Agenda, decisions and minutes

The Chair opened the meeting and welcomed Sandra Ross to her first Board meeting as Chief Officer of the Partnership. He advised that he had found both the Strategic Planning workshop and the Partnership’s annual conference to be very informative and noted that he received a good deal of assurance that the Board had sound governance arrangements in place following the Standards Commission’s IJB workshop on 24 September 2018. He explained that one of the key issues which had arisen from the Standards Commission workshop was the role of service user and carer representatives on IJBs and whether they felt valued. Gill Moffat confirmed that she and her colleagues had always felt valued on the Aberdeen City IJB.

The Chair also highlighted that Jenny Laing (Occupational Therapy, Bon Accord Care) had represented the Partnership during a roundtable meeting on housing adaptations held by the Scottish Parliament’s Local Government and Communities Committee on 3 October 2018 and recommended that Members watch the meeting as it was now available online Here.

The Board resolved:-

(i)             to welcome Sandra Ross to her first Board meeting as Chief Officer of the Partnership;

(ii)           to thank all those involved with the organisation and delivery of the annual conference and Strategic Planning workshop;

(iii)          to thank Jenny Laing for representing the Partnership at the Local Government and Communities Committee on 3 October 2018.; and

(iv)          otherwise note the information provided.

Members were requested to intimate any declarations of interest.

Howard Gemmell declared an interest in agenda item 12 (Disabled Adaptations) as he may possibly be a user of this service in the near future but advised that he would remain in the meeting during consideration of this item.

Kenneth Simpson declared an interest in agenda item 16 (Mental Health Commissioning) as he was a member of the Aberdeen Council of Voluntary organisations (ACVO) Board but advised that he would remain in the meeting during consideration of this item.

The Board resolved:-

To note the declarations of interest intimated.

The Chair proposed that agenda item 17 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 8 of Schedule 7(A) of the Act.

The Board had before it the minute of the IJB meeting of 28 August 2018.

The Board resolved:-

To approve the minute as a correct record.

The Chair asked if there were any matters arising from the meeting of 28 August 2018.

The Board resolved:-

(i)          to request that the Chairs of the Audit and Performance Systems Committee and Clinical and Care Governance Committee discuss areas where the remits of their committees overlap to ensure alignment and reduce duplication; and

(ii)        otherwise note the information provided.

The Board had before it the draft minute of the Clinical and Care Governance Committee of 4 September 2018 for information.

The Board resolved:-

To note the draft minute.

The Board had before it the draft minute of the Audit and Performance Systems Committee of 11 September 2018 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 4 (Board Development Work), item 7 (Primary Care) and item 12 (Prescribing) from the Statement;

(ii)        to agree that a dedicated update on prescribing would be provided to the Board within the regular Finance Report; and

(iii)       otherwise note the Statement.

The Board had before it a report by Iain Robertson (Committee Services Officer, ACC) which proposed meeting and developmental workshop schedules for the Board for 2019-20.

The report recommended:-

That the Board-

(a)           Approve the IJB meeting schedule for 2019-20;

(b)           Approve the stand-alone developmental workshop schedule for 2019-20; and

(c)           Instruct the Chief Officer to publish the IJB meeting schedule on the Partnership’s website.

Iain Robertson proposed the following dates for IJB business meetings and developmental workshop sessions:-

IJB Business Meetings:

10:00am,11 June 2019 - Health Village;

10:00am, 3 September 2019 - Health Village;

10:00am, 19 November 2019 - Health Village;

10:00am, 21 January 2020 - Health Village;

10:00am, 11 February 2020 (Budget Meeting) - Health Village;

10:00am, 10 March 2020 (Provisional 2nd Budget Meeting) - Health Village; and

10:00am, 24 March 2020 - Health Village.

Developmental Workshop Sessions:

10:00am, 16 April 2019 - Foresterhill Health Centre;

10:00am, 13 August 2019 - Seminar Room, Woodend Hospital;

10:00am, 8 October 2019 - 4 – W – 01 Marischal College; and

10:00am, 3 December 2019 - Lewis Room, Royal Cornhill Hospital.

Thereafter there was discussion on the best way of ensuring that workshop venues across the city were accessible to all IJB members and officers, particularly those with mobility issues.

The Board resolved:-

(i)          to approve the recommendations; and

(ii)        to instruct the Chief Officer to make appropriate arrangements for Members with mobility issues to ensure they can attend Developmental Workshop sessions out with the Health Village.

