Item 16.9 for 3 Oct 14 Moray S&HCP 12 June

APPROVED 1

MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP

THURSDAY 12 JUNE 2014

MEETING ROOMS 1 AND 2, SPYNIE DENTAL CENTRE, ELGIN

Present Mr Bill Howatson, Chair of NHSG Board (Chair) NHS Grampian Ms Judith Proctor, Interim General Manager MCHSCP Mrs Tracey Gervaise, Public Health Lead MCHSCP Councillor Lorna Creswell Moray Council Mrs Deborah O’Shea, Principal Accountant Moray Council Mr Bob Sivewright, Finance Manager MCHSCP Mr Fabio Villani, Chief Officer TSI Third Sector Mr George McLean, Business Manager MCHSCP Ms Elsie Watson, Community Representative PPF Mrs Val Thatcher, Community Representative PPF Ms Catriona Campbell, Joint Performance Officer Moray Council Ms Brigid Aitken, R.C.N. Accredited Steward & Safety Rep NHS Grampian

In Attendance Mrs Lorna Bernard, LiU Project Manager; Mr Roddy Huggan, Commissioning and Performance Manager; Ms Eilidh Brown, Development Officer (TSI); Ms Emma Pettis, Corporate Communications and Mrs Isla Whyte, Minuting Secretary.

Apologies Apologies were intimated on behalf of Mrs Jane Mackie, Head of Community Care; Mr Jim Walker, Community Representative; Mr Ian Francis, Partnership Rep; Mrs Liz Tait, Professional Lead for Clinical Governance; Mr Sandy Thomson, Pharmacy Manager; Dr Mark Houliston, GP/ Joint Clinical Lead; Dr Graham Taylor, GP/Joint Clinical Lead; Mr Sandy Dustan, Hospital Manager – Dr Gray’s; Mrs Jennie Williams, AOM Children & Families and Mr Sandy Riddell, Director of Education and Social Work.

1. Welcome The Chair welcomed everyone to the meeting and noted that he would take the Chair for today’s meeting in place of Ms Christine Lester who was on annual leave. Those around the table introduced themselves. Apologies were noted as above.

2. Minute of the Moray Community Health and Social Care Partnership Dated 13 March 2014 The minute was approved as an accurate record of the meeting.

The following grammatical errors are to be amended: Item 6, page 4, second paragraph – the word ago added to sentence. Item 6, page 4, last word – apostrophe added. Item 6, page 5, first paragraph – apostrophe added.

3. Matters Arising Mobile Information Bus (pg3) – now in operation. The MIB preview recently took place for partners and staff, received great reviews. The MIB is a community planning resource; partners gave a number of ideas of how to utilise as well as NHSG.

Audit Commission Report (pg5) – this refers to the Joint Pilot Inspection of Care for Older People carried out by Care Inspectorate. Judith advised that comments re accuracy have been collated and fed back to the 1 APPROVED 2 Inspection agencies and that we now await the final report – due around June, will circulate widely when released.

4. Integration of Health and Social Care - update Judith reported a letter has been received from Kathleen Bessos, SG, detailing the next steps towards integration (attached). The scope of service is wide ranging. More clarity has been received around the draft Orders and Regulations – currently out for consultation – Ms Bessos’s letter advises they expect the Orders and Regulations will be laid in Parliament in September and October 2014 and it is proposed to bring them into force from December 2014. By 1 April 2015 Health Boards and local authorities must submit an integration scheme for approval. Judith reported model schemes are being made available. 1 April 2016 is the date by which all the integration arrangements as set out in the Act, Orders and Regulations, must be in place and responsibility for the functions are delegated according to the integration scheme. Judith confirmed those dates are fixed unless feedback from consultation suggests otherwise. Judith noted the challenges around the timescales in relation to the actions required. There is a Transitional Leadership Group (TLG) meeting next week, looking at timescale of what needs to be done and update on work that is happening on the ground – including the community engagement taking place. In relation to the role of Chief Officer for Moray - Judith confirmed that the interview panel did not appoint to Chief Officer post; and that this will be going out to advert again at the end of this month. A Memorandum of Understanding (MOU) is being developed which will support the TLG to consider its role as shadow Integrated Joint Board– will go to Board Seminar for discussion. The Chair advised there is a Board Seminar with Aberdeenshire tomorrow – keen to have joint meetings. Robin Paterson provided a presentation about the broader engagement work being done to the Moray GP Leadership Group. The GPs recognise the challenges and opportunity. It was agreed at that meeting Robin and others would provide a 30min Q&A presentation and offer attendance at each GP Practice in Moray. Cllr Creswell asked if there is a Patient’s Participation Forum in each ward. Tracy advised that members of PPF attend a number of integration meetings and there are some PPF at practices. Brigid advised, on behalf of staff side, they would welcome some more accessibility for staff understanding and engagement Judith advised there will be further engagement work – second integration newsletter detailed this. Fabio thought it would be helpful to explain the work Robin is doing. Judith advised Robin pulled together beginnings of vision, work in progress, can bring to a future Committee meeting. The Chair thanked Judith for the update and confirmed the Kathleen Bessos’ letter and the above mentioned paper be taken to the next Committee meeting for discussion.

