Agenda, decisions and minutes

The agenda and reports associated with this minute can be located at the following link:-

http://committees.aberdeencity.gov.uk/ieListMeetings.aspx?CommitteeId=516

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.

The Chair opened the meeting and welcomed Rhona Atkinson onto the Board as a voting member representing NHS Grampian. He also advised that a new microphone system was now in place for meetings at the Community Health and Care Village and outlined the procedure for operating the microphones to participate in discussions. Thereafter the Chair proposed to amend today’s agenda to consider item 8 (External Audit Report on Aberdeen City IJB) after item 6 (Period 3 Finance Report).

The Board resolved:-

(i)        to welcome Rhona Atkinson onto the Board as a voting member representing NHS Grampian; and

(ii)       to amend today’s agenda and consider item 8 (External Audit Report on Aberdeen City IJB) after item 6 (Period 3 Finance Report).

The Chair moved that agenda item 14 (Expansion of Interim Bed Position) of today’s agenda (item 15 of this minute) 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 6 and 8 of Schedule 7(A) of the Act.

The Board had before it the minute of the previous Board meeting of 28 June 2016.

The Board resolved:-

To approve the minute as a correct record.

The Board had before it a statement of pending business for information.

The Board resolved:-

(i)            to remove item 9 (Integrated Management Structure) from the Business Statement; and

(ii)          otherwise note the statement.

The Board had before it a report by Judith Proctor (Chief Officer, ACHSCP) which proposed to appoint a new member to the Audit and Performance Systems (APS) Committee.

The report recommended:-

that the Board –

(a)          Note the appointment of Rhona Atkinson to the IJB, replacing Sharon Duncan; and

(b)          Approve the appointment of Rhona Atkinson to the APS Committee.

The Vice Chair noted that the process for appointing a new member to the APS Committee had been followed as per the Board’s standing orders but requested that officers review the process with regards to appointing members to IJB committees and report back to the Board’s next meeting on 15 November 2016.

The Board resolved:-

(i)            to note the appointment of Rhona Atkinson to the IJB, replacing Sharon Duncan;

(ii)          to approve the appointment of Rhona Atkinson to the APS Committee; and

(iii)         to request that officers review standing order 23 and report back to the Board’s next meeting on 15 November 2016.

The Board had before it a report by Alex Stephen (Chief Finance Officer, ACHSCP) which proposed to appoint the shared internal audit service used by both Aberdeen City and Aberdeenshire Councils as the IJB’s internal auditors until 31 March 2017.

The report recommended:-

that the Board –

(a)       Agree the shared internal audit service used by both Aberdeen City and Aberdeenshire Council would provide internal audit services to the IJB until 31 March 2017;

(b)       Instruct a review of the appointment of the Chief Internal Auditor and Internal Auditors before 31 March 2017; and

(c)       Note that Audit Scotland would undertake the 2015-16 audit of the IJB accounts and KPMG would take on this role for the 2016-17 accounts.

Alex Stephen informed the Board that the Internal Auditors would report to the Audit and Performance Systems Committee as per Section 8.4 of the Committee’s terms of reference.

The Board resolved:-

(i)           to agree the shared internal audit service used by both Aberdeen City and Aberdeenshire Council would provide internal audit services to the IJB until 31 March 2017;

(ii)          to instruct a review of the appointment of the Chief Internal Auditor and Internal Auditors before 31 March 2017; and

(iii)         to note that Audit Scotland would undertake the 2015-16 audit of the IJB accounts and KPMG would take on this role for the 2016-17 accounts.

The Board had before it a report by Gillian Parkin (Finance Manager, NHS Grampian) and Jimmie Dickie (Finance Business Partner, ACC) which summarised the current year revenue budget performance for the services within the remit of the IJB as at Period 3 (end of June 2016).

The report recommended:-

That the Board note the report on the month 3 position in relation to the IJB budget and the information on areas of risk and management action that was contained therein.

Alex Stephen spoke to the report and highlighted that the Partnership was forecasting a £1.3million overspend at Year End and this was largely attributable to prescribing. He advised that the Executive Team was reviewing opportunities for efficiencies and reminded members that transformational funding could be utilised to ensure the delivery of a balanced budget.

Thereafter there were questions on the use of transformational funding to cover overspends; the challenges of managing the prescribing budget in a highly volatile market place; and the level of underspend for Learning Disabilities and Mental Health and Addiction budgets. Members also recognised that prescribing was a Grampian-wide issue and Boards had little control over the unit cost of medicines.

The Board resolved:-

(i)            to request a workshop session be arranged to highlight issues related to prescribing; and

(ii)          otherwise note the report.

