A meeting of the Clackmannanshire and Stirling Integration Joint Board will be held on Wednesday 17 June 2020 at 2pm - 4pm, By Video Conference
Please notify apologies for absence to:
INTEGRATION JOINT BOARD MEETING AGENDA
1. NOTIFICATION OF APOLOGIES For Noting
2. NOTIFICATION OF SUBSTITUTES For Noting
3. DECLARATION(S) OF INTEREST For Noting
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
5. MINUTE OF THE CLACKMANNANSHIRE & STIRLING INTEGRATION For Approval JOINT BOARD MEETING HELD ON 25 MARCH 2020
6. ACTION LOG
7. TRANSFORMING CARE AND STRATEGIC PLANNING
7.1 PRIMARY CARE IMRPROVEMENT PLAN For Noting (Paper Presented by Dr Stuart Cummings / Lesley Middlemiss)
7.2 MOBILISATION PLAN For Noting (Paper Presented by Wendy Forrest)
8. FINANCE
8.1 YEAR END FINANCE REPORT For Noting & (Paper Presented by Ewan Murray) Approval
9. PERFORMANCE
9.1 COVID - 19 UPDATE REPORT For Noting (Paper presented by Wendy Forrest / Ewan Murray)
9.2 PERFORMANCE REPORT For Noting & (Paper presented by Carolyn Wyllie) Approval
10. GOVERNANCE
10.1 INTEGRATION SCHEME For Noting (Paper presented by Lesley Fulford)
10.2 URGENT DECISION MAKING For Approval (Paper presented by Lindsay Thomson) 11. FOR NOTING
11.1 MINUTES
a) STRATEGIC PLANNING GROUP: None for noting b) JOINT STAFF FORUM: None for noting c) IJB AUDIT & RISK COMMITTEE: None for noting d) CLINICAL CARE & GOVERNANCE MEETING: None for noting
12. EXEMPT ITEMS
E12.1 None for noting
13. DATE OF NEXT MEETING
Wednesday 23 September 2020 at 2 - 4pm
Location or Videoconference details will be confirmed nearer the time. Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 5
Draft Minute of Clackmannanshire & Stirling Integration Joint Board 25 March 2020
For Approval
Paper Approved for Submission by: Annemargaret Black Paper presented by N/A Author Sandy Blair Exempt Report No
Page 1 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Minute of the Clackmannanshire & Stirling Integration Joint Board meeting held on Wednesday 25 March 2020, at 14:00, by Teleconference Call
John Ford (Chair) welcomed all members to the meeting and confirmed meeting as Quorate.
Participants were made aware that due to the COVID-19 pandemic; the Health and Social Care Partnership, together with partner agencies, are currently focussing on delivering clinical and care services in a safe and effective way to the people of Clackmannanshire & Stirling.
Due to recent Government advice to reduce social contact, the decision was taken to hold this meeting by teleconference. These are exceptional circumstances.
We have reduced the number of papers which were planned for the agenda and asked for questions to be submitted ahead of the meeting to the Partnership mailbox. Paper authors / presenters will address these questions as they present their paper to the Board when called upon to do so.
The chair asked that discussion be limited on the papers so we could make effective, efficient and productive decisions and issue directions (where required); whilst reducing the volume of debate in the meeting.
Agenda item 9.2 Primary Care Improvement Plan was presented by Stuart Cumming & Lesley Middlemiss and was taken as the first agenda item.
Present:
VOTING MEMBERS
John Ford (Chair), NHS Forth Valley Councillor Les Sharp (Vice Chair), Clackmannanshire Council Councillor Dave Clark, Clackmannanshire Council Councillor Susan McGill, Stirling Council Julia Swan, Non executive board member, NHS Forth Valley Allan Rennie, Non executive board member, NHS Forth Valley Councillor Graham Houston, Stirling Council
VOTING MEMBERS - SUBSTITUTES
None to note
NON-VOTING MEMBERS
Fiona Duncan, Chief Social Work Officer, Clackmannanshire Council Ewan Murray, Chief Finance Officer Janine Rennie, Third Sector Representative, Stirling Abigail Robertson, Joint Trade Union Committee Representative for Stirling
Page 2 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Marie Valente, Chief Social Work Officer, Stirling Council and Social Work Advisor to the Integration Joint Board Natalie Masterson, Third Sector Representative, Stirling Angela Wallace, Director of Nursing, NHS Forth Valley Annemargaret Black, Chief Officer
ADVISORY MEMBERS
Lindsay Thomson, Standards Officer, Integration Joint Board Lesley Fulford, Programme Manager
In Attendance Jim Boyle, Chief Finance Officer, Stirling Council Margaret Robbie, PA to Chief Officer Sandy Blair, Business Support Officer, (Minute Taker) Jennifer Baird Dr Stuart Cumming Lesley Middlemiss
Members of the Public None.
Members of the Press None
1. NOTIFICATION OF APOLOGIES
Councillor Scott Farmer, Stirling Council Andrew Murray, Medical Director, NHS Forth Valley Robert Clark, Employee Director, NHS Forth Valley Cathie Cowan, Chief Executive, NHS Forth Valley Helen Maguire Morag Mason Elizabeth Ramsay Dr Scott Williams Nikki Bridle
2. NOTIFICATION OF SUBSTITUES
The following substitutes were noted:
3. DECLARATION(S) OF INTEREST
None
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
Page 3 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Chair wished formal thanks to be made from the Board to core staff for their professionalism and support during these difficult times.
Chair proposed Annemargaret Black issue a letter to staff on behalf of the Board thanking them for their continued efforts in response to the COVID-19 pandemic.
5. MINUTE OF THE CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD MEETING HELD ON 27 NOVEMBER 2019
Approved
6. MINUTE OF THE SPECIAL CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD MEETING HELD ON 26 FEBRUARY 2020
Approved
7. ACTION LOG
None
8. FINANCE
8.1 FINANCE REPORT
This paper was presented by Ewan Murray.
The purpose of the report was to present the Integration Joint Board with an overview of the financial performance and projected financial position for 2019-20.
The Integration Joint Board:
• Approved the finance report and noted the projected overspend on the Integrated Budget of £1.783m • Approved the use of £0.128m of earmarked reserves which would reduce the projected overspend on the Integrated Budget to £1.655m • Noted the projected overspend on the Set Aside budget for Large Hospital Services of £1.325m bringing the overall overspend on the partnership budget including set aside to £3.108m • Noted the significant financial pressures and risks across the Partnership budget
Councillor Clark requested clarification on the children’s services (page 6). Annemargaret Black stated that a meeting has been held and further work will be done on this National issue.
Ewan Murray will circulate details of all questions and answers after this meeting.
The Board approved and noted the paper
Page 4 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
8.2 2020 / 2021 REVENUE BUDGET & MEDIUM TERM FINANCIAL PLAN
Ewan Murray presented this paper. The purpose of this report was to present the Integration Joint Board with the 2020/21 Revenue Budget and Draft Medium-Term Financial Plan for consideration and approval.
Ewan Murray stated that these reports were produced on a ‘business as usual’ basis before the Covid-19 pandemic, which will affect the ability to further develop and deliver plans including, notably, the Transforming Care Programme.
Discussion took place relating to item 2.4 within the report. A number of members felt that it is unacceptable for Stirling Council to not contribute to the staff pay awards directly through the proposed payment. After discussion it was accepted that the Stirling Council proposed payment was compliant with the terms of the Scottish Government settlement and therefore acceptable, however, the Board asked that Ewan Murray and Annemargaret Black discuss the Boards concerns further with Stirling Council and report back to the Board.
The Integration Joint Board:
• Approved the proposed payments and set aside budget for Large Hospitals Services from Clackmannanshire Council, Stirling Council and NHS Forth Valley noting that they are compliant with the terms of the Scottish Government settlement. • Approved the 2020/21 Revenue Budget • Approved a Due Diligence report on budgets proposed to transfer to the Integration Joint Board from Clackmannanshire and Stirling Councils is brought to the IJB Finance and Performance Committee in May to ensure adequacy of resource and understanding of service and commissioning arrangements. • Noted the update in relation to Set Aside budget for Large Hospital Services and approve the recommendation in Section 5.6 subject to further discussion with NHS Forth Valley • Delegated authority to the Chief Officer to issue initial directions for 2020/21 based on payments from constituent authorities. • Noted the background and budget context • Noted the update in relation to Reserves Policy and Strategy. • Noted the update in relation to Property, Assets and Capital Planning • Noted the wider risks and, in particular, the rapidly developing situation in response to the COVID 19 pandemic. There may be a need to consider emergency budget measures as part of responses.
9. TRANSFORMING CARE AND STRATEGIC PLANNING
9.1 CHIEF OFFICE REPORT
Strategic Review of Palliative & End of Life Care
Page 5 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
This verbal update was provided by Annemargaret Black. The purpose of this was to update the Board on Palliative and End of Life Care.
The Integration Joint Board:
• Noted that a paper will be presented to a future Board following engagement with Strathcarron Hospice on the Memorandum of Understanding and Service Level Agreement. This report will be subject to Board approval and a direction to NHS Forth Valley to enter into a SLA with Strathcarron Hospice.
COVID-19
Current Situation
As of 10am on 25 March, there were: • 8077 confirmed cases of COVID-19 in UK • 422 deaths in the UK • Scotland • first case in Scotland was reported by NHS Lothian on 13 March • 584 cases in Scotland • 16 deaths • 43 FV cases
Local Authority Nurseries, Primary Schools and High Schools closed on Friday 20 March 2020 for the foreseeable future.
Actions being taken forward
As part of our efforts to keep you informed, we will be issuing regular updates. These will include information on matters such as planning and resilience, operational service guidance, along with signposting to the latest national advice to ensure clear, consistent and timely sharing of information.
A number of planning and resilience arrangements have been put in place, including:
• Establishment of a local mobilisation centre
• Meetings of operational and strategic leaders from the mobilisation centre, initially twice per week
• Regular dialogue between service level staff and also at organisational level
• Development of a mobilisation plan, outlining planned contingency arrangements and resource requirements
• Arrangements to ensure access to supplies and equipment
Page 6 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Carolyn Wyllie, Head of Community Health & Care Services, is meeting with each of our frontline teams to put in place preparations to ensure that our health and social care services continue to operate safely, and deliver support to those who need it most.
Wendy Forrest, Head of Strategic Planning and Health Improvement, is leading arrangements around planning and resilience.
Further information will be issued as it becomes available via Twitter, our HSCP website, and through the mobilisation centre to our teams and their service users, unpaid carers and our external service providers.
As you will appreciate, this is a changing situation and we would encourage you to keep up to date with national guidance issued by NHS Inform or on 0800 028 2816, and from the Scottish Government.
The Board noted the Chief Officers verbal report
9.2 PRIMARY CARE IMPROVEMENT PLAN
This paper was presented by Dr Stuart Cumming & Lesley Middlemiss. The purpose of this paper was to inform Board Members of the significant progress which been made with regards to implementation of the new GMS contract in line with Forth Valley Primary Care Implementation Plan (PCIP) and seek approval in principle of Iteration 3 of the plan. Iteration 3 provided an update on the current implementation position as well as a review of planned activities
The Integration Joint Board:
• Noted that the draft plan needs to be submitted to the Scottish Government by 14 May 2020, and subject to local approvals. • Agreed the PCIP Iteration 3, noting that it is subject to the approval of the GP Local Medical Committee, Falkirk IJB and NHS FV Board. • Delegated authority to Chief Office and Chair of the IJB to approve the final Primary Care Improvement Plan. • Noted that full implementation of the plan relies on additional funding and that a case to Scottish Government has been made in this regard.
