Agenda and minutes

1.1 Apologies had been received from Cllr E Thornton-Nicol, Elected Member, Cllr R Tatler, Elected Member, Mr J McLaren, Non Executive, NHS Borders, Mr T Taylor, Non Executive, NHS Borders, Ms L Gallacher, Borders Carers Centre, Ms J Amaral, Borders Community Action, Mrs J Smyth, Director of Planning & Performance, NHS Borders, Mrs S Horan, Director of Nursing, Midwifery & AHPs, and Ms L Jackson, LGBTQ+.

1.2 The Chair welcomed attendees and members of the public to the meeting including Mrs S Errington, Interim Director of Planning & Performance, Dr A Cotton, Associate Medical Director MH&LD, Ms J Glen, Operations Director, Adult Social Care, SBC, Mr B Davies, Head of Strategic Commissioning & Partnerships, SBC and Mr P Lerpiniere, Interim Director of Nursing, Midwifery & AHPs.

1.3 The Chair recorded the thanks of the IJB to Mrs Jen Holland for her support to the Board and wished her well in her new role as Chief Executive of Edinburgh Leisure.

1.4 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 none declared.

15/11/2023 (Copy attached.)

3.1 The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 15 November 2023 were approved.

(a)       Action Tracker

(b)       Health and Social Care Partnership Performance and Delivery Report

(Copies attached.)

4.1 Action 2023-2: Mr Chris Myers advised that a briefing session would be organised for members for a maximum of one hour.

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

5.1 Mr Chris Myers gave a slide presentation which highlighted some key elements of the report including: CAMHS waiting times; what matters hubs; pharmacy review of social care service users; and increasing carers support plans; finance, workforce capacity challenges; projected outturn for the year at the end of October of just under a £7.4m overspend; Teviot and Liddesdale day services; PCIP demonstrator site; community hospital medical cover; delayed discharges and surge plans;

5.2 Discussion focused on: What Matters Hubs; frequency of hubs; ethos of the hubs; cost benefit analysis; early intervention prevention agenda; key financial pressure areas within health; pressure in adult social care services; learning disability client specific costs; A&E pressures; older people’s service revised base budget from £24m to £16m; what was within the gift of the IJB to resolve in regard to surge beds; the health board would be unable to support surge beds moving forward; continue to work on the risk to community hospitals; any data on admissions to hospital due to care at home failing as opposed to admission due to medical reasons; potential to be a pathfinder board in relation to care home admissions and professional to professional discussions to support people to remain at home; and delayed discharges are counted per episode ( when fit on the list and when become unfit due to waiting you are removed from the list until you become fit again) and an analysis is within the delivery report.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the contents of the Health and Social Care Partnership Performance and Delivery Report, reviewed the performance highlights and exceptions, and overall delivery against Directions.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD supported the standing down of IJB Direction SBIJB-190723-2 on the basis of the successful bid for the PCIP Demonstrator site and the associated funding.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD considered whether any further recommendations should be made at a strategic level in relation to areas highlighted within the report, in order to inform the ongoing prioritisation of the approach of the Health and Social Care Partnership within the remainder of the current financial year, and/or to inform the 24/25 HSCP Delivery Plan and 24/25 Financial Plan.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD requested to receive an explanation of the line “older people’s service revised base budget from £24m to £16m” as detailed within the financial charts.

6.1 Mrs Jen Holland provided an overview of the content of the paper in regard to the proposal to reduce the night support service from 5 night support teams to 2 rapid response teams. She advised that the service users that were directly involved in the Pathfinders, particularly those in the Peebles area, found it a positive experience with a slightly different picture in the Duns area.

6.2 Mrs Debbie Rutherford highlighted that the Carers Centre had concerns over the consultation especially as only 36% of the 70 responses were in favour of changing the service overall.

6.3 Mrs Jenny Smith also enquired if there was really enough evidence of public support to back the change in service provision. She further enquired about any potential whole system impacts especially in regard to pressure on the Emergency Department at the Borders General Hospital and if the proposal could flex or would be reviewed. It was noted that the concerns highlighted during the consultation and had been mitigated and these mitigations were included in the paper.

6.4 Further discussion focused on: substantial downtime within the existing service; efficacy in the application of the service and the value of a person centred perspective; use of new technology; redeployment of staff; continued engagement with people; mitigation of service users concerns; and correlation of data and how that might impact on the admissions at the Borders General Hospital. As a result of the concerns raised by the carer representative and the third sector member of the IJB, the Chair indicated that it would be helpful to build in a 6 month review of progress in the IJB Audit Committee.

