Public Document Pack

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1 Public Document Pack To: Jonathan Passmore MBE (Chairperson); and Councillors Cooke, Donnelly, Duncan and Samarai; and Rhona Atkinson, Dr Nick Fluck and Professor Mike Greaves (NHS Grampian Board Members); and Mike Adams (Partnership Representative, NHS Grampian), Jenny Gibb (Professional Nursing Adviser, NHS Grampian), Jim Currie (Trade Union Representative, Aberdeen City Council (ACC)), Bernadette Oxley (Chief Social Work Officer, ACC), Kenneth Simpson (Third Sector Representative), Dr Howard Gemmell (Patient and Service User Representative), Gill Moffat and Faith-Jason Robertson-Foy (Carer Representatives), Dr Stephen Lynch (Clinical Director, Aberdeen City Health and Social Care Partnership (ACHSCP)), Dr Satchi Swami (Secondary Care Adviser, NHS Grampian),Judith Proctor (Chief Officer, ACHSCP) and Alex Stephen (Chief Finance Officer, ACHSCP). Town House, ABERDEEN, 30 May 2017 INTEGRATION JOINT BOARD The Members of the INTEGRATION JOINT BOARD are requested to meet in Meeting Room 5, Health Village on TUESDAY, 6 JUNE 2017 at am. FRASER BELL HEAD OF LEGAL AND DEMOCRATIC SERVICES B U S I N E S S DECLARATION OF INTERESTS 1 Members are requested to intimate any declarations of interest DETERMINATION OF EXEMPT BUSINESS 2 Members are requested to determine that any exempt business be considered with the press and public excluded

2 STANDING ITEMS 3 Minute of Previous Board Meeting - 28 March 2017 (Pages 5-14) 4 Draft Minute of Audit and Performance Systems Committee - 11 April 2017 (Pages 15-20) 5 Draft Minute of Clinical and Care Governance Committee - 14 March 2017 (Pages 21-30) 6 Business Statement (Pages 31-34) STEWARDSHIP 7 Appointment to Committees (Pages 35-54) PERFORMANCE REPORTS 8 Annual Performance Report (Pages 55-92) 9 Delayed Discharge Performance Report (Pages ) TRANSFORMATION 10 Transformation Programme (Pages ) 11 Interim Housing Proposal (Pages ) 12 Self-Directed Support Uplift (Pages ) ITEMS THE BOARD MAY WISH TO CONSIDER IN PRIVATE 13 Care at Home Commissioning (Pages ) 14 Northfield/Mastrick Locality (Pages ) WORKSHOP 15 Transformation Programme and Priorities

3 To access the Service Updates for this Committee please use the following link: path=0 Website Address: Should you require any further information about this agenda, please contact Iain Robertson, or

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5 Agenda Item 3 INTEGRATION JOINT BOARD Minute of Meeting 28 March 2017 Town House, Aberdeen Present: Councillor Len Ironside CBE (In the Chair); and Councillors Cameron, Donnelly and Jean Morrison MBE (as substitute for Councillor Young); and Amy Anderson (as substitute for Dr Nick Fluck), Sharon Duncan (as substitute for Rhona Atkinson) Dr Helen Moffat (as substitute for Jonathan Passmore MBE) and Professor Mike Greaves (NHS Grampian Board members); and Mike Adams (Partnership Representative, NHS Grampian), Jim Currie (Trade Union Representative, Aberdeen City Council (ACC)), Heather Macrae (NHS Grampian, as substitute for Jenny Gibb), Joyce Duncan (ACVO, as substitute for Kenneth Simpson), Faith-Jason Robertson-Foy (Carer Representative), Dr Howard Gemmell (Patient/Service User Representative), Dr Stephen Lynch (Clinical Director, Aberdeen City Health and Social Care Partnership (ACHSCP)), Claire Duncan (Lead Social Work Officer, ACHSCP, as substitute for Bernadette Oxley), Judith Proctor (Chief Officer, ACHSCP) and Alex Stephen (Chief Finance Officer, ACHSCP). Also in attendance: Tom Cowan (Head of Operations, ACHSCP), Kevin Toshney (Acting Head of Strategy and Transformation, ACHSCP), Gail Woodcock (Integrated Localities Programme Manager, ACHSCP, for items 8 and 9), Sandra Ross and Alistair MacLean (Bon Accord Care, for item 15) and Iain Robertson (Clerk, ACC). Apologies: Jonathan Passmore MBE, Councillor Young, Rhona Atkinson, Dr Nick Fluck, Jenny Gibb, Bernadette Oxley, Kenneth Simpson, Gill Moffat and Dr Satchi Swami. The agenda and reports associated with this minute can be located at the following link:- Please note that if any changes are made to this minute at the point of approval, these will be outlined in the subsequent minute and this document will not be retrospectively altered. Page 5

6 OPENING REMARKS 1. The Vice Chair (hereafter referred to as the Chair) opened the meeting and explained that in the absence of Jonathan Passmore, he would assume the Chair for today s meeting. The Chair reminded members that it had been a year since the Aberdeen City IJB went live and he remarked on the progress that had been made by the Board in that time. The Chair noted that a significant number of apologies had been received for today s meeting and suggested that the Community Justice workshop be rearranged for a later date. The Board resolved:- (i) to postpone the Community Justice workshop and instruct officers to identify an alternative date; and (ii) otherwise note the information provided. DECLARATION OF INTERESTS 2. Members were requested to intimate any declarations of interest. The Board resolved:- To note that no declarations of interest were intimated at this time. DETERMINATION OF EXEMPT BUSINESS 3. The Chair proposed that item 13 (Bon Accord Care) and item 14 (Review of Internal Auditors) on today s agenda be considered with the press and public excluded. The Board resolved:- In terms of Section 50(A)(4) of the Local Government (Scotland) Act 1973, to exclude the press and public from the meeting during consideration of the aforementioned items of business so as to avoid disclosure of exempt information of the classes described in paragraphs 1 (Review of Internal Auditors) and 7 (Bon Accord Care) of Schedule 7(A) of the Act. MINUTE OF IJB MEETING 31 JANUARY The Board had before it the minute of the Board meeting of 31 January The Board resolved:- To approve the minute as a correct record. MINUTE OF SPECIAL IJB BUDGET MEETING 7 MARCH The Board had before it the minute of the Special Budget meeting of 7 March Page 6

7 The Board resolved:- To approve the minute as a correct record. DRAFT MINUTE OF AUDIT AND PERFORMANCE SYSTEMS COMMITTEE MEETING 28 FEBRUARY The Board had before it the draft minute of the Audit and Performance Systems Committee of 28 February 2017 for information. The Board resolved:- To note the draft minute. BUSINESS STATEMENT 7. The Board had before it a statement of pending business for information. The Board resolved:- (i) to remove item 4 (Integrated Care Fund) from the statement; and (ii) otherwise to note the statement. TRANSFORMATION PROGRAMME 8. The Board had before it a report by Gail Woodcock (Integrated Localities Programme Manager, ACHSCP) which requested approval to incur expenditure in relation to four projects that sit within the Partnership s Transformation Programme. The report recommended:- That the Board (a) Approve expenditure of 1,024,340 (total for two years) in relation to the establishment of Mental Health Community Hubs, for an initial two year period; (b) Approve the expenditure of up to 423,498 (total for three years) relating to Enhancing the Independent Sector Contribution to Integrated Services Project through the provision of a grant to Scottish Care, subject to State Aid assessments; (c) Approve the expenditure of 73,775 required to continue the THInC project through to 31 March 2018, through the provision of a grant to Aberdeenshire Council, subject to State Aid assessments; (d) Approve the expenditure of 104,000 required to continue the Post Diagnostic Support project through to 31 March 2018, through the extension of the existing contract; and (e) Instruct the Chief Officer to issue the Directions attached at Appendix E and Appendix F to Aberdeen City Council and NHS Grampian respectively. Gail Woodcock explained that the report sought approval to incur expenditure for four transformation programmes (Mental Health Community Hubs; Enhancing the Independent Sector Contribution to Integrated Services in Aberdeen City; THInC Transport Extension; and Alzheimer s Scotland Post Diagnostic Support Service) and to issue Directions to that effect to NHS Grampian and Aberdeen City Council. Page 7

8 Thereafter there were questions on the level of financial support to the Mental Health Community Hubs and the multi-disciplinary remit of the Hubs; the development of outcomes to reflect the Partnership s aspiration to release GP capacity; the level of engagement with the independent and third sectors, with particular regards to their expertise in transport provision and working with vulnerable people; and the role and remit of Scottish Care, as the umbrella body representing independent health and social care providers in Scotland. The Board resolved:- (i) to approve expenditure of 1,024,340 (total for two years) in relation to the establishment of Mental Health Community Hubs, for an initial two year period; (ii) to approve the expenditure of up to 423,498 (total for three years) relating to Enhancing the Independent Sector Contribution to Integrated Services Project through the provision of a grant to Scottish Care, subject to State Aid assessments; (iii) to approve the expenditure of 73,775 required to continue the THInC project through to 31 March 2018, through the provision of a grant to Aberdeenshire Council, subject to State Aid assessments; (iv) to approve the expenditure of 104,000 required to continue the Post Diagnostic Support project through to 31 March 2018, through the extension of the existing contract; and (v) to instruct the Chief Officer to issue the Directions attached at Appendix E and Appendix F to Aberdeen City Council and NHS Grampian respectively. BUURTZORG 9. The Board had before it a report by Gail Woodcock which provided information on progress towards utilising Buurtzorg principles to develop new integrated community nursing and care at home teams. The report also sought agreement for a cross sector team to visit the Netherlands to learn more about the approach in order to inform developments in Aberdeen. The report recommended:- that the Board (a) Note the progress towards testing integrated community teams, using Buurtzorg principles, in Aberdeen; and (b) Approve a cross sector team to visit the Netherlands to learn more about the approach in order to inform the development of this project, at an estimated cost of 4,000, funded from the Integration and Change Fund. Gail Woodcock spoke to the report and explained that the Buurtzorg model advocated person centred support and its aim was to enable health and social care practitioners to work collaboratively with the service user s family and other informal networks. She noted that Buurtzorg principles aligned with locality planning and it was the Partnership s intention to test the model in a small number of communities as a test of change prior to a full roll out across the city if outcomes in test areas were being met. Ms Woodcock also highlighted the report s request to approve funding for officers to travel to the Netherlands to meet Buurtzorg staff on a learning visit. Page 8

9 Thereafter there were questions on the involvement of unpaid carers in the Buurtzorg model and the level of engagement the Partnership had had with carer organisations; proposed changes to staff structures and trade union consultation; and members scrutinised the level of funding for the learning visit to the Netherlands, to which Ms Woodcock advised that travel costs were based on tariffs that were standard for visits of this kind. The Board resolved:- (i) to note the progress towards testing integrated community teams, using Buurtzorg principles, in Aberdeen; and (ii) to approve a cross sector team to visit the Netherlands to learn more about the approach in order to inform the development of this project, at an estimated cost of 4,000, funded from the Integration and Change Fund. LIVING WAGE AND SLEEPOVERS 10. The Board had before it a report by Alison Macleod (Social Care Procurement Manager, ACC) which advised the Board on the outcome of the additional 6.4% uplift to care providers in relation to payment of the Scottish Living Wage during ; and the report sought approval for a further uplift of 2.6% during and for additional, individually targeted funding to be allocated to contracted organisations providing a sleepover service to enable them to meet HMRC guidelines. The report recommended:- That the Board (a) Note the outcome of the additional 6.4% funding provided in 2016/17 to contracted providers of social care services in relation to payment of the Scottish Living Wage of 8.25 per hour; (b) Approves the provision of a further uplift of 2.6% funding in 2017/18 to contracted providers of social care services to allow for the increase of the Scottish Living Wage from 8.25 to 8.45 per hour from 1st April The uplift to be paid dependant on receipt of a signed contract variation and completion of the verification questionnaire; (c) Approves the provision of additional, individually targeted, funding to those contracted organisations providing a sleepover service to enable them to meet HMRC guidelines of the average hourly rate for a sleepover shift being equivalent to at least the National Minimum Wage of 7.50 per hour from 1st April 2017; and (d) Issues a Direction to Aberdeen City Council to prepare and issue contract variations to all appropriate contracted providers in relation to the 2.6% uplift to ensure payment of the Living Wage and to prepare and issue contract variations to providers of a sleepover service to award additional funding in relation to the payment of these at an average hourly rate equivalent to the National Minimum Wage. Alex Stephen (Chief Finance Officer, ACHSCP) spoke to the report and explained that the report provided an update on the number of contracted care home providers that had confirmed payment of the Scottish Living Wage since the IJB approved the 6.4% uplift at its meeting on 30 August He informed the Board that of the 78 contract variations, 55 providers had responded to the review and all 55 of these providers confirmed payment of the Scottish Living Wage. In reference to sleepovers, Page 9