5. Finance Update and Performance Measures a) Exception Reporting – ‘At a Glance Summary’ and ‘Basket of Measures’ Moray scorecard circulated with papers. George advised there will be new measures to report against in the future, those detailed in the current report are historical. George highlighted the following areas - sickness absence reducing, diagnosis of dementia increasing – more support available. Delayed discharges – remains low. Anticipatory Care Plans – over 1500 patients with plans in Moray. ACP data will be circulated to GP Practices; will encourage practices to ensure ACPs are in place for those who need one. George surmised that overall Moray is performing very well. Data has shown that Moray has the highest number of terminally ill patients living in their own homes for the last 6 months of their lives – this is what patients are asking for and is a positive indication for preferences being delivered for end of life care and support. George also reported he is leading a community profiling bed / equipment exercise this afternoon as there are a large number of people being looked after at home – that’s what they want. Brigid asked for clarity around the data for sickness absence asking if figures still exclude Dr Gray’s Hospital staff. George confirmed that the data excludes Dr Gray’s as their sickness absence is reported through the acute sector.

Basket of Measures - Catriona presented the ‘Basket of Measures’ circulated with papers, advising those measures highlighted in yellow are incomplete – not yet got full measurement of. Measure B2 - have 1 years worth of data, looking back further, want 3 years of data. Measure B4 – have 2 yrs of data – have further info for people to see if they want. 2 APPROVED 3

Measure B7 – no measure in place medical team is agreeing the content of the comprehensive geriatric assessment. A1 – Moray is the lowest in Scotland for emergency admissions. A2 – 3 delayed discharges that are over 4 weeks for May 2014. A3 – not much change. A lot of work is being done in this area. As previously reported Moray was successful in its bid to become 1 of 5 areas for pilot of the 8 Pillar Model. A4 – above average. A5 – latest figures for 11/12 – still awaiting info for 12/13 and 13/14. A6 - carers feel supported – still maintaining over 90% target. In Q3 – couple concerned about and fed back through services. B1 - 2 figures will do 6 monthly from now on. Hoping to expand more with community care side. B3 – Moray doesn’t look good however not all areas count the same ie some have set packages put out for area, some charge, some don’t, some assess needs. Would be good to have a set measure as currently all doing slightly differently, so not comparing like for like. B5 – same as last time. B6 – falls work; causes, prevention – getting daily information from NHS Grampian now. B8 – permanent care slightly up. Judith asked for clarity these are the basket of measures given to us by JIT? Catriona confirmed for Change fund. It was noted that it will be very difficult to meet new delayed discharges target which is going from 4 weeks to 2 weeks. Catriona spoke re measure B8 – there is a rising elderly population in this area – saw this flat line where people were fitter, seeing a different generation now below that, that are now putting pressure on care homes, can see that increase. Judith asked the appropriateness and usefulness of measures ie falls – nothing shows the appropriateness of what we are doing and elderly population – how do we reflect the appropriateness of the care once they fall? Catriona agreed, she advised can get the patient CHI number to follow patient through to see what problem may be and how to support ie some falls are with patients who have telecare but didn’t use it. Catriona would also like to see consistency in recording of falls. Cllr Creswell referred to a presentation on benchmarking given by SG to Moray and Highland Councillors and had asked if we could measure on social accounting / auditing terms as well as monetary and presenters agreed to explore this. Highland Councillors agreed in terms of care and preventative work often cannot be measured easily, softer data indicators important. Cllr Creswell asked how do we assess and measure in social terms as opposed to monetary terms ie with respite care the benefits to whole family. Judith advised the discussion was a timely one, phrase used before was social return on investment. Health and wellbeing measures – being outcome focused. The Chair asked if the 3 delayed discharges recorded for May is the beginning of upward trend. Catriona confirmed it was and it is being looked at seriously, formed a group to look at individual cases. Judith advised there has been some work done with collegiate Moray – something we are working on all the time. Fabio asked if Catriona knew the cause of those 3 delayed discharges. Catriona advised one was recorded as other and two were patient carer or family related reason. That could mean it was not convenient to go home ie family reasons or home carer sick. b) Financial Performance Finance update circulated with papers – shows position end of financial year 13/14. Overspends detailed in the report. Challenge for next financial year will be going into integration. Judith commented there are continuing challenges in overseeing this budget; however, in terms of budget savings additional efficiency savings have been identified. Committee noted the report and financial position statement.

