Agenda item

5.1 Mrs Jen Holland provided a presentation to the Board which covered several areas including: financial appraisal; bed analysis; equalities impact assessment; non-financial appraisal; revenue implications; and Scottish Borders Council recommendations. She emphasised that the role of the IJB was to commission the service provision of health and social care and the business case was the work to support that provision of service and the Direction asked that SBC proceed with that work to the next stage in the process.  

5.2 In regard to revenue expenditure Mrs Holland advised that it was part of the discussion around the model of care to happen in and around the Hawick care village. She was keen that the IJB understood that it was being asked to note the business case for capital and issue a direction to SBC to proceed with work on the service model.

5.3 Dr Sohail Bhatti sought clarity on the capital allocation given Housing Associations had access to private sector funds. Mrs Holland advised that the care village would be funded by the capital from Scottish Borders Council allocation of capital build and in terms of the care village it was more complex. Mr Nile Istephan commented that the care village would be made up entirely of different elements and parts would be funded through SBC resources and extra care housing co-located to the site and owned and managed by Eildon Housing. He advised that Eildon Housing would have access to housing grants from the Scottish Government as well as other commercial borrowing and the Scottish Government capital investment would enable the extra care element of the care village proposals.

5.4 Dr Lynn McCallum commented that those who would live in the facility were likely to be highly co-morbid, potentially frail and have significant health requirements and she was reflective of the impact that would have on community services in relation to the build. She was pleased to hear that there would be further consultation and enquired of the consultation with the local GPs to date. Mrs Holland confirmed that local GPs had been consulted with and in moving forward with the development further consultation would be required.

5.5 Dr Rachel Mollart commented that it was well recognised in primary care services that care facilities contained high acuity patients and Hawick already had a high number of high acuity beds and were overly care home bedded compared to other GP Practice areas. She suggested further consultation take place via the GP Sub Committee where a representation of GPs from across the Borders was present and could give a more rounded generalised view of what GPs concerns would be.

5.6 The Chair enquired about the practicalities of working on the health and social care service model for the whole development. Mr Chris Myers commented that the care village needed to meet the needs of everybody involved and then the associated service delivery models around it and in meeting that need there would be a requirement for more workforce from primary care and community health.

5.7 Mr Tris Taylor commented that he had a number of concerns and from an IJB perspective suggested the Board should take actual assurance on evidence to meet the standards necessary and cited the judicial review into Teviot Day Services as an example. He enquired if there was an alternative to the care village model? He enquired if the NDTI consultation was about the replacement of Deanfield or on a model of care as a whole and he further enquired about a breakdown of the 113 people who had responded. He suggested the scoring matrix user criteria was on the delivery of services from a single site but could not be read across to the NDTI report as it referred to delivery from multiple sites. From a commissioning point of view he suggested it was difficult to take actions on revenue without understanding the full provision of care village funding.

5.8 The Chair suggested the Impact Assessment should have a version control and contain numbered pages and there was a non-sequitur between pages 2-3 that might miss out evidence of engagement events.

5.9 Mrs Lynn Gallacher enquired why there wasn’t a projection for respite beds given there were none at all in the Borders and there should be data around the number of people waiting for respite beds.

5.10 Mr Myers commented that in regard to the Impact Assessment (IA) work was taking place to clarify the numbers of people engaged with and not just the numbers of people per group. Stage 2 of the IA was a live document and was being continually updated and would inform the development of the full business case. Stage 3 would involve the completion of the IA and the full business case.

5.11 Mr Myers detailed the consultation process that had been undertaken and the holistic sense of different health and care services across Hawick such as extra care housing, sheltered housing, retirement housing, 24 hour residential care, care services and access to services linked to the wider community and the outcome of a care village being more appealing to people than a replacement for Deanfield. In terms of respite he agreed that it was a critical provision required across the Borders and suggested respite bed modelling would be included in the full business case.

5.12 The Chair suggested there should be 2 directions from the IJB. The first one would be the business case for capital for SBC to work on. The second one would be to request a business case for the delivery of what the IJB would commission in the care village and that should be directed to both NHS Borders and SBC.

5.13 Mr Taylor enquired how much of the money was within the gift of the IJB to commission and he queried the quality value of each bed and suggested the funding might be better spent on preventative services. He suggested through the engagement process the question of how best to spend £4.7m should have been asked and had not been asked.

5.14 Cllr Elaine Thornton-Nicol suggested the IJB note the outline business case which was solely on capital expenditure and solely in the gift of SBC and then consider issuing a direction to SBC to consider the development of a service model and the revenue implications associated with it and to formulate a full business case for Hawick and Tweedbank.

5.15 Mr Myers advised of the engagement sessions he had attended in Hawick and the provision of need in that area. He commented that the direction reflected the next step in the process to develop a realistic service model. The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the Outline Business Case (Appendix 1) and the preferred option of the Scottish Borders Council for a new build in partnership with Eildon Housing Association on their Stirches site.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD asked that a revised direction be brought to the next meeting to clearly direct both Scottish Borders Council and NHS Borders to work up a service model business case for the Care Villages.