Present: Highland NHS Board 7 June 2011 Item 3.11 Argyll & Bute Health and Social Care Strategic Partnership DRAFT Minute of Meeting held on Wednesday, 30 March 2011 In Rooms J03, 5 & 7 MACH&ICC, Lochgilphead @ 10.00 am Bill Brackenridge Councillor Andrew Nisbet (Chair) Sally Loudon Cleland Sneddon James Robb Derek Leslie Douglas Dunlop Dr Michael Hall Anne Helstrip Councillor Elaine Robertson Vivian Shelley Lorna McCallum (minutes) Chair NHS Highland Spokesperson Social Affairs (Argyll & Bute Council) Chief Executive Argyll & Bute Council Executive Director Community Services (A&BC) Head of Adult Care (Argyll & Bute Council) General Manager Argyll and Bute CHP Head of Children & Families, Criminal Justice (A&BC) Clinical Director Argyll & Bute CHP Locality Manager Helensburgh & Lomond Non-Executive Director NHS Highland Non-Executive Director NHS Highland 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 Pat Tyrrell Leader Argyll and Bute Council Lead Nurse Argyll & Bute CHP Item: 1. Introductions Bill Brackenridge welcomed everyone to the meeting and introductions were made. As per the Terms of Reference of the Committee, chairmanship of the Strategic Partnership transfers between NHS Highland and Argyll & Bute. As such, Councillor Nisbet was appointed as Chair for 2011 with Bill Brackenridge appointed Depute and Bill therefore handed over the chair to Councillor Nisbet at this point. 2. Minute of Previous Meeting Minute of previous meeting was agreed as a correct record, subject to noting that Bill Brackenridge continued to chair the meeting with the agreement of the group as Councillor Nisbet was just coming into post. Matters Arising C. McCann 4. Joint Performance Prioritisation of Waiting Lists these waiting lists relate to the Private Sector Housing Grants which the Council has retained authority for
granting of these, against national policy. Funding for affordable housing and community transport has been dramatically reduced; therefore, this creates issues outwith Social Work management and budgets. It was also noted that the Integrated Equipment Service can also provide aids, not just Social Work. Jim Robb clarified that self referral figures for residential care are higher in the Helensburgh area mainly due to financial circumstances of individuals. However, Jim reiterated that any individual requesting FPC must be subject to an assessment and assessed as requiring personal care. If these needs are not assessed as being required, then FPC will not be awarded. 6. JIT Update Jim Robb, Locality and Service Managers have all responded to JIT regarding feedback questionnaire to JIT regarding their involvement. 7. e-care Copy of letter from William Reid, Head of ehealth, NHS Highland to Jim Robb was tabled. It was noted that staff are currently working in an integrated manner, however there are still issues regarding not being able to access an integrated information system. NHS has an issue regarding information governance. However, the introduction of the MiDIS system will resolve this. MiDIS is being piloted in Bute at present and evaluations will be undertaken. It is hoped that a joint system via Multi-Agency Store (MAS) will be in place by the end of the calendar year and assessment information will be able to be inputted through both MiDIS and CareFirst. Derek Leslie will invite William Reid to attend the next meeting in July and provide an update and report to the Strategic Partnership Committee. D. Leslie 3. Standing Items (a) Review of Older People s Services Update Minute of the Future Use of Older People s Services Project board of 3 February 2011 were tabled and content noted. Jim Robb advised that the Project Board have decided to move to preparing tender documents for Home Care, Day Services and Care Homes. The market test exercise showed a high level of interest in Home Care Services; a number of interested parties who may wish to redesign the current service, but the indication is that there is no great interest in purchasing Council Care Homes. However, the Project Board agreed to tender all three services and await results of this exercise. The tender documents are currently being prepared and will be presented to the Project Board on 20 May for agreement. The tender period will then be undertaken from May to June with a further meeting of the Project Board to be held late August/September to consider the outcomes of this process. 2
Jim reiterated that no decision has been taken to date to externalise any services. On completion of the tender exercise, the Project Board could recommend that the status quo remains for some or all of the services. Alternatives ways of providing care home services will be explored where no acceptable bids are received i.e. integrated models of care such as progressive care and extra care housing and this has been agreed by the Project Board. Jim Robb, Anne Austin, Service Manager Resources, and Councillor Nisbet are meeting with staff, carers and service users to provide updates of the Project board decisions. These meetings are specifically for these groups and are not public meetings. Staff groups have also had the opportunity to work with ABSEN regarding establishing a social enterprise model. However, it is not yet know if staff will pursue this option. Jim Robb will provide a further update to the next meeting, J Robb (b) Review of Learning Disability Services Update Minute of the Future Use of Learning Disability Services Project Board of 26 November 201o were tabled and content