The Board had before it a report by Martin Allan (Business Manager, ACHSCP) which presented the revised version of the ACHSCP strategic risk register and risk appetite statement.

The report recommended:-

That the Board-

(a)           Note the revised risk appetite statement; and

(b)           Note the revised risk register.

Martin Allan advised that the risk register and risk appetite statement had been reviewed following the risk workshop on 24 April 2018 and added that the Audit and Performance Systems Committee would treat the risk register as a living document by conducting deep dives of three separate risks at each Committee meeting. Mr Allan also asked the Board to provide a steer on its appetite for risks relating to commissioned and hosted services.

Thereafter there were questions and comments on (1) how frequently the register would be reported to the Board; (2) the importance of capturing risks relating to the Brexit transition process; (3) the need to develop a communication plan which would set out the Board’s approach towards risk management; and (4) Members discussed the risks associated with commissioned and hosted services and noted that this was a complex area and requested that a draft proposal be presented to the next meeting of the Audit and Performance Systems Committee for further discussion and development.

The Board resolved

(i)          to endorse the revised risk appetite statement;

(ii)        to endorse the revised risk register;

(iii)       to instruct the Chief Officer to capture risks relating to the Brexit transition process within the Risk Register and to report this update to the Board’s next meeting;

(iv)       to instruct the Business Manager to populate gaps within the Risk Appetite Statement relating to Commissioned and Hosted Services and report this to the next meeting of the Audit and Performance Systems Committee;

(v)        to agree that the Audit and Performance Systems Committee would escalate a risk to the IJB if the Committee agreed that any risk rating within the Strategic Risk Register should be increased; 

(vi)       to instruct the Chief Officer to develop a communication plan which would inform service users and stakeholders of the Board’s approach towards risk management; and

(vii)     to agree to review the Risk Register on an annual basis.

The Board had before it a report by Alex Stephen (Chief Finance Officer, ACHSCP) which updated the narrative and figures contained in the Medium-Term Financial Strategy (MTFS) approved by the Board on 27 March 2018.

The report recommended:-

That the Board -

(a)           Note the updated elements of the Medium-Term Financial Strategy; and

(b)           Note that a further report on theMedium-Term Financial Strategy would be brought back to the IJB in February 2019.

Alex Stephen advised that a high level review of the MTFS had been conducted which found that current assumptions remained in line with projections reported to the Board on 27 March 2018, with the exception of pay award assumptions. He added that a report on charging for the use of health and social care services and equipment would be presented to the Board’s next meeting on 11 December 2018.

Thereafter there were questions and comments on (1) how the MTFS linked in with the risk appetite statement; (2) the process in place for reporting outcomes of service reviews to the Board and its committees; (3) the financial and governance challenges of managing hosted services, with particular discussion on the role and output of the North East Partnership; and (4) the Chief Finance Officer confirmed that NHS Grampian used the mid-point of salary grades as the basis for its assumptions on the financial impact of staff pay awards.

The Board resolved:-

To approve the recommendations.

The Board had before it a report by Kenneth O’Brien (Service Manager, ACHSCP) which (1) provided a brief description of the context and process behind the creation of the current Winter Plan for the Partnership; (2) documented the testing arrangements put in place regarding the 2018-19 Winter Plan; and (3) set out monitoring arrangements for the Winter Plan.

The report recommended:-

That the Board –

(a)           Review and approve the 2018-19 Winter Plan ACHSCP and instruct the Chief Officer to send the Plan to NHS Grampian for inclusion in the Grampian-wide Winter Plan; and

(b)           Endorse the review arrangements for the ACHSCP Winter Plan for over the 2018-19 winter period.

Kenneth O’Brien advised that the Partnership was required to produce a winter plan which covered the scope of its services and included plans for surge demand and difficulty in delivering services over the winter period. Mr O’Brien explained that planning for winter 2018-19 began with a de-brief of the previous plan during February and March 2018, and following this de-brief the Partnership and NHS Grampian’s senior management teams had been developing and testing the new winter plan. He noted that if the Partnership’s winter plan was approved at today’s meeting it would then be incorporated into the wider NHS Grampian winter plan.

Thereafter there were questions and comments on (1) what lessons had been learned from last year’s plan; (2) the importance of focussing on prevention as well as statutory activity, and the Board noted that it would be beneficial if the Third and Independent Sectors were consulted on this section ahead of next year’s winter plan; and (3) Mr O’Brien provided the Board with an update on the Partnership’s efforts to improve the uptake of flu jabs.