6. Sensory Impairment Strategy Implementation Funding The Scottish Government has developed a National Strategy for Sensory Impairment called ‘See Hear: A Strategic Framework for Meeting the Needs of People with a Sensory Impairment in Scotland’ – a copy of which was circulated with papers. Roddy reported it is in good readable format with only 7 recommendations. Will take national strategy and incorporate with local work – links well with physical and sensory. Point 3.7 of the report sets of the proposal on how to utilise Moray’s allocation of funding. Roddy confirmed the two posts and process will support strategy – it is a partnership activity. Due to the staffing issues involved the report will also go to Full Council. The Chair asked Roddy to advise of the level of engagement. Roddy advised there are lots of methods of engagement and open to suggestions. There are questionnaires, get groups of people together to get an idea of what’s important to them, engage with third sector, potential providers, public and staff, will also go to established events / meetings. Public involvement 3 APPROVED 4 officers will support. The Chair agreed it is important not to make assumptions before engagement. Judith made two points, 1) format of engagement, how do we use technology for that in support of people with sensory impairment and 2) if we have short term funding to help with engagement, need to identify support needed after that. Awareness raising and training etc. Roddy acknowledged it is a small amount of money and with it we won’t be able to fully support. Understand we need to invest in resources, working on, it will be challenging. There is an implementation plan to take forward. George said he noticed national strategy is sensory and we are including physical impairment – how can that be done without losing out on outcomes. Roddy replied these pieces of work pull together, any work that needs to be done to support one links with the other. The Chair and Committee are happy to support and agree to use of funding as set out in the report. The Committee would welcome feedback further down the line to see how progressing.

7. ‘ Living It Up’ – Project Update Lorna Bernard joined today’s meeting to provide an update on the Living it Up (LiU) project and provide awareness of the launch of Jimmy’s Blog and Facebook page. Unfortunately Jimmy was unable to attend today. The report circulated with papers celebrates the wide range of community champions who support this project. Jimmy has been writing a blog for LiU since the beginning of the year. The aim is to put the human element back into the work that is being done. The blog has been very well received – lots of people are connecting with it. Jimmy has lots of ideas, he meets with people informally about using technology; some people who would benefit from this project don’t use technology so have to get over that hurdle first. Also trying to engage with some teenagers to help support use of technology with older people (digital engagement) – it is a hidden talent. Lorna is in touch with a group in Moray called Living Golf – using golf as motivation, inspiration and supporting health and well-being. Hope to spread these networks / tools out to other areas ie smoking cessation – could get others to inspire. Funding for Living it Up runs out May 2015. Cllr Creswell asked Lorna how she recruited the champions. Lorna advised Jimmy heard about LiU and got in touch to see if he could get involved. Generally put feelers out and chat to people to see if they wish to get involved. Range of champions involved including an octogenarian who uses a lot of technology. Fabio expressed his interest in intergenerational work. The Chair asked if there has been a report detailing positive outcomes achieved against original plan. Lorna advised the national perspective is in hand – Glasgow Caledonian University are auditing it. Locally focusing on tracking of benefits which is not always that easy. From today’s meeting Lorna advised she will take away the support element outcomes. Judith added that people taking own responsibility of care, Jimmy going out to support others – it’s very powerful. Peoples’ experiences / stories – important to capture that. Champions group – links made with North East Sensory Services – continue to make connections / network. Human interest stories key – they inspire people. Val echoed Judith’s statement, adding it is very inspiring, like the idea of getting in touch with elderly people about technology – would help across the board in a number of areas. The Chair concluded it is very important to personalise the work we are doing the rewards are colossal and is advised he is very interested in Jimmy’s blog, regret that he cannot meet him today. Lorna advised she is happy to come back to a future meeting to update, hopefully jimmy can attend. The Chair noted the report and congratulated Lorna on the work to date.