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

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed the proposal to reduce from 5 Night Support teams to 2 Rapid Response Teams.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted there would be a 6 month review built into the direction for the IJB Audit Committee

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the updated Directions Policy and Procedure that was reviewed in the 18 December 2023 IJB Audit Committee.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved the refreshed IJB Risk Management Policy Statement (Appendix 1) and the updated Risk Management Strategy 2023-2026 (Appendix 2).

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD acknowledged the role and responsibilities of the IJB and IJB Audit Committee within the IJB Risk Management Policy.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the reporting for assurance purposes on the efficacy of risk management arrangements within the IJB Risk Management Policy.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to a discussion on the risk management approach in practice, as set out with the IJB Risk Management Strategy 2023-2026, as part of an IJB Development Session in 2024, which was recommended by the IJB Audit Committee at its meeting on 18 December 2023.

9.1 Mr Chris Myers provided an overview of the content of the paper and highlighted: the payment request letter; consequences of the Scottish Budget; potential flat cash settlement that does not cover inflationary costs; and continue to transform services and ensure sustainability.

9.2 The Chair commented that the letter was both transparent and clear in regard to what the IJB were doing and how. She emphasised that it was critical for the IJB as it was the commissioning body that was effectively a funding body to the partners.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD note the final letter sent to the Directors of Finance in NHS Borders and Scottish Borders Council for consideration by their members, and the next steps outlined in the paper.

10.1 Mrs Jen Holland provided an overview of the content of the report and highlighted: reviewing health and social care capacity; pressures across the whole system and unscheduled care flow across the whole system; profile current and future demand needs against current capacity; complexity of need; modelling; format of early intervention and prevention; discharge and referral process; and discharge pathway review.

10.2 Dr Sohail Bhatti suggested in regard to the data that a sensitivity analysis be included. He further suggested that if service and need was delayed by 6 or 12 months it would have a significant impact and might assist in working out how to stop the tumult of demand that was being serviced with less resource. He suggested the modelling should work out what the impacts might be and enable targeting of groups or the population at the right time. Mrs Holland supported Dr Bhatti’s suggestion and advised that it was within the scope.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the work that will be commissioned by the Health and Social Care Partnership.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD provided comments on the approach being undertaken to inform the commission.

11.1 Mr Chris Myers introduced the item and advised that he felt it important for the Board to be cited on the risk that sat within the mental health medical workforce and across the wider mental health service and to understand the context that the service were working in from a medical perspective.

11.2 Dr Amanda Cotton provided an overview of the content of the report and advised that it set out a strategic approach to the development of medical staffing and how to grow the middle grade tier into our own autonomous and expert doctors to a new senior level.

11.3 Dr Lynn McCallum commented that the lack of consultant psychiatrists was a national issue and locally NHS Borders had been fortunate to recruit 2 consultants however there would still be gaps in the service which the plan would help to mitigate against. She formally recorded her thanks to Dr Cotton for the work she had put into keeping the service safe and able to deliver effective patient care to the people of the Borders.

11.4 Further discussion focused on: creative solution; over medicalising; delivery of services in line with the Mental Health Act; conflation of the mental health and wellbeing agenda; capable communities, society and primary care services; diagnosis and medication; society refer to mental health services as it validates their mental health problem; overall affordability and cost effectiveness; mitigation of risk on workforce performance and safety; and removal of barriers to achieving greater efficiencies.

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

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

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

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

15.1 Commissioning of OD work: The Chair advised that some OD work would be commissioned to assist in building the IJB as a Team.

15.2 Reissue of IJB Handbook: The Chair advised that the revised IJB Members Handbook would be issued to IJB members.

15.3 Joint Staff Forum: Mr Chris Myers advised that the Joint Staff Forum would be holding a workshop to look at how to progress the integration agenda and joint working.

15.4 Employability Partnership: Mrs Jenny Smith advised that Mrs Juliana Amaral was keen to have an update on the funding agreed in 2023 for an NHS employee to work within the mental health service on employability as the third sector were looking to bring in employability working and wanted it to be complimentary. Mr Chris Myers advised that he would feed back to Mrs Amaral.

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

Wednesday 20 March 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 20 March 2024, from 10am to 12 noon through MS Teams and in person in the Council Chamber, Scottish Borders Council.