The Board had before it a report by Alex Stephen which provided the Board with an opportunity to discuss the Annual Audit Report to members and the Controller of Audit.

The report recommended:-

that the Board –

(a)       Note the content of the Annual Audit Report to members and the controller of Audit;

(b)       Agree the action plan appended to the report; and

(c)       Request that an External Audit outstanding recommendations report be presented to the APS Committee to provide assurance that the recommendations contained in the action plan were completed in the agreed timeframe.

Anne MacDonald (Audit Scotland) advised that the report set out the audit framework and a code of practice for the IJB. She explained that the financial statements were only audited for a two month period from the Board’s establishment on 6 February 2016 to 31 March 2016. She noted that the Board had produced a high quality set of accounts and a sound governance framework had been put in place. Ms MacDonald highlighted that the Board had recognised the need to develop a performance management framework to strengthen their governance arrangements and Alex Stephen advised that a draft framework would be presented to the Executive Team on 31 August 2016 and it was their intention to submit the framework to the Audit and Performance Systems Committee on 25 October 2016 and to the IJB on 31 January 2017.

Thereafter there were questions on the development of the Board’s Governance Statement for the 2016-17 Annual Accounts; and how the Board’s Integration Scheme and Scheme of Delegation would address issues relating to conflicts of interest, lines of accountability, decision making and ultimate responsibility for quality of care.

The Board resolved:-

(i)            to note the content of the Annual Audit Report to members and the controller of Audit;

(ii)          to agree the action plan appended to the report;

(iii)         to request that an External Audit outstanding recommendations report be presented to the APS Committee to provide assurance that the recommendations contained in the action plan were completed in the agreed timeframe;

(iv)         to request that the Chief Officer meet with the Chief Executives of ACC and NHS Grampian to discuss the development of the IJB’s Governance Statement to be included in the 2016-17 Annual Accounts; and

(v)          to thank Alan Gray and Paul Dixon for their work during the audit of the Board’s annual accounts.

The Board had before it a report by Alex Stephen which provided an overview of the Board’s 2015-16 Audited Annual Accounts.

The report recommended:-

That the Board consider and approve the Board’s Audited Annual Accounts 2015-16.

Alex Stephen spoke to the report and explained that there was very little detail in the accounts due to the short period of time that the Partnership had been operating but noted that the auditing process had provided them with a robust template for submitting full year annual accounts for 2016-17.

The Board resolved:-

To approve the Board’s Audited Annual Accounts 2015-16.

The Board had before it a report by Gill Mutch (Finance, ACC) and Alison MacLeod and Jean Stewart-Coxon (Commercial and Procurement Services, ACC) which sought approval from the IJB on the proposal to increase rates paid to external providers of care at home from 1 October 2016 to help implement the Living Wage commitment as part of a positive approach to fair working practices.

The report recommended:-

that the Board –

(a)       Agree the proposal of a 6.4% uplift to all rates for purchased services across all client groups and for all hours worked (except those already covered by the National Care Home Contract) from 1 October 2016;

(b)       Instruct the Chief Officer to issue a direction to ACC to provide a 6.4% uplift, at a cost of £1.6million as set out in the recommended option to external care providers; and

(c)       Instruct 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.

Alex Stephen spoke to the report and explained that the Living Wage commitment was made by the Scottish Government and local government as part of the 2016-17 grant settlement to ensure the Living Wage of £8.25 was paid to care workers. He advised that the proposed 6.4% uplift to care providers had been scrutinised through an extensive consultation process and had been agreed by the Audit and Performance Systems Committee on 11 August 2016. Tom Cowan (Head of Operations, ACHSCP) advised that the proposed uplift would make a significant contribution towards stabilising the social care market in terms of recruitment and turnover levels and would provide resources for care providers to invest in their staff through training and development. He added that these investments would help to shape a new paradigm wherein caring would be perceived as an aspirational choice of career with clear routes for progression. Judith Proctor highlighted that the 6.4% uplift was the fairest proposal and aligned with the Partnership’s aim to deliver fairer working practices across the sector. She explained that the Board would receive assurance that the uplift was being used to implement the Living Wage or support training and development programmes through the Board’s Annual Report and the Partnership’s Strategic Commissioning Strategy.

Thereafter there were questions on the process for submitting IJB directions to Aberdeen City Council and NHS Grampian; and the role of third and independent sector partners in the strategic commissioning process. Members also stressed the importance of tracking how the uplift was being utilised by care providers and requested that robust monitoring arrangements be put in place to ensure that the benefits were passed onto staff and not used to award providers who had maintained existing terms and conditions.

