Highland NHS Board 6 December 2011 Item 3.10(a) Argyll & Bute Health and Social Care Strategic Partnership Minute of Meeting held on Wednesday, 27 July 2011 In Council Chambers, Kilmory, Lochgilphead @ 10.00 am Present Councillor Andrew Nisbet (Chair) Spokesperson Social Affairs (Argyll & Bute Council) Bill Brackenridge Chair NHS Highland Cleland Sneddon Executive Director Community Services (A & B C) Derek Leslie General Manager Argyll and Bute CHP Douglas Dunlop Head of Children & Families, Criminal Justice (A & B C) Councillor Elaine Robertson Non-Executive Director NHS Highland Jim Littlejohn Acting Service Manager Operations & MH (A & B C) Pat Tyrrell Lead Nurse Argyll & Bute CHP Lorna McCallum (minutes) Admin Officer Learning Disability (A & B Council) In Attendance: Pat Trehan Lorraine Todd Joint Performance & Planning Manager (A & B Council) Performance Management Assistant (A & B Council) Apologies: Councillor Walsh Sally Loudon James Robb Dr Michael Hall Anne Helstrip Vivian Shelley Leader Argyll and Bute Council Chief Executive Argyll & Bute Council Head of Adult Care (Argyll & Bute Council) Clinical Director Argyll & Bute CHP Locality Manager Helensburgh & Lomond Non-Executive Director NHS Highland Item: 1. Introductions Councillor Nisbet welcomed everyone to the meeting and apologies were noted. 2. Minute of Previous Meeting Minute of previous meeting held on 8 June was agreed as a correct record. Matters Arising Item 2 Mental Health Implementation Plan Derek Leslie advised that Pat Tyrrell will provide staff numbers requiring AWI training. P. Tyrell
Item 7 (1) DALLAS (Delivering Assisted Living Lifestyles at Scale) Funding Cleland Sneddon reported that there was an indication that the joint bid between Argyll & Bute Council, Highland Council and NHS Highland will be one of the five pilot areas. Further discussions will take place at Chief Executive level. It was noted that this bid was successful in recognition of the forward thinking taking place within Argyll and Bute. Item 7 (2) Southern Cross Cleland Sneddon advised that an agreement had been reached with the Landlord s Group to reschedule the debt for a 4 month period. It had been proposed that 250-300 Care Homes would be retained by SC. More recently, it was confirmed that Southern Cross will not retain operational control of any of its 700+ care homes. Liaison is ongoing with the National Contingency Planning Group to assist the identification and transfer of the homes to new operators. New operators are currently being approached for each care home and Local Authorities will be advised of developments within their area as they arise. Item 7 (3) Pyramid The Joint Management Group will discuss key indicators for inclusion in the scorecard at their next meeting. D. Leslie 3. Children s Services Update GIRFEC Dougie Dunlop advised that the rollout of GIRFEC is on track. Training is in place and implementation is scheduled for the autumn. Service Reviews The following Service Reviews, overseen by Argyll & Bute s Children are being undertaken: Vulnerable Young Person s Review this will include the development of a Therapeutic Trauma Recovery Service which will extend the current CAMHS provision. A meeting is to be held on 9 August where the final details will be signed off, with a target date for implementation in November. Primary Mental Health Worker Roles (based within secondary schools) these will be piloted in Oban and Bute. However, there is a resources gap of 0.25 million to fund the service. Dougie, Cleland and Health reps will meet at the end of August to consider reshaping current services to address the funding issues. Review of Early Years Service this is progressing well. There is now an integrated service and the next meeting will formalise the priority of services. Review of Children Affected by Disability Alan Shields, QIM, is now in post and is progressing consultation with 2
parents on the delivery of future services. Interagency Child Protection Inspection Dougie Dunlop reported that initial draft gradings were as follows: Children benefit from strategies to minimise harm Good Children and young people s needs are met Good Children are Listened to and understood and respected Good How good is the management and delivery of services Satisfactory Children and young people are helped by the actions taken in immediate response to concerns Weak It was noted that the weak grading was disappointing as the scorings awarded in the self evaluation were better. Chief Officers are meeting with the Lead Inspector to discuss how this conclusion was reached. However, work is ongoing to collect data which will be presented to inspectors. The inspectors found that there were flaws in the early and initial referral discussions (IRD) between agencies. However, Dougie felt the impact had not led to poorer outcomes which were graded as good by the inspectors. Dougie also acknowledged that processes were in place and although they were not always adhered to, compensatory measures were in place to mitigate the impact. Cleland Sneddon advised that if the findings of the inspectors were indeed proved to be accurate, then these issues can be addressed and resolved within a relatively short time frame. Draft report is due to be received by the end of August for comment with the final report due for publication on 6 th October. Fatal Accident Inquiry Dougie Dunlop reported that all aspects of the FAI are being examined in great detail. As such, the timescales for completion have been delayed and the FAI may now not conclude until the end of the year. Joint Performance Dougie Dunlop advised that a number of new indicators for Children s Services are being devised for Pyramid. Pat Tyrrell is assisting with Health input. 3
