Scottish Government Health and Community Care Delivery Group, 28 November 2011

HEALTH AND SOCIAL CARE AND THE THIRD SECTOR

Report back from relevant working groups from CCPS/third sector representative

NATIONAL STEERING GROUP ON JOINT STRATEGIC COMMISSIONING 4 May 2012 This group is a sub-group of the Delivery Group (see below).  The meeting reviewed the ongoing evidence being taken by the Scottish Parliament Public Audit Committee on Audit Scotland’s recent report, Commissioning Social Care. A number of those round the table have given evidence to the committee (including myself and Ian Welsh of LTCAS on behalf of the third sector). Links to the evidence sessions and written submissions are here: http://www.scottish.parliament.uk/parliamentarybusiness/CurrentCommittees /48441.aspx  The meeting reviewed a paper prepared by SG on a common definition of commissioning, not least because there is still some confusion about the precise difference between it and procurement, and because it still causes alarm within the NHS, where it relates closely (and uncomfortably) to the internal market and the purchaser/provider split that was abandoned several years ago. It was agreed that the SWIA definition1 should serve as the model but that this should be adapted to incorporate the concepts of co-production, investment, and strategic needs assessment. SG will prepare a draft definition based on the discussion.  Once again I suggested that the group should at some point examine, with the Care Inspectorate and Healthcare Improvement Scotland, what formal scrutiny arrangements should be put in place to monitor progress towards improved commissioning. There was also some discussion about the role of the Scottish Social Services Council in promoting skills and qualifications among those charged with strategic commissioning.  There was an interesting discussion about self directed support in the context of commissioning, and specifically the statement by the Cabinet Secretary that SDS will offer people the option to control their social care budget, but not their health care budget. I pointed out that the Cabinet Secretary is also on the parliamentary record as saying that once integrated, budgets will “lose their identity”, meaning that there will no longer be ‘social care’ and ‘health care’ budgets for the purposes of SDS; and that therefore this particular rubric may have to be revisited.  The meeting received a report on progress with the development of a National Learning Framework for strategic commissioning. The Institute of Public Care is developing this framework and will shortly be interviewing all members of the group as part of the process.  The meeting noted a paper from COSLA on its ongoing work to apply a strategic commissioning approach to care home provision. Finally the group agreed that papers from meetings should be made available on the SG website and this will now be put in hand.

1 “the term used for all the activities involved in assessing and forecasting needs, agreeing desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place” SWIA Guide to Strategic Commissioning, 2009

HEALTH AND SOCIAL CARE INTEGRATION BILL ADVISORY GROUP, 22 May 2012  The meeting began with a discussion about the current debate being conducted in the Health Committee regarding the extent to which health services/budgets are implicated, through the integration agenda, in the legislative proposals for Self Directed Support. There was a feeling among some group members that in discussing the SDS Bill in advance of any Integration Bill, the cart is being put before the horse. It was noted that this is ‘one to watch’ and the first of a series of ‘wicked issues’ which will have to be addressed by the group: this also includes the whole area of charging for services.  The group was updated on the progress of the various workstreams associated with the integration agenda. The Scottish Care representative and myself repeated our request, made at the last meeting, for some consideration to be given by the Governance and Accountability sub-group to the involvement of the third and independent sectors in governance arrangements for health and social care partnerships. One or two of the public sector representatives present clearly felt that, because neither the third nor the independent sector will be ‘accountable’ in a formal sense for integrated budgets, they have no place in this debate; however they were swiftly reminded that the third sector in particular was given a formal role in statute on the governing bodies of both community planning partnerships and community health partnerships, and it follows that we should have a similar role in relation to health and social care partnerships. It was agreed that the relevant workstream would look at this and report back.  The meeting discussed the recently-published Health Committee report of its inquiry into health and social care integration, which was duly noted.  The group was asked to share any early issues arising from the consultation paper on integration published on 8 May. One of the key issues raised by several groups members was the continuing uncertainty about the inclusion (or otherwise) of acute care NHS resources in the ‘integrated budget’ pot. I raised an issue which a number of CCPS members have spoken to me about, namely the two consultation questions about outcomes: the paper asks whether an outcomes approach is an appropriate mechanism to drive change; and whether national outcomes for health and social care should be included in Single Outcome Agreements. What it does not ask is whether the proposed draft outcomes (in Annex A of the consultation paper) are themselves appropriate, sufficiently robust, or measurable. I suggested that the process of agreeing national outcomes has not, to date, been sufficiently inclusive and extensive, but that it requires to be much more so in order for appropriate “buy-in” to be secured: this point was noted and SG will report back on how the matter will be taken forward. Meanwhile the local authority representatives outlined the difficulty that they may have in responding appropriately to the consultation, given the significant changes in council elected members and leadership following the recent elections, and the outstanding business (in many councils) of appointing committee chairs/members.  There was some discussion of the level of scrutiny to be applied to both the process of integration and the outcomes achieved. The Care Inspectorate and HIS suggested that a key role for them both would be in identifying good practice; it was also noted that a review of the national care standards will

