Agenda, decisions and minutes

The Chair opened the meeting and advised that further interviews to fill the outstanding Head of Locality posts had been arranged and noted that the standing orders review would be presented to the Board’s next meeting as a number of legal issues had arisen that needed due consideration.

The Chief Officer highlighted that eight colleagues from the Partnership had visited the Netherlands to see the Buurtzorg model in action and noted the visit had proven to be very useful from a learning and development point of view and added that a briefing would be shared with members in due course.

The Board resolved:-

(i)            to thank members who attended the Kingsmead Nursing Home thank you event for colleagues on 27 July 2017;

(ii)          to note that a briefing on the Buurtzorg model would be circulated to members in due course; and

(iii)         otherwise note the information provided.

Members were requested to intimate any declarations of interest.

The Vice Chair declared an interest in relation to item 8 (Ethical Care Charter) by virtue of her membership of Unison and advised that she would remain in the meeting during consideration of the item;

Professor Greaves declared an interest in relation to item 14 (Draft Strategic Commissioning Implementation Plan) by virtue of his membership of the Quarriers Board and advised that he would remain in the meeting during consideration of this item: and

Kenneth Simpson declared an interest in relation to item 14 (Draft Strategic Commissioning Implementation Plan) and item 15 (Transformation Decisions required) by virtue of his Chairmanship of the ACVO Board and advised that he would remain in the meeting during consideration of these items.

The Board resolved:-

To note the declarations of interest intimated by the Vice Chair; Professor Greaves and Kenneth Simpson.

The Chair proposed that items 16 (Aberdeen City Residential Nursing Home Provision) and 17 (Bon Accord Care Contract Review) 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 paragraph 6 (Bon Accord Care Contract Review) and paragraphs 8 and 9 (Aberdeen City Residential Nursing Home Provision) of Schedule 7(A) of the Act.

The Board had before it the minute of the Board meeting of 6 June 2017.

The Board resolved:-

To approve the minute as a correct record.

The Board had before it the draft minute of the Audit and Performance Systems Committee of 20 June 2017 for information.

The Board resolved:-

(i)            to note the draft minute; and

(ii)          to request that the slides from the prescribing workshop held in March 2017 be sent to Cllr Samarai.

The Board had before it the draft minute of the Clinical and Care Governance Committee of 28 June 2017 for information.

The Board resolved:-

To note the draft minute.

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

The Board resolved:-

(i)            to remove item 2 (Delayed Discharges) and item 4 (Document Management) from the Statement; and

(ii)          otherwise note the Statement.

The Vice Chair declared an interest in the following item as outlined in item 2 of this minute and chose to remain in the meeting during consideration of this item.

The Board had before it a report by Claire Duncan (Lead Social Work Officer, ACHSCP) which provided an update on progress with the scoping and planning for the implementation of UNISON’s Ethical Care Charter.

The report recommended:-

That the Board –

(a)       Note the ongoing and planned work in relation to the implementation of the Ethical Care Charter; and

(b)       Request the Chief Officer to arrange for further reports to be presented to the Board detailing the progress made in implementing the Ethical Care Charter on a six monthly basis.

Claire Duncan (Lead Social Work Officer, ACHSCP) provided an overview of the work of the Ethical Care Charter working group and outlined the three stages of the Charter’s implementation. She explained that an initial scoping exercise had found that a significant number of existing providers offered statutory sick pay to their staff; and explained that one of the key aims of the Charter was to increase recruitment and retention rates within the social care sector and hoped that implementation of the Scottish Living Wage would contribute towards this objective. Ms Duncan noted that an action plan had been developed and a further update would be presented to the Board in six months.

Thereafter there were questions and comments on the proportion of providers that were not compliant with the Charter; the use of contract monitoring processes as part of the Strategic Commissioning Strategy to monitor the compliance rate; engagement with unpaid carers during the consultation period; the growing connection between strategic commissioning and locality planning; and measures taken by the Partnership to build relationships with social care providers.

