Agenda and minutes

Apologies had been received from Cllr John Greenwell, Mrs Lynn Gallacher and Mr Murray Leys.

The Chair confirmed the meeting was quorate.

The Chair welcomed Mr Stuart Easingwood to the meeting who was deputising for Mr Murray Leys.

The Chair on behalf of the Board thanked Cllr Helen Laing for her service as a voting member on the Board.

The Chair welcomed Cllr Elaine Thornton-Nicol as a voting member of the Board.

The Chair advised that he had received an informal positive response from the Chairman of NHS Borders in regard to potentially withdrawing the Integrated Care Fund (ICF) conditions, however the matter had yet to be formally approved by the Health Board.

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.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted there were none.

20 August 2018

The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 20 August 2018 were amended at page 2, last paragraph, line 1, to include “that in his opinion the” and at page 3, line 3, to read “Chair of the Community Councils Network” and at page 3, item 6 to amend the title to “Primary Care Improvement Plan (GMS Contract)” and with those amendments the minutes were approved.

4.1       Minute 5: Chief Officer’s Report: Mrs Karen Hamilton sought feedback on the review of the Prof John Bolton work to a future meeting.

4.2       Action 31 & Action 32: Mr Robert McCulloch-Graham advised that both actions would remain delayed until a clear position had been achieved by the Health Board. In the meantime it would be referred to in the regular budget monitoring reports.

A discussion ensued which highlighted: clarification on the delay in identifying savings; the complexities of producing a financial plan within a moving landscape; the risk of producing an incomplete report; management of financial pressures in both the local authority and the health board; operational delivery of strategic decisions could be restricted by the proportion of budget finally available to the Integration Joint Board (IJB); long term direction of travel set by the strategic plan; discussions taking place between the Health Board and Scottish Government in regard to a financial recovery plan over 4-5 years; IJB Audit Committee to discuss the external auditors annual report and evaluation of the financial sustainability of the IJB later that day; and potential to issue directions to contain expense.

The Chair sought a report for the next meeting on how matters would be addressed.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the action tracker and asked that a report be submitted to the next meeting to set out how financial matters would be addressed.

Mr Robert McCulloch-Graham gave an overview of the content of the report and highlighted 7 day discharges; public protection; secondment of Mike Porteous; recruitment to the Chief Officer post for Adult Social Care, a Group Manager post and several Healthcare Support Worker posts; and the set aside budget.

Discussion focused on: 7 day discharge and availability of transport; set aside deliberations; and positive progress on regional work on diabetes.

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

Cllr D Parker left the meeting.

Mr Mike Porteous gave an overview of the content of the report and highlighted the key elements which included: discussions between the Health Board and Scottish Government in regard to brokerage; the forecast financial position; governance around the content of the report; the Health Board financial forecast position and the financial gap; delegated functions forecast position and overspends of £6.1m; unidentified savings and £1m forecast pressures in prescribing and community hospitals; slippage on in year savings; sickness absence levels; expansion of the Hospital to Home and Craw Wood initiatives; and levels of brokerage required and key risks.

Cllr T Weatherston left the meeting

Cllr D Parker returned to the meeting.

Discussion focused on several key elements including: forecast demographic pressures; demand for dementia beds in the community; rates of sickness absence in the nursing community and how that was being addressed; acuity of patients; nursing vacancy rates; dashboard of sickness absence figures; and tendency to have legacy savings.

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 supported NHS Borders in its work to secure brokerage from the Scottish Government for 2018/19 and beyond.

Cllr T Weatherston returned to the meeting.

Mrs Jill Stacey presented the revised Local Code of Corporate Governance of the Scottish Borders Health and Social Care Integration Joint Board (IJB), that provided the framework for the corporate governance arrangements for delivering health and social care integration in the Scottish Borders as recommended by the IJB Audit Committee.

Cllr S Haslam left the meeting.

A robust discussion ensued which included the NHS voting member Mr T Taylor indicating his dissent.  Other members joined in the debate, including Mr C McGrath on behalf of the Public Partnership Forum supporting his contention that there was not sufficient time to look at this matter in depth and further discussions needed to take place. 