10 Mr Stephen explained that in order to be compliant with a recent Her Majesty s Revenue and Customs (HMRC) ruling, an additional 650,000 would have to be found to meet the uplift in the rate of pay from 7.20 to 7.50 per hour on an individual basis. Thereafter there were questions on the rate of pay for sleepover staff, which from 1 April 2017 would be 95p per hour less than the Scottish Living Wage. Members also examined the merits of the working nights and sleepover systems, and discussed which system was the most effective way to deliver care through the night. The Board resolved:- (i) to note the outcome of the additional 6.4% funding provided in 2016/17 to contracted providers of social care services in relation to payment of the Scottish Living Wage of 8.25 per hour; (ii) to approve the provision of a further uplift of 2.8% funding in 2017/18 to contracted providers of social care services to allow for the increase of the Scottish Living Wage from 8.25 to 8.45 per hour from 1st April The uplift to be paid dependant on receipt of a signed contract variation and completion of the verification questionnaire; (iii) to approve the provision of additional, individually targeted, funding to those contracted organisations providing a sleepover service to enable them to meet HMRC guidelines of the average hourly rate for a sleepover shift being equivalent to at least the National Minimum Wage of 7.50 per hour from 1st April 2017; and (iv) to issue a Direction to Aberdeen City Council to prepare and issue contract variations to all appropriate contracted providers in relation to the 2.8% uplift to ensure payment of the Living Wage and to prepare and issue contract variations to providers of a sleepover service to award additional funding in relation to the payment of these at an average hourly rate equivalent to the National Minimum Wage. GOOD GOVERNANCE INSTITUTE IMPLEMENTATION PLAN 11. The Board had before it a report by Laura Botea (Senior Programme Delivery Office, GGI) and Sarah Gibbon (Executive Assistant, ACHSCP) that provided an update on the implementation of the recommendations from the Good Governance Institute (GGI). The report recommended:- That the Board note the progress towards the implementation of the GGI recommendations, as outlined in Appendix 1. The Chief Officer spoke to the report and highlighted progress made by the Partnership against the GGI recommendations outlined in Appendix 1. She noted that the workshops facilitated by the GGI had also contributed to the Board s development. Thereafter members recognised the progress made since the Go Live date and welcomed the continued external critique of the Board s governance and risk management arrangements; and members agreed that the integration workshops facilitated by the GGI had been very useful in supporting the Board s development. Page 10

11 The Board also discussed the development of Carer Pathways and the establishment of the Market Facilitation Steering Group which would inform the Partnership s approach. Further to this point, the Chief Officer highlighted the creation of the digital Ideas Hub which was accessible to colleagues across the Partnership with the aim of providing a platform to generate ideas for service improvement from the bottom-up. The Board resolved:- To note the progress towards the implementation of the GGI recommendations, as outlined in Appendix 1. MEASURING OUTCOMES UNDER INTEGRATION 12. The Board had before it a report by the Chief Officer that sought agreement for the Partnership to participate in national measurement of improvement under integration. The report recommended:- that the Board (a) Agree that publically available data relating to the performance of the IJB and HSCP can be used to support the MSG in measuring performance under integration; (b) Instructs the Chief Officer to develop trajectories for improvement and that these are considered in relation to the IJB s own improvement plan and present these at a future meeting; and (c) Asks the Chief Officer to reply formally to the request setting out the IJB s position. The Chief Officer spoke to the report and explained that each IJB Chief Officer had received correspondence from the Scottish Government and COSLA inviting them to provide the Ministerial Strategic Group with Partnership objectives and to set out improvement trajectories and ambitions against the six key areas of performance noted below:- 1) Unplanned admissions 2) Occupied bed days for unscheduled care 3) A&E performance 4) Delayed Discharges 5) End of life care 6) The balance of spend across institutional and community services The Chief Officer advised that she was seeking the approval of the Board to share relevant performance information with the Ministerial Strategic Group. Thereafter members welcomed this development and highlighted the importance of sharing experiences and best practice. Members also highlighted that the Partnership would have to strike an appropriate balance between the attainment of objectives at national and locality levels. Page 11

12 The Board resolved:- (i) to agree that publically available data relating to the performance of the IJB and HSCP can be used to support the MSG in measuring performance under integration; (ii) to instruct the Chief Officer to develop trajectories for improvement and that these are considered in relation to the IJB s own improvement plan and present these at a future meeting; and (iii) to ask the Chief Officer to reply formally to the request setting out the IJB s position. IJB SCHEDULING 13. The Board had before it a report by the Clerk which sought approval to revise the meeting schedule to take account of the Statutory Council meeting date and to arrange an additional date to consider the IJB budget. The report recommended:- that the Board (a) Agree the revised schedule attached as Appendix A; (b) Agree that the IJB Induction/Refresh session be arranged for 23 May 2017 and for the Developmental Timetable to be updated accordingly; and (c) Instruct the Clerk to make necessary preparations to arrange these meetings. The Clerk suggested that the IJB meeting on 23 May 2017 should be rearranged for 6 June 2017 to take account of the later Statutory Council meeting on 17 May 2017 in which IJB voting members would be appointed. The Clerk proposed that the IJB Induction/Refresh training now be scheduled for 23 May He also recommended that an additional meeting be added to the schedule to consider the IJB budget on 6 February 2018 before submission to the annual budget meetings of Aberdeen City Council and the NHS Grampian Board as per the IJB Budget Protocol agreed by the Board at its meeting on 7 March The Board resolved:- (i) to agree the revised schedule attached as Appendix A; (ii) to agree that the IJB Induction/Refresh session be arranged for 23 May 2017 and for the Developmental Timetable to be updated accordingly; and (iii) to instruct the Clerk to make necessary preparations to arrange these meetings. VALEDICTORY 14. Councillor Ironside was presented with a HEART Award by Professor Mike Greaves, on behalf of the Board in recognition of his Chairmanship of the IJB and his leadership over the past 18 months. In response, Councillor Ironside thanked fellow Board members, the Executive Team and all health and social care colleagues for their dedication and support. He concluded by highlighting how pleased he was with the progress that the Board and Partnership had made towards the integration of health and social care in Aberdeen City and wished members and officers well for the future. Page 12

13 The Board resolved:- To recognise Councillor Len Ironside for his Chairmanship of the IJB; and his leadership and contribution towards the integration of health and social care in Aberdeen City, and to wish him well on his retirement from public life. In accordance with the decision recorded under article 3 of this minute, the following items were considered with the press and public excluded. BON ACCORD CARE 15. The Board had before it a report by Sandra Ross (Managing Director, Bon Accord Care) which presented the format, scope and strategic direction of Bon Accord Care as a provider of a range of commissioned health and social care services to older people within Aberdeen City. The report recommended:- That the Board note the attached report relating to Bon Accord Care. The Board resolved:- To note the report. REVIEW OF INTERNAL AUDIT 16. The Board had before it a report by Alex Stephen (Chief Finance Officer, ACHSCP) which set out the process for appointing an internal auditor for The report recommended:- That the Board agree that the shared internal audit service used by both Aberdeen City and Aberdeenshire Councils will provide internal audit services to the IJB. The Board resolved:- (i) to agree that the shared internal audit service used by both Aberdeen City and Aberdeenshire Councils will provide internal audit services to the IJB; and (ii) to instruct the Clerk to liaise with counterparts in Aberdeen City and Aberdeenshire Councils and IJBs to avoid a conflict of meeting dates for COUNCILLOR LEN IRONSIDE CBE, The Chair. Page 13

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15 Agenda Item 4 AUDIT AND PERFORMANCE SYSTEMS COMMITTEE Minute of Meeting 11 April 2017 Town House, Aberdeen Present: Professor Mike Greaves (NHS Grampian (NHSG)) Chairperson; and Councillor Ironside CBE and Amy Anderson (NHSG, as substitute for Rhona Atkinson). Also in attendance: Judith Proctor (Chief Officer, Aberdeen City Health and Social Care Partnership (ACHSCP)), Alex Stephen (Chief Finance Officer, ACHSCP), Kevin Toshney (Acting Head of Strategy and Transformation, ACHSCP), Sarah Gibbon (Executive Assistant, ACHSCP), David Hughes (Internal Audit), Iain Robertson (Clerk, Aberdeen City Council (ACC)) and Alan Thomson (Legal Services, ACC). Apologies: Rhona Atkinson. OPENING REMARKS 1. The Chair opened the meeting and welcomed Dame Anne Begg who was present to observe the meeting as she had recently been appointed to the Moray IJB. He also introduced Amy Anderson who was substituting for Rhona Atkinson at today s meeting. The Chair referred to the Board Assurance Framework and highlighted Section 1.3 which noted that the Framework should be reviewed at the end of the initial period following the go live date in April 2016 and suggested that the Executive Team conduct this review and report back to the next meeting of the Committee. Councillor Ironside asked about the composition of IJB committees after the Local Government elections in May 2017, to which Judith Proctor (Chief Officer, ACHSCP) advised that committee membership would be reviewed following the elections with the aim of appointing the most appropriate Board members to the APS and Clinical and Care Governance committees. The Committee resolved:- (i) to instruct the Executive Team to undertake a review of the Board Assurance Framework and report back to the Committee s next meeting on 20 June 2017; and Page 15

16 (ii) otherwise note the information provided. DECLARATIONS OF INTEREST 2. Members were requested to intimate any declarations of interest. The Committee resolved:- To note that no declarations of interest were intimated at this time for items on today s agenda. DETERMINATION OF EXEMPT BUSINESS 3. The Chair proposed that all Committee business on today s agenda be considered with the public and press in attendance. The Board resolved:- To agree that all Committee business on today s agenda be open to the public and press. MINUTE OF PREVIOUS MEETING 28 February The Committee had before it the minute of the previous meeting of 28 February The Committee resolved:- To approve the minute as a correct record. PROPOSED REVISION TO MEETING SCHEDULE 5. The Committee had before it a report by the Clerk which sought approval to revise the Committee meeting schedule to take account of the IJB s decision to arrange an annual IJB budget meeting on 6 February 2018 which conflicted with a Committee meeting date. The report recommended:- That the Committee agree the revised schedule attached as Appendix A. The Clerk proposed that the APS Committee meeting date originally scheduled for 6 February 2018 be moved back a week to 13 February 2018 to avoid a scheduling conflict with the IJB Budget meeting. The Committee resolved:- To agree the revised schedule attached as Appendix A. Page 16

17 REVIEW OF FINANCIAL GOVERNANCE 6. The Committee had before it a report by Alex Stephen (Chief Finance Officer, ACHSCP) which outlined the results of the review undertaken by the Executive Team against financial governance requirements contained in the Chartered Institute of Public Finance and Accountancy (CIPFA) s statement on the Role of the Chief Financial Officer in Local Government (2016). The report recommended:- That the Committee note the content of the report and comment on the accompanying results of the Executive Team review. Alex Stephen explained that the Executive Team had conducted a review of the Board's financial governance arrangements against the CIPFA principles outlined in the Role of the Chief Finance Officer (CFO) in Local Government (2016). He advised that evidence of adherence to these principles had been requested during the 2015/16 audit of the final accounts, and noted that areas in need of further development had also been identified. Thereafter Mr Stephen talked the Committee through each of the CIPFA principles: With reference to principle 1, Mr Stephen highlighted the leadership role of the CFO through membership of the Executive Team and the IJB as a non-voting member. He explained that it was the intention of the Executive Team to consolidate all relevant documentation into a governance action plan which would be presented to the IJB for approval, with a recommendation that responsibility for monitoring be delegated to this Committee. Mr Stephen set out his responsibilities, in addition to his role as CFO and noted that in these areas he largely provided an oversight function as operational control was exercised by Partnership colleagues. He confirmed that the financial skillset of the Executive Team was satisfactory but anticipated that financial training would be provided to colleagues involved in the locality planning once locality management structures were more developed. Mr Stephen highlighted the representativeness of the IJB, as it included partners from across the public and third/independent sectors; as well as service users and carer representatives. He also summarised the monitoring arrangements in place between the Partnership and Bon Accord Care; With reference to principle 2, Mr Stephen provided an overview of the business and financial planning process and pointed to the successful approach adopted by the Partnership towards the IJB budget which included the scheduling of workshop sessions and financial briefings prior to the budget meeting which enhanced the Board's decision making capacity and led to the unanimous agreement of the IJB budget in March He explained that in line with the IJB Budget Protocol, a similar approach would be adopted next year as a special budget meeting had been scheduled and there would be greater focus on strategic items such as the transformation agenda. Thereafter Mr Stephen provided a summary of how the Board issued Directions to its partners, particularly in relation to procurement; and he explained that ACC and NHSG had responsibility for treasury management as the Partnership did not have a bank account; With reference to principle 3, Mr Stephen highlighted that Internal Audit would prepare an annual report and statement on the internal control system adopted by the IJB and its partners on the management and safeguarding of public money. He Page 17

18 advised that further assurance had been provided through the publication of IJB/APS Committee papers on the Partnership's website; and noted that IJB and Committee meetings were open to the public and press. The Chief Officer added that the Annual Governance Statement would also be publicly available and the Executive Team would look at how the Statement could be presented in a user friendly format. She further noted that the review of the Board Assurance Framework and the ongoing work of the Good Governance Institute would provide additional assurance in this area; With reference to principle 4, Mr Stephen advised that the CFO had no line management responsibilities for ACC or NHSG finance staff and it was incumbent on both partners to provide resource and capacity to support the Partnership's functions; and With reference to principle 5, Mr Stephen summarised his professional qualifications and experience which enabled him to satisfy the requirements of the CFO job profile. He also pointed to the Partnership's robust recruitment process which led to his appointment. Thereafter there were questions on the best way to communicate the Board's Annual Governance Statement to the public; and the level of support the CFO had received from colleagues within and out with the Partnership. The Committee resolved:- (i) to request that the Executive Team look at how the Annual Governance Statement could be presented in a user friendly format; (ii) to instruct the Clerk to circulate the review of the IJB's financial governance arrangements to all IJB members for information; and (iii) otherwise note the report. LOCAL CODE OF GOVERNANCE 7. The Committee had before it a report by Alex Stephen that outlined the sources of assurances used to measure the effectiveness of the governance principles contained in the CIPFA/Society of Local Authority Chief Executive (SOLACE) Delivering Good Governance in Local Government: Framework document. The report also proposed the establishment of a local code of corporate governance for the IJB. The report recommended:- That the Committee approve the use of sources of assurance, listed in Appendix 1, the local code of governance, and the governance principles, against which the IJB would measure itself in Annual Governance Statements from onwards. Alex Stephen explained that the sources of assurance had been provided to measure effectiveness against the CIPFA principles of good governance and highlighted that ACC had adopted a similar approach which would support strategic alignment. He noted that a number of corporate documents were still being developed and these would provide further assurance on the Board s governance arrangements. Page 18

