managing that to be united.

Mrs Susan Manion acknowledged those important points and recognised the need to use the Joint Mental Health Service’s experience on integration to inform how development could be informed.

Dr Sharp spoke positively about the Communication Plan and acknowledged the importance that it reflected the views of staff as well as service users.

Cllr Jim Torrance reminded the meeting of the ongoing concern that both organizations used very different IT systems. He added that there were issues which needed to be overcome and queried the timescale of when they would be resolved. Mrs Jane Davidson recognised the concerns relating to IT and also noted that both organisations had separate Human Resources Services.

Cllr Catriona Bhatia queried the integration between GP’s and the Community Mental Health Teams (CMHT’s).  Dr Sharp stated that some mental health work was carried out by GP’s who only referred a small number of patients to the Mental Health Service. He noted that the CMHT’s had always had positive links with GP’s, however it had proven difficult to get GP’s to join the partnership due to constraints. Consideration was currently ongoing as to how to include GP’s in the partnership.

Mr David Davidson asked about the Borders Mental Health Service budget and whether it was combined or aligned. Dr Sharp confirmed that the budget was aligned.

Tracy Logan left the meeting

Mr Burt noted that as General Manager of the Learning Disability and Mental Health Teams, he was responsible for both Scottish Borders Council and NHS Borders service budgets.  He advised that there had been no real issues with budgets being aligned for that service.

Mrs Elaine Torrance stated that as well as concerns in terms of separate finances, there was also a concern about processes and procedures and how both services could integrate to provide a good service to the individual needs of the service user.  Mr Burt recognised the concerns, but stated that once staff bought into integration they would work together. He added that it was also important that the management team  ...  view the full minutes text for item 10.

Interim General Manager MH&LD (Presentation)

Mr Simon Burt presented the meeting with a PowerPoint presentation on Integration and the difference it could make to individuals. Michael’s story was shared with the meeting, which demonstrated how an integrated service and good partnership working could support someone with complex needs. The presentation considered what the service had done well and also what the service could have done better for Michael. In addition to that the Learning Disability Dementia Pathway and Post Diagnostic Dementia Pathway was explained to the meeting.

The meeting also saw a presentation relating to the role of Local Citizens Panels within Learning Disability Governance and some case examples of the influence that the Local Citizens Panels had on service users, carers, family members and communities.

Cllr Jim Torrance queried the assessment plan and whether it was prioritised on staff availability or based on service user needs. He also asked how long an assessment was likely to take. Mr Burt confirmed that the assessment was undertaken by a group of professionals who met regularly as a group and discussed those being assessed or who had been diagnosed. Risk and vulnerability was considered in terms of the priority of the service user.  Once the service user reached the age of 40, regular reviews of their care were held and the case is allocated. This could cause some more challenges in terms of capacity and currently there was a Social Work waiting list with service users being allocated in low or high priority. Mr Burt assured that allocations were taking weeks rather than months.

Mrs Jeanette McDiarmid asked if there was a single point of contact in place for service users who did not have an allocated Social Worker.  Mr Burt confirmed that work was ongoing towards having a named person for each service user. This was from within the joint team.

Ms Carol Gillie recognised that the presentation indicated what the service could have done better for Michael and felt that the Integration Joint Board should focus attention on deliverable and measurable outcomes.

Mrs Pat Alexander commented positively on Michael’s story and felt it would help people relate to the service. She queried whether Local Area Coordinators would have more involvement in the assessment stage.  Mr Burt explained that Local Area Coordinators would get involved if a person was struggling, however did not meet the health need to meet the criteria of referral.  The Local Area Coordinators met the needs of the person early to prevent the situation deteriorating potentially resulting in a drain of resources.  The Local Area Coordinator also worked with the person in the local area to set up or support them to find local activities to become involved in.

Mrs Elaine Torrance recognised that the Citizen’s Panel were community led, however felt that the locality approach might be more powerful to support the community to make the changes in their local area.  In addition to this the Citizen’s Panel needed investment and the community could not be expected to provide that  ...  view the full minutes text for item 11.