The Board resolved:-

(i)            to note the ongoing and planned work in relation to the implementation of the Ethical Care Charter;

(ii)          to request the Chief Officer to arrange for further reports to be presented to the Board detailing the progress made in implementing the Ethical Care Charter on a six monthly basis;

(iii)         to request that officers look at ways to maximise engagement with unpaid carers and to consider appointing representatives to the Ethical Charter working group;

(iv)         to request a review of the timescales outlined in stages 2 and 3 of the draft Action Plan and to investigate the feasibility of expediting the delivery dates.

The Board had before it a report by Katharine Paton (Learning Disabilities Service Manager, ACHSCP) that sought approval to recommission the Framework for Learning Disability services by replacing the existing framework with (1) a Framework for Supported Living Services; and (2) a Framework for Training and Skills Development Services which would be commissioned in partnership with Aberdeenshire Health and Social Care Partnership.

The report recommended:-

That the Board –

(a)       Agree to retender the provision of Supported Learning for people with a learning disability in the form of a Framework for supported living with a separate lot for Enhanced Care provision, to the timelines detailed within the report;

(b)       Agree to retender the provision of ‘lifestyle support’ for people with a learning disability in the form of a Framework for Training and Skills Development Services through joint commissioning with Aberdeenshire; and

(c)       Note that another paper would be presented to the Board in early 2018 detailing the result of the tender process and seeking approval to issue contracts.

Jennifer Rae (Principal Planning Officer, ACHSCP) proposed not to extend the current two year Learning Disabilities contract for a further year and to replace existing arrangements from 1 April 2018 with three redesigned frameworks covering Supported Living Services; Training and Skills Development Services; and Care at Home. She also highlighted the proposed introduction of standard and enhanced care rates to take cognizance of support provided by carers to individuals with complex learning disabilities and to enable commissioners to model the cost of care on an hourly basis based on the Scottish Living Wage and other statutory employment requirements to fulfil the recommendations of the Ethical Care Charter.

Thereafter there were questions and comments on the standard and enhanced cost of care rates; the consistency of care provision during implementation of the three frameworks to support learning disability clients; the risk that providers may choose to remove themselves from the current framework and concentrate on Care at Home services; the importance of carer involvement at the earliest possible opportunity; the transition timeline from the existing model to the new frameworks; the impact on existing providers and service specification during the tendering process; and proposals for a joint commissioning arrangement with Aberdeenshire HSCP for the Training and Skills Development Services Framework.

With regards to the joint commissioning proposal, Catherine King (Commercial and Procurement Services) provided assurance to the Board that the Aberdeenshire and Aberdeen City Commercial and Procurement Service intended to lead on this and confirmed they were always supportive of joint working wherever possible.

The Board resolved:-

(i)            to agree to retender the provision of Supported Learning for people with a learning disability in the form of a Framework for supported living with a separate lot for Enhanced Care provision, to the timelines detailed within the report;

(ii)          to agree to retender the provision of ‘lifestyle support’ for people with a learning disability in the form of a Framework for Training and Skills Development Services through joint commissioning with Aberdeenshire;

(iii)         to  ...  view the full minutes text for item 9.

The Board had before it a report by Kenneth O’Brien (Service Manager, ACHSCP) and Kate Livock (Unscheduled Care Project Manager, NHS Grampian) which (1) provided a brief background as to the context and process of winter planning for period 2016-17; (2) set out the learning established from National, Grampian and Aberdeen City specific sessions relating to winter 2016-17; and (3) described how this learning would be incorporated into the winter/surge planning for the 2017-18 period.

The report recommended:-

That the Board –

(a)       Note the information contained in the report relating to learning from the 2016-17 winter period; and

(b)       Note the arrangements put in place to incorporate such learning as part of the 2017-18 winter planning process.

Kenneth O’Brien (Service Manager, ACHSCP) advised that the report provided a debriefing of the 2016-17 winter plan and outlined the process for ensuring that learning would be incorporated into winter/surge planning for 2017-18. Mr O’Brien explained that winter 2016-17 was relatively mild and there were fewer cases of infectious disease admissions and highlighted the increasing effectiveness of the health and social care system in comparison to previous years as a result of more joined up working and greater communication between partners. He noted that discharges from hospitals decreased by 30% over the Christmas and New Year period and there were subsequent capacity challenges from 4 January 2017 onwards.

