Agenda and minutes

1.1 Apologies had been received from Mr T Taylor, Non Executive, Mrs H Robertson, Chief Financial Officer, Miss I Bishop, Board Secretary, Mrs L Gallacher, Borders Carers Centre, Mrs S Horan, Director of Nursing, Midwifery & AHPs, Mr A Bone, Director of Finance, NHS Borders, Mr R Roberts, Chief Executive, NHS Borders, Mrs J Smyth, Director of Planning & Performance, NHS Borders, Mrs J Amaral, Borders Community Action, Ms L Jackson, LGBTQ+, Mr P Grieve, Associate Director of Nursing P&CS, NHS Borders.

1.2 The Chair welcomed attendees and members of the public to the meeting including Mrs A McElrath, Interim Director of Dentistry and Mrs G Lennox, Head of Adult Social Work.

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.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted there were no declarations made.

20.09.23

3.1 The minutes of the previous meeting of the Health & Social Care Integration Joint Board (IJB) held on Wednesday 20 September 2023 were approved.

(a) H&SCP Delivery Report. 

4.1 Mrs Karen Hamilton commented that the meeting had become inquorate from item 12 in the meeting. She asked the Board to consider if any items from that point in that meeting were affected by being inquorate.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed that there was no impact on the further items discussed.

4.2 Minute 9: Mr Chris Myers advised the Mr David Robertson, Chief Executive, Scottish Borders Council (SBC) had written to COSLA in regard to the lack of provision for out of area placements.

4.3 Minute 8: Mr Myers commented that significant capacity had been brought into the system and although Delayed Discharges were currently sitting at 72, it was ahead of predictions in the surge plan, reflecting the level of work taking place.

4.4 Mrs Fiona Sanford complimented the improvement, but drew attention to the number of current delayed discharges in the system and asked the meeting if the discussion around that subject could continue.

4.5 Discussion then focused on: the challenges and causes of delayed discharges; financial pressures; rurality; patient’s individual wishes; family expectations; care home availability and capacity; impact of care home policy and criteria for eligible patients; feedback from the whole system operation pressures group that the IJB were carrying out the correct actions but the volume of delayed discharges meant visibility of results was taking longer to achieve; workforce challenges permeating throughout the health and social care system; an approach to the Scottish Government to consider a ‘rural weighting’ for the Scottish Borders, which would allow an uplift in pay for health care workers; the quality and relevance of data being used; public engagement feedback; and a recent advert for 20 vacancies had attracted over 100 applicants which appeared to suggest an anomaly with recruitment issues and available people to employ.

4.6 Dr Lynn McCallum noted that at the centre of all discussions was the patient and most delayed discharge patients wanted to be at home, but many were frail and needed care packages in place to support them to return home. Delays in arranging packages often extended hospital stays.

4.7 Dr Rachel Mollart suggested that the message about the lack of social care beds appeared to be more widely known by the public and she acknowledged that there were budget constraints to be worked too. She also commented that GPs priorities were the patients who were medically sick.

4.8 Mrs Jen Holland commented that limiting factors, such as staffing, finance and increasing demand remained key challenges. She suggested there needed to be Page 3 of 7 more focus on what was bringing people into hospital, looking at the reablement process, faster decision making in hospital and putting resource in the right places to provide the support needed for the people of the Borders.

4.9 Cllr Thornton-Nicol suggested the partner bodies of the IJB should commit to working even closer together to resolve the issues of delayed discharges and to look to preventing patients arriving at the front door  ...  view the full minutes text for item 4.

5.1 Mr Chris Myers updated the IJB on progress with the Directions Tracker and highlighted that 6 actions were complete and 12 were in progress and the palliative care review would be moved to 2024.

5.2 He anticipated that the Primary Care Improvement Plan (PCIP) would benefit from a recent application to the PCIP Demonstrator Site. A bid had been submitted, follow up interviews had taken place and a positive outcome was awaited.

5.3 Mr Myers agreed to meet with Cllr Thornton-Nicol outwith the meeting to further discuss elements of the delivery report.

5.4 Mr Myers offered to update members via a briefing about the on-going digital work that SBC and NHS Borders were progressing with CGI. It was anticipated that the development of digital packages would change and enhance the way carers worked.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the contents of the Health and Social Care Partnership Delivery Report.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted that Mr Myers would produce a briefing note for members on the on-going digital work.

6.1 Mr Chris Myers commented that Kelso Medical Group had given notice to discontinue medical support of Kelso Community Hospital from the end of March 2024. The practice were contracted through the Health Board to provide the service and were moving to focus on the sustainability of their General Practice core work. He further commented that the Heath Board had also received notice from the Doctor supporting the Knoll Hospital, that they would retire and discontinue medical support from the end of March 2024. The discontinuation of medical support had enabled the bringing forward of planned work around a care model for the 4 community hospitals, recognising the changes in health care provision since the conception of the community hospitals.

6.2 Mrs Cathy Wilson explained that a steering group had been set up which met every 2 weeks and included staff, patient representatives and members of the public. The steering group were working on medium to long term plans which should be available Page 4 of 7 in December. A delivery group had also been set up to meet on a weekly basis to progress any resulting actions.