The Board resolved:-

(i)         to approve the recommendations; and

(ii)        to note that regular updates on the implementation of the Winter Plan would be provided to the Clinical and Care Governance Committee.

Howard Gemmell 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 Alison MacLeod (Lead Strategy and Performance Manager, ACHSCP) which advised of the various arrangements that currently exist in relation to Disabled Adaptations and sought approval for the development of new arrangements going forward which would provide the IJB with greater assurance in relation to its role in managing this delegated function.

The report recommended:-

That the Board –

(a)           Note the current situation with regards to managing Disabled Adaptations in the various tenures and their responsibilities for this delegated function; and

(b)           Establish a Task and Finish Group to negotiate new arrangements that provide the IJB with greater assurance in relation to the management of Disabled Adaptations enabling these to continue to be delivered utilising the necessary expertise and meeting desired outcomes. The Task and Finish Group would also oversee the transition from the current arrangements to the new ones, reviewing processes and procedures and identifying options for efficiencies.

Alison MacLeod advised that responsibility for disabled adaptations formerly rested with Aberdeen City Council but this area had now been delegated to the Partnership. She explained that the report proposed new arrangements for managing this delegated function.

Thereafter there were questions and comments on (1) the roles and remits of the Task and Finish Group and Disabled Adaptations Group; (2) the procurement process that would be required prior to the adaptation of a property; (3) the role of the Council’s Private Sector Housing Team in the administration of adaptation grants; (4) the benefits of having service user representation on the Disabled Adaptations Group; (5) the importance of engaging with private housing developers to encourage the design and development of more adaptable housing units; and (6) Members discussed the importance of establishing good relationships with owners, landlords and tenants to receive assurance on the standard of properties prior to adaptation.

The Board resolved:-

(i)          to note the current situation with regards to managing Disabled Adaptations in the various tenures and their responsibilities for this delegated function;

(ii)        to instruct the Chief Officer to explore the possibility of having service user representation on the Disabled Adaptations Group; and

(iii)       to note that progress updates and assurance on disabled adaptations would be reported to the Clinical and Care Governance Committee on a regular basis.

The Board had before it a report by Kevin Toshney which presented an initial working draft of the Strategic Plan 2019-2022 for consideration.

The report recommended:-

That the Board –

(a)           Note the draft Strategic Plan; and

(b)           Agree for a draft consultation version of the Strategic Plan 2019-2022 to be presented to the next IJB meeting.

Kevin Toshney advised that the Board was statutorily required to produce a Strategic Plan to replace the existing three-year plan which was due to expire in March 2019. Mr Toshney provided an overview of the governance milestones and the engagement activity the Partnership had undertaken to inform the refreshed three year plan and advised that a new suite of indicators would be developed to monitor the achievement of priority areas. He added that following the refresh of the Strategic Plan, the Partnership would review its portfolio of strategic documents.

Thereafter there were questions and comments on (1) ensuring that future commissioning practice would include solutions co-designed and co-produced with partners and communities; (2) including more information within the Plan on staff development and the Board’s endorsement of the Ethical Care Charter; (3) making the Plan as easy to read and user-friendly as possible; (4) re-emphasising the priority that patients and service users are empowered to manage their own health care; (5) ensuring that the Plan aligned with the Primary Care Improvement Plan; (6) making greater reference to tackling inequalities and the role of unpaid carers in this regard; (7) making reference to the Council’s Anti-Poverty Strategy as a way to tackle health inequalities and to achieve strategic coherence with key partners; and (8) the importance of engaging with people who did not regularly use health and social care services before the age of 65.

The Board resolved:-

(i)         to approve the recommendations; and

(ii)        to request that Members submit any editorial issues to Kevin Toshney ahead of publication of the Consultation Draft;

(iii)       to request that more emphasis on prevention and empowering patients/service users be included within the Consultation Draft;

(iv)      to request that more detail on staff development and the Ethical Care Charter be included within the Consultation Draft;

(v)        to review the table on p155 with a view to making it easier to understand for all readers; and

(vi)      to request that greater references are made to health inequalities and Aberdeen City Council’s Anti-Poverty Strategy within the Consultation Draft.

The Board had before it a report by Sandra Ross (Chief Officer, ACHSCP) which sought approval for the intent to move to a three-locality model for the Partnership that would be in alignment with Community Planning Aberdeen locality partnerships.