The Board resolved:-

(i)           to agree the proposal of a 6.4% uplift to all rates for purchased services across all client groups and for all hours worked (except those already covered  ...  view the full minutes text for item 10.

The Board had before it a report by Claire Wilson (Planning and Development Manager, ACHSCP) which advised the IJB of the principles of UNISON’s Ethical Care Charter. It also provided detail in terms of how the adoption of the Charter’s principles might support the Partnership in delivering the ambitions set out in its Strategic Plan, in partnership with its third and independent sector partners.

The report recommended:-

that the Board –

(a)       Support the principles as set out in the Ethical Care Charter;

(b)       Create a working group, including representation from care at home providers to consider the application of principles in the Partnership’s strategic commissioning work;

(c)       Direct the working group to assess the potential financial impacts of adopting the principles of the Ethical Care Charter; and

(d)       Agree to a further update on this to come to a future meeting of the IJB by the end of the financial year.

Tom Cowan spoke to the report and advised that the Charter had been developed in response to a 2011 Unison survey which found that care workers were poorly treated and subject to unfair terms and conditions. He explained that the Charter outlined a set of principles for care providers to phase out existing working practices and highlighted that Unison had indicated their intention to resurvey care providers and review the level of sign-ups to gauge the impact of the principles implementation on the social care sector. Mr Cowan added that the Council’s arm’s length organisation, Bon Accord Care was a signatory of the Charter.

Members discussed the financial challenges of being a care worker as Mr Cowan explained that a number of workers were paid by the quarter hour and some did not receive travel time pay. He advised that this had a detrimental impact on workers who travelled across the city to provide care in the West End where the proportion of care workers who resided in this area was historically low. Thereafter there were questions on the composition of the working group that would consider the application of the Charter’s principles with regards to the Partnership’s strategic commissioning work and the timeframe set aside for the group to report its recommendations.

The Board resolved:-

(i)            to support  the principles as set out in the Ethical Care Charter;

(ii)          to create a working group, including representation from care at home providers to consider the application of principles in the Partnership’s strategic commissioning work;

(iii)         to direct the working group to assess the potential financial impacts of adopting the principles of the Ethical Care Charter; and

(iv)         to agree to a further update on this to come to a future meeting of the IJB by the end of the financial year.

The Board had before it a report by Dr Nick Fluck (Medical Director, NHS Grampian), Amanda Croft (Director of Nursing, Midwifery and AHPs, NHS Grampian) and Susan Webb (Acting Director of Public Health, NHS Grampian) which provided the IJB an opportunity to consider a consultation draft of the NHS Grampian Clinical Strategy.

The report recommended:-

that the Board –

(a)       Endorse the strategic priorities and direction set out in the draft Clinical Strategy; and

(b)       Direct the Chief Officer and the Executive Management Team to ensure that the developing Clinical Strategy’s aims, objectives and actions align where appropriate with the IJB Strategic Plan and Strategic Commissioning and Transformation Programme in order to ensure effective shared development across the public sector in Aberdeen City.

Dr Nick Fluck spoke to the report and advised that the Clinical Strategy provided the context and direction of travel for the next five years and noted that the strategy had been extensively consulted on. He explained that colleagues from NHS Grampian and the Partnership’s Executive Team would meet to ensure that the Strategy’s goals aligned with the Partnership’s aspirations and objectives. Judith Proctor confirmed that the Strategy largely aligned with the Partnership’s ambitions to deliver person centred care and to increase the capacity of individuals and localities to deliver services out with acute settings. She added that the Partnership also endorsed the Strategy’s emphasis on maximising the use of technology to underpin these new pathways. Dr Stephen Lynch advised that a Clinical Workshop was scheduled for 31 August 2016 to discuss the Strategy.

Thereafter there were questions on how the Clinical Strategy could be implemented collaboratively; and how the Strategy would be aligned with the IJB’s Strategic Plan and the National Mental Health Strategy.

The Board resolved:-

(i)        to endorse the strategic priorities and direction set out in the draft Clinical Strategy;

(ii)       to direct the Chief Officer and the Executive Management Team to ensure that the developing Clinical Strategy’s aims, objectives and actions align where appropriate with the IJB Strategic Plan and Strategic Commissioning and Transformation Programme in order to ensure effective shared development across the public sector in Aberdeen City; and

(iii)   to instruct the Clerk to cascade the omitted Grampian Clinical Strategy Implementation Priorities appendix to members of the Board.