A detailed discussion took place particularly around the lack of funding to implement the plan in full. Councillor Clark requested that the plan should not be submitted to the Scottish Government until full funding was agreed as the Integrated Joint Board must live within its means. The Board agreed that the plan should be submitted to meet the deadline set by Scottish Government and that a letter should accompany the plan that outlines the concerns discussed by the Board. This letter is to be circulated to the Integration Joint Board.
Page 7 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
The Board approved the PCIP.
10. COMMISSIONING
10.1 CARE & SUPPORT FRAMEWORK
Paper was presented by Jennifer Baird. The purpose of this paper was to:
• Seek approval from the Integration Joint Board to award a contract to providers of care and support under the Scotland Excel Care and Support Framework from 1 April 2020 until 31 March 2024 and direct Clackmannanshire Council and Stirling Council accordingly • Seek delegated authority to the Head of Community Health & Care, Clackmannanshire and Stirling Health and Social Care Partnership to accept new providers who join the national framework during the next framework period • Highlight risks and mitigating actions in relation to the Framework • Highlight the financial impact of increases to existing rates and rates submitted by potential providers as part of the tendering process • Highlight that while the Framework will allow greater choice of providers and services that can be used it will not in itself tackle the lack of carers availability locally • To provide assurance that people already receiving care and support services will not be impacted through the introduction of the Framework.
The Integration Joint Board:
• Approved the award of the contract as outlined in the paper and direct Stirling Council and Clackmannanshire Council to put in place the contractual arrangements accordingly. • Approved delegation to the Finance and Performance committee to review and approve a payment above 3% if a provider requests this. • Approved delegation to the Audit and Risk committee to review the reserves policy and report back to the Board.
11. GOVERNANCE
11.1 CHAIR & VICE CHAIR PERSONS
This paper was presented by Lesley Fulford. The purpose of this paper was to agree:
• Proposals for Chairing and Vice Chairing arrangements for the Clackmannanshire and Stirling Integration Joint Board and its Committees • To consider appointing period for members and its implications for members
The Integration Joint Board:
Page 8 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
• Approved the nomination Les Sharp (Clackmannanshire Council) as the Chair Person of the Integration Joint Board in first year (2020 / 2021) as per section 2.3 • Approved the nomination Councillor Scott Farmer (Stirling Council) for Chair Person Integration Joint Board in second year (2021 / 2022) as per section 2.4 • Approved the nomination for Vice Chair Person Integration Joint Board for both years (2020 / 2022) as per section 2.5 – To Be Confirmed • Approved the following nominations for: • Allan Rennie (NHS Forth Valley) as Chair Person and Councillor Martha Benny (Clackmannanshire) as Vice Chair Person for Audit & Risk Committee (2020 / 2022) as per report section 3.2 • John Ford (NHS Forth Valley) as Chair Person and Councillor Scott Farmer (Stirling Council) as Vice Chair Person for Finance & Performance Committee (2020 / 2022) as per report section 4.2 • Approved the appointing period of three years is added to the Standing Orders for non voting members as per report section 5.5
Natalie Masterton was concerned that the Third Sector Interface may find it challenging to ensure a suitable representative could be nominate as a member and this concern was mirrored by Abigail Robertson.
The board was approved the paper and for Lesley Fulford to have further discussions with Trade Union and Third Sector Interface and to report back to the Board.
11.2 PROGRAMME OF MEETING DATES
The paper was presented by Lesley Fulford.
The purpose of the paper was to request Board approval of the Programme of Meeting dates for the Integration Joint Board.
The recommendations were:
• Approved the proposed Integration Joint Board programme of meeting dates for 2020 / 2021 set out in paragraph 2.1 • Approved March 2021 meeting is focussed on budget and delivery plan only • Approved the proposed Integration Joint Board Audit and Risk Committee programme of meeting dates for 2020 / 2021 set out in paragraph 3.1 • Approved the proposed Integration Joint Board Finance & Performance Committee programme of meeting dates for 2020 / 2021 set out in paragraph 4.1
The Board approved the IJB and Committee meeting dates.
Page 9 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Councillor Sharp proposed a special thanks for the hard work, coordination and effort made by Lesley Fulford and Ewan Murray in pulling together the meeting dates.
12. EMERGENCY DECISION MAKING POWERS
The paper was presented by Lindsay Thomson.
The purpose of the report was to seek Board approval for urgent decision making authority to be delegated to the Chief Officer in accordance with the terms of this paper.
The Integration Joint Board:
• Delegated authority to take such urgent measures as are required during this period of emergency to: • The Chief Officer (or the Chief Finance Officer or their substitutes) • For the period up until at least 17 June 2020 • And to take those decisions in consultation with the Chief Executives of the constituent authorities (as appropriate), the section 95 officers of the Constituent Authorities and Director of Finance (NHS FV) and the Chair and / or Vice Chair of the IJB (if available) before exercising that delegated power • Agreed that there will be no formal meetings of the Board or Committee until at least 17 June 2020 • Agreed that should the Chief Officer consider it to be necessary, that a virtual meeting of Boards voting members in 17 June 2020 will determine whether, and for how long, the delegated authority should continue
It was requested and agreed that in section 1.3, the wording be changed from ‘if available’ to ‘and / or’.
It was agreed that a report be provided to the Board meeting of 17 June 2020 detailing what delegated actions have been taken.
The Board approved on the basis that the wording is changed as above.
13. FOR NOTING
13.1 MINUTES
STRATEGIC PLANNING GROUP: None for noting JOINT STAFF FORUM: None for noting IJB AUDIT & RISK COMMITTEE: None for noting CLINICAL CARE & GOVERNANCE MEETING: None for noting
Page 10 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
14. EXEMPT ITEMS
• None for noting
15. DATE FOR NEXT MEETING
None provided
16. ANY OTHER BUSINESS
A special thanks and appreciation was given from the Board Members to the Chair for the last 2 years along with all his effort and workload.
Page 11 of 12 Agenda Item 5 - Draft Minute of C&S IJB 25 March 2020
Page 12 of 12 Agenda Item 6 - Integration Joint Board Action Log
Status/Progress
Meeting Date Report Title Action Responsible Timescale Progress/Outcome Status and Paper Officer Number
27 November 7.1 Financial Need to look at projected figures in AmB Will be part of the In 2019 Report relation to care capacity Transformation Progress Plan going forward, including model of care journey. Regarding care/NH capacity, Stirling PS to contact January Report on current Not Council to report on position to next Judy Stein 2020 position. started meeting. Information in weekly Delayed Discharge report. Care home vacancies as of 5 March 2020, Clacks = 13 and Stirling = 18 Pg 4, Under 65 care budget – request Lindsay Sim January This relates to loss Not for clarity on how this has been spent. 2020 of income from started charging rather than spend. An analysis will be prepared at year Not
Last Updated 3 June 2020 Page 1 of 2 Agenda Item 6 - Integration Joint Board Action Log end based on a full started financial year end and included in a future report Appendix C – exactly the same as Lindsay Sim January Not presented to the previous meeting? To 2020 started be checked.
8.1 Presentation of report to be made more Carol Johnson / January Format and content In Performance user friendly. Lesley Fulford 2020 of Performance progress Report Report being reviewed as part of the Board Effectiveness and Governance Review. 31 March 2020 11.1 Chair & Lesley Fulford and Lindsay Thomson to Lesley Fulford and June 2020 Meeting was In Vice Chair meet with Abigail Robertson and Natalie Lindsay Thomson scheduled, progress Persons Masterson regarding implications of postponed due to change to Standing Orders COVID-19
Last Updated 3 June 2020 Page 2 of 2 Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 7.1
Primary Care Improvement Plan
For Noting
Paper Approved for Submission by: Annemargaret Black Paper presented by Dr Stuart Cumming Author Dr Stuart Cumming / Lesley Middelmiss Exempt Report No
Page 1 of 11 Agenda Item 7.1
Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
The purpose of this paper is to provide a further update to Board Members on the submission of the approved Iteration 3 of the Forth Valleys Primary Care Implementation Plan Purpose of Report: (PCIP) to Scottish Government and seek approval of the addition of the Tripartite Statement providing qualifying information to Iteration 3 of the plan. .
The Integration Joint Board is asked to:
1) Note that the IJB approved, in principle, the PCIP Iteration 3 at the last meeting and delegated authority to Chief
Officer and ChairDRAFT of the IJB to approve the final Primary Care Improvement Plan. 2) Note that the draft plan needs to be submitted to the Scottish Government by the revised date of 23rd June 2020 Recommendations: 3) Note the updated Iteration 3 financial projection (appendix 2) and that full delivery of the Primary Care Improvement Plan continues to exceed the indicative recurring funding provided by Government by circa £1.2m. All current year commitments are now sustainable within the final PCIP financial envelope. 4) Agree the Tripartite statement (appendix 1) which proposes to make continued representation to Scottish Government regarding the funding shortfall.
1. Background
1.1. The original PCIP (2018) and PCIP iteration 2 were agreed by both IJBs, NHS FV and GP subcommittee before and submission to Scottish Government in August 2018 and May 2019. Iteration 3 is due to be submitted, to Scottish Government, by June 23rd 2020.
Page 2 of 11 Agenda Item 7.1
1.2. Despite significant additional workload and focus on Covid-19 all PCIP priorities outlined in Iteration 3 of the PCIP are now progressing, summarised in the most recent PCIP practice update (Appendix 3).
1.3. We are keen to ensure the pace and momentum of PCIP Iteration 3 to support sustainability of primary care in the short, medium and long term recognising the challenge of the Covid-19 recovery phase and there is now a renewed focus on the priorities being taken forward by our three key PCIP working groups.
1.4. Notably, the NHS Board, Integration Joint Boards and the GP Sub Committee of the Local Medical Committee agreed on Iteration 2 for 2019/20 planned activities only. This was due to insufficient funding being assured for future years. The original finance projection for Iteration 3 forecast a significant funding gap for 20/21 and a recurrent financial risk from 2021/22 of £1.3m.
1.5. While the recurrent funding gap remains. The in-year picture has improved significantly due to non-recurrent funding from the NHS Board, some slippage of recruitment and start dates due to the covid-19 situation and recalculation of all posts based on their entry point on Agenda for Change scale.
1.6. Current risks in addition to funding remain in relation to IT, primary care premises and workforce. While largely outwith the scope of the PCIP for
DRAFT 2020/21, the 2020/21 influenza immunisation programme is recognised as a particular challenge given the Covid-19 situation particularly in relation to shielding and social distancing. Conventional mass vaccination models will not be appropriate and we will align the flu programme work with that of the VTP.
2. Conclusions
2.1. Delivery of the new GMS contract by April 2021, is an ambitious programme of change, however, Forth Valley are on a clear trajectory, subject to funding availability, to successfully deliver our Primary Care Improvement Plan and achieve practical implementation of the MoU priorities by or very soon after April 2021.
2.2. It is hoped that the Tripartite Statement enables Forth Valley tripartite partners to maintain their collective representation to Scottish Government that they are united in the view that the priorities and revised service specifications described in Iteration 3 of Forth Valleys PCIP continue to set out what we believe is essential to deliver the commitments of the MoU by (or soon after) April 2021. However, partners also agree that the cost of fully delivering the requirements of the new GMS contract continues to exceed the indicative
Page 3 of 11 Agenda Item 7.1
revenue funding allocation provided by the Scottish Government, and without further national funding is not fully deliverable.