The report recommended:-

That the Board instruct the Chief Officer to review the locality structure and consult with relevant stakeholders and staff on the proposal to move from a four to a three-locality model and report back to the IJB on 26^th of March 2019 with the results of this review and consultation along with the new Strategic Plan once finalised.

Sandra Ross advised that options on future locality working would be reviewed during the refresh of the three-year Strategic Plan and explained that as part of this process, the Partnership would look at the option of moving to a three locality model to align with the locality model put in place by Community Planning Aberdeen.

Thereafter there were questions and comments on (1) the potential workforce and financial implications of moving to a three-locality model; and (2) the Chief Officer confirmed that it would be business as usual for existing localities whilst the review was ongoing.

The Board resolved:-

(i)         to approve the recommendation; and

(ii)        to request the Chief Officer to provide further information to Jim Currie on the potential implications for staff if the Board agreed to adopt a three-locality model.

The Board had before it a report by Lorraine McKenna (Head of Central Locality, ACHSCP) which presented a follow up report as requested by the Board on 28 August 2018, on the preferred option to transfer patients to other practices as a result of the closure of the Rosemount Medical Group.

That the Board –

(a)           Note the actions as outlined in this report for the transfer of patients from Rosemount Medical Group (RMG) to other practices and instruct the Chief Officer to implement the changes;

(b)           Agree to incur expenditure of up to £144,026, to be funded from the Primary Care Reserve Fund; and

(c)           Make the Direction, as attached at appendix A, and instructs the Chief Officer to issue the Direction to NHS Grampian.

Lorraine McKenna advised that the Partnership had informed patients registered at RMG of the closure of RMG and the Board’s preferred option for managing this closure by letter and through holding drop-in sessions to provide further information and assurance to patients and stakeholders on the process. She explained that a project group had been established and to date, GP practices in the city had indicated that they could absorb 80% of RMG patients into their practice lists and noted she was hopeful the remaining 20% of patients would be re-allocated before RMG closed in January 2019. Ms McKenna added that the project team continued to engage with First Bus to address transportation issues identified during the consultation and engagement process; as well as pharmacy colleagues to help them prepare for the closure and ensure that patients with repeat prescriptions had enough medication over the transition period.

Thereafter there were questions and comments on (1) the transportation and accessibility issues identified by service users following their re-allocation to new GP surgeries; (2) the challenges of engaging with hard to reach groups or those with complex health needs to ensure they were informed and could cope with re-allocation to a new surgery; (3) Ms McKenna explained that the Partnership had a statutory obligation to ensure that the remaining 20% of RMG patients were assigned to a GP practice by the end of January 2019; and (4) the Chief Finance Officer confirmed that the Partnership had not committed to covering any recurring costs following the re-allocation of RMG patients.

The Board resolved:-

(i)         to agree the recommendations;

(ii)        to instruct the Rosemount Project Team to consider accessibility issues for patients being transferred to new GP practices; and

(iii)       to thank GP practices, First Bus and public sector partners for supporting the Partnership during this challenging time.

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 Claire Wilkie (Service Manager, Mental Health and Substance Misuse, ACHSCP) which outlined the challenges related to the re-provision of care, with particular focus on the housing element, and to provide options for approval.

That the Board –

(a)           Approve the re-provisioning of the balance of accommodation for people with mental health and substance misuse issues from residential care to support living services; and

(b)           Approve the ongoing exploration of all identified options in para 3.4.

Alex Stephen advised that the Strategic Planning Group had oversight of mental health commissioning but the development of options for re-provision of care may depend on areas out with the Partnership’s control such as the availability of land and facilities; and engagement with external providers.

Thereafter there were questions and comments on (1) the cost implications of providing out of area placements; (2) the wider use of housing tenures such as sheltered housing to enhance supportive living; (3) the extent of consultation with carers and the family network when taking decisions on the care and housing needs of patients with complex mental health issues; (4) the level of assurances offered by the Partnership to external providers to ensure they built or operated a health and social care facility in line with the Board’s strategic commissioning intentions; and (5) the importance of having appropriate placement programmes in place for vulnerable patients.

The Board resolved:-

(i)         to approve the recommendations; and

(ii)        to wish Claire Wilkie well on her retirement.

The Board received a verbal update from the Chief Officer on progress with regards to Bon Accord Care’s contractual review.

The Board resolved:-

(i)         to note the verbal update from the Chief Officer; and

(ii)        to agree that updates from the Chief Officer would become a standing item on future IJB agendas.

JONATHAN PASSMORE MBE, Chairperson.