Agenda, decisions and minutes

The Chair opened the meeting and welcomed Councillors Imrie and Laing; and Dr Malcolm Metcalfe onto the Board and thanked Councillors Cooke and Donnelly for their past contributions at Board and Committee meetings. The Chair confirmed to members that the Chief Officer had tendered her resignation and a report was on today’s agenda to set out a process to recruit her successor, in the meantime Sally Shaw had been appointed as the interim Chief Officer. The Chair also thanked Partnership staff who had provided support during a recent visit to Aberdeen by Paul Gray (Director General, Health and Social Care, and Chief Executive of the NHS in Scotland). He added that the visit had focussed on the Partnership’s approach to delay discharges and winter planning and in his view the visit had been successfully delivered.

The Board resolved:-

(i)            to welcome Cllrs Imrie and Laing; and Dr Metcalfe onto the Board;

(ii)          to thank Cllrs Cooke and Donnelly; and Dr Swami for their contributions towards the integration of health and social care in Aberdeen City;

(iii)         to agree to re-order today’s agenda to consider item 13 (Recruitment and Selection of Chief Officer) following item 3 (Determination of Exempt Business);

(iv)         to note that Sally Shaw had been appointed as the interim Chief Officer; and

(v)          otherwise note the information provided.

Members were requested to intimate any declarations of interest.

The Board resolved:-

To note there were no declarations of interest intimated at this time.

The Chair advised that he had accepted item 13 (Recruitment and Selection of Chief Officer) onto today’s agenda as urgent business.

The Board resolved:-

To accept item 13 (Recruitment and Selection of Chief Officer) as urgent business.

The Chair proposed that item 18 (Commissioning Decisions) 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 item of business so as to avoid disclosure of exempt information of the classes described in paragraph 8 of Schedule 7(A) of the Act.

Tom Cowan, Dr Stephen Lynch, Sally Shaw and Alex Stephen declared an interest for the following item as they were members of the Aberdeen City Health and Social Care Partnership Executive Team and withdrew from the meeting during consideration of this item.

The Board had before it a report by Philip Shipman and Lesley Strachan (HR, ACC) which set out proposals to recruit a replacement for the outgoing Chief Officer of the Aberdeen City Health and Social Care Partnership.

The report recommended:-

That the Board –

(a)          Agree the proposed changes to the Chief Officer Job Description;

(b)          Agree to appoint a recruitment partner to undertake an executive search exercise;

(c)          Agree the proposed assessment centre format;

(d)          Note the indicative timeline for the recruitment and selection process;

(e)          Establish a temporary committee of the IJB to be called an Appointments Panel, constituting the Chair and Vice Chair of the IJB and the Chief Executives of ACC and NHS Grampian to interview candidates; and

(f)           Approve the delegation of the appointment of Chief Officer to the Appointments Panel.

The Chair advised that the IJB would lead on the recruitment and appointment of a permanent Chief Officer and highlighted that the report recommended the formation of an Appointments Panel that would have delegated authority to appoint the Chief Officer.

Thereafter there were questions and comments on (1) the cost of conducting the full recruitment process; (2) the rationale for using the Transformation Fund to meet the cost of the recruitment process; and (3) the appraisal process for the post of Chief Officer and the importance of conducting a robust exit interview with the outgoing Chief Officer.

Following questions to officers, the Board agreed to request further information on the cost of conducting a recruitment and selection process and to defer decision making to a Special IJB meeting.

The Board resolved:-

To defer decision making and agree to schedule a special IJB meeting to determine this matter.

The Board had before it the minute of the IJB meeting of 30 January 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 30 January 2018.

The Board resolved:-

To note there were no matters arising.

The Board had before it the minute of the Budget meeting of 13 February 2018.

The Board resolved:-

To approve the minute as a correct record.

The Chair asked if there were any matters arising from the Budget meeting of 13 February 2018.

The Board resolved:-

To note there were no matters arising.

The Board had before it the draft minute of the Audit and Performance Systems Committee of 2 March 2018 for information.

In reference to item 5(xii), Rhona Atkinson requested that risk management be considered at the IJB workshop on 24 April 2018 and for the Strategic Risk Register to be reviewed by the Board at its next meeting on 22 May 2018.

The Board resolved:-

(i)            to request that risk management be considered at the IJB workshop on 24 April 2018;

(ii)           to request that the updated strategic risk register be presented to the Board at its next meeting on 22 May 2018; and

(iii)         otherwise note the draft minute.