2.3. This plan does not commit IJB or NHS Board to funding a deficit. It seeks, through a tripartite statement, to highlight that without additional Scottish Government funding, the years of the plan beyond 2020/21 remain unaffordable and with that the full GMS contact is undeliverable. A summary of the financial position is set out within the financial plan (Appendix 2).
2.4. Without additional recurring Scottish Government funding, sustainable delivery of the plan by April 2021 is not feasible. This presents significant risks to service resilience, ongoing sustainability of primary care and losing the high level of collaborative engagement between services, partners and primary care. Clarity on the funding position is required as a matter of urgency.
2.5. Iteration 3 PCIP also sets out what will be delivered in 2020/21 within currently available resource. While the 2020/21 financial forecast has improved significantly the recurrent funding gap from 2021 remains a significant risk and largely specific to the transfer of immunisation programmes away from practices.
2.6. This plan is directed by GP priorities but, without adequate funding, the risk of losing the high level of collaborative engagement between services and
DRAFT partners is significant, leaving us unable to deliver the GMS contract commitments in full.
3. Appendices
1. Tripartite Statement for Primary Care Improvement Plan (Iteration 3) 2. Iteration 3 Finance Projections 3. PCIP Practice Update which provides, for reference, a summary of progress and deliverables as set out in Iteration 3
Page 4 of 11 Agenda Item 7.1
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities Mental Health Supporting people living with Dementia Alcohol and Drugs
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications Iteration 3 reflects a continual focus on cost effectiveness and best value. The finance plan indicates that the year 3 (20/21) funding gap has reduced to a more balanced picture for 2020/21. The recurrent projected overspend beyond 2021 remains. Finance: The plan does not commit the IJB to funding a deficit position. It seeks, through a tripartite statement, to highlight that without DRAFT additional Scottish Government funding, the years of the plan beyond 2020/21 remain unaffordable and with that the full GMS contact is undeliverable. Other Resources: The Memorandum of Understanding (“MOU”) between The Scottish Government, the Scottish General Practitioners Committee of the British Medical Association, Integration Legal: Authorities and NHS Boards sets out a statement of responsibilities for the tripartite partners and the priorities required in terms of delivering the new GMS contract. Non delivery of the contract brings with it significant risk in terms of general practice sustainability and significant challenge to sustaining the strong collaborative relationships between stakeholders. This risk is notable and high on both IJB and NHS Risk & mitigation: Board risk registers. A risk register and mitigation plan is maintained for the programme. The case for additional funding to Scottish Government is a particular action to try and mitigate many of the risks around non delivery of the contract. Equality and The content of this report does not require a EQIA Human Rights: Data Protection: The content of this report does not require a DPIA
Page 5 of 11 Agenda Item 7.1
Appendix 1
Forth Valley Primary Care Improvement Plan
2018 to 2021 Appendix 1: Tripartite Statement Appendix 2: Financial Projections
Iteration 3 June 2020
DRAFT
Iteration 3 DRAFT V3.7_ 2020
Page 6 of 11 Agenda Item 7.1
Tripartite Statement
Forth Valley’s Primary Care Improvement Plan (Iteration 3) is submitted to Scottish Government on behalf of our tripartite partnership of Clackmannanshire and Stirling, and Falkirk Health and Social Care Partnerships, NHS Forth Valley Health Board and the Forth Valley Local Medical Committee. All partners recognise and commend the significant achievement in delivering all of the commitments of PCIP Iteration 2 to date. This level of progress has been achieved through highly effective local collaboration and with significant additional, but non-recurrent, investment support from Health Board funding and primary care partnership reserves.
The tripartite partners unanimously agree that the priorities and revised service specifications described in Iteration 3 of Forth Valley’s PCIP continue to set out what we believe is essential to enable delivery of the commitments of the MoU beyond April 2021. Our partners agree that Iteration 3 continues to reflect the revenue costs associated with our assessment of what is required to adequately deliver commitments of both the GMS Contract and the supporting MoU.
We have consistently highlighted a significant recurring shortfall (£1.3m) in the funding provided and are extremely disappointed that our detailed business case seeking additional funding was rejected with no explanation or feedback. In the absence of additional funding for 2020/21, we have implemented a number of non-recurring measures to enable us to progress some elements of the plan and ensureDRAFT we do not lose GP engagement. This includes focussing on phasing of the planned recruitment programme and securing additional non-recurring funding through NHS Forth Valley. These actions do not address the underlying funding gap and it is clear that we will not be able to fully implement the contract by 31 March 2021.
While the focus of work in recent months has centred on our response to the Covid-19 situation our tripartite group is strongly aware of the importance of maintaining the momentum and progress of our PCIP work. We are therefore having a renewed focus on the priorities being taken forward by our three key PCIP working groups.
This is considered essential as we recognise that the new models of care supported by the PCIP have been integral to supporting a level of sustainability in primary care that has allowed our rapid mobilisation response to the Covid-19 situation. Practices have been enabled to work collaboratively to engage with and support our Community Assessment Centres, Triage Hub, Care Home Response Team and Enhanced Community Team. This level of support during the pandemic would not have been practical without our PCIP workforce being in place. They will also play a vital role in practices being able to deliver on their recovery plans as we move forward.
Looking to the near future we will also have additional challenges due to Covid-19 including the delivery of the influenza immunisation programme in the context of pandemic
Page 7 of 11 Agenda Item 7.1 restrictions through alignment with the VTP with the flu programme. There remains a position across Forth Valley that the primary care flu programme will be the responsibility of the practices this year in line with the DES requirements but that the programme for this year, due to the impact that COVID 19 will have on our ability to deliver the usual approach to mass vaccination clinics will require a collaborative approach between the Board and the practices. There is no available funding in our plan that can support this in 2020/21
This plan does not commit IJB or NHS Board funds beyond that set out in the finance plan and so without additional recurring Scottish Government funding, sustainable delivery of the plan by April 2021 is not feasible. This presents significant risks to service resilience, ongoing sustainability of primary care and losing the high level of collaborative engagement between services, partners and primary care. Clarity on the funding position is required as a matter of urgency.
DRAFT
Page 8 of 11 Agenda Item 7.1
Appendix 2: PCIP Iteration 3 Financial Projection
The cost of fully delivering the requirements of the new GMS contract continues to exceed the indicative revenue funding allocation provided by the Scottish Government. Our Primary Care Improvement Plan, originally published in July 2018 and updated in May 2019, has consistently highlighted this issue and reports significant projected shortfalls in financial years 2020-21 and 2021-22.
There are 2 key issues:
1. The profile of the allocation over the 4 year period to 2021-22 is out of sync with the timing of when costs will be incurred due to the necessary pace of the recruitment programme if we are to deliver the contract by the end of the agreed 3 year implementation period.
2. The total value of the overall allocation is inadequate to fully deliver all of the agreed MoU commitments.
Whilst significant work has been undertaken to review the proposed service model in terms of skill mix, the phasing of recruitment and our overall assessment of the total number of staff required to adequately deliver the MOU commitments, iteration 3 continues to reflect the revenue costs associated with our assessment of what is required to adequately deliver
DRAFT the MoU commitments. In addition, iteration 3 now also incorporates the estimated capital costs arising from the necessary eHealth/IT and premises upgrades required to facilitate the successful implementation of the contract.
2019-20 – current financial position
The total number of staff in post or in process to be employed by March 2020 is 125 WTEs (v’s 119 in plan) at a cost of £5.161m for 2019-20 (see appendix 1 for details of current position). Whilst this represents excellent progress, it has only been possible through significant additional non-recurring funding provided in year by the NHS Board and IJBs over and above our 2019-20 Primary Care Improvement Fund (PCIF) allocation.
At this stage in the roll out of the plan, it is recognised that the current profile of expenditure across both IJBs is not precisely in line with Scottish Governments funding allocations for the IJBs largely due to phasing of e.g. transfer of childrens vaccinations from general practice. However, once the plan is fully implemented, it is anticipated that the overall investment at the end of year 4 will be broadly in line the NRAC funding allocations.
2020-21 and 2021-22 financial projections
This year’s PCIF allocation (estimated at £5.962m) requires supplementation of a further £2m additional funding to support the recurring costs of maintaining our plan towards
Page 9 of 11 Agenda Item 7.1 contract delivery in 2020/21. A case, for £1.6m in year and £1.3m recurring, additional funding was submitted to the Scottish Government in December. An email rejection of the case was received at the end of March.
With clarity over our end of year financial position and in light of rejection of our business case, all efforts have been made at tripartite level to maintain and adequately progress PCIP. 2020/21 funding assumptions are outlined in the table below. These unfortunately includes exclusion of lowest priority services (e.g. link workers), detailed revision of costs including individual level pay scales, part year cost alignment with projected start dates, additional support through Action 15 funding, carry forward of under spend and additional board funding. It is clear that without the significant funding in addition to PCIF allocation, further implementation of the plan would not significantly progress during 2020-21 This is a completely unacceptable position to our Local Medical Committee and GP contractors.
NHS FORTH VALLEY 2020-21 2021-22 PCIP FINANCIAL PROJECTION AS AT MAY ESTIMATE ESTIMATE 2020 £m £m WTE 169.55 207.02 Funding assumptions PCIF allocation £5.962 £8.401
IJB reserves & c/f funds DRAFT £0.579 £0.150 NES GPPN trainees £0.068 £0.000 Action 15 mental health £0.367 £0.462 Other NHS Board funding £0.699 £0.192 Total £7.675 £9.204
Forecast expenditure Vaccine Transformation £0.587 £1.480 Pharmacotherapy Service £2.663 £3.437 Community Treatment & Care Services £0.909 £1.140 Urgent care - advanced practitioners £1.625 £1.819 Additional professional roles £1.759 £2.238 Other (link workers & programme mgt) £0.133 £0.381 Total £7.675 £10.494
Underspend(Overspend) (£0.000) (£1.290)
All of the costs incurred in 20/21 will be sustainable within the year 4 PCIP allocation (estimated at £8.4m), however a residual recurrent £1.290m gap remains against the plan to deliver all of the required MoU commitments.
Page 10 of 11 Agenda Item 7.1
Of note the board funding includes NHS core funds which the Board have agreed to make available on a non-recurring basis to enable the PCIP to continue to progress at pace during 2020-21 in light that no additional funding has been granted by the Scottish Government. This funding has previously been used to support sustainability in 2C practices on a temporary and gradually reducing basis. This is not part of the General Medical Services funding envelope and is therefore not in scope in term of the IJB delegated budgets. It also includes recurring funding for workforce superannuation uplift. With respect to financial year 2021-22, it is intended that the final recruitment programme will focus on appointing a further 25 WTE posts during this period. This will increase the total number of PCIP staff to 196 WTEs. In addition, £750k is assigned to adult flu vaccinations for 2021/22. The current situation regarding COVID 19 may bring an additional potential risk if the population cohort for flu immunisation is extended.
Total costs by 2021-22 are therefore estimated at £10.650m, which compare to total available funding of £9.360m, resulting in a longer term £1.290m recurring deficit.
Note that this projection is subject to change pending confirmation of pay awards (currently estimated at 1.5% for 2021-22) and the impact of incremental drift following changes to the Agenda for Change pay scales.
DRAFT
Page 11 of 11
Primary Care Improvement: Practice Update – May 2020 Contact [email protected]
Primary Care Improvement Plan; Iteration 3 The case highlighted the pace, scale and strength of collaboration and implementation achieved in Forth Valley to date. This has been achieved through the enormous efforts of practice teams, clusters, new services, GP sub and programme team. Also with support of significant, non-recurring, additional funding from NHS FV and HSCP Partnerships reserves.
