Agenda item

Presentation by Elaine Torrance, Interim Chief Officer, Health and Social Care Integration.

2.1       The Chairman welcomed Ms Elaine Torrance, Interim Chief Officer Health and Social Care Integration, to the meeting to provide Members with an update of progress made with the Health and Social Care Integration Programme.  Ms Torrance began by summarising the reasons for integrating health and social care services and explained that the Public Bodies (Joint Working) (Scotland) Act 2014 had set the framework for integration to take place.  Integration would provide planned health and social care services in a seamless way, both from the perspective of the service user and carer, and would ensure greater focus on prevention, early intervention, resilient communities and a locality-based approach.  Progress to date included:  the designing of the Strategic Plan comprising nine local objectives; the Commissioning and Implementation Plan which indicated how those objectives would be met through a planned programme of change and redesign; the establishment of a Joint Learning Disability Team and a Joint Mental Health Team; and use of the Integrated Care Fund (ICF) to fund eighteen projects so far, including Stress and Distress training.  ICF funding had been guaranteed for three years by the Scottish Government and Ms Torrance went on to explain the principles supporting the Tiered Model of Partnership Projects and how this was applied to a range of projects such as the Community Transport Hub, Borders Ability Equipment Store and Men’s Sheds.

2.2       With reference to new models of health and social care, the configuration of services and the person-centred model, Ms Torrance explained that there were a number of shared principles which would be applied across all services, whilst always ensuring that the individual was at the centre of what was being put into practice.  ICF funding had been agreed to take forward Community Led Support (CLS) projects intended to make health and social care more visible within local communities via Community Hubs staffed by individuals specifically trained to advise and support service users.  Two pilot Hubs were currently being developed in Burnfoot and Ettrick Valley and would be operational in May 2017.  Community Led Support would build on the skills of individuals and community assets and would invest in early intervention and prevention thus simplifying the way in which people could access support.  This approach also made best use of professional workers’ time by decreasing the hours that they spent travelling between appointments and therefore increasing the number of clients who could be seen in a day from perhaps two to five.  Service users who were unable to travel to a Hub would continue to receive a home visit when necessary.  In order to maintain the person-centred approach, staff, service users, carers and members of the public were involved in the planning groups for the various CLS projects. 

2.3       Ms Torrance explained that Buurtzorg was a nursing model of care with its main focus on prevention.  It had originated in the Netherlands and had been well-received by the Scottish Government.  Buurtzorg involved close, collaborative working relationships with GPs and health and social care professionals.  Test sites for this project were being discussed and a programme of public information events was being planned to inform communities about Buurtzorg.   In terms of locality working, Ms Torrance advised that there were three Health and Social Care Locality Co-ordinators employed with responsibility - in conjunction with a number of established Locality Working Groups - for developing a Locality Plan for each of the five localities in the Scottish Borders.

2.4       With regard to Performance Monitoring, Ms Torrance informed Members that there had been some slippage in the planned timescales and that this was being addressed going forward.  The Health and Social Care Delivery Plan had been published in December 2016 and included information on integration and gave a clear indication of the key areas for action.  Ms Torrance advised Members of the role of the Ministerial Strategic Group in measuring performance in areas such as unplanned admissions; occupied bed days for unscheduled care; Accident and Emergency performance; delayed discharges; end of life care; and balance of spend across institutional and community services.  Performance reports were presented to the Integration Joint Board, the most recent being in February 2017.  Ms Torrance explained that re-categorisation of some services could potentially improve SBC performance levels, eg the Margaret Kerr Unit at the Borders General Hospital was currently classed as “end of life choice” rather than “hospice”.  Ms Torrance indicated that in order to progress Health and Social Care Integration, continued communication, engagement and involvement within communities would be key to ensuring that local opinions and suggestions were considered throughout the process.  Challenges facing the Integration Joint Board included reaching agreement on budget contributions by NHS Borders and SBC for future years.  There were also opportunities in terms of developing a joint transformation and efficiencies programme and work was ongoing in this area.

2.5       Discussion followed and Members requested clarification on a number of issues.  Ms Torrance confirmed that the recent contracts agreed with GP practices were using a cluster-based approach which offered opportunities for further engagement with GPs, service users and the local communities.  With regard to “changing goalposts”, Ms Torrance was asked how this might affect the Health and Social Care Integration programme in terms of available budget, training for staff, etc.  In response, Members were advised that the direction of travel remained the same and that the Strategic Integration Plan covered a three year period and was flexible and capable of responding to new initiatives and changing pressures.  Further work was ongoing to look at how training was delivered currently and ways in which this might be redesigned and shared across localities.  Ms Torrance also confirmed that options for how home care would be delivered in the future were being considered in terms of focussing on clients’ needs rather than purely on 15 minute time blocks.  She went on to explain that there were electronic tools currently available which identified what care was provided and the length of each home care visit.  This information could be used to assist managers when considering the future design and delivery of home care.  Other factors to be taken into account included self-directed support; demand for home care visits at specific times throughout the day; increased demand for complex home care packages; recruitment; and the need to increase the number of providers on the framework for the home care service.  Members were advised that substantial work was ongoing to address issues such as options for community nurses and social workers to share work space/buildings; ensuring that resources such as Occupational Therapy were located most effectively to assist in hospital discharge; and collection of data relating to post-discharge experiences.  The Chairman thanked Ms Torrance for her attendance and it was agreed that a further report on the progress of the Health and Social Care Integration Plan be presented to the Scrutiny Committee in 12 months.

            DECISION

(a)       NOTED the presentation.

(b)       AGREED to receive a further progress report on the Health and Social Care Integration programme in 12 months.