NHS GRAMPIAN Integration of Health and Social Care Readiness Board Meeting 04/02/2016 Open Session Item 9.2 1. Actions Recommended The Health and Social Care Partnerships (HSCPs) for Moray, Aberdeenshire and Aberdeen City will be formally established in April this year following significant preparations undertaken by NHS Grampian, the Moray, Aberdeenshire and Aberdeen City Councils, and the new Integrated Joint Boards (IJBs) which will govern the HSCPs. This will be a significant step in the implementation of major reforms which will pool health and social care budgets and integrate health and social care around the needs of individuals and communities. The purpose of this paper is to summarise the actions that have been taken to support the development and establishment of the HSCPs and provide assurance to the Board that appropriate arrangements will be in place in advance of the formal establishment date of April 2016. The Board is asked to note the state of readiness and the actions that will be taken to provide continued support for the new Partnerships. 2. Strategic Context The Public Bodies (Joint Working) (Scotland) Act was enacted on 1 April 2014 and set out the legislative framework for the formal integration of adult health and social care in Scotland. Regulations and Orders associated with the Act were released for consultation over the summer of 2014 and were published in October and November 2014. 3. Key Matters Relevant to Recommendation An action plan was formulated during 2015 which outlined the key actions that needed to be taken to prepare for the implementation of health and social care integration and the establishment of the HSCPs. The plan has been regularly reviewed and monitored by the Senior Leadership Team of NHS Grampian and a specific Integration Planning Group which has involved senior officers of NHS Grampian and the Chief Officers of the shadow IJBs. A range of actions have also been reviewed and developed by the North East Scotland Partnership Steering Group (NESPG), a group which brings together NHS Grampian Board members and senior officers, and the co chairs and Chief Officers of the IJBs. All actions that require to be taken in advance of formal establishment have been completed or will be completed by April 2016. A brief summary of the key issues and status is set out below: Professional Governance: The Medical Director and Director of Nursing, Midwifery and Allied Health Professionals (AHPs) will remain accountable for professional governance. A professional governance framework will be agreed with a named lead 1
for each professional group who will have clear roles and responsibilities to ensure appropriate links to NHS Grampian and regulatory professional processes. Clinical Governance: NHS Grampian retains responsibility for clinical governance and action has been taken to revise the arrangements across the HSCPs and within NHS Grampian. This culminated in a seminar involving all parties on 28 January which will result in the submission of the finalised arrangements to the NHS Grampian Clinical Governance Committee (CGC) in February 2016. The arrangements will continue to be refined under the auspices of the CGC and the Medical Director and Director of Nursing, Midwifery and AHPs who are the responsible senior officers in NHS Grampian. Medical and Nursing Advice to IJBs: The nursing advisers are in place for each of the IJBs. Medical advisers i.e. non primary care medical advisers will be in place during February. Primary Care medical advisers have already been identified by the IJBs. Budgets: Budgets for those services that require to be delegated according to the legislation require to be finalised by the end of March 2016. The budgets are delegated by NHS Grampian and the relevant Councils and draft budgets must be notified to the IJBs by the end of February 2016. Draft budgets have been prepared which indicate the contributions from NHS Grampian as follows: Moray: 71.197 million Aberdeenshire: 175.912 million Aberdeen City: 199.573 million The total contribution from NHS Grampian is estimated at 446.7 million, equivalent to 43% of the Board s total revenue budget. The draft budgets include those which relate to the community services provided within the HSCP area, and those relating to hosted services i.e. services which are provided to more than one IJB and which require to be hosted by one Partnership on behalf of the others. Existing underspends or overspends on budgets will not be adjusted for when setting the initial budgets for the IJBs. In addition, the budget for each IJB includes a notional set aside budget for delegated hospital services for specific specialties which have a high proportion of unscheduled care activity. The IJBs will have strategic planning influence over this resource, but day to day operational management responsibility will remain with the Acute Sector. A summary of the draft budgets for each IJB is included in appendix 1. Workforce and Staff Governance: Around 6,000 NHS Grampian staff will transfer into the new HSCPs on 1 April 2016 although these staff will continue to be employees of NHS Grampian. All staff affected by the change have received a letter confirming this transfer. The staff in the hosted services have received a similar letter, but will require a further letter to confirm which IJB, they will transfer to, once this is agreed. 2