The Board had before it a report by Sarah Gibbon (Executive Assistant, ACHSCP) which informed the IJB about an ongoing Grampian wide review into dispensing GP Practices, including the consultation process and to highlight the actions required on the part of the IJB.

The report recommended:-

that the Board –

(a)       Note the ongoing work on the review as outlined in the report; and

(b)       Agree that the review group recommendations, implementation plan and written responses from principal interested parties would come to the IJB for discussion prior to final approval by the NHS Grampian Board.

David Pfleger (Director of Pharmacy and Medicines Management, NHS Grampian) informed the Board of an ongoing NHS Grampian review of dispensing GP Practices and he explained the existing procedure for dispensing prescriptions and highlighted there were exceptions to these procedures in the general medical regulations if patients had limited access to a community pharmacy. Mr Pfleger explained that the practice at Udny Station was the only practice which provided services to an Aberdeen City practice that would be subject to review and noted that colleagues from NHS Grampian had attended meetings of the local Community Council to raise awareness and receive community feedback on the general practice dispensing review. Thereafter he referred to the key stages and timeframes of the review and noted that the findings of the review and an implementation plan would be presented to the IJB in early 2017 before final approval by the NHS Grampian Board in March 2017.

The Board resolved:-

(i)        to note the ongoing work on the review as outlined in the report; and

(ii)       to agree that the review group recommendations, implementation plan and written responses from principal interested parties would come to the IJB for discussion prior to final approval by the NHS Grampian Board.

The Board had before it a report by Gail Woodcock (Integrated Localities Programme Manager, ACHSCP) which proposed to develop a programme of achievement recognition, including an awards ceremony to celebrate and formally recognise the dedication, efforts and achievements of Partnership staff.

The report recommended:-

that the Board –

(a)       Endorse the development of a programme of activities to recognise the efforts and achievements of staff working for the ACHSCP; and

(b)       Agree to the establishment of an annual awards ceremony to serve as the pinnacle of formal recognition for ACHSCP’s workforce and as a way to recognise the contribution made by partner organisations to support the integration of health and social care in Aberdeen City.

Gail Woodcock spoke to the report and advised that the proposal would introduce a distinctive award scheme for 1800 Partnership staff and provide a platform to celebrate the delivery of the Partnership’s values. She added that the report recommended that an annual awards ceremony be arranged as a way to bring all partners together and formally recognise the efforts of staff and community partners who had made a valuable contribution towards the integration of health and social care in Aberdeen City over the previous twelve months.

Members welcomed the proposal and suggested that the scope of the scheme should be expanded to recognise the contribution of colleagues from the third and independent sectors in supporting the Partnership’s objectives and aspirations. Members also discussed the possible award categories that could be included in the award scheme.

The Board resolved:-

(i)        to endorse the development of a programme of activities to recognise the efforts and achievements of staff working for the ACHSCP; and

(ii)       to agree to the establishment of an annual awards ceremony to serve as the pinnacle of formal recognition for ACHSCP’s workforce and as a way to recognise the contribution made by partner organisations to support the integration of health and social care in Aberdeen City.

In accordance with the decision recorded under article 2 of this minute, the following items were considered with the press and public excluded.

EXPANSION OF INTERIM BED POSITION

15.       The Board had before a report by Kenneth O’Brien (Service Manager, ACHSCP) which proposed to expand the interim care home bed base to support immediate discharge of patients/clients delayed in hospital. The plan would result in up to thirteen additional beds being brought online to complement the six existing beds already in place. This would be for a twelve month period initially with a review built in.

The report recommended:-

that the Board –

(a)       Approve the project to expand the interim bed base;

(b)       Request to be updated on the interim bed base project as part of the IJB’s periodic updates on the Partnership’s delayed discharge position; and

(c)       Formally instruct the Chief Officer to issue the Direction to Aberdeen City Council to purchase the thirteen additional beds.

The Board resolved:-

(i)           to approve the project to expand the interim bed base;

(ii)          to request to be updated on the interim bed base project as part of the IJB’s periodic updates on the Partnership’s delayed discharge position; and

(iii)         to submit a Direction to Aberdeen City Council to purchase the thirteen additional beds.

The Board then broke out for a workshop session on mental health presented by Jenny Gibb (Professional Nursing Adviser, NHS Grampian), Dr Alastair Palin (Clinical Director, Mental Health Services and Deputy Medical Director, NHS Grampian) and Claire Wilkie (Service Manager, ACHSCP).

The Board resolved:-

To thank Jenny Gibb, Dr Alastair Palin and Claire Wilkie for the informative presentation.

COUNCILLOR LEN IRONSIDE CBE, Chairperson.