Agenda and minutes

1.1        Apologies had been received from Cllr R Tatler, Elected Member, Ms L Gallacher, Borders Carers Centre, Ms J Amaral, Dr L McCallum, Medical Director, Mr S Easingwood, Chief Social Work Officer, Mr A Bone, Director of Finance, NHS Borders, Mrs J Smyth, Director of Planning & Performance, NHS Borders, Miss I Bishop, Board Secretary, NHS Borders, and Ms D Rutherford, Borders Carers Centre.

1.2        The Chair welcomed attendees and members of the public to the meeting including MrsC Wilson, General Manager Primary & Community Services, Ms C McElroy, Public Health Lead and Mrs E Dickson, Associate Nurse Director Acute and Mr I Ritchie, Aspiring Chair (shadowing Karen Hamilton).

1.3       The Chair confirmed that the meeting was quorate.

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.

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

Dr Rachel Mollart tendered a declaration of interest for the PCIP item (as Chair of LMC & Chief Negotiator of LNC). Dr Mollart advised that she would leave the discussion for that item.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the declaration.

17.05.2023

3.1    The minutes of the previous meeting of the Health & Social Care Integration Joint Boardheld on 17 May 2023 were approved.

Action Tracker

4.1       There were no matters arising.

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

5.1    Mrs Cathy Wilson provided an overview of the content of the proposal and highlighted:a in breach of contract and risk to the delivery of the bundle. Dr Tim Young gave an outline of the situation regarding the GP sustainability position and CTAC.

5.2    Mrs Wilson indicated that the presentation had been received at the Health Board meeting on 29 June 2023 where the proposal had been agreed in principle with certain caveats. She also intimated that a meeting regarding Polypharmacy would be taking place on 20 July 2023.

5.3    Mrs Wilson commented that further discussions would take place at the GP Executive following discussions with GPs regarding the TUPE of staff arrangements.

5.4    Mrs Wilson referred to the reserves from the IJB and noted any offset in savings would come from the Polypharmacy review. It was noted that it was a 3 year plan and an exit strategy was required. It was noted that Mrs Hazel Robertson has also written to the Scottish Government on the issue.

5.5    In response to the caveats referred to above, Mrs Karen Hamilton stressed the need for the recommendations and caveats to be included within the paper to ensure the IJB were fully aware of the position within NHS Borders. In addition, Mrs Hamilton referred to point 5.12 of the paper and the need to ensure the date was added and also raised concern at the use of the word “lucky” at point 5.15.

5.6    In response to a query from Mrs Jenny Smith regarding any benefits and impacts for the third sector, Mrs Wilson confirmed that engagement was underway complete stages 2 and 3.

5.7    Mrs Sarah Horan commented on the purpose & scope “realistic medicine” and intimated she would like to include “values-based care”. It was also noted that paediatrics had not been mentioned within the impact assessment.

5.8    Mrs Jen Holland referred to a social care proposal for pharmacotherapy and home care to reduce the amount of visits and reduce delayed discharges and highlighted the need to be coherent around priorities regarding efficiencies in health as well as health & social care.

5.9    Mrs Fiona Sandford referred to the “fragility of GP services” and noted NHS Borders had the highest vacancy rate for GPs than any other Health Board and commented that it was imperative to highlight that to the Scottish Government.

5.10 Mr Tris Taylor welcomed the approach outlined regarding the delivery of savings and the impact assessment section “improvement to health & equalities......” if there was increased capacity.

5.11 In response to a query from Mr John McLaren regarding GP payments, Mr Ralph Roberts intimated that the details of contractual parties were the responsibility of the Health Board and he was clear that it was not compensation and was paying for a contractual service around Polypharmacy. It was being funded through the funds available within the PCIP as they currently stood and the commitments of savings to fund on an ongoing basis until additional funding was received from the Scottish  ...  view the full minutes text for item 5.

6.1    Mr Chris Myers provided an overview of the content of the proposal and highlighted: the overspend on set aside services; the suggestion to accelerate the programme; the single assessment process; and role of the third sector.