Work to establish the future staffing arrangements within the Partnerships and between the Partnerships and, the host employer are progressing. Arrangements to define the future employee relations model within the Partnerships are broadly agreed. Following a workshop on 18 th January 2016 with representatives from each employer and their recognised trades unions, a plan will now be developed to establish joint staff fora within each Partnership. Discussions on the process of organisational change and the implications of this are ongoing, as are the development of future workforce plans. NHS Grampian and the Partnerships are committed to meeting staff governance standards for all staff. Work is ongoing to ensure that the appropriate assurances can be provided on compliance with these standards. Risk Management: A joint risk framework has been agreed between the representatives of NHS Grampian and the IJBs which will guide the approach to risk management beyond the formal establishment of the IJBs. The Risk Management Strategy for NHS Grampian was approved by the Audit Committee in January 2016. The Risk Management Strategies for the individual HSCPs will be approved by the respective IJB. Hosting of Services: As indicated above, work has been done to develop proposals for the hosting of delegated services which are currently provided on a Grampian wide basis. The proposals have been considered by the NESPG and are mainly based on the previous Community Health Partnership hosting arrangements. A high level terms of agreement has been drafted to guide the arrangements for hosting. This will summarise the proposals and the requirements of an IJB which is hosting a service in relation to the other IJBs which will be receiving a service. It is for the IJBs to reach an agreement on the hosting proposals and the matter will be discussed by the NESPG on the 29 January 2016 in advance of the proposal being formally submitted to the IJBs for approval during February. Integration Schemes: The Integration Scheme documents set out the governance arrangements for each HSCP. The Schemes were formally approved by the Scottish Government in December 2015 providing the opportunity for formal establishment from 6 February 2016. However, establishment also requires the formal approval of the HSCP strategic plans by the relevant IJB and this will be achieved in advance of April 2016. Civil Contingencies: An interim major incident/emergency response framework is under development by a cross system working group to put in place arrangements for the 1st April 2016, that will take account of the new management structures within IJBs. Civil contingencies systems and plans will be further reviewed and updated throughout 2016/17 to ensure that they remain robust and reflect the new management structures. Complaints Procedures: The current complaints system will continue after April 2016 but will be amended to take account of the new organisational arrangements. A national programme is being developed which will harmonise all public sector complaints processes. NHS Grampian and partners will work on these new 3
arrangements with the aim of implementation from April 2017. In the meantime a pragmatic approach will be taken, with one agency taking the lead role for each complaint, as appropriate. Organisational Accountability: New performance management arrangements have been put in place which includes joint performance management of the Chief Officers and system wide performance management. The joint Chief Executive performance management is carried out on a monthly basis and deals with individual Chief Officer and IJB performance. The system wide performance management is undertaken by the Senior Leadership Team of NHS Grampian on a monthly basis and reviews a wide range of system wide indicators. The broader issues relating to organisational accountability have been discussed at the NEPSG and these will be further explored at a joint meeting between all IJB members, NHS Grampian Board members, and the senior officers of the Councils, IJBs and NHS Grampian on 1 March 2016. Information Sharing: Improved information sharing between the partners is a requirement of the health and social care integration legislation and is of key importance in the delivery of high quality integrated services. A cross system steering group for information sharing has been established which will develop a joint vision and organise joint decision making processes to maximise the benefits of information sharing whilst meeting the requirements of legislation. Strategic Planning: The three IJBs have published their draft strategic plans and all have been the subject of wide engagement and consultation. The plans will provide the high level guidance for the preparation of more detailed commissioning plans during 2016. The HSCPs also have strategic planning responsibility for