4 (a). Update on Redesign of Older People s Services Minute of Project Board meeting, held on 27 th June 2011 was circulated for information. Cleland Sneddon advised that at the Special Committee following the Project Board, the Committee made the following decisions: Day Care Four of the five Pre Qualifying Questionnaires (PQQ) submitted were successful and the Special Committee agreed that these four providers will be invited to tender. Care at Home It is proposed that the tender would divide care at home services into nine geographical areas. Substantial interest was shown with at least five providers for each area making it through the PQQ stage and will be invited to tender, if the Special Committee agree to proceed. However, the Special Committee have asked that an additional report, prepared by HR and Legal is presented to a further meeting in August which details TUPE issues for staff which will allow them to make a decision on whether to proceed to tender. The Special Committee expressed some concerns that staff being transferred via TUPE are on zero hour contracts. However, as staff who are transferred via TUPE retain their terms and conditions, if they are on zero hours contracts, some operators may feel it is more economical not to use transferred staff. If, however, the Council were to average out the number of hours staff work, this may affect the tender prices received. If the Special Committee to decide to proceed to tender, it is proposed that three providers would be awarded contracts in each locality to maintain choice. Also, to ensure continuity of care for existing service users, they will have the option of retaining their current provider, with the new providers being awarded all new business. Care Homes Only one provider met the PQQ requirements, however, they were only interested in operating three care homes. Therefore, the decision taken was not to proceed to tender but to concentrate on both day care and care at home services at present. Cleland advised that later this year, he will bring forward proposals to discuss future arrangements with the interested provider. Cleland also reiterated that the Council will not withdraw from residential care until an agreed model of care for future services is in place. 4
Councillor Robertson enquired about the level of uptake of direct payments. Jim Littlejohn advised that uptake has now levelled out following an initial good uptake of DPs. ILF funding has also now been withdrawn and this funding stream, along with direct payments, was used to fund complex packages of care. Jim also highlighted that cost factors for care can differ significantly in rural localities due to the limited number of agencies and/or carers available, especially on islands. 4. (b) Update on Redesign of Learning Disability Services Cleland Sneddon reported that the Learning Disability Redesign is a couple of months behind older people s services. The Commissioning Team are revising timescales which will be presented to the Project Board/Special Committee in August for agreement. The deadline for the return of Pre-Qualifying Questionnaires close on 18 August and the results will be reported to the Project Board at the end of September. If it is agreed to proceed to tender, tender documents will be issued to be returned in December. As such, it is proposed that new services will be implemented in April 2012. 4. (c) Update on Redesign of Mental Health Services Derek Leslie advised that bed numbers have reduced to 44 with demand contained within Glassary Ward, MACH&ICC. It is planned to reduce bed numbers to 22 with increased investment in community services. Clinical Psychology and Talking Therapy posts have been created with the expectation being that increasing resources within the community will assist in maintaining people there. There are 12 resettlement patients. These have been long term residents within the Argyll & Bute Hospital and will require provision in the community. 0.5 million was identified in the transitions plan for this purpose. However, further discussions have been scheduled to look at actual funding required as the amount identified may be insufficient. This is a key issue to be addressed and Chris Goan and Kate MacAulay are leading on this. The Scottish Government have responded advising that they are fully committed and have agreed the proposals. The redesign will therefore now proceed through the revenue funded hub route. Workforce Planning is ongoing with matching, reconfiguration of job descriptions and training and development of staff being undertaken. 5