Various points were raised including: purpose of the document; legislative requirements following local authority governance principles; responsibilities of Board members and officers; good governance relates to culture and values and the code relies on the values of the partnership organisations not the actual Integration Joint Board; the strategic plan can be used to instil and reflect the IJBs culture, values and engagement in communities and with service users; the local code was evolving and an annual review would take place and allow Board members to feed into the process; no mention of a commissioning policy given the IJB is a commissioning body; annual financial audit process includes an evaluation and assessment each year against the previous version of the local code and improvements are being made and the code will continue to evolve; and potential inclusion in the next iteration of the code of sustainable, economic and social environmental benefits.

During the robust debate in response to Mr Taylor, Mr McCulloch-Graham stated that he saw two types of situations, one where the IJB was led by the community and where the IJB could lead public opinion on health.  Mr McGrath immediately interjected stating his opposition to that view as it was against the IJB Corporate Governance and the law.

Cllr S Haslam returned to the meeting.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer a decision until further discussion had taken place.

Cllr D Parker left the meeting.

Mrs Tracey Graham gave an overview of the content of the report and highlighted: improved engagement with communities; focus on improving sign posting; and the launch of Borders Healthy Lives week.

A discussion ensued which highlighted several areas including: resources for communications were provided by both the NHS and Local Authority communications teams; #yourpart campaign and how it relates to IJB outcomes; future discussion of the partnership plan; the strategy as well as signposting should include “ encouraging and collating public feedback”; developing improving relationships with the media; more focus on values and culture and the partnerships shared communications culture and behaviours; partnership to be clear about its opportunities to listen to communities and service users; strategic plan values were included in the communications strategy; and whilst there was no statutory duty to respond to journalists there was a statutory duty to engage and involve the public which should set the direction of the communications strategy.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the integrated approach to Partnership communication and the launch of the refreshed Health and Social Care Strategic Plan via the #yourpart campaign.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed the communication work streams and standard operating procedures and joint working principles outlined in the Partnership Communication Strategy.

Mr Robert McCulloch-Graham reminded the Board of the previous discussion and ratification of the report.

A discussion took place which raised several questions in regard to the report content including: how attendances in A&E were counted which was the number who turned up and the number who were admitted were explicitly linked in the reports; requested inclusion of the number of admissions that had been avoided due to SBCares or other packages of care being in place; assurance that the achievement of objective 2 is not at the expense of objective 3; if the key work of IJB is to interact and transform services and work co-productively, where was the efficacy of process to provide assurance; delay in providing delayed discharges comparison data across Scotland was due to a delay with the confirmed national data being available; in regard to co-production there were national standards for community engagement that could be used to match against as a self evaluation as well as providing an opportunity for the public to get involved; and requested inclusion of the number of discharges in relation to the number of readmissions.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD ratified the changes to the performance report as detailed in the report submitted to the Board meeting held on 20 August 2018.

Mr Robert McCulloch-Graham presented the joint winter plan and advised that the experience and learning from the previous winter period had been turned into actions for the coming winter period. He reminded the Board that the Integrated Care Fund (ICF) allocation had been agreed to drive forward 2 main pieces of work to relieve winter pressures in the system, namely Craw Wood and Hospital to Home.

Dr Angus McVean noted that whilst the winter plan appeared very robust he could not see any mention of primary care, GPs or District Nurses, who would be fundamental to the success of the winter plan. He further commented that he was concerned about formulating a plan without input from primary care services, although he was aware the plan was due to be submitted to the GP Sub Committee the following month. Mr McCulloch-Graham advised that there was a plan to enhance support around district nurses through Hospital to Home, to look at support to community hospitals and have a full discussion with GPs at the GP Sub Committee.

Further discussion focused on: concern around evening discharges, transport and ensuring family or carers were available; increases in social work admin to support social work 7 day a week provision; and inclusion of the transport hub and third sector support.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the Joint Winter Plan 2018/19.

(a)   Health & Social Care Integration Joint Board Development Session:
19 November 2018

·        Look Back: Look Forward

·        Public Protection Service

·        2019/20 Finance

·        Strategic Plan

Mr Colin McGrath spoke of his interpretation of legislation in regard to the Community Empowerment Act, his role as a representative of the PPF and the governance structure of the IJB. Cllr Tom Weatherston reminded the Board that every IJB across Scotland had the same voting members ie NHS Non Executives and Local Authority Elected Councillors.

Mr McCulloch-Graham raised the Strategic Plan.  Mr McGrath advised the IJB that at their latest meeting in August the Public Partnership Forum did not accept the Strategic Plan as it related to the PFF.

Monday 22 October 2018 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 22 October 2018 at 2.00pm in Committee Room 2, Scottish Borders Council.