Mr O’Brien advised that Aberdeen City was further impacted by the withdrawal of a Care at Home provider on 6 January 2017 which put additional strain on care at home supply and care management colleagues. In terms of next steps, he explained that the Partnership’s Senior Operational Management Team would review the Aberdeen City component of the plan prior to its incorporation into the comprehensive NHS Grampian winter/surge plan. Mr O’Brien provided further assurance to the Board that 2017-18 winter planning was not contingent on receiving additional funding from the Scottish Government.

Thereafter there were questions and comments on the rate of flu jab take up during 2016-17; planning for major incidents such as a pandemic flu outbreak; the Partnership’s plans for meeting social care demand during public holidays; and the impact on unpaid carers during these periods.

The Board resolved:-

(i)            to note the information contained in the report relating to learning from the 2016-17 winter period;

(ii)           to note the arrangements put in place to incorporate such learning as part of the 2017-18 winter planning process;

(iii)         to agree that the Grampian-wide Winter Plan be submitted to the 3 October meeting of the Clinical and Care Governance Committee in order to meet the submission deadline to the Scottish Government, and to further request that all IJB members be sent the committee papers for information;

(iv)         to request that information be sent to Cllr Donnelly on the level of flu jab take up during winter 2016-17; and

(v)           to request that information be sent to Dr Howard Gemmell on when NHS Grampian received funding from the Scottish Government to support winter planning  ...  view the full minutes text for item 10.

The Board had before it a report by Kenneth O’Brien which provided an update on (1) background information relating to the use of interim care home beds; (2) recent performance information relating to delayed discharges associated with a need for care home admission; (3) financial breakdown summarising the costs of renewing interim beds; and (4) an indication of next steps if the IJB approved funding as requested.

The report recommended:-

That the Board –

(a)          Approve the project to renew the funding of the thirteen interim beds for a further twenty four month period commencing 1 December 2017;

(b)          Instruct the Chief Officer to provide an update on the interim bed base project by the end of the twenty four month period unless by exception; and

(c)          Instruct the Chief Officer to issue the Direction to Aberdeen City Council to purchase the 13 interim beds for twenty four months.

Tom Cowan (Head of Operations, ACHSCP) explained that the proposal aimed to support patients who were fit to be discharged from an acute setting and had been assessed as requiring nursing home admission but had no care home of their choice to be transferred to. He advised that the Partnership’s Delayed Discharge Group had considered this issue in detail and recommended funding the thirteen interim beds to improve patient flow through the system and support the attainment of delayed discharge outcomes.

Thereafter there were questions and comments on the Delayed Discharge Group’s assessment of the optimal number of interim beds; the possibility that the beds may be utilised by primary care colleagues; and the importance of recording how the beds were being utilised and their occupancy rate.

The Board resolved:-

(i)            to approve the project to renew the funding of the thirteen interim beds for a further twenty four month period commencing 1 December 2017;

(ii)           to instruct the Chief Officer to provide an update on the interim bed base project by the end of the twenty four month period unless by exception;

(iii)         to instruct the Chief Officer to issue the Direction to Aberdeen City Council to purchase the 13 interim beds for twenty four months; and

(iv)         to request that performance information on the occupancy rate and use of the thirteen interim beds be integrated into the performance management framework and presented to the Clinical and Care Governance Committee for monitoring purposes.

The Board had before it the Strategic Risk Register.   

The Chief Officer advised that the register had been presented to the Board for its six month review and reminded members that the Audit and Performance Systems Committee monitored the register as part of its regular business. She explained that a number of amendments had been made to the register and provided an overview of these revisions:-

With reference to risk 1 (Significant Market Failure), she noted that this risk remained high but additional mitigation had been added in terms of the Board’s endorsement of the Ethical Care Charter and the development of strategic commissioning;

With reference to risk 2 (Financial Failure), she noted that this risk had increased due to additional budget complexity; and

With reference to risk 6 (Capacity of IJB partners to exercise functions), she noted that this risk had reduced as the Partnership had now been operating for over 16 months.