We now know that SG has declined the business case. However, whilst we continue to make the case for additional £1.2m recurring funding, we have £500k further non recurring funding from NHS FV, increased Action 15 funding for mental health posts, some slippage and through extremely detailed budgeting i.e. costing at individual pay scale level and part year costs aligned with likely start dates. This means that we do have the majority of funding available for the coming year. We also have a prioritisation plan which
was informed with GP sub representatives late 2019,
Iteration 3 PCIP in order for us to maintain momentum with the Having all been consumed by the COVID rollercoaster, immediate priorities of our plan and MoU. The I now realise that the March update didn’t go further outcome of this exercise has enabled us to progress than the GP sub. This May update picks up on a few with pharmacotherapy and additional professional things that have progressed. Iteration 3 of Forth roles as first call on available funding for year.
Valleys PCIP has been circulated to GP sub, Falkirk, As of now, we are progressing 40 of the 45 additional Clacks and Stirling IJB, Primary Care Programme posts outlined in Iteration 3 for the coming year, with Board. Scottish Government has delayed the a clear plan for further deployment when additional submission date until 23rd June at earliest which gives funding is received from either local or national us June to complete our governance journey. sources.
What is new in Iteration 3?
PCIP End of Year Snapshot:
Whilst the document outlines more information which has been set out in the government’s guidance • More than 10,500 acute prescriptions for Iteration 3, the plan reiterates the intentions for authorised by the pharmacotherapy team in Jan
year 3 and 4, largely as set out in Iteration 2. We’ve • More than 1200 MSK and Mental Health
tried to highlight any specific changes in this update. appointments available per week
• 1300 phlebotomy appointments per week Of note, we achieved our Iteration 2 workforce plan • More than 1000 ANP appointments per week with more than 120 new roles now in post. Forth Valley is also recognised as one of the few boards who
are on plan and believe that we can deliver our PCIP; if the funding we seek is put in place. Pharmacotherapy Whilst still evolving, four clusters have full Maintaining Momentum pharmacotherapy resource is in place. Iteration 2 A business case for significant additional funding was proposed to continue a cluster by cluster role out of submitted to the Scottish Government in December. full pharmacotherapy resource over 2020 and2021.
This would result in some clusters having no immunisations, generating an income stream, in pharmacotherapy support at April 2021. future years.
Iteration 3 now proposes that all practices will have at Adult Flu: Iteration 3 maintained the objective of flu least partial pharmacotherapy service by autumn transfer in 2021, with practices delivering this in 2020 2020 with full service available in 2021. The interim partial pharmacotherapy service In light of the likely implications of COVID 19 on specification, for implementation in 5 remaining delivery of mass flu vaccinations, the issue of flu clusters, has been agreed with GP sub and shared immunisation programme is recognised as a particular with the relevant clusters. challenge which requires urgent organisational consideration. Do we have funding in place? Yes, Pharmacotherapy is a clear priority for the Do we have funding in place for this? contract and for GPs. We already have a significant Progression of children’s flu, travel and any flu imm’s number of the workforce in place and the partial this year relies on additional funding becoming service has started in Slamannan and the Braes, and available. Year 4 funding will require to be prioritised Bo’ness and Grangemouth. Practices are now to vaccination to ensure delivery post April 2021. starting preparatory work for service to start in Clacks in May and Stirling and West Stirling in Sept / Oct.
As part of the recruitment plan, 6 student technicians will be recruited to initiate a sustainable pharmacy Additional technician pipeline for Forth Valley. Professional Roles Vaccine Transformation All additional roles planned for 2019/21 are recruited. Iteration 2 proposed that re- • 17 primary care mental health nurses working provision of under 5 yrs in 40 GP practices immunisations would extend into 2020/21. Aside • 9.4 Advanced Practice Physio's in 28 practices from rural practices, Falkirk central cluster will be the • 21 ANPs working / training across 5 clusters last to conclude childhood vaccinations by July. and care homes (not yet in all practices) More than 12,000 vaccinations were delivered in the Iteration 3 proposes to implement 14 of the last year with pre-transfer uptake rates for the 0-5 remaining 26 additional roles in 20/21 with the aim Primary Immunisation Programme being maintained. that all practices in NW Stirling, Falkirk, Denny / Iteration 2 also proposed that: subject to available Bonnybridge and Stenhousemuir will have at least funding, it is anticipated that the transfer of all one additional professional role by July. Most will immunisations except Travel vaccinations will have new roles between May and July with some conclude in 2020/21, with Flu and final transfer of posts in addition to these by autumn. 6 ANP posts travel vaccinations completing in year 2021. were advertised with good response at closing date.
Children’s Flu: Iteration 3 proposes that a staged We have recruited more than the planned number of transfer of children’s flu will commence in winter ANPs in 2019. Training and retaining remaining ANP 2020 concluding winter 2021. The scale and target workforce remains a challenge and some phase 1 populations for the first stage are yet to be defined practices await placement of ANP sessions once training is concluded (for most in May). ANP Travel: Iteration 3 proposes that Travel Vaccination commitment to the COVID assessment centres and service in scope for 20/21 will cover NHS routine now CHART team has led to delay in ANP exams and immunisations only with the expectation that the for ANP moves to remaining practices. This is being service will grow to cover yellow fever and non NHS reviewed and whilst ongoing commitment to COVID
services will be required, this will be reviewed and CTAC – Treatment Room plans with practices put in place over the next month. Unlike many other boards, who are investing PCIP funds to develop core treatment room services, Forth It is recognised that the Care Home model requires Valley has an area wide treatment room service. review. The current balance of support to care homes Guidelines for the service are agreed between will require to be reviewed at cluster level. community nursing and GP sub.
Iteration 2 & 3 aligns 8 link workers with year 3 of the Building on the existing service, the transfer of a plan. Currently Falkirk partnership is funding 3 link significant number of B12 injections from general workers who are supporting practices in Denny / practice to treatment room is the only additional Bonnybridge, Falkirk central and in Grangemouth. treatment room service commitment within the PCIP.
Do we have funding? Yes, funding is in place for 14 Funding for CTAC? Recruitment of a further 6 HCSWs additional professional roles. Link worker funding for is agreed which will support Clackmannanshire and Clacks and Stirling remain subject to SG funding case Grangemouth / Boness in first instance. It is hoped and would be targeted to practices with highest levels that secondary care will support the development of a of population deprivation. Falkirk phlebotomy hub enabling and area wide
integrated service. Funding for 2 B12 nurses also in CTAC – Phlebotomy place. Iteration 2 highlighted that 4 clusters would have phlebotomy Infrastructure and Premises Review service at April 2020 and all practices by April 2021. PCIP Iteration 3 also highlights the challenges with Stirling, Denny and Bonnybridge, NW Stirling (non infrastructure and the outcome of the primary care rural practices) are in place with Stenhousemuir premises review which will be submitted as an annexe starting March 2020. to the plan. All practices have also recently been
surveyed and premises condition reports prepared. Iteration 3 confirms the aim for all practices to have access to the phlebotomy service by April 2021. The PCIP Programme and Improvement Team phlebotomy service will generally deliver from one or We were very sad to lose Bryony Murray our two hubs within a cluster, outreaching to practices Improvement Advisor at the end of January. Bryony is with sufficient population or geographical need. The now working with CHAS as an improvement manager. approach for rural practices will be confirmed through an ongoing options appraisal process. A part time Improvement Advisor role, targeted to Practice Managers, was advertised and we are The service will, for the time being, work via EMIS and delighted that Fiona McGirr and Louise McCallum practices will manage patient app’ts into dedicated have jointly accepted the role. They will be practice phlebotomy appointments until IT solution supporting the PCIP programme, seconded for a day a improves. CDM will be rolled out as resource allows. week each for the next year. This will be limited to one annual appointment for bloods BP, weight, urinalysis and pulse as appropriate. A note on Practice Workforce Planning and PCIP It is unlikely that clusters other than Stirling, Denny/ Although GP recruitment is challenging, it is important Bonnybridge and Stenhousemuir will receive CDM to remember that the principles of the PCIP and the beyond phlebotomy in 20/21. GMS Contract are to support GPs working in practices and to allow GPs to spend the time with patients with We are now working more closely with secondary who require GP input the most. care to develop a more integrated approach including maintaining the recently initiated phlebotomy hub in The PCIP workforce is an additional resource and FCH. should not be seen as an alternative or replacement for GP sessions.
Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 7.2
Clackmannanshire and Stirling HCSP Mobilisation Plan
For Noting
Paper Approved for Submission by: Annemargaret Black Paper presented by Wendy Forrest Author Wendy Forrest / Ewan Murray Exempt Report No
Page 1 of 5 Agenda Item 7.2
Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
To provide the Integration Joint Board with the HSCP Purpose of Report: Mobilisation Plan and an update on the activity described within the Plan
The Integration Joint Board is asked to:
· Note the content of the HSCP Mobilisation Plan Recommendations: · Note the financial framework and financial reporting to Scottish Government
1. Background
1.1. On 11 March 2020 John Connaghan, who was at the time, Chief Performance Officer, NHS Scotland and Director of Delivery and Resilience wrote to all NHS Chief Executives requesting, within one week, a local mobilisation plan preparing for COVID-19. This letter was copied to Local Authority Chief Executives and to HSCP Chief Officers.
1.2. The Plans were expected to follow a similar format within each Health Board area and sought to cover the following areas:
1. How you will scale up ITU and what is the timescale. 2. How you will scale up your general bed capacity in line with the return you made last week. 3. What your plans will be to scale back elective inpatients, day cases and outpatients commencing next week and assuming that by the end of March you are capable of scaling back all non-urgent elective treatment but maintaining a full cancer and urgent care service. This should specify numbers by specialty by week. 4. How you are working with partners to reduce Delayed Discharges (how much/by when) 5. How you are planning your entire “whole system” response across Acute/Primary/Social Care. We expect that your local response will reflect the views of local partners and particularly IJBs as they finalise their planning in response to COVID-19. I am copying this note to local authority CEXs and IJB Chief Officers in the expectation that your Mobilisation Plan will represent a whole system response to what is an unprecedented situation – with implications which will not respect organisational boundaries”.
Page 2 of 5 Agenda Item 7.2
1.3. The expectation was that each Health Board area’s Mobilisation Plan would reflect joint working across the whole acute and community system with an opportunity for testing new ways of working and taking advantage of the flexibility within the system within unprecedented times.
1.4. Each Mobilisation Plan would also be expected to reflect costs incurred such as staff, training, equipment, and supplies as well as bringing mothballed facilities back on stream.
2. Clackmannanshire and Stirling Health and Social Care Partnership Mobilisation Plan
2.1. On 18 March 2020, as per request from Scottish Government, as outlined above, Clackmannanshire and Stirling HSCP submitted an HSCP Mobilisation Plan with costings to NHS Forth Valley. A pan-Forth Valley Mobilisation Plan was then submitted by NHS Forth Valley directly to Scottish Government.
2.2. At the same time, the HSCP Mobilisation Plan was shared with both Council Chief Executives and the Chair and Vice Chairs of the Integration Joint Board.
2.3. At this time, the Cabinet Secretary declared the NHS is in an emergency situation so the Plan reflected the mobilisation of all HSCP resource available. As described above, the focus for the HSCP was to be effectively managing individuals who were delayed unnecessarily in hospital; opening up care homes that were previously closed and not progressing other actions which were not deemed as essential at this time.