noted. Jim Robb advised that the Project Board agreed that the Project Team be tasked to develop a Full Business Case for consideration at the next meeting on 4 May. A Market Test has been undertaken and the outcome of this will be reported to the Project Board. The Project Board also requested that a visit to the day service in Helensburgh be arranged for service users and carers from other areas of the Authority to explore the services and experiences of service users there who receive services outwith a building base. This visit took place on 14 March and was facilitated by the Advocacy Service. Representatives who attended have now been tasked to feedback their findings to their respective Locality Groups and again, the Advocacy Service will collate responses and report back to the Project Team. These findings will then be reported to the Project Board. It was acknowledged that ongoing communication with service users and carers was worthwhile. Jim Robb will provide a further update at the next meeting. J Robb (c) Redesign of Mental Health Services Update Derek Leslie provided a verbal update on the Redesign of Mental Health Services. Josephine Bown is retiring on 31 st March and her post is not being replaced. However, John Dreghorn will assume the leadership role for progressing this agenda and developing the interface between Primary Care, Community Care and Hospital services. John will also have the overarching responsibility for the pathway to these services. Christina 3
West will be the acting Locality Manager for MAKI in the interim. Derek advised that capital funding has been reduced by the Scottish Government and this has an impact on proposals. The option appraisal from maintaining the status quo through to a new build facility has been presented to NHS Highland Board and the outcome is currently awaited. Dementia patients with challenging behaviours are currently being moved into the MACH&ICC and consideration is also being given to extending the current community hospital building. Staffing levels have been agreed for both community and in-patient services and redeployment of staff is ongoing. Bridging finance of 350,000 has been secured to move services into the community and reduce the number of inpatient beds. The modernisation agenda is proceeding with the number of beds reduced from 700 to 82. The final number of beds proposed is 32. Derek agreed to re-circulate the Project Implementation Document to the group. It is hoped that the redesign of MH services will be fully implemented by Spring 2013. D. Leslie Mental Health services in the Helensburgh and Lomond area continue to be provided through Greater Glasgow and Clyde Health Board for inpatient services with community services provided via a SLA with West Dunbartonshire Council. Derek will provide a written report of progress to date at future meetings and will also ask John Dreghorn to attend and provide an update to the meeting of 8 June. D. Leslie (d) Partnership Working Integrated Services The Chief Executives of both NHS Highland and Argyll and Bute Council are meeting to discuss and following this, a paper will be presented to a future meeting. In the interim, there are a number of operational integration opportunities in the near future, for example, the Bute pilot will recommend appointing a single operational manager. The restructuring of the Adult Care service within the Council has been agreed but has not yet been implemented. (e) SWIA/Draft ISLA Report Report detailing the Initial Scrutiny Level Assessment (ISLA) was tabled. Dougie Dunlop advised that the SWIA inspection process is nearing completion. Social Work service have been tested against 9 factors and Argyll and Bute have been graded with four factors no significant risk and five as area of uncertainty. Follow up work with has been undertaken with SWIA on the five areas of uncertainty and feedback is 4
awaited from the Moderation Panel within SWIA. questions 1 & 7 will move to no significant risk. It is hoped that SWIA will continue to engage and work in collaboration regarding key processes. They will provide a consultancy and organisational development role over the next year. The Social Work Evaluation Day highlighted that Argyll and Bute are currently in the mid range of performance of Local Authorities. However, it is acknowledged that we are one of the best improved Councils. Good clear messages have been given to staff that we are ambitious to improve. The action plan will be updated over the next two years. Cleland Sneddon advised that the Council is now considered low risk. Greater emphasis is on self evaluation rather than audit process. Admission, Transfer and Discharge policy discussions are ongoing regarding governance and structure with a final report being tabled at the next meeting. Dougie Dunlop advised that the service must move towards personalised outcomes for individuals, not outputs to service. To assist this, updated assessments and care plans for more individualised services are now available on CareFirst. Dougie also highlighted that good qualitative data should be recorded and this should be complimented with more systematic feedback from service users of their experiences of services received. Sally Loudon also noted that both Corporate and Service Plans are now much more outcome focussed. The SWIA report on ISLA is due for publication at the end of May/June. 4. Joint Performance Update Joint Performance report for February 2011 prepared by Pat Trehan was tabled. Performance