19 Thereafter members enquired if the NHSG elements of the local code of corporate governance and sources of assurance had been overseen by an NHSG colleague. Mr Stephen confirmed that the Assistant Director of Finance had provided this oversight. The Committee resolved:- To approve the use of sources of assurance, listed in Appendix 1, the local code of governance, and the governance principles, against which the IJB would measure itself in Annual Governance Statements from onwards. ANNUAL GOVERNANCE STATEMENT 8. The Committee had before it a report by Alex Stephen which provided the Committee with an opportunity to comment on and approve in principle the annual governance statement. The report also requested that the Committee provide assurances to Aberdeen City Council and NHS Grampian on the governance framework. The report recommended:- That the Committee (a) Comment on the draft annual governance statement, as set out in Appendix 1, Additionally, on the proviso that no significant weaknesses impacting on the IJB s governance framework are identified in the assurances received by Aberdeen City Council, NHS Grampian and the IJB s internal auditors: (b) Delegate authority to the Chief Finance Officer to complete the governance statement and provide responses to Aberdeen City Council and NHS Grampian that reasonable assurance can be placed upon the adequacy and effectiveness of the Aberdeen City IJB s systems of governance. Alex Stephen advised that the Governance Statement would be produced annually and performance would be measured against CIPFA s principles of good governance. He explained that there was a degree of complexity in receiving and providing assurance on IJB governance as any significant IJB governance issues may need to be reflected in ACC and NHSG governance statements; similarly the IJBs reliance on some of ACC and NHSG policies and procedures may require any significant weaknesses identified in their controls to be reflected in the IJB s governance statement. Thereafter the Committee discussed whether more explicit reference could be made to the Partnership s transformation agenda and if these could be aligned with the CIPFA principles. The Chief Officer highlighted that transformation was cited in Principle 3 and Principle 5 but noted that the Executive Team would be happy to look at this again to provide additional assurance. The Chair noted that the Governance Statement was well constructed and no significant weaknesses had been identified by the Committee. He advised that at this stage the Committee was duly assured on the robustness of the IJB s governance arrangements and thanked Mr Stephen for his work in producing all the financial and governance documents presented at today s meeting. The Committee resolved:- Page 19

20 (i) (ii) (iii) to delegate authority to the Chief Finance Officer to complete the governance statement and provide responses to Aberdeen City Council and NHS Grampian that reasonable assurance can be placed upon the adequacy and effectiveness of the Aberdeen City IJB s systems of governance; to thank Alex Stephen for his work in preparing the financial and governance documentation; and otherwise note the report. INTERNAL AUDIT PLAN The Committee had before it a report by David Hughes (Internal Audit) which sought approval of the Internal Audit Plan for the Aberdeen City IJB for The report recommended:- That Committee approve the Internal Audit Plan for David Hughes spoke to the report and advised that the Internal Audit Plan was proportionate and in line with the light touch approach adopted by internal auditors across Scotland with regards to IJBs. Mr Hughes noted he would receive assurance on the robustness of IJB governance through receipt of IJB papers and attendance at Board and Committee meetings; as well as work undertaken by ACC and NHSG internal auditors. He added that this assurance would support the development of Internal Audit s financial control statement. Thereafter the Committee discussed the development of governance arrangements for hosted services and the Chief Officer explained that a Pan-Grampian agreement on a framework for hosted services was being discussed. She confirmed that a workshop session on hosted services would be added to the Developmental Timetable. The Committee resolved:- (i) to approve the Internal Audit Plan for ; and (ii) to request that a workshop session on Hosted Services be added to the Developmental Timetable. PROFESSOR MIKE GREAVES, Chairperson. Page 20

21 Agenda Item 5 CLINICAL AND CARE GOVERNANCE COMMITTEE 14 March 2017 Town house, Aberdeen Present: Councillor Alan Donnelly (Chairperson), Jonathan Passmore MBE, Councillor David Cameron Also in attendance: Professor Mike Greaves (NHS Grampian Board member); Bernadette Oxley (Chief Social Work Officer, Aberdeen City Council), Kenneth Simpson (Third Sector Representative),Dr Howard Gemmell (Patient/Service User Representative), Judith Proctor (Chief Officer, Aberdeen City Health and Social Care Partnership), Tom Cowan (Head of Operations, Aberdeen City Health & Social Care Partnership), Kevin Toshney (Acting Head of Strategy & Transformation, Aberdeen City Health & Social Care Partnership), Ashleigh Allan (Clinical Governance Facilitator), Brenda Lurie (Clinical Effectiveness Team Leader, NHSG), Julie Warrender (Nurse Manager, for item 4d, Jillian Evans (Head of Health Intelligence, NHSG, for item 4f) & Trevor Gillespie (Team Manager, Aberdeen City Council, for items 5d & e) Apologies: Dr Nick Fluck, Dr Stephen Lynch, Heather MacRae Page 21

22 OPENING REMARKS Judith Proctor updated the committee on a successful tendering process for the new practice in Northfield/Mastrick. MINUTE OF PREVIOUS MEETING 1. The Committee had before it the minute of the previous Committee meeting of the 1 st of November The Committee resolved to:- i. Approve the minute as a correct record. BUSINESS STATEMENT 2. The Committee had before it a statement of pending business for information. The Committee resolved to:- i. Note the statement. Judith Proctor additionally informed the Committee that Item 3 and outlined the intention to take an update on the development of the workforce plan to the Committee at its June meeting. REPORTS FOR THE COMMITTEE S CONSIDERATION JOINT INSPECTION OF SERVICES FOR OLDER PEOPLE IN ABERDEEN CITY UPDATE REPORT 3. The committee had before it a report by Heather MacRae (Professional Lead for Nursing and Quality Assurance) and Brenda Lurie (Clinical Effectiveness Team Leader, NHSG) which provided information on further work undertaken to develop an action plan to implement the recommendations from the Joint Inspection of Adult Health and Social Care Services in Aberdeen City Health and Social Care Partnership (ACHSCP) report. The report recommended that the Clinical & Care Governance Committee:- i. Endorse the agreed action plan. ii. Request reports every 6 months on the progress in implementing the action plan. Page 22

23 Judith Proctor spoke to the report and reminded members of the inspection process, which reached its conclusion with the production of an action plan for improvements against certain areas and formal conclusion in January 2017 after approval by the inspectors. Going forward, managers will meet with the link inspectors for Aberdeen City to evidence work and implementation of the action plan. She then invited questions on the action plan and the content of the Report. Members thereafter looked for assurances the actions would be completed in designated timescales; requested a final report in 6 months time; and enquired as to if the cancelled IJB self-directed support workshop was to be rescheduled. The Committee resolved to:- i. Endorse the agreed action plan ii. To request a final report on the implementation of the action plan in 6 months time CLINICAL & CARE GOVERNANCE MATTERS CLINICAL & CARE GOVERNANCE REPORT 4a. The committee had before it a report by Brenda Lurie (Clinical Effectiveness Team Leader, NHSG) which provided the details of any governance issues or concerns that the Clinical & Care Governance Group agreed should be escalated to the committee. The report recommended that the Clinical & Care Governance Committee:- i. Note the content of the report ii. Confirm that the revised report provides assurance that services are considering the impact of clinical and care governance issues on the delivery of safe, effective and person centred care. Brenda Lurie spoke to the report and emphasised that the Clinical & Care Governance Group had a workshop at the end of November where they looked at the reporting to this committee. Following the session a short life working group was set up to review the format, which has now changed slightly to have more focus on the impact of issues identified. Guidance was also developed, which was sent out to the group along with the revised report template. This was all tested at the February 2017 meeting and received positive feedback from the group members. Accordingly, it is the template used for this meeting. Thereafter, it was requested to have draft minutes from the most recent meeting of the Clinical & Care Governance Group included in the papers for the committee. Additionally, there was in-depth discussion on Item 1 of the summary sheet which indicated a 15-week wait for social work assessment: this will be investigated to ensure its accuracy and impact, and reported back to the next meeting. Finally, Page 23

24 additional queries were raised over the balance of risks across health and social care, as it was felt that the risks identified were weighted towards health. The Committee resolved to:- i. Note the content of the report. ii. Ask for additional work to get the appropriate level of assurance from a truly integrated report. MINUTE OF THE CLINICAL & CARE GOVERNANCE GROUP 19 OCTOBER b. The committee had before it the approved minutes of the Aberdeen City Clinical & Care Governance Group meeting of the 19 th of October for noting. The committee had no comments on the content of the minute. REPORT FROM CLINICAL & CARE GOVERNANCE GROUP MEETING - 8 TH FEBRUARY c. The committee had before it a summary report to inform the Clinical & Care Governance Committee of key clinical and care governance issues and actions for noting. Judith Proctor referred back to the previous recommendation to bring this back to a future meeting. NATIONAL IN-PATIENT SURVEY WOODEND HOSPITAL RESULTS 4d. The committee had before it a report from Alison McGruther (Unit Nurse Manager, Elderly and Rehabilitation Services) which sought to provide assurance to the committee that information gained from the National Inpatient Survey 2016 has provided opportunities for learning and is informing improvement work. The report recommended that the Clinical & Care Governance Committee:- i. Note the content of the report. ii. iii. Endorse the work being undertaken to learn and improve the service and experience that patients, their families and carer have within Elderly and Rehabilitation Services. Support the improvement work, despite the service having clear difficulties in identifying specific examples to work on individually, across the service as a whole. Page 24

25 Julie Warrender spoke to the report and first highlighted both the many positive elements of the report and the working ongoing to address improvements in: gaining feedback; identification of the person in charge of a ward; reducing the noise in wards at night; and improving discharge transport. Thereafter there was a query on the item relating to discharge transport, as it wasn t clear from the report what the issue actually was (i.e. availability, suitability etc ). This was as the survey did not ask respondents to specify. Judith Proctor then gave an update on the THinC service mentioned in the paper and the option for developing the service. This will be brought to the IJB at its meeting on the 28 th of March. The Committee resolved to:- i. Note the content of the report. ii. iii. Endorse the work being undertaken to learn and improve the service and experience that patients, their families and carer have within Elderly and Rehabilitation Services. Support the improvement work, despite the service having clear difficulties in identifying specific examples to work on individually, across the service as a whole. ARRANGEMENTS WITHIN ACHSCP GENERAL PRACTICES TO MONITOR ADVERSE EVENTS/COMPLAINTS 4e. The committee had before it a report by: Brenda Lurie (Clinical Effectiveness Team Leader, NHSG) Dr Stephen Lynch (Clinical Lead ACHSCP) Shona Smith (Lead Officer for Primary Care Modernisation) Dr Caroline Howarth (Cluster Clinical Lead, ACHSCP) This report sought to provide assurance to the Clinical and Care Governance Committee that robust arrangements are in place, within both independent and directly managed GP practices in ACHSCP, to monitor adverse events and complaints from patients. The report recommended that the Clinical & Care Governance Committee:- i. Note the report and support the ACHSCP s current arrangements to monitor adverse events and patients complaints within General Practices in ACHSCP. ii. Request a report on the themes from the 2016/2017 programme of annual contract visits for the next meeting. Page 25

26 Brenda Lurie spoke to the paper, highlighting the main issues and summarising the work undertaken. Thereafter, members queried whether use of Datix could be included in contract negotiations and who could report adverse incidents in practices using Datix. Additional discussion considered whether these figures were relatively low; comments on what external processes there were to verify the peer review elements; and how we could include examples of good practice. A final point requested a little more context around the data, such as benchmark information to help the committee understand the information. The Committee resolved to:- i. Note the report and support the ACHSCP s current arrangements to monitor adverse events and patients complaints within General Practices in ACHSCP. ii. iii. Request a report on the themes from the 2016/2017 programme of annual contract visits for the next meeting. Seek a more detailed report on the reporting and analysis of adverse and significant events in those practices which don t use Datix, and more information on the checks and balances around the peer reviews. FALLS 4F. The committee had before it a report from Jillian Evans, Head of Health Intelligence NHSG, which looks to improve understanding of the scale and impact of falls in Aberdeen hospitals, clinical and surgeries, and to highlight areas of practice and process where improvements should be made. The report recommended that the Clinical & Care Governance Committee:- Find an appropriate member of NHS staff to: i. Note the findings of this report relating to falls across all Grampian premises. ii. iii. iv. Review staff awareness and training for Level 1 reviews and the requirements for RIDDOR reporting. Confirm and reinforce incident monitoring arrangements in Sector Clinical Governance Process. Extend monitoring and formal governance process to Level 2 reviews. Jillian Evans spoke to the papers and highlighted the detail within the report which gives a sense of scale and impact. Today, she has drawn out the ACHSCP part of this report and given some recommendations on this basis. She emphasised that Page 26

27 only 1 fall over the 2 year period in ACHSCP was classified as extreme, but also emphasised that this has a large human impact. Thereafter, members queried whether the classification of a fall was a product of the situation or severity. It was noted that the consistency of coding was variable in some places. The Committee resolved to:- i. Note the findings of this report relating to falls across all Grampian premises. ii. iii. iv. Review staff awareness and training for Level 1 reviews and the requirements for RIDDOR reporting. Confirm and reinforce incident monitoring arrangements in Sector Clinical Governance Process. Extend monitoring and formal governance process to Level 2 reviews. v. To request a report to on the learning gained from examining level 2 reviews. CARE GOVERNANCE DATA CARE GOVERNANCE REPORT 5a The committee had before it a report from Brenda Lurie, Clinical Effectiveness Team Leader, NHSG) which sought to provide an overview of the Care Governance Data reports (following this report) and an outline of further work to streamline these reports for the Committee. The report recommended that the Clinical & Care Governance Committee:- i. Note the Care Governance Data Reports as presented in the Appendices Brenda Lurie spoke to the paper and explained that the main change was to include a covering paper for the datix paper to the group. The Clinical & Care Governance Group has also discussed developing a joint reporting framework to streamline the reports coming to the committee. However it was noted that due to existing reporting cycles and systems this work is still to be undertaken. The Committee resolved to:- i. Note the Care Governance Data Reports as presented in the Appendices Page 27