Director of Nursing & Midwifery (Appendix-2015-46)

Mr David Thomson shared the Transforming Nursing and Midwifery Roles report with the meeting.  Mr Thomson noted that part of the national programme, in conjunction with the Scottish Executive placed an emphasis on the provision of care in hospitals to home based care, recognising that it placed a different demand on nursing staff.

Cllr Jim Torrance recognised the benefits of community care, however queried whether it would increase the number of staff required in communities rather than in hospital. Mr Thomson confirmed that it might result in a transfer of hospital based staff to communities, however noted that he was not in a position to say where and who. He highlighted the importance that there remained the right number of staff to deliver an acute service to the public.

Mr Thomson went on to say that it would be brought together by considering the roles and qualifications of staff to deliver the required care taking into consideration how health care workers could be supported.

Cllr Frances Renton left the meeting.

A discussion ensued relating to the financial impact of moving resources from a central hospital to communities. The discussion progressed to discuss GP services and how that change would impact the service and the public. .

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the proposal and were assured that NHS Borders was fully engaged with the national work programme.

Chief Social Work Officer (Appendix-2015-47)

Mrs Elaine Torrance spoke of the role of the Chief Social Work Officer (CSWO). The CSWO’s role covered all social work and social care services and Mrs Torrance confirmed she was responsible for criminal justice services, child and adult protection, MHO services and out of hours social work.

Cllr John Mitchell asked about the reporting of critical incidents.  Mrs Torrance explained that adult protection and child protection case reviews were brought to the Critical Services Oversight Group (CSOG). In attendance was the Chief Executive of NHS Borders, Chief Superintendent of Police Scotland and the Chief Executive of Scottish Borders Council. Collectively CSOG identified cases which could have been handled better and were proactive in improving and addressing the issues. Mrs Torrance added that it was also her responsibility to provide that information in an annual report.

A discussion ensued relating to the recommendation of the report. 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the Role of the Chief Social Work Officer.

Director of Finance/Chief Financial Officer (Appendix-2015-48)

Mrs Carol Gillie introduced the Monitoring of the Integration Joint Budget 2015/16 report to the meeting. Mrs Gillie shared that the projected year end expenditure position had been calculated at £146,000 against the revised annual budget.  She noted that it was still very early in the financial year therefore the sum should be viewed with caution. Mrs Gillie noted that although the overall budget had been increased, the overall costs continued to increase.

Mr David Robertson confirmed that if the out turn position continued to the financial year end each department would be responsible for bringing forward action plans to contain the overspend.

Mr Robertson confirmed that the overspend was as a result of frontline staff services. Mr David Davidson acknowledged that, however he noted that in the future the government would expect service delivery regardless of funding. 

Mrs Susan Manion noted that in Mr Burt’s presentation he made reference to how resources could be reallocated to focus on the best outcome. He also recommended planning ahead to ascertain what the issues might be. Mrs Manion acknowledged the difficulty planning ahead, however highlighted the importance of balancing outcomes and numbers with demand and capacity.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the budget monitoring reports. 

Director of Finance/Chief Financial Officer (Verbal)

Mrs Susan Manion updated the Health & Social Care Integration Joint Board on progress being made towards the appointment of a Chief Financial Officer. Mr David Robertson confirmed that he and Mrs Carol Gillie had reached an agreed job description and the draft would be discussed with Mrs Manion and both Chief Executives. There were elements to the size and remit of the role that remained to be resolved. The vacancy would then be graded and advertised.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD will be notified on the process towards the appointment of a Chief Financial Officer once a decision has been made.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted there was no other business.

Monday 12 October 2015 at 2.00 pm in the Council Chamber, Scottish Borders Council

The Chair confirmed that the next meeting of Health & Social Care Integration Joint Board would take place on Monday 12 October 2015 at 2.00pm in the Council Chamber, Scottish Borders Council.