information is recorded on Pyramid and this was demonstrated to the Committee. Pat advised the Balance of Care figures show the shift from services provided in institutional settings services to those provided in the community. This information is broken down into localities. In Year figures detail the number of people who have commenced services within the current financial year. This demonstrates the direction of travel is moving to ensuring people remain in the community. The target will be raised in the longer term to above 70% which should be achieved through the increase in extra care housing and the reduction of continuing care beds. Delayed discharges have achieved a zero target in the last eleven out of twelve months. However, Pat advised that the future target is to reduce the overall number of delayed discharges. Pat explained that a large number of patients are admitted as an emergency and then become 5
delayed discharges. These individuals are often not known to Social Work and are not in receipt of any services prior to admission. Consideration will therefore need to be given as to how these admissions are prevented. Councillor Robertson asked if these individuals could be identified and whether they were already considered as priority 3 or 4 by Social Work. The Bute Project is looking to create a menu of options to be considered prior to admission and it is proposed that these will then be rolled out across the Authority. Also, better information is required as to the reason people are being admitted into hospital. This should be recorded on the day of admission, not a number of weeks later. The Admission, Transfer and Discharge policy may not be being adhered to and Clinical Services Managers in each locality are looking into this. An update will be provided to the next meeting. Dr Hall advised that GPs will buy into menu of options if services are available. It was noted that there are problems with Glasgow Hospitals who are discharging patients from Acute to Community Hospitals without a package of care in place. Bill Brackenridge highlighted a number of issues: Kerr Report the anticipatory care agenda needs to be driven forward. GPs are not employed by NHS but are independent. The model of Health Care needs to be changed, with a clear vision. It was suggested that the Strategic Partnership should make actions points against issues highlighted in the Joint Performance report and these should then be addressed by both the Council and CHP. It was agreed that the Joint Performance Report should be presented to the next CHP Board meeting. Also, this item will be taken at the start of the next Strategic Partnership meeting which will be held in Kilmory to enable the Pyramid scorecard to be viewed effectively. C McCann 5. Change Fund Bid/IRF Scoping Report Copies of submission and Scoping Report where tabled and noted. Derek Leslie advised that the bid for 1.71 million has been accepted. The next part of the process will be discussed with representatives of the Partnership in Edinburgh on Friday. A meeting will be arranged for Derek Leslie, Jim Robb, Anne Helstrip and Anne Austin to meet with the JIT support team to discuss feedback received from the bid and devise an action plan. Partnership working and communication will remain ongoing with the independent and third sector. 6
A report will be presented to the next meeting. D Leslie 6. Children s Services Update Report prepared by Dougie Dunlop providing an update on Children s Services was tabled. Dougie advised that the Children s Service Plan 2009-12 is entering its final year and is tied into national outcomes. The implementation of GIRFEC has also made significant progress. The single assessment plan has been piloted in Bute and will be rolled out across the Authority in the Autumn. A pre-referral process is also being developed to divert children from the Children s Hearing System prior to reports being requested. With regard to Service Redesign, Dougie advised that reviews and reshaping of services have been ongoing for the following services: Getting it Right for Vulnerable Young People; Getting it Right for Children Affected by Disability and the Integrated Early Years Service. Terms of Reference are being formalised for the Early Years Service. Alan Shields has been appointed as Quality Improvement Manager and will commence this post in May. The Inter-Agency Child Protection Inspection is due to commence in May. There has been a significant reduction in the number of Looked After Children being placed in a residential setting which has been complimented with the introduction of two LAAC children s nurses. Dougie also clarified that there are no external foster care placements outwith Argyll and Bute. Dougie also highlighted that early intervention and preventative measures will be monitored. Future governance arrangements are currently in abeyance until after the May election. 7. A.O.C.B. Alcohol & Drug Partnership Cleland Sneddon advised that Superintendent Raymond Park, the current chair, is leaving the area. As such, the Lead Officer group will determine who the new chair will be. Third Sector representation is also required for the Lead Officer Group. Substantial changes are imminent and these will be addressed at the next meeting of the partnership as a matter of priority. 8. Date of Next Meeting The next meeting of the Health & Care Strategic Partnership Committee will be held on Wednesday, 8 June 2011 @ 10.00 am in the Council Chambers, Kilmory, Lochgilphead. C McCann 7