Agenda and minutes

Apologies had been received from Cllr Jim Torrance, Cllr David Parker, Mrs Fiona Morrison, Ms Jenny Miller, Dr Sheena MacDonald, Mrs Tracey Logan and Mrs Elaine Torrance.

The Chair confirmed the meeting was quorate.

The Chair welcomed various attendees to the meeting.

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

Dr Stephen Mather raised the matter of two late papers (Chief Officer Report and Financial Regulations paper) being emailed to members the previous day and tabled at the meeting.  He confirmed that he and other members of the Integration Joint Board had been unable to read the papers in advance of the meeting and requested they be withdrawn and submitted to the next meeting.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to receive the Chief Officer report at the meeting and to defer the Financial Regulations paper to the Development session on 20 January 2016.

Monday 12 October 2015

The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 12 October 2015 were amended at page 2, paragraph 3, line 1, replace “Torrence” with “Torrance” and at page 4, minute 8, line 5, replace “Governance” with “Government”  and with those amendments the minutes were approved. 

Action Tracker

4.1         Minute 5: Consultation on the Draft Strategic Plan for Health & Social Care:  Clarification of dealing with Delayed Discharges was sought.  It was noted that Delayed Discharges was a feature of the Development session to be held on 20 January 2016, where a full discussion of the topic would take place. 

4.2         GP Representation:  Mr John Raine advised that it was for the Health Board to determine the GP representative on the Integration Joint Board, and noted that Mrs Pat Alexander had made a sensible suggestion of seeking a representative by inviting across all GP Practices, the GPs who wished to show an interest in being part of the Integration Joint Board or showed a contribution to the work of the Integration Joint Board, be considered and formally appointed by the Health Board. 

Mrs Susan Manion confirmed that discussions had taken place with the GP Sub Committee, which was the usual engagement route for the Health Board to GP Practices in that regard.  She further commented that information on the new GP contract was anticipated and had the expectation that GP leads would be identified for each GP Practice on a cluster basis in localities and the finer details of that would be discussed with colleagues across primary care.

Dr Angus McVean commented that GPs would welcome the broadening of input into the process and suggested the Health Board might consider clarification of the role and function of the GP representative to the Integration Joint Board, were they to represent the GP community across Scottish Borders or as an interested individual. 

Mrs Alexander noted the parallel between the GP representative and the Third sector representatives to the Integration Joint Board.  Cllr Catriona Bhatia suggested the Organisational Development plan might assist. 

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

Verbal update by Director of Strategy

Dr Eric Baijal advised that the formal consultation had concluded on 11 December 2015.  Cllr Catriona Bhatia noted the different methods of consultation used and looked forward to hearing the substance of the feedback.  Mr David Davidson enquired how many people had actually participated in the consultation.  Dr Baijal gave a commitment to circulate that information to the Integration Joint Board. 

Mr Davidson enquired if all of the opportunities to engage through social media had been used.  Cllr Bhatia noted there had been over 100 people present at the interchange session and Mrs Susan Manion confirmed there had been a very good turnout at each of the engagement sessions that had been held. 

Dr Baijal confirmed that there was sufficient feedback to be able to analyse it by locality.

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

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to receive the consultation participation numbers from Dr Eric Baijal by email. 

Director of Workforce & Planning, Chief Officer HR

Mrs June Smyth gave an overview of the content of the plan and advised that it remained a working document.  It had been designed around the development of the Integration Joint Board, Strategic Planning Group and Health and Social Care Management Team.  She further commented that she was keen to take forward something around the Joint Staff Forum at a future point. 

Dr Eric Baijal welcomed the Organisational Development (OD) Plan and suggested inclusion of the Integration Joint Board establishing “Vision and Values” and inclusion of a risk commentary at the end of the plan to mitigate some of the issues, given the activity was heavily loaded towards the early months of the year.  It was noted that some of the dates seemed challenging in relation to the March 2016 deadline. Mrs Smyth agreed to revise with the managers and Integration Joint Board to ensure realistic implementation.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the updated Organisational Development Plan.

The HEALTH AND SOCIAL CARE INTEGRATON JOINT BOARD requested the Board Secretary confirm the outstanding appointments for the Integration Joint Board members with Mr George Hunter.

Jane Douglas, Principal Assistant SC&H

Mrs Jane Douglas gave an update on the Dementia Strategy and highlighted several key elements including: commitments 10 and 11 had launched as national strategies; reconstitution of the dementia training group; funding of stress and distress training for staff; formation of enhanced dementia team; development of dementia friendly communities;  and evaluating the effectiveness of the objectives moving forward.

Dr Angus McVean noted the progress made with post dementia support and enquired if more focus was now required on the post diagnostic dementia element.  Mrs Douglas agreed that more focus on raising awareness was now required. 

Mrs Evelyn Rodger welcomed the detailed paper and suggested a gap analysis against the strategy be produced to enable clear sight of progress and the difficulties to be mitigated.