Thereafter there were questions and comments on risks associated with failure to engage with staff and how the register could capture this for monitoring purposes; the role and membership of the Joint Staff Forum to reflect the development of locality planning; the risk rating for risk 11 (Workforce Planning); and housing provision for key workers such as nurses and care workers within Aberdeen City.

The Board resolved:-

(i)             to request that consideration be given to whether an additional risk should be inserted into the register with regards to not meeting expectations on staff engagement; and

(ii)          otherwise note the register.

Declaration The Board had before it a report by Gillian Parkin (Finance, NHS Grampian) and Jimmie Dickie (Finance, ACC) which (1) summarised the current year revenue budget performance for the services within the remit of the IJB as at Period 3; (2) advised on any areas of risk and management action relating to the revenue budget performance of the IJB services; and (3) requested approval of budget virements so that budgets were more closely aligned to anticipated income and expenditure.

The report recommended:-

that the Board –

(a)       Note the report in relation to the IJB budget and the information on areas of risk and management action that were contained therein; and

(b)       Instruct officers to review the financial position and identify savings to bring the mainstream budget back to a break even position.

The Chief Finance Officer advised that the Partnership projected a £4.518m overspend on mainstream budgets and outlined the areas of pressure that had contributed to this position. He explained that the Executive Team and budget holders were looking at areas where further efficiencies could be found and noted that use of Transformation Funding may have to be considered to meet mainstream budgeting pressures. He added that a special meeting of the Audit and Performance Systems Committee would be scheduled during September 2017 to review the budgetary position in detail and thereafter a report would be submitted to the Board’s next meeting on 31 October 2017 for decision making.

Thereafter there were questions and comments on the level of efficiencies that could be made from the staff training budget through the development of a joint partnership training plan; how the IJB could continue to improve its due diligence through adherence to the requirements of the IJB Budget Protocol; and how the Partnership would ensure the delivery of safe and effective services if additional savings had to be made. At this point, the Board recognised that difficult decisions would have to be taken on resource allocation and future use of Transformation Funding.

The Board resolved:-

(i)            to note the report in relation to the IJB budget and the information on areas of risk and management action that were contained therein;

(ii)          to instruct officers to review the financial position and identify savings to bring the mainstream budget back to a break even position;

(iii)         to agree to schedule a special meeting of the Audit and Performance Systems Committee during September 2017 to address the issues raised in the report prior to decision making at the Board’s next meeting on 31 October 2017; and

(iv)         to request that a risk register be developed focussing on the deliverability of the budget recovery plan and for this to be presented to the September meeting of the Audit and Performance Systems Committee.

Professor Greaves and Kenneth Simpson declared an interest in the following item as outlined in item 2 of this minute and chose to remain in the meeting during consideration of this item.

The Board had before it a report by Kevin Toshney (Planning and Development Manager, ACHSCP) which outlined additional information in respect of the IJB’s commissioning intentions which were set out in the attached draft Strategic Commissioning Implementation Plan.

The report recommended:-

that the Board –

(a)       Agree that consultations on the draft Strategic Commissioning Implementation Plan be undertaken as outlined in the accompanying consultation plan; and

(b)       Instruct that following consultation, an updated Strategic Commissioning Implementation Plan be presented to the IJB at its December meeting for approval.

Kevin Toshney (Planning and Development Manager, ACHSCP) advised that the draft plan had been presented to members for comment and feedback ahead of the consultation plan’s submission and noted that the final plan would be presented to the Board at its meeting on 12 December 2017. Mr Toshney summarised the draft plan’s priority areas and provided an overview of the roles played by the third and independent sectors and the Market Facilitation Steering Group in its development. He explained that the plan’s aim was to support the local care market by increasing its strength and resilience.

Thereafter the Board endorsed the approach taken by the Partnership and agreed that the draft plan was an excellent first step. Members suggested that consideration be given to providing further detail on aspirations for driving up quality standards and more information on locality planning prior to the publication of the consultation plan.