28 INCIDENT REPORT NHS 5b The committee had before it a report from Brenda Lurie, Clinical Effectiveness Team Leader NHSG, which sought to provide an overview to the Clinical and Care Governance Committee on the adverse event report from 1 st October to the 31 st December The report recommended that the Clinical & Care Governance Committee:- i. Acknowledge that the report provides the assurance required. Brenda Lurie spoke to the report and informed the committee that it presents the date for adverse events for the last quarter report for the quarter. It was highlighted that the main difference was an increase in the number of events coded under security (10 to 48), which was attributed to a number of school children using the premises as a short. Actions are being taken to address this. The Committee resolved to:- i. Acknowledge that the report provides the assurance required. FEEDBACK REPORT NHS 5c The committee had before it a report from Brenda Lurie, Clinical Effectiveness Team Leader NHSG, which sought to provide an overview to the Clinical and Care Governance Committee on the feedback report from 1 st October to the 31 st December The report recommended that the Clinical & Care Governance Committee:- i. Acknowledge that the report provides the assurance required. Brenda Lurie spoke to the report and highlighted that there were fewer complaints received compared with the previous quarter. Thereafter the committee requested a themed analysis of the complaints from the last 12 months to come back to the committee. It was also noted that the Clinical & Care Governance Group already look at these themes, which has led to improvement work. The Committee resolved to:- i. Acknowledge that the report provides the assurance required. Page 28

29 FEEDBACK (COMPLAINTS) REPORT SOCIAL WORK 5d The committee had before it a report from Trevor Gillespie, Team Manager, which sought to provide an analysis to support the performance information being presented to the committee. The report recommended that the Clinical & Care Governance Committee:- i. Note the content of the report Trevor Gillespie spoke to the report, highlighted the main trends in the report and invited questions. It was noted that there is the potential for an increased number of incidents with the opening of a new centre, as this is an unsettling time for vulnerable people. Additional support has been put in place to manage this transition period. Thereafter, members raised queries related to the process for upheld/partially upheld complaints; and how complaints which indicate issues in policy or legislation are escalated. The Committee resolved to:- i. Note the content of the report INCIDENT REPORT SOCIAL WORK (ADULT SOCIAL CARE HEALTH AND SAFETY UPDATE REPORT) 5e The committee had before it the Adult Social Care Health & Safety Committee Report from the 10 th of January 2017 for noting, provided as an appendix to item 5d. ITEMS TO REPORT TO THE INTEGRATION JOINT BOARD 6 The Chair of the Committee invited any escalations to the IJB, given that the draft minute of this meeting shall be presented to the IJB in March. There were no escalations. AOCB Councillor Donnelly thanked the C&CG committee, ahead of the elections. Councillor Cameron echoed these sentiments. Page 29

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31 BUSINESS STATEMENT INTEGRATION JOINT BOARD 6 JUNE 2017 Please note that this statement contains a note of items which have been instructed for submission to, or further consideration by, the Integration Joint Board (IJB). All other actions which have been instructed are not included, as they are deemed to be operational matters after the point of decision. Items which have been actioned are shaded. No. Minute Reference IJB Decision Update Lead Officer(s) Due Page TLG Article 3 2. sijb Article 5 Delegated Functions and Services The TLG agreed that the starting position in terms of delegated functions and services would be those set out in set one of the regulations and orders as set out in tables 2 and 3 appended to the report, and within that starting point, agreed that further work on the handling of NHS services delivered across the north east and in relation to hosted services within scope would be carried out by the Strategic Change Management Group and recommendations brought back to the Shadow Board. Delayed Discharges The Shadow Board agreed in principle to the proposals attached and for officers to develop these further. The Shadow Board also agreed to additional funding support from the Scottish Government and to receive regular updates on progress in developing this work and in relation to Delayed Discharge performance. The Scheme of Delegation was deferred by the Board at its meeting on 28 June 2016 and will be aligned to the development of Aberdeen City Council s revised Scheme of Delegation. A Delayed Discharge performance report is on today s agenda. Chief Officer, Aberdeen City Health and Social Care Partnership Chief Officer, Aberdeen City Health and Social Care Partnership Agenda Item 6

32 2 No. Minute Reference IJB Decision Update Lead Officer(s) Due 3. sijb Article 5 Winter Planning The Shadow Board requested a report that would provide an early update on winter planning and the roles of both parent organisations be added to the schedule and for said report to be submitted no later than the August meeting. An update will be provided at the Board s next meeting on 15 August Chief Officer, Aberdeen City Health and Social Care Partnership Page sijb Article 6 5. sijb Article 7 Document Management The Shadow Board requested a report on document management and storage. Performance Assurance Framework The Shadow Board requested a report on the development of a performance assurance framework. An update will be provided at the Board s next meeting on 15 August The Annual Performance Report is on today s agenda. Chief Officer, Aberdeen City Health and Social Care Partnership Chief Officer, Aberdeen City Health and Social Care Partnership sijb Article 5 Locality Planning The Shadow Board requested a timetable which outlined the development of locality planning. A locality workshop session is scheduled for 20 June Integrated Localities Programme Manager, Aberdeen City Health and Social Care Partnership sijb Article 6 Clinical and Care Governance Framework The Board resolved to defer decision The 14 March 2017 minute of the Clinical and Care Governance Committee is on today s agenda. Chief Officer, Aberdeen City Health and Social Care

33 3 No. Minute Reference IJB Decision Update Lead Officer(s) Due making on the Clinical and Care Governance Framework on 23 February 2016 to the Board s next meeting on 29 March Partnership Page IJB Article IJB Article 5 Good Governance Institute Implementation Plan The Board instructed the Chief Officer to prepare an action plan on how the recommendations in the Good Governance Institute s final report would be implemented. Standing Orders The Board requested that officers review standing order 23 and report back to the Board. The GGI Implementation Plan was presented to the Board at its meeting on 28 March Recommended for removal A wider review of standing orders has been scheduled for 15 August Chief Officer, Aberdeen City Health and Social Care Partnership Senior Democratic Services Manager, ACC IJB Article 10 Living Wage Monitoring Arrangements The Board instructed the Chief Officer to ensure the implementation of the Living Wage and Fair Working Practices through appropriate contract monitoring processes to provide assurance to the IJB that this had been implemented by the end of the financial year. A report on the implementation of the Living Wage was presented to the Board on 28 March Recommended for removal Chief Finance Officer, Aberdeen City Health and Social Care Partnership IJB Article 12 Ethical Care Charter The Board requested an update on the work of the Ethical Care Charter Working Chief Officer, Aberdeen City Health and Social Care

34 4 No. Minute Reference IJB Decision Update Lead Officer(s) Due Group Partnership Page 34

35 Agenda Item 7 INTEGRATION JOINT BOARD Report Title Lead Officer Report Author, Job Title, Organisation Report Number Appointment of Members to Committees and Appointment of Chairperson of Clinical and Care Governance Committee Judith Proctor Iain Robertson, Committee Services Officer, Aberdeen City Council HSCP/17/051 Date of Report 4 May 2017 Date of Meeting 6 June : Purpose of the Report To advise the Board of the requirement to appoint committee members and to appoint a Chairperson to the Clinical and Care Governance Committee. 2: Summary of Key Information 2.1 At its meeting on 29 March 2016, the Integration Joint Board (IJB) agreed to establish two committees to support its functions. These were the Audit and Performance Systems (APS) Committee and the Clinical and Care Governance (CCG) Committee. 2.2 The terms of reference for both committees have been attached under Appendices A and B. 2.3 As per IJB standing order 2(1) the composition of IJB committees have been based on the principle of equal representation between Aberdeen City Council (ACC) and NHG Grampian (NHSG) in terms of voting membership. 2.4 Item 2.1 of the APS Committee s terms of reference and item 3.2 of the CCG committee s terms of reference note that the power to appoint committee members rests with the IJB. 2.5 Following the local government elections on 4 May 2017, there are now two vacancies on both the APS and CCG committees. It is recommended that these vacancies be filled by voting members from Aberdeen City Council. 2.6 The Board is also required to appoint a Chairperson to the CCG Committee as per standing order 23(2). In order to adhere to the Board s equal representation 1 Page 35

36 INTEGRATION JOINT BOARD principles it is recommended that a voting member from ACC be appointed as Chairperson of this committee. 2.7 The Board has discretion to appoint voting members to a committee based on a member s experience, interests and skills; and whether their appointment would be beneficial to the committee s functions and capacity. 2.8 Members should note that IJB standing orders and committee terms of reference are due to be reviewed by the Board at its August meeting and this may have implications for committee compositions and appointments from that date onwards. 2.9 The IJB meeting schedule has been attached as Appendix C for members reference. 3: Equalities, Financial, Workforce and Other Implications 3.1 As per the IJB s standing orders, it is recommended that voting members from Aberdeen City Council and NHS Grampian be equally represented on each committee. 3.2 From a good governance perspective, the Board should bear in mind that NHSG members are currently the Chairs of the IJB and APS Committee and it is recommended that the IJB appoint a voting member from Aberdeen City Council as Chairperson of the CCG Committee to support the representativeness principle outlined in standing orders. 4: Management of Risk Identified Risk(s): If appointments to IJB committees are not balanced in terms of membership there is a risk that perspectives from both partners may not be reflected during meetings and this may have an impact on decision making and scrutiny capacity. Link to risk number on strategic or operational risk register: Strategic Risk Register, item 3: Failure of the IJB to function and make decisions in a timely manner 2 Page 36

37 INTEGRATION JOINT BOARD How might the content of this report impact or mitigate the known risks: By appointing an equal number of members to each committee the Board would adhere to provisions and principles set out in standing orders. This would mean that both committees would have members in place to capture perspectives and expertise from both partners and strengthen their capacity to hold Partnership officers to account. 5: Recommendations It is recommended that the Integration Joint Board: 1. Appoint two ACC voting members to the Audit and Performance Systems Committee; 2. Appoint two ACC voting members to the Clinical and Care Governance Committee; 3. Appoint an ACC voting member as Chairperson of the Clinical and Care Governance Committee; and 4. Note the IJB meeting schedule for attached as Appendix C. 6: Signatures Judith Proctor (Chief Officer) Alex Stephen (Chief Finance Officer) 3 Page 37

38 INTEGRATION JOINT BOARD Appendix A 1 Introduction ABERDEEN CITY INTEGRATION JOINT BOARD AUDIT & PERFORMANCE SYSTEMS COMMITTEE TERMS OF REFERENCE 1.1 The Audit & Performance Systems Committee is identified as a Committee of the Integration Joint Board (IJB). The approved Terms of Reference and information on the composition and frequency of the Committee will be considered as an integral part of the Standing Orders. 1.2 The Committee will be known as the Audit & Performance Systems Committee (APS) of the IJB and will be a Standing Committee of the Board, 2 Constitution 2.1 The IJB shall appoint the Committee. The Committee will consist of not less than 4 members of the IJB, excluding Professional Advisors. The Committee will include at least two voting members, one from Health and one from the Council. 3 Chair 3.1 The Committee will be chaired by a non-office bearing voting member of the IJB and will rotate between NHS and ACC. 4 Quorum 4.1 Three Members of the Committee will constitute a quorum. 5 Attendance at meetings 5.1 The Board Chair, Chief Officer, Chief Finance Officer Chief Internal Auditor and other Professional Advisors and senior officers as required as a matter of course, external audit or other persons shall attend meetings at the invitation of the Committee. 5.2 The Chief Internal Auditor should normally attend meetings and the external auditor will attend at least one meeting per annum. 5.3 The Committee may co-opt additional advisors as required. 4 Page 38

39 INTEGRATION JOINT BOARD 6 Meeting Frequency 6.1 The Committee will meet at least 4 times each financial year. There should be at least one meeting a year, or part therefore, where the Committee meets the external and Chief Internal Auditor without other seniors officers present. A further 2 developmental sessions will be planned over the course of the year to support the development of members. 7 Authority 7.1 The Committee is authorised to instruct further investigation on any matters which fall within its Terms of Reference. 8 Duties 8.1 The Committee will review the overall Internal Control arrangements of the Board and make recommendations to the Board regarding signing of the Governance Statement, having received assurance from all relevant Committees. Specifically it will be responsible for the following duties: 1. The preparation and implementation of the strategy for Performance Review and monitoring the performance of the Partnership towards achieving its policy objectives and priorities in relation to all functions of the IJB; 2. Ensuring that the Chief Officer establishes and implements satisfactory arrangements for reviewing and appraising service performance against the national health and wellbeing outcomes, the associated core suite of indicators and other local objectives and outcomes and for reporting this appropriately to the Committee and Board.. The performance systems scrutiny role of the Committee is underpinned by an Assurance Framework which itself is based on the Board s understanding of the nature of risk to its desired priorities and outcomes and its appetite for risk-taking. This role will be reviewed and revised within the context of the Board and Committee reviewing these Terms of Reference and the Assurance Framework to ensure effective oversight and governance of the partnership s activities.. 3. Acting as a focus for value for money and service quality initiatives; 4. To review and approve the annual audit plan on behalf of the IJB, receiving 5 Page 39

40 INTEGRATION JOINT BOARD reports, overseeing and reviewing actions taken on audit recommendations and reporting to the Board; 5. Monitoring the annual work programme of Internal Audit, including ensuring IJB oversight of the clinical and care audit function and programme to ensure this is carried out strategically; 6. To consider matters arising from Internal and External Audit reports; 7. Review on a regular basis actions planned by management to remedy weaknesses or other criticisms made by Internal or External Audit 8. To support the IJB in ensuring that the strategic integrated assurance and performance framework is working effectively, and that escalation of notice and action is consistent with the risk tolerance set by the Board. 9. To support the IJB in delivering and expecting cooperation in seeking assurance that hosted services run by partners are working effectively in order to allow Aberdeen City IJB to sign off on its accountabilities for its resident population. 10. Review risk management arrangements, receive annual Risk Management updates and reports and annually review with the full Board the IJB s risk appetite document. 11. Ensure existence of and compliance with an appropriate Risk Management Strategy. 12. Reporting to the IJB on the resources required to carry out Performance Reviews and related processes; 13. To consider and approve annual financial accounts and related matters; 14. Ensuring that the Senior Management Team, including Heads of Service, Professional Leads and Principal Managers maintain effective controls within their services which comply with financial procedures and regulations; 15. Reviewing the implementation of the Strategic Plan; 16. To be responsible for setting its own work programme which will include the right to undertake reviews following input from the IJB and any other IJB Committees; 17. The Committee may at its discretion set up short term working groups for review work. Membership of the working group will be open to anyone whom the Committee considers will assist in the task assigned. The working groups 6 Page 40