Mr John McLaren noted the approach to train up 500 staff in distress/stress training and enquired if there would be a further roll out to staff.  Mrs Douglas gave a commitment to clarify the position and advise Mr McLaren outwith the meeting.

Cllr John Mitchell enquired if the Scottish Dementia Working Group had branches UK wide and if the service required volunteers?  Mrs Douglas confirmed that the group was made up of those who already had dementia, for those with dementia and there were several main groups across Scotland that linked together and into Alzheimers Scotland.  She confirmed the intention to set up a branch in the Scottish Borders and advised that recruiting those with dementia to the group was currently underway.

Mr John Raine commented that he was encouraged to hear Dr McVean express a need to increase the rate of diagnosis and he sought quantification against the objectives.  He further queried why the Enhanced Dementia Team had concluded given the suggestion had been that it was ahead of its time.  Mrs Douglas confirmed that work was required to reframe, relaunch and implement alongside other existing teams. 

Mrs Jane Davidson encouraged the Integration Joint Board to consider how the strategy would influence the strategic commissioning plan moving forward and how it would contribute to the outcomes set by the Integration Joint Board.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the report and agreed to receive an update in April 2016. 

Programme Manager

Mr James Lamb gave an overview of the content of the report, highlighted several key elements including: stock take; transition from phase 1 to phase 2; programme plan to phase 2; and introduce of the new programme manager.  Whilst the Joint Staff Forum was not mentioned in the paper Mr Lamb recorded that credit should be afforded to them for their input to the engagement sessions and the position engagement that had taken place with both management, staff and unions.

Mrs Sandra Campbell, gave an overview of the content of Appendix 2 highlighting the formation of a small focus team to oversee delivery and address any risks and difficulties.  She further commented that there would be a rationalisation of the current working groups to ensure they were outcome focused with clear delivery plans and they would include the commissioning and implementation plan; locality plans; performance monitoring work; and the integrated care fund plan.

Mr John Raine raised issues of governance in regard to the Integrated Care Fund.  Mrs Susan Manion suggested addressing those issues during the Integrated Care Plan Update item later on the agenda.

Cllr John Mitchell suggested there remained gaps in the plan to be addressed before “business as usual” could commence.  Mrs Campbell confirmed that names, dates and plans were being clarified so that implementation could progress. 

Mrs Karen Hamilton highlighted several typographical errors within the document.

Mr David Bell noted that the revised Draft Scheme of Integration stated that the Integration Joint Board “may” set up a Joint Staff Forum and he requested that the Integration Joint Board reaffirm its commitment to a Joint Staff Forum.  Mrs Manion commented that the change had been made on the advice received from Scottish Government.  Mrs Jane Davidson clarified that it referred to the Integration Joint Board having the ability to set up a Joint Staff Forum the same as it had the ability to set up an Audit Committee.  She assured both Mr Bell and Mr McLaren of the commitment of NHS Borders to the Joint Staff Forum.

Mrs Manion recorded her thanks to Mr Lamb for developing the programme and bringing it to the point of moving into implementation. 

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

Mr David Robertson arrived.

Mrs Susan Manion gave an overview of the report.

Dr Stephen Mather commented that delayed discharges were a risk to the system over the winter period and he enquired about the current position in regard to delayed discharges and social care provision.

Mrs Marion referred to the presentation and discussion at the recent NHS Board meeting which had outlined in detail the actions being taken in support of the winter plan. She advised that there were some 30 delayed discharges with pressures across both health and social care systems.  Operationally a number of different options were being taken forward. 

Mrs Jane Davidson suggested the Integration Joint Board needed to commit to deliver against the Delayed Discharges target.  He further commented that bearing in mind there were 2 different organisations that had come together, the Integration Joint Board was the ideal body to look at the total outcome from both commissioned services.  The Integration Joint Board should commit to ensuring both bits worked for the collective good and in future he wished to receive reports that tied the 2 parts of the journey together. 

Mr David Davidson commented that it should also be looked at to what extent services were able to reduce admission to hospital. 

Cllr Catriona Bhatia highlighted the immediate winter plan issues and the longer term strategic issues of preventing admissions in the first instance.

Dr Angus McVean suggested looking at the bigger picture of readmission rates.  Mrs Davidson advised that Mrs Jane Douglas and others from health were reviewing readmissions as a specific issue and would be engaging with GPs to work out what was of concern as it appeared to be a holistic issue. 

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

Chief Officer

Miss Iris Bishop gave an overview of the business cycle and meeting dates for the 2016.

Cllr John Mitchell suggested revisiting the choice of venue for Development sessions in order to reduce any costs. 

Mrs Jeanette McDiarmid enquired about the formal approval by Scottish Parliament of the Scheme of Integration in regard to impact on meetings in 2016.  Mrs Susan Manion advised that once approved by the Cabinet Secretary it would be laid before Parliament for 28 days.  Formal approval was therefore expected to be received by 6 February 2016 which would mean the Development session on 7 March would commence as a formal meeting for the first hour or so to formalise the Health & Social Care Integration Joint Board.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the meeting dates and business cycle for 2016.

