Agenda item

9.1    Mr Simon Burt provided a presentation on the Coming Home programme and highlighted several key elements including: strategic direction to ensure people are cared for as close to home as possible; dynamic support register monitoring by Scottish Government; current demand is 12 people in out of areas placements; prediction is 3 people coming through the system per year; Coming Home Programme Board and associated workstreams; financial implications; Scottish Government allocation; and risks and mitigations.

9.2    The Chair commented that some individuals in long term placements may potentially consider their placement as home and not recognise the Scottish Borders as their home. Mrs Susan Henderson commented that there were some 19 people in out of area placements who were happily settled and did consider those facilities as their homes.

9.3    Dr Sohail Bhatti suggested the issue represented capacity rather than risk and suggested the commissioning of a private provider or registered social landlord to base a facility in the Borders could generate extra resource and potentially attract clinicians.

9.4    Mrs Julianna Amaral enquired in terms of specific support required and what the gaps were in the Scottish Borders.

9.5    Cllr Elaine Thornton-Nicol enquired if the anticipated additional placements each year were drawn from the transitions process for 14 year olds, so that a more definitive forecast could be provided instead of an averaging. She was concerned about the appropriateness of on-going input of a 5:1 staffing ratio in private hospitals for individuals, especially if there was no improvement plan or improved outcomes for the individual. She suggested an early involvement with children’s services to identify potential future service users be considered.

9.6    Mr Stuart Easingwood commented that he was supportive of the programme and that children’s services were in a similar position in the sense that they were seeing a new level of complexity in child cases. He advised that there was also already a good partnership approach with registered social landlords to look at future solutions. In terms of predictors for the future, he agreed that more involvement with children’s services was required and he emphasised that people were also identified through adult LD services. He also reminded the Board that there were people that migrated into the Scottish Borders with complex needs.

9.7    Mr Nile Istephan commented that the properties at Kelso that were alluded to earlier in the discussion were Eildon Housing properties and they represented a £600k investment by Eildon (60%) and the Scottish Government had funded the remaining 40%. The properties were for service users and further work was being taken forward to find solutions for vulnerable people. He suggested there was positive collaboration and partnership opportunities across the housing sector to provide people with complex issues with a home environment and support. There were challenges in terms of workforce to ensure the sustainability of services.

9. 8   Mr Burt welcomed the discussion and commented that the service worked closely withchildren’s services and with registered social landlords. He reassured the Board that younger people in the age range 13-14 years old were being identified and services liaised closely with clinical teams who regularly visited clients.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD supported the initiatives being developed to achieve the Scottish Governments strategic aims set out in the “Coming Home: A Report on Out-of-Area Placements and Delayed Discharge for People with Learning Disabilities and Complex Needs” and ‘Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge’ (2022).

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that the Scottish Government would be monitoring the H&SC partnerships progress in achieving the Strategic aims set out in the reports in 2.1a via the “Dynamic Support Register”.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that based upon current forecasts, to deliver placements for all 17 people in scope created a financial plan gap.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed with the development of a future funding model between NHS Borders, Scottish Borders Council and the IJB, which will require resources to be identified within the totality of the IJBs financial plan.