41 INTEGRATION JOINT BOARD will not be decision making bodies or formal committees but will make recommendations to the Audit Committee; 18. Promoting the highest standards of conduct by Board Members; and 19. Monitoring and keeping under review the Codes of Conduct maintained by the IJB. 20. Will have oversight of Information Governance arrangements and staffing arrangements as part of the Performance and Audit process. 21. Ensuring effective IJB oversight of the scrutiny of Serious Incidents in health and social care, including monitoring and reporting systems, timely action, training and improvement activities. 22. To be aware of, and act on, Audit Scotland, national and UK audit findings and inspections/regulatory advice, and to confirm that all compliance has been responded to in timely fashion. 9 Review 9.1 The Terms of Reference will be reviewed every six months to ensure their ongoing appropriateness in dealing with the business of the IJB. 9.2 As a matter of good practice, the Committee should expose itself to periodic review utilising best practice guidelines and external facilitation as required. 7 Page 41

42 INTEGRATION JOINT BOARD Appendix B ABERDEEN CITY HEALTH AND SOCIAL CARE PARTNERSHIP CLINICAL AND CARE GOVERNANCE COMMITTEE TERMS OF REFERENCE 1. INTRODUCTION 1.1 The Clinical and Care Governance Committee will provide assurance to the Integrated Joint Board (IJB) on the systems for delivery of safe, effective, personcentred care in line with the IJB s statutory duty for the quality of health and care services. 2. REMIT 2.1 To provide assurance to the IJB that clinical and care governance is being discharged within the Partnership in relation to the statutory duty for quality of care and that this is being led professionally and clinically with the oversight of the IJB. 2.2 To provide the strategic direction for development of clinical and care governance within the Partnership and to ensure its implementation. 3. MEMBERSHIP 3.1 The Committee shall be established by the IJB and will be chaired by a voting member of the IJB. The Committee shall comprise of: 4 voting members of the IJB Chief Officer Chief Social Work Officer Chair of the Clinical and Care Governance Group Chair of the Health and Safety Committee (this group is in development) Chair of the Joint Staff Forum Professional Lead GP Professional Lead Nurse/AHP 8 Page 42

43 INTEGRATION JOINT BOARD Public Representative Third sector and Independent Sector representatives 3.2 The Chair and members of the Committee will be appointed by the IJB. Committee membership and Chairmanship will be reviewed annually. 3.3 Where a member is unable to attend a particular meeting, a named representative shall attend in their place. 3.4 The Committee may wish to invite appropriately qualified individuals from other sectors to join its membership as it determines or as is required given the matter under consideration. This may include NHS Board Professional Committees, Managed Care Networks and Adult and Child Protection Committees. 3.5 The Committee may co-opt additional advisors as required with approval of the Chair. 4. QUORUM voting IJB members will be required and a total of 4 other committee members (6 in total) shall constitute a quorum. 5. FREQUENCY OF MEETINGS 5.1 The Committee shall meet quarterly and will meet at least 4 times a year. 5.2 The Chair may, at anytime, convene additional meetings of the Committee. 5.3 Two development workshops/activities will be held each year. 6. CONDUCT OF BUSINESS 6.1 A calendar of Committee meetings, for each year, shall be agreed by the members and distributed to members. 6.2 The agenda and supporting papers shall be sent to members at least seven days before the date of the meeting. 6.3 Administrative support shall be provided by the Health and Social Care Partnership. 7. AUTHORITY 9 Page 43

44 INTEGRATION JOINT BOARD 7.1 The Committee is authorised on behalf of the IJB to investigate any matter that falls within its Terms of Reference and obtain professional advice as required. 7.2 The Committee may form one or more sub-groups to support the clinical and care governance function within the Partnership. 8. DUTIES The Committee shall be responsible for the oversight of clinical and care governance within Aberdeen City Health and Social Care Partnership. Specifically it will: 8.1 Agree the Partnership s clinical and care governance priorities and give direction to clinical and care governance activities. 8.2 Oversee the work of the Clinical and Care Governance Group and Staff Governance Groups receiving a quarterly report and meeting minutes for consideration and assurance as necessary 8.3 Monitor the Partnership s Risk Register from a clinical and care governance/staff governance perspective and escalate to the IJB any unresolved risks that require executive action or that pose significant threat to patient care, service provision or the reputation of the Partnership. 8.4 Oversee and direct the processes within the Partnership to ensure appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, complaints and litigation. Also ensures that examples of good practice and lessons learned are disseminated within the Partnership and beyond if appropriate. 8.5 The Chief Social Work Officer will provide appropriate professional advice to the Clinical and Care Governance Committee in relation to statutory social work duties in terms of the Social Work (Scotland) Act In their operational management role the Chief Officer will work with and be supported by the Chief Social Work Officer with respect to quality of integrated services within the Partnership in order to then provide assurance to the IJB. 8.6 The Professional Leads nominated by NHS Grampian will be supported by NHS Grampian s Medical Director and Director of Nursing and Allied Health Professions through formal network arrangements. In their operational management role, the Chief Officer will work with and be supported by these 10 Page 44

45 INTEGRATION JOINT BOARD Professional Leads with respect to quality of integrated services within the Partnership in order to then provide assurance to the IJB. 8.7 The Chief Officer has delegated responsibilities from both Chief Executives, for the professional standards of staff working in integrated services. The Chief Officer, relevant Lead Professionals and the Chief Social Worker will work together to ensure appropriate professional standards and leadership particularly during times of transition. 8.8 Through the Clinical and Care Governance Committee, the Chief Officer will ensure that clear strategic objectives for clinical and care governance are agreed, delivered and reported through an annual clinical and care governance action plan. This will include actions to ensure the quality of service delivery including that delivered through services procured from the third and independent sector. 9. REPORTING ARRANGEMENTS 9.1 The Clinical and Care Governance Committee will formally provide a copy of its minutes to the IJB for inclusion on the agenda of subsequent IJB meetings. These minutes will be made publically available. 9.2 The Chief Officer will provide assurance to the IJB on the development and completion of the Annual Clinical and Care Governance Workplan. 9.3 The Committee will provide assurance to the IJB and inform the NHS Clinical Governance Committee on the operation of clinical and care governance within the Partnership. 9.4 The Committee will conduct a review of its role, function and membership within the first year and then regularly at a frequency to be determined. 9.5 The Clinical and Care Governance Group will report to the Clinical and Care Governance Committee 11 Page 45

46 INTEGRATION JOINT BOARD Appendix C APRIL 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT APS Health Village Room 4& MAY 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT Page 46

47 INTEGRATION JOINT BOARD IJB Inductions Health Village Room 4& JUNE 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT IJB Health Village Room 4& APS Health Village Room 4& Page 47

48 INTEGRATION JOINT BOARD C&CG Health Village Room 4 & JULY SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT AUGUST 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT Page 48

49 INTEGRATION JOINT BOARD IJB Health Village Rooms 4& SEPTEMBER 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT APS Town House Committee Room Page 49

50 INTEGRATION JOINT BOARD OCTOBER 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT C&CG Health Village Rooms 4& IJB Health Village Room 4& NOVEMBER 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT Page 50

51 INTEGRATION JOINT BOARD APS Health Village Room 4& DECEMBER 2017 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT IJB Health Village Rooms 4& Page 51

52 INTEGRATION JOINT BOARD JANUARY 2018 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT CCG Health Village Rooms 4& IJB Health Village Rooms 4 & FEBRUARY 2018 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT Page 52

53 4 5 6 IJB Budget special Health Village Room 4 & APS Health Village Room 4& INTEGRATION JOINT BOARD MARCH 2018 SUN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT IJB (provisional special budget meeting) HV Room 4& Page 53

54 INTEGRATION JOINT BOARD CCG Health Village Rooms 4& IJB Health Village Rooms 4& Page 54

55 Agenda Item 8 Integration Joint Board Report Title Lead Officer Report Author Report Number Annual Performance Report Judith Proctor, Chief Officer Kevin Toshney, Acting Head of Strategy and Transformation HSCP/17/040 Date of Report 4 th May 2017 Date of Meeting 6 th June : Purpose of the Report This report presents the draft content of the Partnership s Annual Performance Report of its first year of operation to the Integration Joint Board for approval, outlining how the Partnership has met the nine national health and wellbeing outcomes as well as setting out wider achievements and other highlights. The report, once approved will be subject to design formatting prior to publication and will have an Executive Summary version also available. It will be distributed widely in line with the methods and channels set out in the Partnership s Communications Strategy. 2: Summary of Key Information 2.1 The Public Bodies (Joint Working) (Scotland) Act 2014 obliges the integration authority to prepare a performance report for the previous reporting year and for this report to be published before the end of the fourth month (July) following that reporting year. 2.2 This Partnership s three year Strategic Plan was published on 1 st April 2016 (integration go live day) and the performance report must outline a description of the extent to which the arrangements set out in the strategic plan have achieved, or contributed to achieving, the national health and wellbeing outcomes. 1 Page 55

56 Integration Joint Board 2.3 Improved personal experiences and outcomes are pivotal to our ambition to be recognised as a high performing partnership which is delivering good quality, person centred services. A key element of the report sets our progress in that respect through an assessment of our performance in relation to the national health and wellbeing outcomes and their associated core indicators. 2.4 The Partnership s Chief Finance Officer has provided regular budget monitoring updates to the IJB throughout the year. This performance report includes an overview of the total amount of money spent and also the total amount and proportion of spend in the reporting year broken down by the various services to which the money was allocated. The accompanying narrative will analyse our total expenditure against the budget that was set by the IJB before integration go live last year and possible reasons for any variations in this. The Chief Finance Officer will present the Partnership s audited accounts for 2016/17 later this year. 2.5 In addition to the Partnership s financial performance, the report must also assess whether best value has been achieved in terms of the planning and delivery of services. This should include, where applicable, identification of whether there were opportunities for further efficiencies. 2.6 The implementation of our locality model will be critical to the success of our transformation programme and to our overall strategic ambitions and priorities. We will provide a brief overview of the establishment of our locality leadership groups and our locality planning timeline. Future reports will provide an assessment of performance in planning and carrying out functions in localities, including appropriate financial information in respect of this. 2.8 Neither the legislation or accompanying guidance prescribes a specific template to be used for the annual performance report. Each partnership has the opportunity to design its own format to best explain and illustrate its performance against the national outcomes and its narrative for the year. It is expected though, that as a public document the annual performance report will be placed on the Partnership s website and made as accessible to as wide a readership as 2 Page 56

57 Integration Joint Board possible. 2.9 The integration authority is required to provide a copy of this performance report to its constituent authorities, Aberdeen City Council and NHS Grampian 2.10 The Aberdeen City Health and Social Care Partnership s annual performance report for 2016/17 Transforming Care Through Integration is set out in Appendix B The performance report will be widely circulated and made available to all staff and, through our communications strategy, publicised through all available channels and methods. An executive summary will also be produced. 3: Equalities, Financial, Workforce and Other Implications Financial Implications There are no financial implications arising from the proposed approval of the annual performance report. Equalities Implications There are no immediate and obvious equalities implications but it is hoped that the Partnership s continued focus on improving the health and wellbeing of its local population and the social and health inequalities that it experiences will have positive implications for the client groups. Workforce Implications There are no workforce implications arising from the publication of this annual performance report. 4: Management of Risk Identified risk(s): There is a risk that this annual performance report does not illustrate well enough 3 Page 57

58 Integration Joint Board the attainments of the Partnership in giving itself a positive platform on Integration go live day to initiate a large scale transformation programme across all sectors and at the same time continuing to deliver good quality services across the diverse and complex range of delegated functions. Link to risk number on strategic or operational risk register: 7. There is a risk that the IJB and the services that it directs and has operational oversight of fail to meet performance standards or outcomes as set by regulatory bodies. How might the content of this report impact or mitigate the known risks: This report seeks to mitigate the possible risk by illustrating our performance against the national outcomes in the context of the early stages of our large scale transformation and the many, different initiatives and activities that are being progressed across the partnership. 5: Recommendations for Action It is recommended that the Integration Joint Board: 1. Approves the annual performance report. 2. Agrees that this report should be distributed widely, as according to the communications plan outlined in Appendix A. 3. Instructs the Chief Officer to provide copies of the annual performance report to the IJB s partner organisations, Aberdeen City Council and NHS Grampian. 6: Signatures Judith Proctor (Chief Officer) 4 Page 58

59 Integration Joint Board Alex Stephen (Chief Finance Officer) APPENDIX A Internal Communication Communication Method When Intranet w/c 05/06/12 Newsletter June 2017 OurIDEAS w/c 05/06/17 Distribution via Senior Managers w/c 05/06/17 External Communication Communication Method When Website w/c 05/06/17 Provision to Partner Chief Executives w/c 05/06/17 Press Release w/c 05/06/17 5 Page 59

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61 Transforming Care Through Integration Aberdeen City Health Integration Joint Board Annual Report Page 61

62 Contents 1. Exciting and Dynamic Times Executive Summary Our Partnership The Case for Change How Are We Doing? Looking Forward 28 If you require further information about any aspect of this Annual Report please contact: Aberdeen City Health and Social Care Partnership Community Health and Care Village 50 Frederick Street Aberdeen AB24 5HY Website: Twitter: 2 Page 62