The Board resolved:-

(i)            to agree that consultations on the draft Strategic Commissioning Implementation Plan be undertaken as outlined in the accompanying consultation plan; and

(ii)          to instruct that following consultation, an updated Strategic Commissioning Implementation Plan be presented to the IJB at its December meeting for approval.

Professor Greaves and Kenneth Simpson declared an interest in the following item as outlined in item 2 of this minute and chose to remain in the meeting during consideration of this item.

The Board had before it a report by Gail Woodcock (Lead Transformation Manager, ACHSCP) which requested approval from the IJB to incur expenditure, and instruction to issue Directions to NHS Grampian and ACC in relation to projects that sit within the Partnership’s Transformation Programme.

The report recommended:-

that the Board –

(a)       Approve expenditure of up to £189,532 (total for two years) in relation to the Enhanced Carers Support project, subject to State Aid assessments;

(b)       Approve the project change in relation to the grant funding for the THInc project as per section 2.3; and

(c)       Issue the Direction attached as Appendix B, and instruct the Chief Officer to issue to Aberdeen City Council, appending the business cases to the Direction.

Gail Woodcock (Integrated Localities Programme Manager, ACHSCP) requested authorisation for the Enhanced Carers Support Service to test the implications of identifying and supporting carers at an earlier stage and to streamline processes to ensure that unpaid carers would have access to support in order to help them in their caring role. She provided additional assurance to the Board that carers were already represented on the Carers Strategy Steering Group and how engagement with carers could be further strengthened. With regards to the THInc project, Ms Woodcock advised that a change control was required to allow the Partnership to allocate the same level of funding but to more than one source.

The Board resolved:-

(i)            to approve expenditure of up to £189,532 (total for two years) in relation to the Enhanced Carers Support project, subject to State Aid assessments;

(ii)          to approve the project change in relation to the grant funding for the THInc project as per section 2.3; and

(iii)         to issue the Direction attached as Appendix B, and instruct the Chief Officer to issue to Aberdeen City Council, appending the business cases to the Direction.

At this juncture the Chair announced that today’s Board meeting would be Professor Greaves’ last meeting before he stepped down from the Board and thanked him for his contribution towards the integration of health and social care in Aberdeen City, particularly for his expertise at Board meetings and his chairmanship of the Audit and Performance Systems Committee.

Professor Greaves thanked the Chair and the Board for their support and advised that it had been an honour to serve on the Board since its inception and remarked that he had learned a great deal from fellow members and officers on community care and social care in general; and was impressed by the level of dedication and professionalism exhibited by all partners who were supporting integration. He appreciated that the Board would have to address a number of challenges but expressed his confidence that the Board and the Partnership would continue to successfully navigate the integration journey.

The Board resolved:-

To thank Professor Mike Greaves for his contribution towards the integration of health and social care in Aberdeen City and to wish him well on his future endeavours.

The Board had before it a report by Tom Cowan (Head of Operations, ACHSCP) and Alex Stephen (Chief Finance Officer, ACHSCP) which provided an update on the situation which developed at Kingsmead Nursing Home in April 2017 and made proposals to ensure the continuation of services and quality of care.

The Board resolved:-

To agree the recommendations outlined within the exempt report together with three additional resolutions.

The Board had before it a report by Judith Proctor (Chief Officer, ACHSCP) which provided (1) an overview of the current arrangements and provided information regarding the proposed service specification and better alignment of service provision to the direction set by the IJB Strategic Plan.

The Board resolved:-

To agree the recommendations outlined within the exempt report together with two additional resolutions.

The Chair noted that today’s meeting continued a recent trend in which meetings had run over the allotted time and requested that officers look at how IJB business and workshop sessions could be accommodated in the future.

The Board resolved:-

To instruct officers to develop a proposal to extend the length of Board meetings to ensure that all items of business and workshop sessions could be appropriately considered.

The Board was due to receive a presentation on the role of the Chief Social Work Officer but agreed to postpone this presentation to a later date.

The Board resolved:-

To postpone the workshop session to a later date.

The Board was due to receive a presentation on Adult Support and Protection but agreed to postpone this presentation to a later date.

The Board resolved:-

To postpone the workshop session to a later date.

JONATHAN PASSMORE MBE, Chairperson.