6.3 A discussion followed that highlighted: examination of data about patients currently using the community hospitals; what the patient’s needs were; the level of care required and if it was medical or nursing; average length of stay in community hospitals; governance to be adhered to in regard to a Doctor’s presence in community hospitals; the potential risk of bed closures without a Doctor’s presence; high levels of public and staff concern about the future of community hospitals; recruitment of geriatrician doctors; and the recognition that 70% of patients in community hospitals did not require the care of a Doctor, but did require a package of care.

6.4 Mrs Wilson reassured the Board, that everything was being considered. 6.5 Mr Nile Istephen noted that whilst there were clear processes in place, the IJB could explore more innovative ideas.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the situation in relation to medical cover at Kelso and Knoll Community Hospitals from 1 April 2024.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the work that will start to review the future model of care for the Community hospitals.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that the work would require significant public and staff engagement.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that linked work had started to identify and assess options for ongoing medical cover for the Community Hospitals from April 2024.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed to issue a direction to NHS Borders.

7.1 Cllr Tom Weatherston commented that the report was self-explanatory and illustrated progress made over the past year. Mrs Jill Stacy noted there had been a delay in bringing the report to the IJB and highlighted that work was on-going to improve the report in order to make it more effective.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the IJB Audit Committee Annual Report 2022/23 which presented the self[1]evaluation of the Committee’s performance, effectiveness and areas of improvement, based on the outcomes of its self-assessments using the CIPFA Audit Committees Guidance.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD acknowledged the assurances from the IJB Audit Committee to the Integration Joint Board and its identified areas of improvement to enhance its effectiveness as a scrutiny body.

8.1 Mr Chris Myers introduced the Quarterly Performance Report and commented that there were gaps and omissions within the data as it was a work in progress and would be completed at a later stage. He advised that new metrics had been included in regard to social care unmet needs, information about GPs, child and adolescence services, psychotherapy and workforce challenges. He drew the attention of the Board to the demography of the Scottish Borders which was some 30 years ahead of the rest of Scotland in terms of an aging population.

8.2 Mrs Karen Hamilton commented that the report contained a wealth of data, but the July data was now out of date and she enquired if the data for the report could be brought forward to be more relevant. She also enquired if it was possible to look at capacity outwith the Health Board when looking at vacancies in social care.

8.3 Mrs Jen Holland commented that there was a bed based report on available beds in social care and the data was shared daily with the Discharge Team. She reminded the Board that social care provision and care homes had to comply with Care Inspectorate regulations. demands. She also acknowledged that there were complexities in gathering data from the social care sector due to different reporting and recording mechanisms, which meant not all data was available equally. Mrs Holland also explained that the criteria for a patient’s suitability for a bed was changing and with Care Inspectorate guidance, moving people around the system was no longer as straightforward. She suggested it might be useful to gather data on self-directed care.

8.4 Mrs Jen Holland advised that she would be meeting with Mr Myers and Dr McCallum to further discuss the provision of social care and care home beds.

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

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

9.1 Mr Chris Myers delivered the Strategic Risk Update and highlighted the level of on[1]going work to align the risk report to the strategic objectives and the actions and controls put in place to reduce risk. The biggest risk to the IJB was increased demand coupled with financial restraint.

9.2 There followed a discussion about risk and its effect on performance. The inadvertent transfer of risk was considered, but overall the Joint Executive were managing risk collectively.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD considered the reframed and refreshed IJB Strategic Risk Register to ensure it covered the key risks to the IJB.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the work in progress to manage the risks.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that a further risk update would be provided in 2024.

10.1 Mrs Adelle McElrath provided a brief overview of the content of the update and commented that the recent changes brought in by the Scottish Government were progressing well.

10.2 Mr Chris Myers commented that the work carried out in gathering the correct data had led to the Scottish Borders being recognised as a rural area for dentistry which had in turn led to an increase in funding for dentistry.

10.3 Discussion followed that focused on: the reach of the dental service; providing national and local initiatives; and the impact of dental services and how they fitted into the wider framework.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the ongoing concerns regarding access to NHS dental care across all areas of the Scottish Borders and that they would be kept under close review for a further update in three months to consider the implementation of the new dental payment reform.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that this risk was being managed closely both operationally and strategically.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that a strategic plan for oral health and dental services was being developed based on the recommendations of the local Oral Health Needs Assessment

11.1 Due to long term sickness absence this item was withdrawn.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the business plan and meeting cycle for 2024.

13.1 Mrs Gwyneth Lennox introduced the Chief Social Work Officer (CSWO) report produced by Mr Stuart Easingwood. She reflected that it had been a busy year with both challenges and successes. She highlighted the recent inspections that had been undertaken and the positive feedback received, in particular the adult support and protection and children at risk inspection. It was noted that challenges were increasing across all areas, with workforce recruitment issues and increased demand on services.

13.2 Cllr Tom Weatherston complimented the social work department for an excellent report.

13.3 Cllr Elaine Thornton- Nicol noted the challenge around recruiting social workers and thanked Mrs Lennox for presenting an outstanding public protection report.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report from the Chief Social Work Officer.

02.08.23

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 24 January 2024

10am to 12pm

Scottish Borders Council and via Microsoft Teams

16.1 The Chair confirmed that the next meeting of the Scottish Borders Health & Social Care Integration Joint Board would be held on Wednesday 24 January 2024, from 10am to 12pm through MS Teams and in person in the Council Chamber, Scottish Borders Council.