63 1. Exciting and Dynamic Times Welcome from the IJB Chair I warmly welcome the publication of this, our first Annual Report which sets out how we have performed in establishing both the Integration Joint Board and the Health and Social Care Partnership and how we are working towards fulfilling the ambitions and priorities outlined in our Strategic Plan. I am delighted to have taken over the Chair of the IJB following the baton being passed to me from the IJB s first Chair, Cllr Len Ironside CBE. Cllr Ironside steered the IJB during its first 10 months of live operation and was a champion for integration and improving outcomes for people. My aim now as Chair is to continue to build upon the strong foundations we have made and to drive our ambitions of delivering significant transformation improved outcomes for people in Aberdeen. I will be supporting our new IJB members who have joined us since the Local Government elections in May 2017 in fulfilling their important roles as members of the IJB in setting the direction and ensuring sound governance for our endeavours. We aim to be one of the top performing IJBs in Scotland one which attracts the best people and professionals to work with us and which strives to reduce inequalities in health and improve the wellbeing of our communities. We have made a start and I look forward to leading a Board and supporting an Executive Team in making even greater progress in across this year and into the next. Jonathan Passmore, MBE, Chair Chief Officer Foreward We can be proud of what we have achieved in our first 12 months of operation. We have lived within our means during this challenging financial year and delivered a balanced budget for 2017/18, accommodating payment of the Scottish Living Wage to our external care providers. We have also maintained a continuity of service for the people who depend upon us during this time of significant change. We have made significant strides towards establishing the necessary senior management structure to give us the leadership capacity to deliver on our strategic priorities and we have established our own strong Team Aberdeen identity as a Partnership by holding our first Transformation Conference and HEART Awards celebration. We have opened our new 4.3million Len Ironside Centre to cater for some of Aberdeen s most vulnerable adults and we have driven our priority of reducing 3 Page 63

64 delayed discharge to a point where we are seeing real results in reducing both the numbers of people delayed as well as the length of time people are delayed. We have laid the groundwork to establish Link Workers in every GP practice and to pilot the Buurtzorg care-at-home model in our emerging Localities, while at the same time creating the foundations for our Carers Strategy and our Commissioning Plan. These are exciting and dynamic times for health and social care in Aberdeen as we forge ahead on our journey of change, transformation and improvement and I want to thank every colleague for their help, their support and their great ideas over the past year. There are demographic and financial challenges ahead but, strongly supported by our Integration Joint Board, we will meet them together as a team and develop sustainable solutions which meet the needs of all who rely upon our services. Judith Proctor, Chief Officer. 2. Executive Summary The population of Aberdeen City is ageing with a projected 70% increase in people over the age of 75 by This is likely to place enormous pressure on health and social care services and forces us all to think differently about how we achieve and maintain good health and well-being. Our ambitious transformation programme is developing new models of care to support people with long term health conditions and provide traditional hospital (acute) care in communities or even at home. The development of an adaptable and sustainable workforce is key to this, and we aim to develop our assets across primary, community, social care and the third sector. Underpinning all of this is a positive can-do organisational climate with staff and communities being fully engaged and supported to do their very best for the people of Aberdeen. The drive for effective performance and high quality of care is at the heart of everything we do. Working within a framework adapted from the Care Quality Commission, we monitor measures that are most important to us as a quality organisation. These are based on those where we have the greatest level of accountability and leverage to improve. In some cases the data may be limited and 4 Page 64

65 the measures may be imperfect, but we can still use it to understand where we are, and where we want to be. Safe: Developing systems and approaches to keep people and communities safe from harm is a priority of the Community Planning Partnership. Our role in this is to raise awareness of risk and to ensure referrals are made for adult support and protection when appropriate. This is an area where referrals are inconsistent a situation we wish to understand better and improve. Effective: Co-ordination of care between professionals is a key ingredient in improving health and well-being outcomes for people in Aberdeen. In the first year of Partnership, we have maintained a downward trend in the rate of emergency admissions to hospital each month, and in the number of bed days used for unscheduled care a trend which we believe will place us in the top quartile of all Scottish Partnerships next year. Alcohol consumption and related harm is a significant public health issue in Scotland and particularly so in Aberdeen. Our focus in this first Partnership year has been to increase the number of alcohol brief interventions that are delivered in settings outside of GP surgeries, reaching more people in need of support. Responsive: Increasing the uptake of self-directed support and reducing unmet need for social care are all indicators of independent living. There has been little change in performance of services in the past year a situation we aim to improve in 2017/18. Reducing the number of people affected by delays in hospital discharge has been a key priority for us this year and one where improvement has been considerable. Improved operational processes, effective service commissioning and the combined one team ethos has improved the experience of care for many older people and their families. Against the context of an ageing and growing population, our focused efforts have meant that fewer people are delayed in hospital when they are ready to be discharged. At the end of our first full Partnership year, the number of people in hospital each month with standard delays reduced by 22% and the number of avoidable hospital bed days reduced by 47%. Caring: Almost 89% of care for people in the last six months of their life takes place at home or in a homely setting. This compares well with other places in Scotland, but our aim in 2017/18 is to drive improvement in palliative and end of life care which reflects best practice and accords as much as possible with the needs and wishes of patients and their families. 5 Page 65

66 Well- led: The driving ethos of the Partnership is that staff engagement, participation and delegated authority promotes trust and autonomy an important factor in a modern, adaptive organisation. The use of i-matter as a feedback and participation tool will be extended into our second year, aiming to work with staff to enhance team working and address difficult issues such as staff sickness. Our transformation programme to develop staff and culture includes effective communication, co-location of teams, information sharing and leadership development. We have placed particular importance on Partnership identity and awarding staff for efforts that have made a notable difference in the job that they do. 3. Our Partnership We are a caring partnership working together with our communities to enable people to achieve fulfilling, healthier lives and wellbeing The Aberdeen City Health and Social Care Partnership (ACHSCP) formally came into existence in February 2016 with the approval of its Integration Scheme by Scottish Ministers. The Integration Joint Board (IJB) the Partnership s board of governance, strategy and scrutiny became responsible for its delegated health and social care functions on the 1 st of April Integration go live was a hugely significant event, given the many different arrangements that we were obliged to have in place as well as the obvious requirement to ensure continuity of care and support for the many individuals who use our health and social care services across the city.. We believe that our integration transition was successful and gave us a positive platform to begin the transformation of our services and deliver the vision and ambitions of our Strategic Plan. 6 Page 66

67 The IJB is growing in its leadership role and relationships within it are positive and supportive of good decision-making. We have navigated significant governance challenges arising from the legislation with a focus on enabling the IJB s decisionmaking authority and siting this appropriately within delegations from partner organisations. Did you know That one of the ways that we ensure that the voice of people who use our services and carers in the city is heard is through the participation of their representatives on our Integration Joint Board? They fulfil a crucial role in articulating the user and carer experience and we will develop support networks for them and the many different organisations that operate in the city to support them. At its first meeting last year, the IJB agreed our strategic ambitions and priorities, and set out its expectations about the scale and pace of our transformation programme. The IJB is clear that they now expect the Chief Officer and her Executive Team to deliver the anticipated benefits from the many different change activities and initiatives that are being progressed by staff across the Partnership. 7 Page 67

68 held seven public meetings over the last year, establishing the relationships and procedures required to effectively deliver the strategic plan prepared and agreed its first joint budget established and operated two sub committees (Audit and Performance System Committee and Clinical and Care Governance Committee) hosted its first annual conference and an awards ceremony agreed spend for several significant transformation projects established performance management and risk frameworks held several workshops to inform IJB members of the services for which the IJB has strategic responsibility in conjunction with Aberdeen City Council opened a new day care centre called the 'Len Ironside Centre' approved and is in the process of implementing a new management structure The Chief Officer s Executive Team is now firmly established and is supporting the IJB with its discussions and decision-making, leading the organisation and improving our service delivery. The senior management structure below the Executive Team has also been established and the final posts are anticipated to be filled in the first few months of the new financial year. Providing this enhanced leadership capacity will significantly help with the scale and pace of our transformational change activity. The commitment and motivation of our staff underpins our ambitions and priorities and their involvement is at the heart of everything we do and hope to achieve. Some 8 Page 68

69 of the many initiatives that we have put in place to support improved relationships and engagement includes: Establishing a Joint Staff Forum with trade union and staff side representation. Supporting trade union and staff side representation on the IJB. Developing our Organisational Development (OD) Plan. Developing a Workforce Plan. Promoting the Aston Team tool Rolling out the imatter engagement tool across the partnership Developing an ACHSCP specific Induction for new staff. Publishing a bi-monthly Partnership Matters newsletter Developing a programme of Executive Team job shadowing sessions/workshops Our Strategic Plan: Our Strategic Plan outlines the demographic and financial challenges that the partnership must address as it sets out its strategic ambitions and priorities for the delegated health and social care services. Our priorities are: Develop a consistent person-centred approach that promotes and protects the human rights of every individual and which enable our citizens to have opportunities to maintain their wellbeing and take a full and active role in their local community. Support and improve the health, wellbeing and quality of life of our local population. Promote and support self-management and independence for individuals for as long as reasonably possible. Value and support those who are unpaid carers to become equal partners in the planning and delivery of services, to look after their own health and to have a quality of life outside the caring role if so desired. Contribute to a reduction in health inequalities and the inequalities in the wider social conditions that affect our health and wellbeing. Strengthen existing community assets and resources that can help local people with their needs as they perceive them and make it easier for people to contribute to helping others in their communities. Support our staff to deliver high quality services that have a positive impact on personal experiences and outcomes. 9 Page 69

70 During the first full year of operation, our focus has been on establishing the building blocks to enable the transformation of service delivery in future years. Pivotal to our ambitions is having a locality model that connects us to our communities and which underpins the delivery of our integrated health and social care services. We have established Leadership Groups in our four localities. The membership of these groups includes residents, community activists and locality based colleagues from across the health, social care, third and independent sectors. These groups are reaching out into their communities and initiating conversations about what matters to local residents. This is informing and influencing the development of our locality profiles and plans. The Chairs of the Leadership Groups also sit on our Strategic Planning Group to ensure a stronger strategic, locality based coherence across all our planning activities. Did you know That profiles for each of our four localities highlighting the area s assets as well as the health and wellbeing of the local population are being developed. Each Locality Leadership Group will use their own profiles as the basis for their engagement activities with their local communities so that appropriate priorities can be agreed, with a key focus on building on existing community strengths and assets. Another key activity where significant progress has been made is in our good, positive and improving relationships with our partner organisations in the third and independent sectors. Aberdeen Council for Voluntary Organisations (ACVO) and Scottish Care (the umbrella group for many of our care home and care at home provider organisations) have both played a prominent role in the constructive discussions that have taken place about how we ensure that improved personal experiences and outcomes for the many different people who use, and rely on, our services are delivered. 10 Page 70

71 4. The Case for Change Our Strategic Plan has made it clear that because of the impending demographic and financial challenges we can t continue to deliver services as we have traditionally done. We need more than just incremental change to ensure our solutions are fit for the 21st century: we need transformation. Our IJB expects us to deliver significant transformational change at pace, to improve the personal experiences and outcomes for individuals who use our services now and for those who will do so in the future. It has outlined in its Transformation Plan, the six big ticket items that it wishes to see progressed and completed and has set up the Integration Transformation Programme Board to oversee an ambitious programme of work that will fulfil our strategic priorities and deliver our strategic vision. Our Big Ticket Items are: Organisational Development and Cultural Change IT, Infrastructure and Data Sharing Modernising Primary and Community Care Supporting Self- Management of Long Term Conditions and Building Community Capacity Strategic Commissioning Acute Home 11 Page 71

72 Organisational Development & Cultural Change In its broadest sense, our partnership includes colleagues who work for our partner agencies (Aberdeen City Council and NHS Grampian) as well as those colleagues who work in the third and independent sectors, our carers and volunteers. Reshaping our services in order to deliver them differently will require the partnership to invest in its workforce across all these sectors. This enabler work-stream recognises that people are key to delivering our integration and transformation ambitions. Activities in this work-stream will support this new Team Aberdeen culture to be developed and will support the development of people in the right places and with the right skills and attributes to support people in communities. The work-stream also recognises the anxiety many of our staff will feel as we transition into our new partnership and integrate at every point of delivery, aligning with our values of caring, person-centred and enabling. During 2016/17 we have: Firmly established the ACHSCP brand identity. Delivered the Partnership s first Conference: Taking Care of Transformation #TCOT16 Delivered the Partnership s first Staff and Partner Celebration Event: Having Exceptional Achievement Recognised Together HEART Awards Established multi-partner and community Locality Leadership Groups, tasked to develop and delivery locality plans for each locality Launched an online innovation platform called OurIDEAS for colleagues across the partnership to share and develop their ideas. Designed a series of shadowing opportunities for the Executive Team along with a programme of workshops for 3 rd and 4 th tier managers. Developed a series of engagement opportunities via social media, including locality-based Facebook pages and a unique Twitter handle for ACHSCP. 12 Page 72

73 Did you know.. That the Partnership s first conference, Taking Care of Transformation: TCOT 2016 was held in November 2016 and brought together around 300 staff and partners, with a shared agenda of innovation, transformation and integration. IT, Infrastructure and Data Sharing Effective and linked ICT systems will be an essential, enabling component of the various integration and transformation themes. Our ambitions to innovate and transform will be hampered if there is a continued reliance on current, single service systems. We are developing an integrated IT system, associated equipment and infrastructure that reflects and supports the alignment of our multi-disciplinary teams with our localities. The effective use of ICT will also assist in the bringing together of our new organisation and help to ensure that our staff and wider partnership community have opportunities to participate and engage with our planning and service delivery processes, including being able to influence and identify innovation opportunities. During 2016/17 we have: Relocated the Healthy Hoose into the new Middlefield Community Hub Completed the new Len Ironside Centre Agreed additional ICT and Business Development capacity to support delivery of our ICT work stream Commenced testing of a data-sharing and video-conferencing virtual hub to support better care to be delivered more efficiently Supported the roll-out of public wifi in health and social care facilities in the South Locality Developed a service agreement for data-sharing across HSCP services including performance monitoring Developed a single shared file for the Executive Team Begun work towards trialling Microsoft Office 365 across the partnership 13 Page 73