2.4. The HSCP had no one delayed in hospital at this time and additional community bed capacity was created with services being brought back into service within Beech Gardens and Allan Lodge care homes. These homes were created to provide 'safe haven care' for people unable to go straight home from a hospital setting.
2.5. The Plan laid out an approach to:
2.5.1. Mobilise additional capacity within community health and care services whilst creating access to acute services for those with intensive care support needs. 2.5.2. Seek additional financial support for the wider third sector, including carers’ centres, third sector interfaces and drug and alcohol support services as well as independent sector services to help build resilience within our communities for those affected by all aspects of the pandemic. 2.5.3. Seek additional staffing through redeployment of staff who have been stood down as a result of ceasing of non-essential services. Additional training was made available through NHS Director of Nursing and through Organisational Development within both Councils. 2.5.4. Creating as safe a working environment for staff as possible from all sectors through timeous access to PPE; supporting all opportunities
Page 3 of 5 Agenda Item 7.2
for home working; and access to support and resources linked to effects of COVID-19 on mental health and well-being.
2.6. The HSCP Mobilisation Plan laid out the HSCP’s continuity planning for COVID-19 whilst continuing to take account of the strategic aims of the HSCP Strategic Plan to support people at home or in a homely setting where possible.
3. Mobilisation Plan Financial Framework
3.1. The Mobilisation Plan was submitted with a detailed financial plan as additional monies were being made available by Scottish Government to support the delivery of essential services through the course of the pandemic. The HSCP worked with NHS FV and both Councils to effectively manage spend and ensure that spend was made available for frontline support for the most vulnerable in our communities.
3.2. The additional resources sought via the initial Mobilisation Plan submitted to NHS Forth Valley for onward submission to Scottish Government – totalled an estimated cost of £6.920m to cover additional care and support required within the community as described previously.
3.3. The current estimated cost per the Mobilisation Plan return of 18 May 2020 totalled £12.4m reflecting current estimated cost impact including Financial Assistance to Social Care Providers and an assessment of savings delivery at risk.
3.4. Work is ongoing with Scottish Government colleagues to secure approval for expenditure within the Mobilisation Plan, secure financial allocations to support cash flow and inform discussions with UK Treasury. Cost estimates will continue to be reviewed and refined in light of service requirements and actual cost levels being incurred. Work is ongoing to integrate this process into monthly reporting cycles.
3.5. An initial weekly reporting template was completed by the HSCP and returned to Scottish Government with detailed spend against priorities. This has subsequently moved to a monthly reporting schedule from May 2020.
4. Conclusions
4.1. The development and delivery of the HSCP Mobilisation Plan has demonstrated how whole system working can deliver focused and integrated community health and social care services within a wider context of acute and emergency hospital services and third and independent sector provision.
4.2. The impact of COVID-19 on the wider IJB budget going into 2020/2021 continues to be analysed and is described in more detail in the financial report to this meeting. Furthermore an assessment of the impact on the IJBs Medium Term Financial Plan will be prepared based on Quarter 1 financial
Page 4 of 5 Agenda Item 7.2
performance and reported, initially to the Finance and Performance Committee.
5. Appendices
5.1 Appendix 1 - Clackmannanshire and Stirling HSCP Mobilisation Plan March 2020
5.2 Appendix 2 - Clackmannanshire and Stirling HSCP Mobilisation Plan Financial Return May 2020
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities Mental Health Supporting people living with Dementia Alcohol and Drugs
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications Ongoing review of budgetary impact as described within the Finance: body of the report As detailed within the body of report and appendices Other Resources:
Legal: Risk & mitigation: Equality and The content of this report does/does not require a EQIA Human Rights: Data Protection: The content of this report does/does not require a DPIA
Page 5 of 5 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Clackmannanshire and Stirling Health and Social Care Partnership Mobilisation Plan COVID-19 ______Clackmannanshire and Stirling Health and Social Care Partnership is the delivery vehicle for all community health and care services delegated by the three constituent authorities of Clackmannanshire Council, Stirling Council and NHS Forth Valley. This is a unique partnership in Scotland as there are two local authority areas and one health board all of whom have voting members on the Integrated Joint Board alongside representatives of the wider partnership including third sector, carers and community representatives. This Mobilisation Plan lays out the HSCP’s continuity planning for COVID 19 however the HSCP is continuing to take account of the strategic aims of the Strategic Plan to support people at home or in a homely setting where possible. The HSCP Senior Leadership Team has established a senior co-ordinating group with operational, finance and clinical managers; this group has oversight of the HSCP response and supports the business continuity functions of Clackmannanshire Council, Stirling Council and pan-NHS Forth Valley. The HSCP Head of Community Health and Care has established co-ordination arrangements to have oversight of community operational services across the HSCP area. This co-ordination group has service managers and clinicians from across community health and care services in Clackmannanshire and Stirling; as well as from NHS Forth Valley where there are pan-Forth Valley services being co-ordinated on behalf of both Clackmannanshire & Stirling HSCP and Falkirk HSCP. There are representatives from across frontline operational services and senior leadership actively participating in business continuity and resilience planning within Stirling Council, NHS Forth Valley and Clackmannanshire Council.
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020 1. Community support the demand for capacity to acute services in Forth Valley Royal Hospital sites by working towards zero delayed discharge position, including both community hospitals Actions Lead Timescales Status Staffing Finance Impact Implications
1.1 Retain and Expand Carolyn Wylie 31/03/20 Partly in Place Extend £0.501m Additional Capacity requires expansion to existing Tranistion Team Linked 5 to Bellfield (extend winter project) 1.1 Focused MDT activity Carolyn Wyllie 16/3/20 Completed Existing staff on prevention of Current staff admissions and early redeployed planning for discharge Additional £0.033m admin staff
1.2 Focused SW activity on Carolyn Wyllie 16/3/20 In place and being Existing staff £0.563m AWI and the use of actioned by individual Current staff (based on 13za assessment redeployed NCHC plus 20% premia assumption) 1.3 Re-ablement service Carolyn Wyllie 16/3/20 In place and being Existing staff focused activity on actioned by individual management of all assessment Current staff hospital discharges and redeployed admission prevention 1.4 Negotiation with care Jennifer Baird 17/3/20 In place and being Additional care £0.580m home providers to actioned by providers home staff £0.380m (LD identify additional beds Clients)
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
within the community Additional capacity for commissioning £0.070m
1.5 Community Carolyn Wyllie 20/3/20 In place and being Additional care £0.493m reassessment of critical Jennifer Baird actioned with SWs home staff care packages with care and providers at home providers Additional Included at 1.4 capacity for commissioning
1.6 Develop Hospital at Carolyn Wyllie 30/3/20 In planning stages Additional TBC Home model to support clinical nursing enhanced care in and admin community and prevent staff & AHPs admissions
1.7 Retain Care Home Carolyn Wylie 30/3/20 In place 0.5WTE £0.015m Liaison Capacity for 6 months 1.8 All HSCP teams and Carolyn Wyllie 17/3/20 Underway and will 2 x Locums £0.100m activities being reviewed continue as part of OT to ensure they are mobilisation planning delivering supported discharges
1.9 MECS (falls and Carolyn Wyllie 17/3/20 Underway and will Tbc
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
community alarm continue as part of service) focus on mobilisation planning reassessment and identifying where family members as first responders is possible
1.10 HSCP Mobilisation Carolyn Wyllie 17/3/20 Underway and will Additional Included above centre to review delays continue as part of administration daily mobilisation planning Supplies £0.015m 1.11 Care home beds Jennifer Baird April 20 In planning stages Requirement £0.830m (BG) brought back into for deep clean, service / or repurposed staff group, £1.500m (AL) Beech Gardens equipment Allan Lodge including beds £0.744m (LH) Ludgate House (to 20 and all beds) ancillary £0.130m (MH) Menstrie House requirements Strathendrick House £0.629m (SH)
Equipment £0.100m Provision (to be refined)
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
2. Maintain Essential services Actions Lead Timescales Status Staffing Finance Impact Implications
2.1 Monitor daily absences All 16/3/20 In place and working Will be across NHS / Clacks monitored Council / Stirling Council going forward
2.2 Daily Huddle NHS FV All 16/3/20 In place and working
2.3 Three times weekly Wendy Forrest 16/3/20 In place and working Existing staff meetings of leadership team at Stirling Council
2.4 Three times weekly Carolyn Wyllie 16/3/20 In place and working Existing staff meetings of leadership team at Clacks Council
2.5 Seek redeployment All with three HR 16/3/20 Underway £0.500m opportunities for staff leads within establishments Link with LA across all employing Supporting Economy agencies Hub to Recruit Staff requiring work / income
Overtime and Bank Useage
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
2.6 HR Departments Wendy Forrest with 16/3/20 Underway across three employing three HR leads agencies support fast recruitment
2.7 Establish HSCP Carolyn Wyllie 16/3/20 Completed Existing staff Mobilisation Centre for Current staff single point of co- redeployed ordination and support Additional Included admin Above requirement
3. Reduction in Non Essential Services Actions Lead Timescales Status Staffing Finance Impact Implications
3.1 Intake Team – social Carolyn Wyllie 16/3/20 In place and will be Existing staff work/social care / monitored through Current staff occupational therapy mobilisation centre redeployed
All non-statutory SW visits and work has ceased – focus on
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
statutory provision including adult protection
3.2 Cancel all planned Carolyn Wyllie 16/3/20 Completed Existing staff respite to free up available beds in the community for discharges
3.3 Review all providers Jennifer Baird 30/3/20 Being reviewed and Additional Business Cont Plans will be monitored commissioning through mobilisation capacity centre Additional £0.033m admin capacity
3.4 Seeking to ensure Carolyn Wyllie 30/3/20 Being reviewed and TBC ACPs in place and will be monitored being reviewed as through mobilisation circumstances change centre to prevent admission and support care at home
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
4. Staff are safe, supported and protected
Actions Lead Timescales Status Staffing Finance Impact Implications
4.1 Promote hand washing Stephanie 15/3/20 Underway Existing through all McInairney resource communications channels across three organisations
4.2 Access to appropriate Carolyn Wyllie 15/3/20 Underway TBC £0.020m PPE Procurement
4.3 HSCP communications Stephanie 15/3/20 Underway Existing in place across three McNairney resource organisations for consistent messaging
4.4 Identify staff at risk and All 16/3/20 Underway Staff numbers provide alternative may reduce – working arrangements predicted 30% absence in care at home staff group
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
4.5 Support home working All 16/3/20 Underway where possible
4.6 Bellfield Centre - limit All 16/3/20 Underway public flow through the building to prevent infection
4.7 Care facilities and care All 16/3/20 Underway homes - limit public flow through the building to prevent infection
4.8 Escalation protocols HSCP SLT 16/3/20 Underway for practitioners have been established through commissioning team to HSCP Senior Leadership Team to support quick and effective decision making.
4.9 HSCP is awaiting HSCP SLT Tbc further detail on the national emergency legislation on adults with incapacity. This
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
will require sourcing appropriate environments to place individuals and ensure appropriate workforce in place to provide care, support and treatment.