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

The Board resolved:-

(i)            to remove items 3 (Strategic Commissioning Plan), 10 (Understanding Progress Under Integration) and 11 (Care Home Provision) from the Statement; and

(ii)          otherwise note the Statement.

The Board had before it a report by the Clerk which reviewed IJB meeting arrangements and recommended a course of action for future Board meetings.

The report recommended:-

That the Board –

(a)          Agree to retain the existing meeting arrangements for Board meetings; and

(b)          Request a further review of IJB meeting arrangements on 11 December 2018 which would accompany the proposed schedule of Board meetings for 2019-20.

The Clerk advised that over the past few cycles the additional time dedicated for meetings and developmental workshop sessions had been needed and recommended that current arrangements remain in effect until further review in December 2018.

The Board resolved:-

(i)            to agree to retain the existing meeting arrangements for Board meetings; and

(ii)          to request a further review of IJB meeting arrangements on 11 December 2018 which would accompany the proposed schedule of Board meetings for 2019-20.

The Board had before it a report by Alex Stephen (Chief Finance Officer) which (1) provided an update to the Board on the final levels of funding delegated by Aberdeen City Council and NHS Grampian for health and social care activities in 2018/19; (2); requested final approval of the Medium Term Financial Strategy; (3) requested approval of the Bon Accord Care final 2018/19 contract value; (4) advised on risk fund levels contained within the Medium Term Financial Strategy; (5) requested approval of the position re uplifts for contracts and direct payments not covered by the national care home contract; and (6) requested approval to submit formal budget directions to Aberdeen City Council and NHS Grampian.

The report recommended:-

That the Board -

(a)          Note the financial allocations proposed to be allocated by the partner organisations;

(b)          Approve the Bon Accord Contract level for 2018/19 of £26,750,000 and budget assumptions noted in section 2.3;

(c)          Formally approve the 2018/19 budget and the Aberdeen City IJB Medium Term Financial Strategy included as appendix 1 of this report;

(d)          Note that the IJB previously agreed to earmark £2.5 million in a risk fund and that this is included in the Medium Term Financial Strategy;

(e)          Instruct the Chief Officer to uplift the direct payments for clients with a staffing element included in their payment by 3.5% from the 1 May 2018 to cover the increase in the Scottish Living Wage;

(f)           Instruct the Chief Officer to negotiate uplifts for those Social Care providers not covered by the National Care Home Contract; and

(g)          Make the budget directions contained in appendix 2 of this report and instruct the Chief Officer to issue these directions to the constituent authorities.

The Chief Finance Officer advised that both Aberdeen City Council and NHS Grampian had confirmed the provisional IJB budget with no material changes and he requested formal approval of the 2018-19 budget.

Thereafter there were questions and comments on (1) uplifts within the National Care at Home Contract; (2) the possibility of additional Public Health funding being allocated to IJBs; (3) the monitoring arrangements the Partnership had put in place to ensure external care providers payed the Scottish Living Wage; and (4) members requested an update on the implementation of the Ethical Care Charter.

The Board resolved

(i)            to note the financial allocations proposed to be allocated by the partner organisations;

(ii)          to approve the Bon Accord Contract level for 2018/19 of £26,750,000 and budget assumptions noted in section 2.3;

(iii)         to formally approve the 2018/19 budget and the Aberdeen City IJB Medium Term Financial Strategy included as appendix 1 of this report;

(iv)         to note that the IJB previously agreed to earmark £2.5 million in a risk fund and that this is included in the Medium Term Financial Strategy;

(v)          to instruct the Chief Officer to uplift the direct payments for clients with a staffing element included in their payment by 3.5% from the 1 May 2018 to cover the increase in the Scottish  ...  view the full minutes text for item 13.

The Board had before it a report by Dr Stephen Lynch (Clinical Director, ACHSCP) which provided an overview of the current budget position in relation to prescribing and the actions being taken by the Primary Care Prescribing Group in response to these pressures.

The report recommended:-

That the Board –

(a)          Endorse the changes to prescribing recommended by the Grampian Primary Care Prescribing Group;

(b)          Instruct the Chief Office to prepare a report detailing other drugs being prescribed with limited clinical value and recommending the process to be followed to de-prescribe these drugs; and

(c)          Instruct the Chief Officer to prepare a report on prescribing indicating how a regional approach to prescribing could operate. 