Chief Financial Officer, Director of Finance

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer the paper to the Development session on 20 January 2016.

Mrs Jane Davidson left the meeting.

Director of Finance/Chief Financial Officer

Mrs Carol Gillie gave an overview of the report and highlighted the overspend on NHS drug costs and confirmed that a breakeven position would be achieved at the year end.  In regard to local authority adult services she confirmed that there was a projected overspend and a number of actions were being taken forward to address the position.

Mr David Robertson commented that in relation to Scottish Borders Council there was an overspend at this point in the year as additional residential and flex beds were commissioned.  The current budget was for about 50 beds however activity levels were greater and there had been additional pressure from two major care home contracts being passed back to the Council during the current financial year.  Actions were being taken forward to address the pressures. 

Mr David Davidson suggested the Integration Joint Board receive assurance on the stability and sustainability of some of the services that Border residents relied on especially during the winter period. 

Cllr Catriona Bhatia outlined that in terms of strategic commissioning, Scottish Borders Council provided 50% of home care provision and the private/third sector provided 50%.  However, that balance had now moved to 60% Scottish Borders Council, 40% private/third sector.  She suggested that in future the Integration Joint Board would receive a report in relation to qualitative and quantitative elements across the range of services provided.

Mrs Jeanette McDiarmid highlighted that costs of other providers were increasing and the dilemma was the ability to meet the increase in costs or use SB Cares as an alternative.

Mrs Karen Hamilton commented that it was important the Integration Joint Board was sighted and aware of the consequences for service users and patients.

Mrs Pat Alexander enquired in regard to the GP prescribing budget if any work was underway nationally in terms of direct contact with drug companies.  Mrs Gillie confirmed that the NHS Board Directors of Finance were working collectively on the matter. 

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the reported projected position of overspend by £891k at 31st October 2015 and noted that both organisations were working to address the financial pressures and put in place actions to ensure financial targets were delivered.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted that Budget Holders/Managers would continue to work to deliver planned savings and deliver a balanced budget.  Where this was not possible managers would work to bring forward actions to mitigate any projected overspends.

Chief Officer

Mrs Susan Manion advised that the Integrated Care Fund (ICF) plan had been agreed the previous year in line with the criteria for the funding given at that time.  The ICF Plan had been developed to assist in meeting the national outcomes and had been mindful of the lessons learnt from the Change Fund programme.  Rather than seeking bids, work was done to commission key pieces of work to achieve outcomes   Commissioned projects were taken through the ICF Programme Board and Strategic Planning Project Board before being submitted to the Integration Joint Board.  Mrs Manion recalled that Mr Raine had been concerned that the Integration Joint Board was not sighted on how the ICF monies were being used and that the governance routes were unclear.  She suggested that the governance arrangements be refreshed and the plan be updated. 

Mr David Davidson enquired if the ICF monies were spent without the direction of the Integration Joint Board?  Mr Raine clarified that it was a similar point that he had tried to raise earlier seeking clarification on how the Integration Joint Board satisfied itself that it had proper governance over the £6.3m over the next 3 years, when the report before the Integration Joint Board gave a schedule of schemes which could not determined as to what they were, how they were prioritized and what they were delivering. 

Mrs Carol Gillie confirmed that earlier in the year the governance arrangements around the ICF had been agreed and it had been confirmed that the Integration Joint Board delegated the authority to approve project funding to the ICF Programme Board and had asked for six monthly update reports.  She summarized that the ICF Steering Group reviewed each project against the criteria which included outcomes, sustainability and financials, the ICF Programme Board had authority to approve up to £75k anything above that level was escalated to the Strategic Planning Project Board.  It was obvious that by the time the update was submitted to the Integration Joint Board it was presented as a very high level update with the detail removed.

Mr David Robertson clarified that the budget for 2015/16 for the ICF was £2.1m with a projected spend of £470k by end of March 2016.  Discussions had taken place between Mr Robertson and Mrs Gillie in regard to passing the resource to Scottish Borders Council to carry forward. 

Mr Davidson enquired if the Health Board had made a formal arrangement to ring fence the money when passing across to Scottish Borders Council in terms of audit.  Mrs Gillie confirmed a formal arrangement had been made to satisfy NHS audit purposes.

Cllr Bhatia noted that the report was light on detail in relation to the projects themselves. It was agreed that, as well as a refresh of the governance arrangements, more detail on the agreed pieces of work would be outlined at the next meeting.

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to a refresh of the ICF governance arrangements and an update  ...  view the full minutes text for item 13.

Chief Officer

The HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the committee minutes.

The Chair confirmed that the next Integration Joint Board Development session was being held on Wednesday 20 January 2016 at 9.30am, at Tweed Horizons.

Dr Stephen Mather recorded his apologies for the Development session.

Monday 1 February 2016 at 2.00 pm in Committee Room 2, Scottish Borders Council

The Chair confirmed the next meeting of the Health & Social Care Integration Joint Board would be held on Monday 1 February 2016, at 2pm in the Council Chamber, SBC.