Agenda item

Verbal update by the Chief Officer, Health & Social Care Integration.

3.1       With reference to paragraph 11 of the Minute of 14 May 2018, the Chairman welcomed Mr Robert McCulloch-Graham, Chief Officer Health and Social Care Integration, to the meeting who was in attendance to provide Members with a greater understanding on how the Health and Social Care Integration Joint Board (IJB) was delivering its Strategic Plan to improve the lives of Borderers and meet the growing demands in the care sector.  Mr McCulloch-Graham began by informing the Committee that the Interim Chair of NHS Borders Board was Non-Executive Director Karen Hamilton, and the new Chief Executive of NHS Borders was Ralph Roberts who was due to take up the post on Monday 22 April 2019.  Mr McCulloch-Graham updated Members on the identified challenges facing the Health and Social Care Partnership which included an increase in the population in the Borders, an increase in the complexity of cases being presented, and the reduction in available resources, with difficulties in balancing the budget.  More people were accessing Primary Care (GPs) and presenting at hospital; admissions were more complex and therefore patients were remaining in hospital for longer; more care at home was required; and more care home places were also required.  Mr McCulloch-Graham explained the governance of the Integrated Joint Board (IJB) and how funding under Delegated Funds and Set Aside Fund was allocated differently at a local level in the Scottish Borders and nationally, an example being that Palliative Care may or may not be included in this Set Aside Fund.  The process for the Discharge to Home Service was now across the five localities and numbers had increased with the STEP down facilities at Garden View (Craw Wood) and Waverley improved.  Work was ongoing to put savings in place to close the budget gap.  There had been challenges during the previous winter period through significant delays and cancellations although due to the partnership working this year this had substantially improved and the joint winter plan had worked well.  Mr McCulloch-Graham went on to explain how integrated services were provided and funded under the headings of Community Health Services, Acute Health Services provided in a hospital and Adult Social Care Services.  Mr McCulloch-Graham reported that SB Cares and the NHS were working closely within the partnership with a consultation firm called Meridian now in place to look at improvements in processes.  There had been a particular challenge around nursing care and the Council had helped to purchase beds at Queens House in Kelso.  The question was how to make the best use of health care services in communities.  A new system had been trialled at The Knoll, using a consultant from the BGH and nurse practitioners, with the rest of the Community Hospitals supported by GPs.  The whole essence of the Health and Social Care partnership was to shift from acute to community based services, and there was a need to have a fundamental look at how health was managed in the Borders.   The Primary Care Improvement Plan, led by GPs, was being introduced, with the intention being to support GPs work and adopt different models of triage going forward.  Scottish Government was happy with progress made to date although there were some issues to resolve. 

3.2       Members raised a number of questions, in particular around delayed discharges and lack of transport.  Mr McCulloch-Graham advised that transport was reliant on the ambulance service and there was some funding of voluntary transport services.  Some delayed discharges had been due to lack of transport at the weekends and SB Cares had brought in a vehicle/driver to assist.  Issues still remained with transport and this was being worked on within the partnership.  Rurality was an issue in the Borders but had not impacted on the recruitment of GPs in the Borders, although there were difficulties in recruiting nurses and care staff to work in residential and private homes.  Some nursing homes were changing to residential care homes.  Most of the GP practices in the Borders were individual companies but the property was owned by NHS.  With regard to delayed discharges, the measure for these had changed and there had been a 10% improvement over the last year.  If that rate of improvement continued, then it would be possible to release acute beds.   In response to a question from Members on pay scales and terms and conditions for NHS and SBC staff, Mr McCulloch-Graham advised that the differences still existed as the IJB was not an employer.  NHS and SBC mental health and learning disability had been operating as joint services for 8 years, but they were still using separate IT systems, etc. although that was being worked on to try to find a solution.  

3.3     Further discussions followed in relation to the way the Borders was changing, with communities growing at different rates.  Rurality was a very important factor and an example was given of physiotherapy service being hospital based when the service should be out in the community in clinics.  The challenge was also around communication and ensuring the public understood the changes in services.  The example was given of the recent gap in communication around proposed changes to the Day Centre provision.  Mr McCulloch-Graham confirmed that only 40 clients were currently using the Day Centres and these Centres would not close until alternative provision had been put in place for clients.  The Chairman thanked Mr McCulloch-Graham for his attendance and update on the work of the partnership.

            DECISION

NOTED the update.