74 Did you know. That, in conjunction with our partner, Aberdeen City Council, in spring 2017 we opened a brand new community asset: the Len Ironside Centre? This valuable resource provides support and activities, helping some 50 adults with severe learning and physical disabilities. The expansive facilities including an extensive outdoor sensory garden, a hi-tech computer room, a specially adapted kitchen and café area, a special sensory room and a large dining room/lounge which can double up as a theatre, and will provide an opportunity to explore and develop community-centred relationships. Acute Home We are seeking to develop a Hospital at Home service that will provide, for a limited time period, active treatment by appropriate professionals, in the individual s home, of a condition that would otherwise require acute hospital in-patient care. The development of such a service fits with our ambition for our strategic intentions to have a greater preventative impact especially since we know that prolonged length of stay for the frail elderly and those with long-term conditions can lead to a higher risk of acquired infection and other complications such as loss of confidence, function and social networks. During 2016/17 we have: Engaged with a range of stakeholders to develop an options appraisal of different Hospital at Home Models Developed a project proposal for a phased roll out of a home model, which was approved by the Executive Programme Board for progression to full business case Developed a draft specification for a new Hospital at Home service Supporting Self-Management of Long-Term Conditions and Building Community Capacity This work stream recognises that pressures on mainstream primary and community care services cannot be reduced through a more of the same approach. The work stream seeks to shift our relationship with communities to enable a more co- 14 Page 74

75 productive approach and to nudge the culture towards being more empowered and responsible in relation to ourselves and each other. There is a strong consensus across the Partnership in support of developing new lower level support and link posts embedded in our communities and in our locality teams. There is clear alignment with what our statement of intent says in relation to improving health and wellbeing, reducing health inequalities, taking greater responsibility for our health and wellbeing and letting innovation flourish in our localities. During 2016/17 we have: Developed a case for rolling out Link Workers in every practice in the City Continued to support a range of dementia-related services Supported the early roll-out of Making Every Opportunity Count Facilitated the Silver City project - a self-management approach to tackling social isolation for the older population at high risk of hospital admission Continued to deliver the Golden Games Worked in communities in the South Locality, adopting a co-production approach to develop innovative solutions to local challenges Did You know A co-production developed, locality based Falls Clinic involving Occupational Therapists, Physiotherapists, District Nurses and Clinical Support Workers now takes place monthly in Kincorth. This clinic benefits people who have had a fall, have lost confidence due to slips and trips or who are unsteady on their feet. During their clinic appointment service users develop their own, individualised Falls Action Plan with support from staff. Service users are encouraged to self-manage some areas of their falls risk with guidance from clinic staff. Referral on to other specialist services, provision or review of walking aids, home assessments for provision of equipment and adaptations to the home environment are all common outcomes following clinic appointments. Modernising Primary & Community Care This proposed investment recognises that there are a range of elements that will help modernise and develop primary care. An approach that offers a menu of change for primary care to test, will give the widest spread of change activity, enable practices to step in at a level they can manage and will grow new models appropriate for their context. 15 Page 75

76 Collaborative working, in locality hubs, with increased pharmacist provision, social work links and GP-led beds will help to reduce admissions to hospital, prescribing costs and provide more sustainable primary and social care services. These hubs will be supported by the design of integrated health and care teams, local communities and a Team Aberdeen and person-centred culture and ethos throughout our wider organisation. Different approaches may include models such as the Buurtzorg model and Advanced Nursing and Allied Health Professional (AHP) roles in the community. During 2016/17 we have: Developed a business case and received approval to roll-out Community Mental Health Hubs across the city Established a Project Team to design and implement an integrated care model in Aberdeen s communities using the Buurtzorg Principles Progressed a project proposal relating to a multi-skilled pharmacy team to business case stage Developed new ways of working at Dyce Medical Practice Did You Know At Denburn Medical Practice, the traditional model for accessing services has been turned on its head, and a new approach adopted which uses a range of techniques including proactive GP-led triage, increased use of telephone consultations, and removing barriers to patient contact by increasing the number of practice telephone lines and changing the reception culture. This logical, person-centred approach has increased productivity by 50%: Clinical contacts for each GP have increased from 110 per week to 220 per week. The non attendance for booked appointments (Did Not Attend or DNA) rate has practically been eliminated resulting in savings of 20,000 per year. Out of Hours contacts have reduced by approximately 20%. There are no backlog appointments. Strategic Commissioning 16 Page 76

77 This proposal is fundamental to our ambition to work with our partners across all sectors in reshaping the services that we deliver to address the common challenges that we face. A coherent commissioning approach will be pivotal to the people who use our services having improved personal experiences and outcomes. Other anticipated benefits include a more resilient, local marketplace, innovative and effective care models and contractual arrangements that are fit for purpose. During 2016/17 we have: Established a Market Facilitation Steering Group to oversee the development of our agreed facilitation principles and activities Provided additional funding to Scottish Care to enhance their developmental capacity for working with the care at home/care home sectors Established a range of work streams to develop service specifications for key commissioning activities 5. How Are We Doing? Our Performance Framework Achieving our aims and objectives depends on having an effective performance framework to measure progress. There are hundreds of indicators used to monitor the services we deliver, the quality of care we offer and the outcomes we achieve. Our approach has been to develop a structured framework for managing information to ensure the right information reaches the right people at the right time. This helps prevent information overload and ensures that important information is not missed. We are operating in a constantly changing environment and what we measure now to assess performance is likely to develop as we pool data between health and social care, particularly at locality and community level. During our first year we have drawn on indicators that help to assure performance of current practice and support continuous improvement. They are based on aspects of care and management where we have the greatest level of accountability and leverage to improve. In some cases the data may be limited and the measures may be imperfect, but we can still use it to understand where we are, and where we want to be. The national and local indicators we use are contextualised around a balanced performance framework adapted from the Care Quality Commission. Safe how well do our services protect 17 people from abuse and avoidable harm Effective how well does the care and treatment we provide and commission achieve good outcomes, help people Page maintain 77quality of life and is based on the best available evidence

78 Table 5.1 summarises our current situation and the progress we have made in our first year. This draws from measures which have been set nationally ones we have chosen locally to align with our strategic goals and ambitions. Each indicator shows the most recent performance position and the proportionate change from the baseline position of April 2016 when the Partnership became live. A trend line is also shown based on historical data, enabling change and improvement to be viewed in a longer term context. 18 Page 78

79 Table 5.1. Headline Performance National & Local Indicators 19 Page 79

80 Safe As a Community Planning Partner, we have a responsibility to keep people and communities safe from harm and our collective aim is to develop systems and approaches that raise awareness and identify risk. Supporting all Partners and agencies to refer vulnerable adults for support and protection is a key objective and we have set improvement outcomes to do this collectively. These involve increasing the number of referrals from the HSCP (and other agencies) and identifying a sensitive way to measure appropriateness. The number of referrals at the end of 2015/16 (the baseline position) was 98 and we have seen a rise of 8% at the end of 2016/17. Effective Supporting people to live fulfilling and healthy lives is at the heart of what we do. During our first year our award winning Silver City Team helped older people take up new hobbies and build confidence in looking after their health and well-being. A new Advanced Nurse Practitioner in Kincorth focuses specifically on supporting older people and helping to co-ordinate care. These are just two examples where new efforts are helping to build individual resilience in health and well-being for people in our communities. Confident individuals, supported communities and effective co-ordination of care between professionals are key ingredients in improving health and well-being outcomes for people in Aberdeen. One measure of progress is the number of emergency hospital admissions. In the first year of Partnership, we have maintained a steady downward trend in the rate of emergency admissions to hospital each month, and in the number of bed days used for unscheduled care a trend which we believe will place us in the top quartile of all Scottish Partnerships next year. Figure 5.1 illustrates the reduction in patient admissions each month from November 2014 to December Page 80

81 Figure 5.1. Emergency admissions and hospital bed days used Alcohol consumption and related harm is a significant public health issue in Scotland and the rate of alcohol related hospital admissions in Aberdeen City is statistically higher than Scotland overall. 1 Whilst there are many universal prevention interventions (such as alcohol pricing), the HSCP aims to widen access to individual support and behaviour change through alcohol brief interventions (ABIs). For the past number of years this intervention has relied heavily on GPs, and Aberdeen City Practices conduct almost two thirds of all ABIs in Grampian. Our focus in this first Partnership year has been to increase the number of ABIs offered in wider settings, aiming to reach even more people in need of support. So whilst the number of ABIs has not increased between 2015/16 and 2016/17 overall, the balance between those delivered by GPs and wider settings has changed. This is as a result of increased staff training within the Alcohol and Drug Partnership and the identification of new opportunities to deliver ABIs a more sustainable model for the future. Responsive For some people, support and care is needed to help people lead an independent life. Self-directed support (SDS) is an arrangement that allows people to choose how their support is provided and gives them as much control as they want of their 1 ScotPho Alcohol profiles 21 Page 81

82 individual budget. It can include support for daily living, to go to college, to be employed or to enjoy leisure pursuits more. Having greater control of your life leads to improved health and well-being and the HSCP is working hard to encourage people to take advantage of SDS. In the past year there has been little change in the proportion of people who take up SDS (options 1 and 2) at just 7% of all eligible people, this is a situation we wish to improve upon in 2017/18. With a growing number of older people living with high and complex care needs, the need for social care services is increasing, alongside workforce recruitment and retention challenges. This situation can lead to unmet need, affecting individuals who are struggling to cope and putting strain on carers and family members. In some cases it can lead to hospital admission and the risk of delayed discharge. Unmet need can be difficult to define and harder still to measure. The data we capture may be incomplete or imperfect, but it gives us an initial indication of progress as we improve data quality. Over the past year, there has been a downward trend in both the number of clients awaiting care and the number of hours required. This reflects the collaborative approach to commissioning services between HSCP staff and care providers. Delays in being discharged from hospital affect mainly older people and usually occur because of the time needed to secure care home accommodation or to arrange social support for returning home. Figure 5.2 shows the number of standard patients delayed each month and the number of hospital bed days used per month from July 2012 until March This improving situation, which at its peak culminated in 125 patients delayed in hospital in January 2015, is set in context of reducing care home capacity and a loss of some 160 beds since Page 82

83 Figure 5.2. Delayed standard discharges and bed days used The steady improvement from early 2015 is the result of Partnership efforts during the shadow period and the first live year of operation. These endeavours were initially focused on improving operational processes which have since matured, and we are now seeing the impact of specific initiatives. Over the past year, our health and social care staff have worked particularly hard to co-ordinate services for patients and to secure appropriate follow-on care. Increasing the number of intermediate care beds has allowed patients and their families more time in an appropriate environment to consider their care home options. Caring Person centred care and positive experiences of services are features of the caring organisation to which we aspire. Humanising health and social care is the way we will achieve this, where success is based on the way care is delivered as well as health outcomes. Measuring our progress so far has been based on large scale surveys of service satisfaction and we aim to do more here in the coming years. Nonetheless this information has highlighted aspects of care where improved experience of care may be needed, particularly in primary care and in home care. Almost 89% of care for people in the last six months of their life takes place at home or in a homely setting. This compares well to Scotland overall, but our aim is to drive improvement in palliative and end of life care which reflects best practice and 23 Page 83

84 accords as much as possible with the needs and wishes of patients and their families. Invasive, painful and costly treatment in acute hospital is not always the best course of action. Through our transformation programme, we will be aiming to find sensitive and person-centred ways to improve this and to combine facts and values in our measurement to ensure we keep in touch with the human factors of quality. Well-led The driving ethos of the Partnership is that staff engagement, participation and delegated authority promotes trust and autonomy an important factor in a modern, adaptive organisation. Our transformation programme to develop staff and culture includes effective communication, co-location of teams, information sharing and leadership development. We have placed particular importance on Partnership identity and awarding staff for efforts that have made a notable difference in the job that they do. An indication of an engaged, supported and motivated workforce is absenteeism. Over the past year, sickness absence in social care (headcount 560) has increased and the average number of sickness days per employee in a year is currently thirteen. This is measured differently for health care staff (headcount 1381), where the average percentage of work hours lost per month due to sick leave is just under 5% and similar to the national average for Scotland. During the past year we introduced i-matter, a feedback tool for staff which provides a measure of engagement, communication and motivation. Our plan for 2017/18 is to use the tool pro-actively to engage with staff and teams on ways to address and improve sickness absence. This is a key area of improvement work affecting culture and productivity. Driving improvement 2017/18 We believe our Partnership efforts and focus over the past year have impacted positively towards many national and local outcomes as demonstrated by the progress shown against our baseline position. In addition to our ambitious transformation plans we have identified a number of key areas which will be a focus for our improvement activities during 2017/18. These include: 24 Page 84

85 Emergency Admission To reduce the number and rate of avoidable unplanned admissions for older people. We aim to be in the top percentile when benchmarked against all other local authorities in Scotland. End of Life/Palliative Care To maintain support for people at home or in a homely setting in their last six months of life and to establish new ways to monitor and report the preferences of people. Staff Engagement To establish and develop a 'fully engaged' workforce across all of the partnership. Self Directed Support To increase the uptake of SDS options 1 and 2. Unmet Care Needs To reduce the number of people whose social care needs have been identified but care has not been established. Delayed Discharge To reduce delayed discharge and shorten the length of delays. We aim to be in the top 25th percentile when benchmarked against all other local authorities in Scotland. Figure 5.3 ACHSCP Improvement Priorities. Our performance in these areas will be reported to the IJB and its Audit and Performance Systems Committee throughout the year and highlighted in next year s annual performance report. Our Financial Stewardship The Integration Joint Board (IJB) has a responsibility under the Public Bodies (Joint Working) (Scotland) Act 2014 to set a balanced budget. The funds for the Integration Joint Board are delegated from Aberdeen City Council and NHS Grampian with the purpose of delivering the IJB s Strategic Plan. The level of funding available to the 25 Page 85