Dr Lynch provided an overview of the national pressures within the health and social care system which had been caused by rising drug prices; inefficient prescribing; and an increase in the number of elderly patients with complex illnesses and conditions. He explained that in comparison to other Partnerships, Aberdeen City GPs were amongst the most efficient prescribers but improvements could still be made and advised that Primary Care colleagues would be asked to review their prescribing practices to identify additional opportunities for efficiency savings. Dr Lynch acknowledged the sensitivities surrounding this area of health and social care and highlighted the importance of a Grampian-wide approach to address the issue.

Thereafter there were questions and comments on (1) the importance of developing a public engagement strategy on prescribing in order to manage expectations and concerns; (2) the role of Public Health to promote healthier diets and exercise as alternatives to prescribed medication; (3) the level of buy-in from local GPs; and (4) the anticipated impact of the GMS contract on prescribing practice.

The Board resolved:-

(i)            to endorse the changes to prescribing and commend the work of the Grampian Primary Care Prescribing Group;

(ii)           to instruct the Chief Office to prepare a report detailing other drugs being prescribed with limited clinical value and recommending the process to be followed to de-prescribe these drugs;

(iii)         to instruct the Chief Officer to prepare a report on prescribing indicating how a regional approach to prescribing could operate;

(iv)         to extend an invitation to NHS Grampian’s Director of Pharmacy to address the Board prior to the 2019-20 budget setting process; and

(v)           to instruct the Chief Officer to draft a wider communication strategy to include budgetary and financial elements linked to prescribing, and present this to a future meeting of the Board for consideration.

The Board had before it a report by Jess Anderson and Vicki Johnstone (Legal Governance Team, ACC) which presented the revised Integration Scheme for Aberdeen City to reflect changes in legislation brought about by the Carers (Scotland) Act 2016. Further changes in the scheme were made to reflect the passage of time and to bring clarity and accuracy to arrangements since the IJB was established.

The report recommended:-

That the Board endorse the Health and Social Care Integration Scheme for Aberdeen City which had been amended to reflect changes in legislation brought about by the Carers (Scotland) Act 2016.

Vicki Johnstone advised that the Scheme had been updated to accommodate changes brought about by the Carers (Scotland) Act 2016 and to reflect the passage of time since the Board went live in April 2016.

The Board resolved:-

(i)            to endorse the Health and Social Care Integration Scheme for Aberdeen City which had been amended to reflect changes in legislation brought about by the Carers (Scotland) Act 2016; and

(ii)          to thank Vicki Johnstone and the ACC Legal Governance Team for a well presented report and Integration Scheme.

The Board had before it a report by Alan Thomson (Legal Governance Team, ACC) which (1) outlined the delegations reserved to the IJB; (2) set out the Operational Protocol to the Chief Officer and Chief Finance Officer; and (3) to clarify the accountability considerations.

The report recommended:-

That the Board –

(a)          Approve the attached Scheme of Governance- Role and Responsibilities protocol at Appendix 1;

(b)          Agree that the Scheme of Governance- Role and Responsibilities be reviewed annually, or as and when required by officers; and

(c)          Note the powers delegated to the Chief Officer by Aberdeen City Council at Appendix 2.

Alan Thomson advised that approval of the roles and responsibilities paper would complete the IJB‘s suite of core governance documents and confirmed that the IJB Scheme aligned with the recently approved Aberdeen City Council Scheme of Delegation. Mr Thomson explained that the Scheme set out which powers were reserved to the Board and which were within the remit of the Chief Officer and Chief Finance Officer.

The Board resolved:-

(i)            to approve the attached Scheme of Governance- Role and Responsibilities protocol at Appendix 1;

(ii)          to agree that the Scheme of Governance- Role and Responsibilities be reviewed annually, or as and when required by officers;

(iii)         to note the powers delegated to the Chief Officer by Aberdeen City Council at Appendix 2;

(iv)         tothank Alan Thomson and the ACC Legal Governance Team for a well presented report and Scheme of Governance.

The Board had before it a report by Gail Woodcock (Lead Transformation Manager, ACHSCP) which requested the Board to instruct the Chief Officer to (1) authorise grants for up to £10,000 per annum to organisations to support the delivery of strategic priorities; and (2) to bring to the attention of the IJB, a proposed grant to support the delivery of the Golden Games, and which would be authorised under the proposed instruction to the Chief Officer.