As such, the Project Plan is on track subject to agreement on resource release for community based care packages. 4. (e) Partnership Working, Integrated Services Derek Leslie confirmed that both parties have approved the outline paper. A meeting is being arranged for Chief Officers and Leaders to meet to consider the scope of work and who will take forward. Cleland Sneddon has drafted a report for the meeting outlining the scope of work. 4. (f) SWIA/Draft ISLA Report Dougie Dunlop advised that the report has been published. Rosie Lawrence, Link inspector will make a presentation to the full Council on 18 August highlighting the four recommendations. Dougie summarised that it is a positive report and confirms the progress made in Social Work Services. In the main, the recommendations are quite broad; however, the central recommendation to be addressed is Outcome Focussed Planning. 5. Joint Performance Update and Pyramid Presentation Report prepared by Pat Trehan, Joint Performance and Planning Manager for information was circulated. Pat Trehan advised that a scorecard is being developed to replace the paper report circulated. She then highlighted a number of points contained within the report as follows: Emergency Admissions work is ongoing with Locality Managers to improve the recording of the reason why a person is admitted into hospital. At present, Medical Records staff currently code patients on discharge and the reason for admission may be different to what they were later diagnosed with. Cleland Sneddon asked for a further update on GP adherence to the ATD protocol. Overnight Teams commenced in January. Pat Trehan is currently working with them to refine their reporting systems. Pat will also look into what capacity teams are working to and report back to the next meeting. P. Tyrrell P. Trehan Continuing Care Beds Occupancy this will be amended once discussion on continuing care beds and resource release has taken place. Social Care Bed Vacancies these have reduced. Highland Council have purchased empty beds within Lorne and this may 6
impact on our services in the future. Delayed Discharges these have reduced from 14 in June to 8 in July. The ADT policy has assisted in ensuring systems are in place. A report on progress will be presented in three months time. Derek Leslie highlighted how much progress has been made on managing delayed discharges. Jim Littlejohn also explained that Catriona Flannigan has been working with individuals and families to give them confidence to maintain people at home and therefore reduce the number of emergency admissions. Pat Tyrrell also confirmed that 20 out of 34 GP practices have anticipatory care plans in place for the top 2.5% of high risk patients within their surgery. Integrated Substance Misuse Service Pat Trehan explained that she is looking at collating the data together from substance misuse work. ADP performance indicators are scheduled to be developed in October. TOPs Outcomes show that alcohol misuse is high in all areas; there are a low number of injectors and criminal activity is also low. P. Trehan OT Services some data is missing and this is due to data currently being uploaded onto AWT system. Will be available next meeting. Children and Families Pyramid Indicators As Dougie Dunlop had explained earlier, new indicators are being devised which will focus on the balance of care; care planning; child protection and Early Years. Both Dougie Dunlop and Pat Tyrrell and working on devising both qualitative and quantitative indicators. D.Dunlop/ P. Tyrrell 6. Change Fund Bid/IRF Scoping Derek Leslie advised that Anne Helstrip is due to retire in August and as such, Pat Tyrrell will lead on the Change Fund with Anne Austin on a transitional basis. Pat Tyrrell reported that Anne Austin and Anne Helstrip have been working on the full implementation plan which will be presented to the Joint Improvement Team at the end of August. Work is also ongoing with George Morrison and Allan MacDonald regarding areas of disinvestment as required. Derek noted that a clear disinvestment plan is required before final sign off. The wider Change Fund Group will approve the high level plan in early August. Each workstream has an identified lead and timescale. The plan needs to show the proposals are achievable and will improve the impact of service delivery. A further update will be provided to the next meeting. 7
7. Resource Release Copies of Bute Pathfinder report were circulated for information. Derek Leslie advised that this report has been agreed by Officers of the Partnership. Jim Robb has requested that some additional background contextual information is included in the report and the Partnership are asked to agree the proposals subsequent to the additional information being incorporated. It was agreed that Resource Release expenditure will be reviewed twice yearly. 8. A.O.C.B. No further additional business was tabled. 9. Date of Next Meeting The next meeting will be held on Wednesday, 28 September @ 10.00 am in the Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead. 8