5. Working with third and independent sector
Actions Lead Timescales Status Staffing Finance Impact Implications
5.1 Individual dialogue Jennifer Baird 16/3/20 Being reviewed and Existing staff + £0.017m with providers to will be monitored Liaison worker assess capacity through mobilisation role centre
5.2 Identify shift patterns Jennifer Baird 16/3/20 Being reviewed and Existing staff and staffing levels to will be monitored ensure business through mobilisation continuity during centre increased activity
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
5.3 Reassure processes Jennifer Baird 16/3/20 Being reviewed and Existing staff are being implemented will be monitored as per agreed through mobilisation business continuity centre planning in line with contracting arrangements;
5.4 Providers - reassure Jennifer Baird 16/3/20 Being reviewed and Existing staff HSCP that workforce will be monitored management is through mobilisation underway to ensure centre business continuity as systems pressure increases
5.5 Providers - support Jennifer Baird 16/3/20 Being reviewed and Existing staff management of will be monitored capacity i.e. review through mobilisation packages of care to centre ensure that people have safe levels of care
5.6 Providers - support Carolyn Wyllie 16/3/20 Being reviewed and Existing staff management of care will be monitored packages to release through mobilisation any additional capacity centre
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
quickly into the system whether care at home or in care homes
5.7 Third sector ensure Wendy Forrest 30/3/20 In planning stages £0.050m essential support is in TSIs place for the most Carers Centres vulnerable and to combat the long term effects of social isolation which will result from self- isolation.
5.8 Third sector Wendy Forrest 30/3/20 In planning stages £0.150m organisations have TSIs already come forward Carers Centres with offers of support, and informally organised community groups are offering support on a neighbourhood level
5.9 Coordinate requests Wendy Forrest 30/3/20 In planning stages for support across TSIs established third sector Carers Centres organisations in the Clackmannanshire and
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
Stirling area, who have the systems and processes in place to offer assistance to vulnerable groups e.g. PVG checks, reference checks, specialist skills
5.10 Access to support and Wendy Forrest 30/3/20 In planning stages good practice to inform TSIs community groups that Carers Centres have been created specifically to support the COVID 19 pandemic and are operating at a community or neighbourhood level
5.11 Utilise the skills and Wendy Forrest 30/3/20 In planning stages Included above experience of wider TSIs third sector Carers Centres organisations operating in services that cannot currently continue, for community cafés, face to face groups or social enterprises
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 Mobilisation Plan Appendix 1 - HSCP Mobilisation Plan 18 March 2020
Actions Lead Timescales Status Staffing Finance Impact Implications
relying on trading. These organisations have the means to assist the most vulnerable members of our community, but without being usefully redirected to priority tasks they will be forced to close, losing staff and valuable infrastructure for our rebuilding efforts following the COVID 19 Pandemic
Total Estimated Cost £6.920m
18TH MARCH 2020 VERSION 1.2 Agenda 7.2 - Mobilisation Plan Appendix 2 - HSCP Mobilisation Plan 18 May 2020 with costings
COVID-19 Local Mobilisation Plan- Financial Plan- H&SCP
Instructions Please complete the below table to reflect your indicative financial plan for response to COVID19. Duplicate tabs as necessary for each HSCP Update cells in yellow Figures are in £s Please include sufficient narrative to support figures recorded in the template. Where costs do not fit into any of the categories given, please put in 'other', with description in the notes column of what this is for. Please use additional rows where required (under 'Other'). Costs should only be included for additional costs incurred as a result of COVID-19 emergency
Name of Body Clackmannanshire and Stirling H&SCP Finance Contact: Ewan Murray, CFO Date of last update 22-Apr
Key Assumptions
Additional Hospital Beds Please complete tab 'Bed Model (HSCP)'
Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Staff absence rates assumption (%) 25% 25% 25% 13% 13% 13%
Average Unit Delayed Discharge Reduction- Assumptions Number Supporting Narrative Cost (£) NCHC Rates or Cost per Case for LD Residential Delayed Discharge Reduction- Additional Care Home Beds 19 Placements Across older people and Learning Disability Delayed Discharge Reduction- Additional Care at Home Packages 0 tbc Partnership have very low reductions in packages with these being predominantly at service user request. There is significant cost impact of maintaining this position Delayed Discharge Reduction - Additional Residential Home Beds 10 10 beds at Beech Gardens now open and required to take pressure of intermediate care and community hpospital capacity and ensure system flow. Delayed Discharge Reduction- Contingency for Further Residential Home Beds 48 Not opening at this point but ensuring 25 beds available early to mid May as contingency. Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures
Revenue Capital Revenue Capital Body incurring H&SCP Costs 2019/20 2019/20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 2020/21 Supporting Narrative cost (NHS or LA) Additional Hospital Bed Capacity/Costs - - 66,250 66,250 66,250 ------
221,522 97,917 97,917 97,917 97,917 97,917 97,917 97,917 97,917 97,917 97,917 97,917 April includes £161k revenue refurb and equipping costs for Beech Gardens and Allan Lodge £52k of this cost relates to Delayed Discharge Reduction- Additional Care & Residential Home Beds LA having Allan Lodge available in extremis but hopefully not required. Beech Gardens opened first April. Delayed Discharge Reduction- Additional Care at Home Packages 41,083 41,083 41,083 41,083 41,083 41,083 41,083 41,083 41,083 41,083 41,083 41,083 LA Estimate per previous. Still to be reviewed for next return. Delayed Discharge Reduction- Transistions Team 41,750 41,750 41,750 41,750 41,750 41,750 41,750 41,750 41,750 41,750 41,750 41,750 Both Delayed Discharge Reduction- OT supported discharges 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 Both Delayed Discharge Reduction- Enhanced Community Team (ECT) Expansion 25,639 51,278 51,278 51,278 51,278 51,278 51,278 51,278 51,278 51,278 Delayed Discharge Reduction- other measures Personal protection equipment 24,668 4,167 4,167 4,167 4,167 4,167 4,167 4,167 4,167 4,167 4,167 4,167 LA Some local supplementary procurement still required. Partcularly masks. Deep cleans 18,447 3,825 3,825 3,825 3,825 3,825 3,825 3,825 3,825 3,825 3,825 3,825 LA Estimated per guidance Estates & Facilities cost 2,000 LA Infection Control Equipment for Additional staff overtime 14,472 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 Both Aiming to refine on service by service basis over comign weeks Additional temporary staff spend 14,000 215,779 139,846 139,846 100,000 100,000 100,000 61,667 61,667 61,667 61,667 61,667 61,667 Both Covers pay for staff isolating also including bank. Additional cost from Contract Rate Uplift 22,667 22,667 22,667 22,667 22,667 22,667 22,667 22,667 22,667 22,667 22,667 22,667 LA Early estimates working through detailed calculations for next return. Includes PA rates. Additional costs for externally provided services 600,000 250,000 250,000 250,000 250,000 150,000 150,000 150,000 150,000 150,000 150,000 LA High level estimates. Spread over year with assumption sick pay claims will reduce over year. Cost to 3rd Parties to Protect Services (where services are currently 85,599 85,599 85,599 85,599 85,599 85,599 stopped) Strathcarron Hospice and Marie Curie Additional costs to support carers LA Assumed Additonal Carers Payments made nationally compensates Mental Health Services Additional FHS Payments- General Opthalmic Services 5,321 10,642 10,642 10,642 Additional FHS Payments- GP Practices 415,000 143,000 NHS Per 7 April Allocation Letter. Additional FHS Prescribing 480,000 24,417 24,417 24,417 24,417 24,417 24,417 NHS Per national assumptions. £480K 19/20 cost managed by NHS FV. Community Hubs Other Community Care Staff Accommodation Costs Additional Travel Costs Loss of income Not yet examined impact but could be considerable. IT & Teleconferencing Costs 422 400 5,400 5,400 400 400 400 400 400 400 400 400 400 Both Additional laptops for remote working ensuring social distancing Clacks ASC teams Substance Services 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 8,333 Both Additional outreach services etc Mobilsation Centre Costs including admin Cover 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 Both Commisioning Support LA Absorb within existing capacity Care Home Liasion 2,500 2,500 2,500 2,500 2,500 2,500 NHS 6 month enhanced capacity Care Home Support Team (CHART) 5,000 11,667 11,667 11,667 11,667 11,667 11,667 11,667 11,667 11,667 11,667 11,667 Both Marginal Cost @ Some reployment some additional capacity. Estimate of costs at this point. Community Equipment 11,875 56,400 56,400 56,400 56,400 56,400 56,400 Both 3rd and Independent Sector Additonal Liasion Capacity No addition now assumed Additional Admin Capacity - Risk and Business Continuity 2,750 2,750 2,750 2,750 2,750 2,750 2,750 2,750 2,750 2,750 2,750 LA Uniforms to Improve Infection Control in Residential Homes 5,000 LA Proposed use of ADP reserve to match additional support costs for substance users. No offsetting savings currently (480,000) (91,667) Offsetting savings - HSCP identified however will be kep under review. Total 26,297 - 1,212,357 1,392,545 923,184 903,977 827,085 827,085 519,836 519,836 519,836 519,836 519,836 428,169 - Subtotal 9,139,878 Initial estimate subject to further review. Now adjusted for Prescribing savings at risk @ £0.368m (48% of £766k prescibing Expected underachievement of savings (HSCP) 272,083 272,083 272,083 272,083 272,083 272,083 272,083 272,083 272,083 272,083 272,083 272,083 savings at risk) Total 26,297 - 1,484,440 1,664,627 1,195,266 1,176,059 1,099,167 1,099,167 791,919 791,919 791,919 791,919 791,919 700,252 - Total 12,404,870
Flu immunisation 12,496,537 Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 8.1 Financial Report for Year Ended 31 March 2020 For Noting & Approval
Paper approved for submission by Annemargaret Black Paper presented by Ewan Murray, Chief Finance Officer Author Ewan Murray, Chief Finance Officer Exempt Report No
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Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
To present the Integration Joint Board with an overview of the Purpose of Report: financial performance and financial position for 2019-20 subject to statutory audit.
The Integration Joint Board is asked to:
1. Approve the finance report and note the overspend on the Integrated Budget of £0.957m 2. Approve the issuing of final directions for 2019/20 financial year to the constituent authorities. 3. Note the projected overspend on the Set Aside budget for Large Hospital Services of £1.316m bringing the overall overspend on the partnership budget including set aside Recommendations: to £2.273m 4. Note the significant financial pressures and risks across the Partnership budget; 5. Note the agreed risk sharing basis for 2019/20. 6. Note the impact of COVID19, estimated financial quantum of HSCP Mobilisation Plan including current assessment of impact on savings delivery and proposal to further review based on Quarter 1 2020/21 financial performance.
1. Background
1.1 The Integration Joint Board approved an initial unbalanced budget for 2019/20 in March 2019 and further considered options for financially sustainable service delivery in July 2019. The budget was dependent on delivery of a significant savings and efficiency programme, which was regarded as high risk. The budget also included an overall assessment of risks and a clear statement that resources were inadequate to continue to deliver services in their current form.
1.2 The Board and the Finance and Performance Committee have been receiving financial monitoring reports throughout the year. The format of these reports will continue to evolve over time taking due account of relevant elements of the partnerships consolidated response to the Ministerial Strategic Group Proposals on Progress on Integration, aligning investment to strategic priorities, evolution of the Transformation Programme and development of locality planning. Page 2 of 13 Agenda Item 8.1
1.3 The Partnership remains under significant financial pressure as evidenced by the projected out-turn position, albeit the level of projected overspend continued to materially reduce in the later months of the financial year.
1.4 This report should be read in conjunction with Performance Reports to give a rounded view of financial performance and overall Partnership performance.
1.5 Due to various issues including the system wide capacity challenges of responding to the COVID19 pandemic and technical issues associated with supporting remote working it took longer than timetabled to reach a year-end financial position and agree a risk sharing basis.