The report recommended:-

That the Board –

(a)          Agree that grants up to £10,000 per annum are made to individual organisations and up to £2,000 per annum to individuals, provided that the aims of the project to be funded comply with the Strategic Plan, the Strategic Commissioning Plan and/or the National Outcomes;

(b)          Instruct the Chief Officer, following consultation with the Chief Financial Officer, and the Chair and Vice-Chair of the IJB, to accept, assess and make arrangements for grants up to £10,000 per annum to be paid to individual organisations and up to £2,000 per annum to individuals, and to report quarterly to the Audit and Performance Systems Committee with details of the grants paid and accepted; and

(c)          Note the information about the Golden Games project and that, subject to recommendations 1 and 2 above, this project would be approved and grant funding provided in line with these recommendations.

Gail Woodcock advised that the report was a technical report which aimed to align IJB procedures for paying and accepting grant funding with Aberdeen City Council’s Scheme of Delegated Powers which authorised Chief Officers to approve and accept grants of up to £10k for organisations and £2k for individuals. Ms Woodcock also provided an overview of the Golden Games and how it supported priorities within the Strategic Plan and she requested approval for this year’s project.

Thereafter there were questions and comments on (1) the provision of recurring grant funding for events such as the Golden Games and how the Partnership would monitor compliance and benefits realisation; (2) whether the Partnership had developed a budget line within the Transformation Programme to record the receipt and authorisation of grant funding; and (3) how the Audit and Performance Systems Committee would receive assurance on the Partnership’s management of grant funding.

The Board resolved:-

(i)            to agree that grants up to £10,000 per annum are made to individual organisations and up to £2,000 per annum to individuals, provided that the aims of the project to be funded comply with the Strategic Plan, the Strategic Commissioning Plan and/or the National Outcomes;

(ii)          to instruct the Chief Officer, following consultation with the Chief Financial Officer, and the Chair and Vice-Chair of the IJB, to accept, assess and make arrangements for grants up to £10,000 per annum to be paid to individual organisations and up to £2,000 per annum to individuals, and to report quarterly to the Audit and Performance Systems Committee with details of the grants paid and accepted; and

(iii)         to note the information about the Golden  ...  view the full minutes text for item 17.

The Board had before it a report by Alison MacLeod (Lead Strategy and Performance Manager, ACHSCP) which sought approval of the Carers Strategy and provided an overview of next steps in relation to implementation, subject to approval.

The report recommended:-

That the Board –

(a)                  Approve the final draft of the Aberdeen City Carers Strategy;

(b)          Approve the next steps in relation to the launch and implementation of the Aberdeen City Carers Strategy;

(c)          Instruct the Chief Officer to bring back further detail of the funding prioritisation and allocation process to the May meeting of the IJB;

(d)          Instruct the Chief Officer to submit the finalised Eligibility Criteria for Carers to the May meeting of the IJB; and

(e)          Instruct the Chief Officer to submit the Aberdeen City Short Breaks Services Statement to the IJB meeting in October 2018.

Alison MacLeod provided an overview of the consultation process and advised that all feedback had been acknowledged and taken into consideration during preparation of the final Strategy, including additional consultation with individuals and groups representing children and young carers. Ms MacLeod highlighted that an At a Glance summary of the Strategy had been prepared along with an action plan that would be overseen by the Carers Strategy Implementation Group. She also confirmed that the children and young carers element would be presented to Aberdeen City Council’s Operational Delivery Committee on 29 May 2018, and pending approval it was the Partnership’s intention to launch the Carers Strategy during Carers Week which would run between 11- 17 June 2018.

Thereafter there were questions and comments on (1) the importance of developing a policy to determine which charges could be waived for respite care; (2) the response rate from carers and carers groups during the consultation process; (3) how the Partnership would liaise with Aberdeen City Council in relation to the children and young carers element within the Strategy; (4) the level of unmet need amongst young carers throughout the city and the stigma that may be felt by having social care involvement in family life; (5) the level of respite care being met through Self Directed Support; and (6) the importance of integrating the needs of carers into the commissioning framework in order to provide support and meet outcomes.

The Board resolved:-

(i)            to approve the final draft of the Aberdeen City Carers Strategy;

(ii)          to approve the next steps in relation to the launch and implementation of the Aberdeen City Carers Strategy;

(iii)         to instruct the Chief Officer to bring back further detail of the funding prioritisation and allocation process to the May meeting of the IJB;

(iv)         to instruct the Chief Officer to submit the finalised Eligibility Criteria for Carers to the May meeting of the IJB;

(v)          to instruct the Chief Officer to submit the Aberdeen City Short Breaks Services Statement to the IJB meeting in October 2018;

(vi)         to request the Chief Officer to develop local guidelines with regards to waiving charges for respite care in order for carers  ...  view the full minutes text for item 18.