6.2    Mrs Laura Jones highlighted the significant pressures currently within the whole system.

6.3    Mrs Jen Holland commented that “Discharge to Assess” was a fundamental whole system model.

6.4    Cllr Elaine Thornton-Nicol expressed concern regarding Single Assessment/Older People’s Pathways and the importance of communications signposting – right place, right care, right time.

6.5    Mrs Fiona Sandford highlighted the need to get the elective capacity back and the need to have the polypharmacy review undertaken before the anticipated winter surge which would assist with the overall health of the population.

6.6    Mr Ralph Roberts welcomed the paper and highlighted that it was a joint responsibility and noted there was a lot of work ongoing including improving flow and prevention. He further noted that the Scottish Borders had the worst levels of delays in Scotland and highlighted the need for collective working.

6.7    Mr David Robertson enquired what more could be done to prevent deconditioning in hospital resulting from the significant delayed discharges.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the position relating to acute hospital unscheduled care pressure outlined within the report.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the position relating to the Urgent and Unscheduled Care Programme Board.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the issue of a direction to NHS Borders and the Scottish Borders Council to commence the Surge / Winter planning process, and to develop and implement the following policies: single assessment and home to assess; and to work towards strengthened engagement with the third sector, and communications which promote community supports.

7.1       Ms Clare McElroy provided an overview of the content of the IIA report and highlighted gasp with the engagement work.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the IIA for Creating Hope in the Scottish Borders, prior to IJB

8.1       Mrs Hazel Robertson provided an overview of the content of the MSG self assessment and intimated that she had re-issued the Action Plan.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD endorsed the enclosed self-assessment process.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the associated action plan for delivering on the proposed improvement actions, prior to submission to the Scottish Government.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD requested an update to the IJB Audit Committee on progress against the delivery of the actions outlined in March 2024 from the Chief Officer.

9.1       Mr Chris Myers provided an overview of the content of the Annual Performance Report and Delivery Plan and indicated that the national level reporting cycle has changed, meaning local comparison would not take place until the national data was available in May 2024. Mr Myers indicated that he was currently working with Miss Iris Bishop in regard to the work plan and range of key themes for the coming year. He then referred to page 129 – development of a Delivery structure and indicated that the Joint Executive would have oversight in advance of the IJB, with escalation as and when required.

9.2       Mrs Fiona Sandford commented that the number of days spent in hospital when patients were ready for discharge was very concerning as it impacted patients health.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD proposed no changes to the draft APR.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the APR for publication.

10.1  Mrs Hazel Robertson provided an overview of the financial regulations and commented that they had been co-produced with colleagues in both NHS Borders and Scottish Borders Council.

10.2 Mrs Karen Hamilton acknowledged the large volume of work undertaken within the IJB and its partners.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted that the Regulations had been substantially reviewed by the IJB CFO and confirmed by SBC and NHSB. All outstanding matters had now been resolved.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted that the IJB Audit Committees approved those for implementation, replacing the current regulations.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD requested that the CFO implement those, making the required improvements in financial control, management and reporting, and communicating best practice to finance teams within the Partnership.

11.1 Mrs Hazel Robertson provided a presentation on the financial position.

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

12.1 Mr Chris Myers provided an overview of the content of the proposal.

12.2 Mrs Karen Hamilton referred to the new strategic planning objectives and asked if there was any core data available. In response Mr Myers referred to the unscheduled care element and intimated it would remain and was more around unpaid carers, social care and social work and primary care activity at a local level and the new national datasets would assist in understanding.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted and approve any changes made to performance reporting and the key challenges highlighted.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD directed actions to address the challenges and to mitigate risk.

13.1 Mrs Hazel Robertson referred to the Directions Tracker and intimated that the Audit Committee had indicated that some other factors would be relevant to consider such as materiality to the IJBs strategic direction and any legal issues or concerns. Consideration was also given as to whether to add any of the outstanding directions to the risk register.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the contents of the Directions Tracker.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the minutes.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the minutes.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted there was none.

Wednesday 20 September 2023

10am to 12pm

Scottish Borders Council and via Microsoft Teams

17.1 The Chair confirmed that the next meeting of the Scottish Borders Health & Social Care Integration Joint Board would be held on Wednesday 20 September 2023, from 10am to 12 noon through MS Teams and in person in the Council Chamber, Scottish Borders Council.