2 shortly be announced by SG, and that this review should take into account the work on outcomes (as noted above) The next meeting of this group will be held on 28 August 2012.

SCOTTISH GOVERNMENT HEALTH AND COMMUNITY CARE DELIVERY GROUP, 24 May 2012 Regrettably I was unable to attend this meeting due to prior (and unmoveable) commitments. The Group has asked the SG secretariat to set a year’s dates in advance to facilitate attendance, however this has not happened and meetings continue to be called without reference to the availability of members. Nevertheless I put some comments in on the papers. One paper set out some proposals for amending the existing Directions on Choice of Accommodation for people assessed as requiring care home provision. One idea being floated is that councils should only fund a care home place if the home is of sufficiently good quality: I offered the view that a lot will depend on what precisely constitutes “sufficiently” good quality – the CCPS view, certainly, is that it should attain a grading record of at least 4 (“good”) - and how that is decided on. Will each authority be able to determine this for itself, for example, or will this in effect be a national standard? If the latter, will there be implications for other service areas that do not come within the scope of a national contract?

On a paper about “Understanding progress” in relation to the Change Fund, I did my usual broken record thing and commented once more that “understanding progress” is important, but so is “being held to account”, and I’m still not sure that the appropriate balance between these two has yet been struck.

I also repeated the comments I made in the BAG about the outcomes agenda, as noted above.

Formal minutes of all these groups are now attached. Also appended to this paper is the most recent version of the Scottish Government ‘governance infrastructure’ for these, and whole range of other, working groups relating to health and care. The ones I am sitting on are highlighted. I believe that Ian Welsh of LTCAS sits on the Quality Alliance Board, and Martin Sime of SCVO is on the Delivery Group, but I’m not sure whether there are third sector reps anywhere else. Enjoy!

Annie Gunner Logan, CCPS May 2012

3 National Strategic Capacity

Ministerial Strategy Group for Health and Social Care

Health and Social Care Delivery Group Health and Social Care Integration Bill Advisory NHS Quality Alliance Board Group

Subgroup Officer Lead Subgroup Officer Lead Subgroups Officer Lead

- Joint Alan Gunning, - Integrated Christine - Person-Centred Ros Moore Commissionin NHS Peter Resources McLaughlin, SG Delivery Group Anne Hendry g McLeod, ADSW - Workforce and John Connaghan, SG - Effective Delivery Frances Elliot HR Kathleen Bessos, SG Group Jill Vickerman - Outcomes Derek Feeley, SG - Safe Delivery - Governance & Alexis Jay, SG Group Margaret Accountability Alison Taylor, SG - Infrastructure - Whoriskey, JIT - Impact on Social Delivery Group Improvement Work and Support - Locality Planning

Health and Social Care Delivery Group Group Management Joint Chair: Tim Davison (Representing NHS Chief Executives) Additional members are invited to - Bi-monthly Meetings Colin McKenzie (Representing attend at the discretion of the Delivery - Substitutes agreed by co-chairs SOLACE) Group. Secretariat: Scottish Government x 4; COSLA x 1 Secretriat to develop a work plan, to be

4 Membership considered at a future meeting of the Scottish Government x 2 Delivery Group COSLA x 1 SOLACE x 2 (in addition to the joint-chair) NHS Chief Executives x 2 (in addition to the joint-chair) ADSW x 2 ALACHO x 1 Ass. CHPs x 2 Scottish Care x 1 CCPS x 1 SCVO x 1 Care Inspectorate x 1 HIS x 1 JIT x 1 Health Scotland x 1