The Board had before it a report by Jenny Rae which sought approval of the Aberdeen City Learning Disability Strategy, known as A’thegither, which will run from 2018-2023.

The report recommended:-

That the Board –

(a)          Approve the Learning Disability Strategy known as A’thegither in Aberdeen; and

(b)          Note that further reports would be presented to the IJB in reference to a Local Action/Implementation Plan and specific Learning Disability Commissioning Plan (as per the timelines identified in the body of the report).

Jenny Rae provided an overview of the Strategy’s development including consultation and engagement activity. She highlighted that the Strategy was accessible and easy to read for people with learning disabilities and if the Strategy was approved at today’s meeting, it was the Partnership’s intention to launch the Strategy during the nation-wide Learning Disability Week which commenced on 14 May 2018.

Thereafter the Board welcomed the Strategy and thanked Ms Rae for her excellent work and suggested that the Strategy should be shared as an example of best practice with other Partnerships.

The Board resolved:-

(i)            to commend and approve the Learning Disability Strategy known as A’thegither in Aberdeen;

(ii)          to note that further reports would be presented to the IJB in reference to a Local Action/Implementation Plan and specific Learning Disability Commissioning Plan (as per the timelines identified in the body of the report); and

(iii)         to thank Jenny Rae for a well presented report and Learning Disability Strategy.

The Board had before it a report by Judith Proctor (Chief Officer) which provided an overview of the key steps and timeline for the implementation of the 2018 General Medical Services (GMS) Contract in Scotland).

The report recommended:-

That the Board –

(a)          Note the implications, key steps and timeline for implementation of The 2018 General Medical Services (GMS) Contract in Scotland, considering the key implications;

(b)          Agree that the IJB Chair sign the Memorandum of Understanding to commit the Aberdeen City Health and Social Care Partnership to undertake its responsibilities in relation to the implementation of the new GMS contract;

(c)          Note that the Memorandum of Understanding would also be presented to the NHS Grampian Board where it will be recommending for signing by NHS Grampian; and

(d)          Ask the Chief Officer to bring a final Primary Care Improvement Plan to the IJB for agreement prior to its submission to Scottish Government in July 2018.

The Chief Officer advised that the GMS Contract would come into effect on 1 April 2018 with the purpose of establishing a payment to GPs for the provision of primary care services. She explained that the terms of the Contract set out a significant change in the delivery of primary care services and although the Contract was between the NHS and primary care providers, there was acknowledgement that IJBs had responsibility for strategic planning.

The Chief Officer explained that the recently established Grampian Regional Oversight Group had responsibility for overseeing the implementation of the Contract on a Pan-Grampian basis and that the Group was led by the Chief Officer of the Moray IJB. She noted that the Aberdeen City IJB would be represented by the interim Chief Officer and the Clinical Director. She also informed the Board that the Memorandum of Understanding between the British Medical Association (BMA), NHS Boards, Integration Authorities and the Scottish Government had been signed by the Chief Officer of the Glasgow HSCP in his capacity as Chairperson of Chief Officers, Health and Social Care Scotland on behalf of all Scottish IJBs.

Thereafter there were questions and comments on (1) the level of contracted funding which had been pre-committed to existing workstreams and programmes; (2) the development of the three year Primary Care Improvement Plan; (3) the importance of managing expectations on how GP services would be delivered over the course of the contract; (4) the governance protocol, with regards to signing the Memorandum of Understanding; and (5) the importance of involving localities in the roll out of the Contract to ensure buy-in from local GP practices and communities.  

The Board resolved:-

(i)            to note the implications, key steps and timeline for implementation of the 2018 General Medical Services (GMS) Contract in Scotland, considering the key implications;

(ii)          to ask the Chief Officer to bring a final Primary Care Improvement Plan to the IJB for agreement prior to its submission to Scottish Government in July 2018; and

(iii)         to circulate an appointment to members for the Primary Care Workshop on  ...  view the full minutes text for item 20.

The Board had before it a report by Alison MacLeod which sought approval for a number of commissioning decisions required as interim arrangements pending the outcome of future service reviews.

The Board resolved:-

(i)            to approve the proposals for putting the existing services listed in the report under robust contractual arrangements;

(ii)          to make the Direction under Appendix A and instruct the Chief Officer to issue the Direction to Aberdeen City Council to undertake the work to make these contractual arrangements on behalf of the IJB; and

(iii)         to instruct the Chief Officer to report progress on the development of a Contracts Register to the Audit and Performance Systems Committee.

JONATHAN PASSMORE MBE, Chairperson