specific acute services and dedicated planning processes have commenced for each of these services. This planning will continue to be led by the IJBs with the participation of clinicians and acute services management. The formulation of the NHS Grampian Clinical Services Strategy is also underway with the aim of submitting the strategy for approval to the Board in June 2016. The strategy will build on the IJB planning process to develop high priority system wide themes which will influence the formulation of the commissioning plans and the NHS Grampian Delivery Plan. Developing the Organisation: Integration represents a major reform of the health and social care system in Scotland and in the north east of Scotland. It has introduced a new dynamic in the form of HSCPs which will work to integrated services around communities and individuals with a high degree of autonomy from NHS Grampian. It is recognised that this will change the role of NHS Grampian and the following initial actions have been or are being taken forward: The NHS Grampian Executive Team has been reformed to be the Senior Leadership Team with a specific aim of supporting and encouraging integration. The Team has agreed a new method of operation with the IJB Chief Officers and the Acute Services General Manager as full members 4
Acute services will be developed to have a similar level of autonomy as HSCPs to ensure that the management team can work directly with the HSCPs in the planning, redesign and delivery of services. Work to develop acute services in this way will be undertaken during 2016 In order to support integration, NHS Grampian will continue to work with key partners in relation to issues that need to be taken forward on a north east Scotland basis. A high priority will be given to the development of relationships with partner Councils, IJBs and improved team working across the health and social care system through the NEPSG. 4. Risk Mitigation In support of the above, there is a risk plan with mitigating actions in place which is monitored fortnightly by the Integration Planning Group. This paper relates to corporate risk 1784 i.e. there is a risk that the Board does not maximise the potential to be gained from health and social care integration. The structures put in place, the representation of Board members on the Transitional Leadership Groups (TLGs)/IJBs and the regular involvement of the whole Board at seminars and formal Board meetings supports the mitigation of the risk. As indicated above all actions that need to be put in place by April 2016 have been completed or are in the process of being completed. The main actions for completion relate to the delegation of budgets and the agreement of the hosting arrangements between the IJBs in relation to Grampian wide services. In relation to the latter issue the proposals have been considered by the NEPSG and there is a general acceptance of the proposals. 5. Responsible Executive Director and Contacts for Further Information If you require any further information please contact: Responsible Executive Director Graeme Smith Director of Modernisation graemesmith@nhs.net Chief Officers Adam Coldwells, Aberdeenshire adam.coldwells@nhs.net Pam Gowans, Moray pamela.gowans@moray.gcsx.gov.uk Judith Proctor, Aberdeen City judith.proctor@nhs.net Modernisation Directorate Mark McEwan mark.mcewan@nhs.net Date: 27 January 2016 5
Appendix 1: Summary of Proposed Delegated Budgets Assumptions The budgets for core community, community mental health and primary care services and prescribing are based on the actual budgets in the current year. Initial budgets for hosted services are based on average usage of the service by the HSCP population over the past three years, or NRAC formula information where activity usage information is not available. It is acknowledged that the allocations based on current service usage may not accurately reflect the needs of the HSCP populations. Further consideration will be given as to how adjustments to the initial allocations of funding could be made through the annual budget setting process to more accurately reflect local health need. Notes: City A'Shire Moray Total k k k k Core Community Services 47421 52937 20600 120958 Community Mental Health 9073 6547 6409 22029 Prescribing 38334 41881 16590 96805 Primary Care 33476 33702 13270 80448 Share of Hosted Services 40901 21198 4455 66554 Total Directly Controlled Budget 169205 156265 61324 386794 "Set Aside" Budget For Hospital Services 30368 19647 9873 59888 Total Contribution from NHSG 199573 175912 71197 446682 Figures are indicative at this stage and will be confirmed once NHS Grampian s revenue budget setting process has been concluded Figures do not yet reflect budget uplifts for 2016/17 for pay awards, national insurance and GP Prescribing. They also do not include the 22.8 million announced by the Scottish Government for improved social care outcomes The figures above assume that Inpatient Mental Health & Learning Disabilities services are delegated to HSCPs as a hosted service The figures do not yet include the budgets to be delegated for out of area HSCP referrals 6