Agenda and draft minutes

1.1 Apologies had been received from Cllr N Richards, Elected Member, Mr J McLaren, 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, Mrs J Smith, Borders Care Voice and Dr R Mollart, GP.

1.2 The Chair welcomed attendees and members of the public to the meeting including Mr A Small, Independent Chair Scottish Borders Public Protection Committee. 2

1.3 The Chair welcomed Mr P Lerpiniere, Associate Director of Nursing to the meeting who was deputising for Mrs S Horan, Director of Nursing, Midwifery & AHPs.

1.4 The Chair welcomed Ms L Turner, Interim Chief Financial Officer.

1.5 The Chair welcomed Mr J Ayling, Non Executive as a new voting member of the Integration Joint Board.

1.6 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.

24.01.24

3.1 The minutes of the previous meeting of the Health & Social Care Integration Joint Board held on 24 January 2024 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 it was intended that a briefing session would take place in April.

4.2 Action 2024-1: Mr Chris Myers advised that the item was closed and explained that it had been a reporting issue and finance colleagues were considering how to present that item more accurately in future reports.

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: GP access; social work waiting lists reducing; reducing community homecare unmet need; homecare trends; hospital occupancy; demand for social care from hospitals; delayed discharge surge plan and performance against trajectory; development of carers strategy; what matters hubs; and CAMHS progress.

5.2 Discussion focused on: the terminology of demand versus need; robust review of care packages to free up resource for others in need; what matters hubs and information sharing; energy consultants and the quantification of the level of money brought into the system; further work required to move forward with the integration of Home First and Adult Social Care; locality function to work more effectively at a locality level; further work progressing around the preventive agenda in regard to smoking cessation, 3 sexual health and health living; and planning now for next winter to manage the anticipated surge and reviewing those that impacted the surge this year to work up assumptions on expected surge requirements next winter.

5.3 Cllr Elaine Thornton-Nicoll enquired if individuals without capacity or powers of attorney were counted differently or excluded from the delayed discharges list. Mr Myers advised that there were 6 adults with incapacity and they were included in the delayed discharges figures in line with the national definition. Those individuals had longer legal processes to follow and it was important to ensure they were supported in the right setting in the right way within the legal constraints that services operated within.

5.4 Mr David Robertson reminded the Board of the amount of activity that took place across the whole system and highlighted that 96% of people admitted to hospital were effectively discharged. He suggested it would be helpful to include that fuller picture in future reports.

5.5 Ms Linda Jackson enquired about the change in process on placement of care being carried out by the community care team and commented that the Carers Centre were concerned that it might be a change in process and have a negative impact on carers in the longer term. Ms Gwyneth Lennox confirmed that the approach to the Carers Centre had not changed however the replacement care element had been aligned to the assessment review function for the cared for person.

5.6 Mrs Jill Stacey also commented that there was a planned piece of internal audit work to be carried out on support for carers.

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

6.1 Mrs Lizzie Turner provided an overview of the content of the paper and highlighted that there was not yet an offer from NHS Borders, however she anticipated that an offer would be supplied the following week. Mrs Turner drew the attention of the Board to the Scottish Borders Council offer of £81.5m and explained that the level of additional monies anticipated from the council for additional expenditure was unknown and work was taking place to provide clarity on that. She advised that the offer did meet the payment request issued in December 2023 and whilst there were new savings within the offer, there was also £1.1m of savings brought forward that were not delivered on a permanent basis.

6.2 Mr Andrew Bone commented that he appreciated how difficult it was for the IJB to be in such a position so close to the new financial year, where it was unable to set a budget due to the health budget offer not being available. He advised that circumstances surrounding the financial position in the NHS and NHS Borders had been fluid with lots of conditions being set and being subject to change and revision continually. Clarity on Scottish Government funding for a number of elements supplementary to core funding remained outstanding such as the 2023/24 and 2024/25 pay deals. The position in NHS Scotland in terms of funding remained uncertain with reviews of Health Board 4 budgets ongoing especially in relation to the delegated functions to the IJB. In regard to NHS Borders the biggest issue was the scale of the financial deficit and the inability to provide a balanced budget position. Overall NHS Borders faced a deficit position in excess of £40m with significant elements in relation to the delegated functions. Planning on savings continued to take place however less than 50% had been identified and the Scottish Government had offered support to identify any further savings.

6.3 Mr Bone commented that he recognised with hindsight that it would have been better to provide the IJB with an indicative budget based on the baseline of options with caveats pending progress on the NHS Borders budget. He committed to provide an indicative budget within the next 7 days.

6.4 Cllr David Parker challenged the situation and advised that the Scottish Borders Integration Joint Board was the only IJB in Scotland that was unable to set a budget. He welcomed the firm offer received from the local authority and showed his disappointment that an indicative offer had not been forthcoming from the health board. He reminded the Board that the Chief Officer had set out a clear mandate of what he had expected in terms of payment offers to the IJB. He suggested the IJB was being disrespected by the Health Board year on year in its inability to provide an indicative offer as it could not get the process right. He commented that the IJB would need to set savings targets and close surge beds, however it was unable to  ...  view the full minutes text for item 5a

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer the item.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer the item.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer the item.

11.1 Mr Alan Small, Independent Chair Scottish Borders Public Protection Committee provided an overview of the content of the report and advised that it set out the journey the Public Protection Committee was on. He highlighted that it had restructured its strategic plan and had 3 objectives and within those objectives it had sub actions that sat within the working groups of the Committee. He advised that the strategic plan had been reviewed and stretched to 2026 to bring it into line with the children’s services plan.

11.2 Dr Sohail Bhatti commented that it was helpful to have the whole system overview of the public protection.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the action plan. The Underpinning message is that Child and Adult Support and Protection is everyone’s business irrespective of role or position in NHS Borders.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the report would be circulated separately.

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 15 May 2024 10am to 12pm Scottish Borders Council and via Microsoft Teams

13.1 The Chair confirmed that the next meeting of the Scottish Borders Health & Social Care Integration Joint Board would be held on Wednesday 15 May 2024, from 10am to 12 noon through MS Teams and in person in the Council Chamber, Scottish Borders Council.