86 IJB is heavily influenced by these organisations grant settlements from the Scottish Government. The level of funding delegated to the IJB at the start of the 2016/17 financial year was (Figure 5.4): 14m 111m 139m NHS Council Scottish Government Figure 5.4 IJB Funding. The IJB s Position at 31 st March 2017 The Integration Joint Board has an ambitious strategic plan which seeks to transform the health and social care services under its remit within Aberdeen City. In order to facilitate this, additional funding has been provided by the Scottish Government which can be used to help transform services, support integration and reduce delayed discharges. This additional funding is now all mainstreamed and recurring. It is important to note that whilst the allocation of this funding is extremely useful in terms of delivery of the strategic plan, other services are being transformed from within mainstream budgets on a continuous basis. A good example of this is our public health and wellbeing team who are now undertaking new duties linked to the delivery of the strategic plan. In reality the whole budget is available to integrate, change and transform. 26 Page 86

87 Service Gross Expenditure ( ) Community Health Services 31,649,313 Learning Disabilities 29,264,461 Mental Health & Addictions 18,304,741 Older People, Physical & Sensory Impairments 69,719,818 Criminal Justice 4,413,345 Housing 2,197,288 Primary Care 36,846,589 Primary Care Prescribing 40,125,916 Hosted services 21,207,851 Out of Area Treatments 1,219,506 Set Aside Services* 46,732,000 Head Office/Admin 1,007,021 Transformation 2,856, ,544,132 Table 5.2 Service Expenditure (* these relate to the services delivered in the Acute Sector for which the IJB is responsible for Strategic Planning but not Operational Delivery. This is a notional budget) 27 Page 87

88 Set Aside Services Out of Area Treatments Primary Care Transformation Community Health Services Hosted Services Learning Disabilities Primary Care Prescribing Housing Criminal Justice Head Office/Admin Older People, Physical & Sensory Impairments Mental Health & Addictions Figure 5.5 Service Expenditure 2017/18 Financial Year. A proposed budget for 2017/18 which outlined budget pressures, budget reductions and an indicative budget position for the next five financial years was presented to a special meeting of the IJB on 7 th March. The proposed balanced budget was approved. Did You Know In February 2017, 230 colleagues came together to celebrate at the partnership s first ceremony to celebrate the exceptional work of our extended workforce across the partnership. The HEART Awards Having Exceptional Achievement Recognised Together aimed to celebrate the exceptional work of colleagues in ACHSCP and its partner oragnisations. At the event, as well as showcasing some exceptional talent and achievements of staff within the partnership, 5 awards were presented under different categories: Hearing Others: The Communication and Inclusion Award Empowering People: The Enablement Award The Respect and Equality Award #Team Aberdeen: The Integration Award Our Pick: The Staff Choice Award. 28 Page 88

89 6. Looking Forward In addition to everything that we have highlighted thus far there are also a key number of activities that are already underway and we are going to highlight because of their importance to the partnership s ambitions and priorities. We look forward to reporting on the completion of all these in next year s annual performance report. These include: Buurtzorg: The Buurtzorg model of community care is a consistent person-centred approach that seeks to enable our citizens and their friends, family and neighbours to have opportunities to take a full and active role in their wellbeing. The integrated nurse and care worker teams will be supported to self-manage, taking the appropriate decisions in the right place at the right time. 29 Page 89

90 Link Workers: Appropriate person-centred wellbeing support is organised through a dedicated community orientated member of staff in each practice, called the Link Worker. Such Link Workers aim to improve people s resilience where people see themselves as part of an interconnected whole, by supporting them to link more closely with their communities and opportunities in the community. The implementation of Link Workers will directly support the strategic priorities for the ACHSCP. A project team has been set up to drive this high profile innovative intervention forward. Work is ongoing to procure a partner provider to deliver the Link Worker resource, in partnership with our GP practices, and embedded in local communities. Carers Strategy: This strategy is being developed in a co-productive manner with carers, recognising the very important role that many thousands of unpaid carers undertake and the supports that we need to provide in order for them to feel able to continue in this role. We are developing our Carers Strategy in line with the Carers (Scotland) Act 2016 and this will outline how we hope to develop our understanding of the carer role, be able to identify more readily who are carers are and what informal and formal supports can be offered to them. Locality Teams: The operationalisation of our locality model has commenced with the recruitment of our Heads of Localities and an initial alignment of service functions within our senior leadership team. With assistance from a design support organisation we will be working with our staff across the four localities to develop our vision of integrated, multi-disciplinary, locality based teams working in and with our local communities. Conclusion. When the IJB published its Strategic Plan on 1 st April last year it emphasized the need to ensure that the day to day delivery of services was not compromised by our integration transition or the commencement of our transformation programme. On integration go live day we gave ourselves a very positive platform for our next steps. Our performance over the past year, on the whole, has been good. It will be better next year. 30 Page 90

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93 Agenda Item 9 INTEGRATION JOINT BOARD Report Title Lead Officer Report Author (Job Title, Organisation) Report Number Delayed Discharge Performance and Improvement Programme - Update Judith Proctor, Chief Officer Aberdeen City Health and Social Care Partnership Kenneth O Brien, Service Manager Aberdeen City Health and Social Care Partnership HSCP/17/050 Date of Report 15 May 2017 Date of Meeting 6 June : Purpose of the Report This report is presented to the Integration Joint Board (IJB) for the purposes of provision of information, supporting scrutiny of the Partnership s performance, and to facilitate further discussion. This paper follows on from the previous update provided to the Integration Joint Board at its meeting of 31 st January Two key areas are discussed: Current delayed discharge performance information in regards to the Aberdeen City Partnership; AND The current status of the Aberdeen City Delayed Discharge Action Plan with information on progress and recent developments. 2: Summary of Key Information Current Performance Information For the purposes of clarity, the IJB should be aware that the Delayed Discharge figures classify patients/clients into THREE types of delay: Standard Delays which are individuals who are medically fit for 1 Page 93

94 INTEGRATION JOINT BOARD discharge and yet remain in a hospital bed. Code 9 Complex Delays which are individuals who have particularly complex needs (such as requiring legal intervention in the courts) that would indicate a longer timescale for a safe and appropriate discharge. Code 100 Commissioning/Reprovisioning Delays which are individuals who have exceptional complex needs relating to previously being long-term hospital inpatients or other such prolonged circumstances. It is recognised by the Government that the normal timescales for discharge would be unable to be adhered to for such patients/clients. Code 100 delays are reported to the Government however are not included in nationally published data. The IJB may also wish to note that the Scottish Government changed the criteria, definitions and data recording requirements for Delayed Discharges starting from the July 2016 census point onwards. This has had a particular impact on the counting of the number of clients/patients delayed at each census point as individuals who were not previously counted are now included in the definition of a delayed discharge. Where trend information is presented in this report that incorporates pre and post July 2016 figures, the post July 2016 figures have been adjusted to allow for trend comparison. This does not affect the count of bed days lost due to delayed discharges, as this data was not significantly affected by the changes in counting methodology. As more delayed discharge data accrues under the new data definitions, this adjustment will be phased out of general delayed discharge reporting. 2 Page 94

95 INTEGRATION JOINT BOARD No. of Delays Number of Patients Delayed at Census (Standard & Code 9 Only) Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Census Month Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Number of Delays Linear (Number of Delays) [FIGURE 1] Numbers of Patients/Clients Delayed at Census Figure 1 shows the overall count of those patients/clients classified as a delayed discharge as at the monthly census point, (reflecting the fact that the Government captures Delayed Discharge performance on a monthly basis). This includes both standard delays and code 9 delays. As can be seen, performance has continued to improve on this measure, however at a slower rate than previously. 3 Page 95

96 INTEGRATION JOINT BOARD Bed Days Lost Due to Delayed Discharges Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 No of Bed Days Census Month Bed Days Lost Linear (Bed Days Lost) [FIGURE 2] Bed Days Lost Due to Delayed Discharges Figure 2 shows the number of bed days occupied by patients/clients classified as a delayed discharge, also presented at monthly intervals. This too has continued to fall, but at a slower rate of decrease than has recently been seen. 4 Page 96

97 INTEGRATION JOINT BOARD Number of Patients Delayed (Standard & Code 9 Only) No. of Delays January February March April Month [FIGURE 3] Number of Patients/Clients Delayed January-April 2016/17 Comparison Figure 3 compares the most recent reporting period to the IJB (January-April 2017), with the same period in the previous year. The volume of delayed discharge individuals has decreased 38% comparing Jan-April 2016 vs Jan-April Page 97

98 INTEGRATION JOINT BOARD Bed Days Occupied Number of Bed Days Occupied by Delayed Discharges January February March April Month [FIGURE 4] Number of Bed Days Occupied by Delayed Discharges January-April 2016/17 Comparison Figure 4 also compares the most recent reporting period to the IJB (January-April 2017), with the same period in the previous year. The overall volume of bed days lost to delayed discharges has decreased 42% comparing Jan-April 2016 vs Jan- April Page 98

99 INTEGRATION JOINT BOARD No. of Delays City of Edinburgh Highland Comparison with Other Partnership Areas as at March 2017 Census South Lanarkshire North Lanarkshire Glasgow City Perth & Kinross Fife Aberdeen City West Lothian Scottish Average Aberdeenshire Standard Delays Moray South Ayrshire Scottish Borders North Ayrshire Midlothian Dundee City Code 9 Delays Falkirk Dumfries & West Health Board of Residence Comhairle nan East Lothian East Ayrshire Angus Argyll & Bute Stirling East Renfrewshire Clackmannanshire Renfrewshire East Inverclyde Orkney Other [FIGURE 5 Comparison with Other Partnership Areas ] Figure 5 shows Aberdeen City s number of delayed discharges in the context of other partnership areas. The most current cross-partnership data comes from the nationally published census information gathered for March When progress was last reported to the IJB, Aberdeen City had the seventh highest number of delayed discharges across Scotland (having been the fifth highest partnership area in July 2016). The position as of the most current data available is that Aberdeen City now ranks eighth in regards to overall volumes of delayed discharges. Rate per 100,000 Population Comparison with Other Partnership Areas - Rate per 100,000 Population Health Board [FIGURE 6 Comparison with Other Partnership Areas Rate per 100,000 Population ] Figure 6 shows Aberdeen City s position against other Partnership areas when the 7 Page 99

100 INTEGRATION JOINT BOARD March 2017 census figures are adjusted to reflect population figures. The total of 57 delayed discharges in Aberdeen City in March 2017 equated to a rate of 24.7 delayed discharges per 100,000 population. This was above the Scotland wide rate of 23.9 per 100,000 population and 10 Partnerships recorded a higher rate than Aberdeen City. Aberdeen City continues to rank just above the Scottish average, having previously been performing significantly above the Scottish average for an extended period. Length of Delay at Census Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 No. of Delays Census Month 1-14 days days days days Over 200 Days [FIGURE 7] Length of Delay at Census Figure 7 provides information on the length of delay for delayed discharge patients/clients at monthly census points. The longer delay periods ( days and 200+ delays) tend to only be complex cases. What is notable is the continued progress in reducing longer lengths of delay which, even a year ago, were standard. 8 Page 100

101 INTEGRATION JOINT BOARD [FIGURE 8] Proportion of New vs Recurring Delayed Individuals at Census Figure 8 shows (over the past 12 month period) the proportion of individuals at each census who were new delays that month vs those who had been carried forward from the previous census period. The shift from recurring delays to new delays has improved further over the Jan-April 2017 period. [FIGURE 9] Location of Delays by Speciality 9 Page 101

102 INTEGRATION JOINT BOARD Figure 9 breaks down where within hospital specialisms delays are occurring. This is the latest information available based on the April 2017 census information. Geriatric Medicine remains, by far, the largest speciality for delayed discharge patients, followed by Rehabilitation Medicine. Reasons for Standard Delays No. Of Standard Delays Awaiting completion of social care arrangements - In order to live in their own home awaiting social support (nonavailability of services) Awaiting place availability in Nursing Home (not NHS funded) Awaiting completion of post-hospital social care assessment (including transfer to another area team). Social care includes home care and social work OT Awaiting place availability in care home (EMI/Dementia bed required) Awaiting commencement of post-hospital social care assessment (including transfer to another area team). Social care includes home care and social work OT Awaiting completion of social care arrangements - In order to live in their own home awaiting procurement/delivery of equipment/adaptations fitted All other Delays 0 Census Month April 2017 [FIGURE 10 Reasons for Standard Delay] 6 Resons for Complex Delays No. Of Complex Delays Census Month April 2017 Adults with Incapacity Act Awaiting place availability in Specialist Facility for high level younger age groups (<65) where the Facility is not currently available and no interim option is appropriate [FIGURE 11 Reasons for Complex Delays] Figures 10 and 11 shows the reasons why patients/clients are a delayed 10 Page 102

103 INTEGRATION JOINT BOARD discharge. The vast majority of standard delays are accounted for due to care at home provision and care home bed accessibility. The majority of current Code 9 complex delays are due to the need to seek legal orders for patients/clients under the auspices of the Adults with Incapacity (Scotland) Act 2000, along with a small number of individuals with a need for specialised care services. No. Of Delays No. Of Code 100 Delays at Census Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Census Month Apr-17 FIGURE 12 Code 100 Delays, Trend Code 100 Length of Delay Length of Delay Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Census Month FIGURE 13 Code 100 Delays, Length of Delay 11 Page 103

104 INTEGRATION JOINT BOARD Figures 12 and 13 shows the number of individuals who have been classed as a Code 100 Delayed Discharge over the past 12 month period, and the accumulated bed days attributed to these complex cases. It should be noted, that whilst the overall volume of individuals who are classified as Code 100 remains small overall, the lengths of delay recorded are very significant reflecting the ongoing difficulties in commissioning bespoke support services for these complex client groups. FIGURE 14 Emergency Bed Days, Aberdeen City, Recent Trend Figure 14 evidences a trend of declining emergency bed days for the over 65 s within Aberdeen City over the past 12 months, thereby reducing the flow/demand into hospital of patients who will then subsequently require discharge arrangements. Whilst it remains early to draw overall conclusions, the work of the Partnership in regards to its development of community focused and preventative interventions may be beginning to entrench. Summary of Key Data There has been a continued downward trend in both numbers delayed and bed days lost due to delayed discharges since the last report to the IJB in January 2017, albeit at a slower rate of reduction. Aberdeen City has seen a 38% reduction in numbers of people delayed, comparing January-April 2016 and Page 104