2. 2019/20 Financial Position
2.1 This financial position for 2019/20 (subject to statutory audit) is an net overspend of £0.957m on the Integrated Budget and £1.316m on the Set Aside budget for large hospital services.
£m
Operational and Universal Health Services 1.012 Adult Social Care Services 0.745
Integrated Budget (Gross) 1.757
Less: Transformation Funding Offset 0.800
Overspend Integrated Budget 0.957
Overspend Set Aside for Large Hospital Services 1.316
Overspend Partnership Budget 2.273
The split of gross overspend on the integrated budget includes a £0.607m adjustment for allocation of staffing costs in the Bellfield Centre.
2.2 The only material financial impact in relation to COVID19 in financial year 2019/20 was in relation to Family Health Services Prescribing. Medicines and therapeutic products dispensed in March were around 20% higher than previously forecast. Actual cost data for March had not yet been received at time of writing however the cost impact was estimated using best information available at £0.480m. Additional funding was provided by NHS Forth Valley to meet this cost.
It is currently anticipated much of this cost may be a timing impact with a possible compensating reduction in April/ May 2020 though. Should this be the case NHS Forth Valley will seek to recover this benefit in 2020/21.
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In any case prescribing costs and volumes will require to be closely monitored in coming months for changes in patterns and possible market price impacts.
2.3 Various movements in budget positions have been evident since the report to the IJB in March (£1.1655m projected overspend on Integrated Budget and £1.325m projected overspend on the Set Aside budget for large hospital services).
There was a significant reduction from previous projections particularly within social care costs in the Clackmannanshire Locality and as such an analysis was requested, prepared and has been shared with the HSCP Senior Leadership Team.
The significant movements within this were in relation to:
· Staffing costs being £0.172m lower than projection due to recruitment plans put in place by the previous locality manager not coming to fruition and less than anticipated offsetting agency staffing costs. · Income being £0.038m higher than projected · Commissioned costs for care at home services being £0.235m less than forecast reflecting a reduction in hours provided including the impact of review activity. · Day Care being £0.022m less than forecast due to adjustments to care packages as a result of review activity.
Outturns positions elsewhere across the partnership budget were broadly in line with projection, prescribing aside.
2.4 The financial outturn includes a non recurrent benefit of £0.826m as a result of favourable resolution of ordinary residence claims as previously reported to the Board. Setting this element aside the provision of Adult Social Care services in Clackmannanshire would be broadly in line with budget.
2.5 It is therefore necessary to remember that the recurrent underlying financial pressure remains, as detailed in the budget and Medium Term Financial Plan approved in March, considerably higher than the 2019/20 outturn.
2.6 The outturn reflects a position significantly below the maximum tolerable level of overspend on the integrated budget for 2018/19 (£2.45m) agreed by the Board for 2019/20 in July 2019.
2.7 As previously reported, it is clear that delivery of the care models within the Bellfield centre are the most significant area of financial pressure for the Partnership. The overspend reported in relation to Bellfield is £1.369m. The concerns previously raised by the Board in relation to early warning of the pressure have been noted and, as previously reported; steps have been taken in consolidating the operational budgets for the Bellfield Centre to prevent recurrence.
2.8 The reasons for the financial pressure in the Bellfield centre are multi-factorial with two key cost drivers. Firstly, continued reliance on agency staffing at
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premia rates to staff the facility and secondly the staffing levels being above the planned workforce model based on an assessment of required safe staffing levels. The Medium Term Financial Plan approved by the Board in March 2020 took cognisance of the requirement for a sustainable service model in the Bellfield Centre.
2.9 The pressure through use of agency staffing is anticipated to significantly dissipate during 2020/21 as a result of successful recruitment efforts. Month 1 costs for 2020/21 are already illustrating a significant reduction in use of agency staffing.
2.10 A review of the care and staffing models, linked to the Post Project Implementation Review is being undertaken but has been delayed as a result of operational pressures in response to COVID19. Potentially, whole system working opportunities can be explored to assist in bringing the service delivery models within the Bellfield Centre into a sustainable position. As previously agreed by the Board, and in recognition of the concerns raised, a report will be brought to the August meeting of the Finance and Performance committee. The report will require to cover lessons learned including financial controls and begin to examine sustainable service delivery models.
2.11 The outturn for the Set Aside budget was a financial pressure of £1.316m which is line with the previous projection of £1.325m. The financial pressure on the Set Aside budget relates to increasing costs, demand and complexity associated with the specialities therein. These include A&E / Emergency Department, General, Geriatric Medicine, Learning Disabilities and Mental Health inpatients services.
2.12 At present the financial pressure associated with the Set Aside budget is met by the NHS Board. There will be a requirement to consider future financial risk sharing arrangements in relation to set aside as part of the set aside project and Integration Scheme review.
2.13 The Transformation Funding offset represents the balance of transformation funding contribution agreed by the Board per previous reports. For context the level of offset from Transformation Funding in 2018/19 was £0.598m. The Transformation Funding is Integrated Care Fund and Delayed Discharge funding form Scottish Government previously called Partnership Funding now relabelled to provide an appropriate distinction form the overall totality of Partnership funding supporting delivery of integration functions.
Reserves
2.14 The Integration Joint Board has a reserves policy and strategy which has been agreed to be reviewed post approval of the Medium Term Financial Plan.This review will now require to take cognisance of the issues detailed in section 4 of this report.
2.15 The Integration Joint Board does not hold any general or contingency reserves. Current reserves are held for specific purposes, generally to achieve
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specific outcomes or national policy objectives such as Primary Care Transformation.
2.16 The reserves position of the IJB at the start of the financial year, as documented in the 2018/19 accounts was £1.977m
2.17 The year end reserves position is a reserves balance of £1.696m meaning that reserves held have reduced by £0.281m over the course of the financial year and this will be reflected in the Comprehensive Income and Expenditure Statement (CIES) within the IJBs annual accounts.
2.18 An analysis of reserves held at 31 March 2020 is detailed at Appendix 2 to this report.
3. Risk Sharing
3.1 The constituent authorities have agreed to meet the overspend on the Integrated Budget after offsetting of Transformation Funding on a voting shares basis as in previous years.
3.2 NHS Forth Valley have agreed to meet the financial pressure in relation to the set aside budget for 2019/20.
3.3 The arrangements above are for financial year 2019/20 only.
3.4 Financial risk arrangements require to be reviewed as part of the review of the Integration Scheme, notwithstanding the need for service delivery to be financially sustainable on a whole system and recurrent basis.
4. Impact of COVID19 and Health and Social Care Partnership Mobilisation Plan on Financial Strategy and Medium Term Financial Plan
4.1 The mobilisation plan and costs update process is described in the COVID19 update paper on this meeting agenda.
4.2 The HSCP Senior Leadership will continue to take an overview of the mobilisation plan and costs submissions to government and press for clarity on approvals and allocation of funding.
4.3 In doing this we require to continue to ensure costs are identified and reported in relation to COVID and work with Scottish Government colleagues to support their discussions and negotiations with UK Treasury.
4.4 The latest costs submission in relation to the mobilisation plan totalled £12.405m with £3.265m of this quantum relating to planned savings for 2020/21 assessed as being at risk.
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4.5 Financial sustainability will be an ongoing concern for the IJB and all constituent authorities and the financial implications of COVID will extend far beyond the current financial year alone.
4.6 It is critical that revitalising the Transformation Programme, Recovery / Renewal and Financial Planning are taking forward together as part of whole system working to both mitigate as far as possible the risks and untap opportunities.
4.7 It is proposed that an initial review of the savings and efficiency programme and the impact on financial planning be undertaken based on the first quarter of the financial years financial performance and form part of the reporting to the August meeting of the Financial and Performance Committee along with updates on mobilisation planning including approvals and allocations from Scottish Government.
5. IJB Annual Accounts
5.1 The position detailed in this report will form the basis of the IJBs Annual Accounts for 2019/20 and Health and Sport Committee financial return.
5.2 Whilst the delay in closing the year end position detailed at section 1.5 has an impact on preparation of draft accounts the IJB Chief Finance Officer is working to ensure draft accounts are available for presentation to the Audit & Risk Committee. The Chief Finance Officer is also liaising with the IJBs external auditors regarding flexibility in the audit programme.
5.3 Whilst COVID19 did not have a material impact on costs in 2019/20, prescribing aside, it will have a profound impact on 2020/21 and beyond and this requires to be articulated within the management commentary of the accounts.
6. Directions
6.1 As part of established year end processes final directions are issued to the constituent authorities reflecting final payment values including the impact of additional contributions for agreed risk sharing as detailed in Section 3.
6.2 The IJB are asked to approve issuing of final 2019/20 directions in line with normal processes.
7. Conclusions
7.1 Whilst the overspend on the integrated budget materially reduced towards the year end and was met on a voting share basis by the constituent authorities it was still dependent on a significant offset from transformation funding which the budget strategy aims to reduce dependence on over the coming period.
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7.2 It will be necessary, as detailed above, to dovetail review of financial strategy with intelligence on resource availability, transformation and recovery/renewal for service delivery to be sustainable.
7.3 It is critical to secure the benefits of the emergency response to COVID19 as part of this process including rapid service redesign and transformation, low delayed discharges, community / home first approaches and use of technologies as integral parts of sustainable service design.
7.4 More than ever this requires integrated service delivery designed around the needs of communities and outcomes for citizens and aligned to agreed strategic priorities.
8. Appendices
Appendix 1 – Overview & Budget Analyses Appendix 2 – Reserves Analysis @ 31 March 2020 Appendix 3 – Final 2019/20 Directions
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities Mental Health Supporting people living with Dementia Alcohol and Drugs
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications Per body of report. Finance:
As referenced in the report. Other Resources:
The report references the Annual Accounts process which is a Legal: statutory duty of the Integration Authority.
Financial Resilience is a key risk detailed within the Boards Risk & mitigation: Strategic Risk Register. Financial planning and reporting is part of the mitigation approaches to assist in managing these risks. Page 8 of 13 Agenda Item 8.1
COVID19 is also reflected in the Strategic Risk Register. Equality and The content of this report does not require a EQIA Human Rights: Data Protection: The content of this report does not require a DPIA
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Appendix I – Overview of 2019/20 Financial Position
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Page 11 of 13 Agenda Item 8.1
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Page 13 of 13 APPENDIX 3 – Final 2019/20 Directions Date Directions issued and recipient – [17 June 2020, Cathie Cowan, Chief Executive, Forth Valley Health Board] – FINAL 2019/20 Direction
DIRECTIONS FROM CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD (the “IJB”) TO
NHS FORTH VALLEY HEALTH BOARD (the “CONSTITUENT AUTHORITY”)
ISSUED UNDER 26(1) OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014
Direction Statutory Function(s) to which Any limitation/ caveat specific Substance of Direction Budget or reference Number Direction relates to Function(s) to where Budget outlined (status – current, superseded or revoked)
All Directions listed below are subject to the following:
1. They shall be discharged within the budget prescribed. The prescribed budget shall be used by the Constituent Authority to discharge the statutory function and deliver services within scope of these Directions; 2. They shall be discharged in a manner consistent with: · the IJB’s Strategic Plan approved on 27 March 2019 · the Integration Delivery Principles; and · the National Health & Wellbeing Outcomes. 3. They shall continue to be discharged, and relevant services shall continue to be delivered, by the Constituent Authority as they were immediately prior to 1 April 2016, subject to any subsequent decision by the IJB which has otherwise directed how that function should be discharged by the Constituent Authority (strategic decisions as to the discharge of any of the functions within these Directions require to be referred to the IJB for a decision prior to implementation); and 4. Any future Direction by the IJB to the Constituent Authority.