8. Draft Market Position Statement First iteration of draft Market Position Statement is attached with papers as Appendix 1. This is a transparent process, with open dialogue with the wider community stakeholders by providing them with the current picture of social care delivery including demand and finance. Judith stated that this was a very useful document that brings together what we know about the challenges and sets out transition towards SDS and how we facilitate that transition using models available. Clearly sets out transition and intent and it is open to ideas. Roddy informed the Committee that feedback is welcomed. Fabio advised one idea is reducing use of block contracts; gives purchasing power to stimulate economy. That is great; however, releasing use of block contracts can create challenges – to transition onto different model etc, he asked how that will be managed. Roddy replied it will be assessed and only progressed if appropriate – very open at this stage. If not appropriate to move out of block contracts will consider that and engage with public. He expressed it will be a very thoughtful process. Pauline Knox, SDS Commissioning Lead, put this report together. It is evolving, considered approach, engaging nationally as well. George made references to SDS in report, he advised this approach is new to us in health; legislation doesn’t allow 4 APPROVED 5 us to do that, will be a challenge. Judith added the root of it is outcomes of what people want to achieve – not always about money and commissioning services, it can be about engaging with groups ie LiU project. Roddy advised further iterations will be circulated when available. The Committee noted the report.

9. Introduction to the 10 Year Plan Tracey reported the 10 year plan is a visionary document of where we (Moray) would like to be in 10 years time, it is an approach taken by community planning partnership. Obesity – would like to reduce prevalence in over 16s and young people, smoking cessation, reduce %age of admissions to hospital relating to alcohol, mental health and wellbeing (will include suicide), early years early preventions, breast feeding rates, community care service delivery – clients and service users feel safe, reduce fuel poverty, there are a range of targets. It is quite challenging and a priority for community planning partnership. Judith added it is a developmental document and one that will be flexible. Tracy agreed saying it is an opportunity to engage with community planning board to enable and support them to make informed decisions. Cllr Creswell added it is a real shift in whole partnership moving forward, lots of players, lots of opportunities, lots of resources. The Chair asked how plan will mesh with integration. Judith replied there is no real clarity, integrated joint board recognises there will be a relationship between health and social care partnership and community planning board but accountable to respective boards. Would like to see good partnership working – dialogue to be had to see how the two organisations will work together. Cllr Creswell stated health and social care is part of everyone’s agenda within Community Planning Partnership 10 Year Plan. The Chair noted the information given and would welcome a presentation at the next CHSCP Committee to look at in more detail.

10. AOCB Dementia Awareness Week – Cllr Creswell referred to Dementia Awareness Week which was last week. Lorna attended Dementia Adventure where a couple told a story about dementia and how it affected them and their family from diagnosis to treatment; despair to a great outcome. Great human interest story.

8 Pillar Model – Cllr Creswell noted the reminiscent box in libraries – simple resource, all can get involved to help.

Person Centred Approach – George attended a patient safety workshop in Glasgow where Sally Magnusson did a presentation on dementia including the benefits of music. Pledge to provide music to those in community hospitals with dementia. George reported Moray will try and put in place in the near future – huge benefits.

11. Date of Next Meeting

The next meeting of the Moray CHSCP Committee will take place on Thursday 11 September, 10:00am, Meeting Room, Spynie Dental Centre, Elgin.