19/20 – Per Annex 1 Part 1 of Integration Budget Prescribed Continuation of Delegated Functions & Services Payment £124.394m [NHSFV] – 1 Scheme per Annex 1 Part 1 and 2 of Integration Scheme Set Aside Budget for (Final) Large Hospital Services £22.006m Date Directions issued and recipient – [17 June 2020, Chief Executive, Clackmannanshire Council] – FINAL 2020/21 Direction
DIRECTIONS FROM CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD (the “IJB”) TO
CLACKMANNANSHIRE COUNCIL (the “CONSTITUENT AUTHORITY”)
ISSUED UNDER 26(1) OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014
Direction Statutory Function(s) to which Any limitation/ caveat specific Substance of Direction Budget or reference Number Direction relates to Function(s) to where Budget outlined (status – current, superseded or revoked)
All Directions listed below are subject to the following:
1. They shall be discharged within the budget prescribed. The prescribed budget shall be used by the Constituent Authority to discharge the statutory function and deliver services within scope of these Directions; 2. They shall be discharged in a manner consistent with: · the IJB’s Strategic Plan approved on 27 March 2019 · the Integration Delivery Principles; and · the National Health & Wellbeing Outcomes. 3. They shall continue to be discharged, and relevant services shall continue to be delivered, by the Constituent Authority as they were immediately prior to 1 April 2016, subject to any subsequent decision by the IJB which has otherwise directed how that function should be discharged by the Constituent Authority (strategic decisions as to the discharge of any of the functions within these Directions require to be referred to the IJB for a decision prior to implementation); and 4. Any future Direction by the IJB to the Constituent Authority.
19/20 – [CC] – Per Annex 2 Part 1 of Integration Budget Prescribed Continuation of Delegated Functions & Services Payment £17.323m 1 (Final) Scheme per Annex 2 Part 1 and 2 of Integration Scheme Date Directions issued and recipient – [17 June 2020 Carol Beattie, Chief Executive, Stirling Council] FINAL 2020/21 Direction
DIRECTIONS FROM CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD (the “IJB”) TO STIRLING COUNCIL (the “CONSTITUENT AUTHORITY”)
ISSUED UNDER 26(1) OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014
Direction Statutory Function(s) to which Any limitation/ caveat specific Substance of Direction Budget or reference Number Direction relates to Function(s) to where Budget outlined (status – current, superseded or revoked)
All Directions listed below are subject to the following:
1. They shall be discharged within the budget prescribed. The prescribed budget shall be used by the Constituent Authority to discharge the statutory function and deliver services within scope of these Directions; 2. They shall be discharged in a manner consistent with: · the IJB’s Strategic Plan approved on 27 March 2019 · the Integration Delivery Principles; and · the National Health & Wellbeing Outcomes. 3. They shall continue to be discharged, and relevant services shall continue to be delivered, by the Constituent Authority as they were immediately prior to 1 April 2016, subject to any subsequent decision by the IJB which has otherwise directed how that function should be discharged by the Constituent Authority (strategic decisions as to the discharge of any of the functions within these Directions require to be referred to the IJB for a decision prior to implementation); and 4. Any future Direction by the IJB to the Constituent Authority.
19/20 – [SC] – Per Annex 2 Part 1 of Integration Budget Prescribed Continuation of Delegated Functions & Services Payment £35.769m 1 (Final) Scheme per Annex 2 Part 1 and 2 of Integration Scheme Integration Joint Board
17 June 2020
Agenda Item 9.1
COVID-19 Update Report
For Noting
Paper Approved for Submission by: Annemargaret Black Paper presented by Wendy Forrest Author Wendy Forrest Exempt Report No
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Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
To provide the Integration Joint Board with an update on the Purpose of Report: operational and strategic response to the COVID-19 pandemic
The Integration Joint Board is asked to:
· Note the integrated response from the HSCP to the COVID-19 pandemic · Support the HSCP in the extreme circumstances and the Recommendations: impact that this virus may is having on the workforce and population · Note the financial impact of COVID-19 on the HSCP Budget · Note the decisions taken under Emergency Powers
1. Background
1.1. The purpose of this report is to inform the Integrated Joint Board of the supports put in place by the Health and Social Care Partnership (HSCP) with regard to the current pandemic. The virus has spread across most of the world and is known as COVID-19, which is a new and emerging infectious disease threat.
1.2. There is still much uncertainty around COVID-19’s clinical presentation but the spectrum of the disease may range from mild-to-moderate illness to pneumonia or severe acute respiratory infection. COVID-19 can be spread from person to person and based upon current knowledge there continues to be potential for increased cases or mini outbreaks in our communities.
1.3. Due to the nature of COVID-19, the continuing risk of an outbreak has placed unprecedented pressure on the provision of community health and social care services & NHS acute care across the country, as such putting considerable strain on a range of service provision across third and independent sectors. In response, the HSCP, third and independent sectors have worked tirelessly and collaboratively across boundaries within our communities and alongside acute clinical services within NHS Forth Valley.
1.4. On 10th April, the Cabinet Secretary asked all Health Boards and HSCPs to focus activity on ensuring hospital beds were available for acute clinical care Page 2 of 9 Agenda Item 9.1
to manage the Covid-19 response, whilst ensuring HSCP’s continued to be focussed on ensuring people have access to the care that is most appropriate to their needs and wellbeing.
1.5. As such, the first act from the HSCP within the response to COVID-19 was for all non-essential community health and social care work to cease and for the focus to move to emergency management of the pandemic with and across our communities.
1.6. The HSCP Senior Leadership Team established a senior co-ordinating group with operational, finance, Third Sector Interface Chief Executives, GP leads and clinical managers; this group has oversight of the HSCP response and supports the business continuity functions of Clackmannanshire Council, Stirling Council and pan-NHS Forth Valley. Additionally, senior managers and service managers have been actively participating in resilience planning within NHS Forth Valley through Incident Room at Carseview and with Director of Public Health and his team.
1.7. The HSCP Senior Leadership continues to work with Scottish Government, Chief Officers’ network and Chief Finance Officers’ network at a national level to ensure the most up to date information and to influence the approach to best reflect the position in Clackmannanshire and Stirling.
1.8. A programme of HSCP communications has been developed with a regular staff briefing to managers, staff and trade unions – this includes information for staff on use of PPE, latest guidance for staff employed by NHSFV, Clackmannanshire and Stirling Councils, staff testing, good news stories and news from individual teams working within our communities. As members will know, Integration Joint Board members and Elected Members across both Council areas have been receiving regular briefings on the current response from the HSCP; key updates from operational services and reports on finances linked to the Mobilisation Plan.
1.9 Working with the third sector and carers centres, the HSCP is ensuring that third sector providers are being actively supported and staff are being deployed to support the most vulnerable in our communities e.g. Enable for those with a learning disability and both carers’ centres are keeping in touch with carers, by phone and on-line, and ensuring there are emergency plans in place and escalation & support pathways are easily accessible.
1.10 The HSCP is actively involved in the delivery of community response across Clackmannanshire Council (Clacks Aid) and Stirling Council (Care for People) working with local lead officers in both Council areas to support referral pathways and support from wider system including community pharmacy and primary care.
2. Health and Social Care Partnership Mobilisation Plan______
2.1. At the start of the pandemic the HSCP developed a Mobilisation Plan with key actions and activities alongside a detailed financial framework. This Plan
Page 3 of 9 Agenda Item 9.1
focuses on additional resource required for example additional staffing, a continuation of statutory social work, staff safety, support to the third sector and additional community beds within community settings. This has been submitted and agreed by Scottish Government and has been subject to weekly reported financial updates submitted via the HSCP’s Chief Finance Officer.
2.2. To implement the Plan, the HSCP established co-ordination and mobilisation arrangements to have oversight of community operational services across the HSCP area. This co-ordination group has service managers and clinicians from across community health and care services in Clackmannanshire and Stirling; as well as from NHS Forth Valley where there are pan-Forth Valley services being co-ordinated on behalf of both Clackmannanshire & Stirling HSCP and Falkirk HSCP. There are representatives from across frontline operational services and senior leadership are actively participating in business continuity and resilience planning within Stirling Council, NHS Forth Valley and Clackmannanshire Council.
2.3. The Mobilisation Plan lays out the HSCP’s continuity planning for COVID 19 whilst continuing to take account of the strategic aims of the Strategic Plan to support people at home or in a homely setting where possible. Where this is not possible, practitioners are arranging ‘safe haven’ care; HSCP practitioners and our partners are assessing and reviewing each individual’s situation frequently with a view to providing care at home where this is appropriate.
2.4. Operationally, the HSCP is accelerating integration within frontline supports and services; for example rapid service redesign to move to a hospital at home model. The successful re-ablement transition team, based at the newly opened Bellfield Centre has been expanded; this was initially funded by the Scottish Government’s winter planning initiative and supports people out of hospital to have independent lives through a re-ablement approach.
2.5. In addition, the HSCP is accelerating the development of aspects of the model of care at home across Clackmannanshire and Stirling. The HSCP recognises that the Scottish Government has brought forward legislation to help us to free up capacity within the local health and social care system and this Plan will continue to develop our response to ensure we can take advantage of these additional powers. Whilst at the same time continuing to meet the core statutory social work responsibilities and focus on public protection during this time; arrangements have been reviewed in the context of the current COVID-19 pandemic to ensure compliance and assurance.
2.6. Due to the shift in focus for the pandemic, the HSCP has created a local Care Homes Mobilisation Plan which lays out the approach to provide additional support to care homes across Clackmannanshire and Stirling area.
3. Support to Care Homes
3.1 On the 17 April 2020, the Director General Health & Social Care (DGHSC) and Chief Executive of NHS Scotland wrote to Health Board Chief
Page 4 of 9 Agenda Item 9.1
Executives. The letter set out a number of immediate actions to support the delivery of an enhanced system of assurance around the safety and wellbeing of care home residents and staff in response to this COVID-19 national emergency.
3.2 Within Clackmannanshire and Stirling, there are 13 care homes within the nursing sector, which are commissioned from the third and independent sector and consist of a total establishment of 608 beds. The residential sector is partly commissioned and consists of 13 residential care homes equating currently to 189 beds. In addition to care homes, the HSCP has short-term assessment beds based within the community. The model of care, as expected, is being constantly refreshed and updated as the situation develops to ensure staff and resources are being effectively deployed. Additional support has been identified within primary care and wider team to include nursing, geriatrician and GP support as well social care dedicated to the care homes.
3.3 In April, NHS Directors of Public Health were tasked to take the enhanced clinical leadership for care homes and are responsible for reporting how each home is faring in terms of infection control, staffing, training, social distancing, testing, care standards and the actions that they are taking to rectify any deficits identified. The aim is to deliver an enhanced system of assurance around the safety and wellbeing of care home residents and staff.
3.4 A range of practitioners and professionals already provide clinical and care support to those living within our care homes; general practice and nursing staff provide primary care clinical support; care home liaison nurses provide clinical advice, training and continuous professional development (including palliative and end of life care); allied health professionals support residents develop skills for daily living activities and social workers have a generic oversight of the overall care and wellbeing of residents by undertaking statutory functions such as annual reviews and adult protection investigations.
3.5 In response to COVID-19, and in collaboration with Public Health, the HSCP focused on enhancing and augmenting the current support and care offered to care homes, in order to protect residents as well as their families, and developed plans for a multi-disciplinary team which consists of clinical, nursing and adult social care staff. This multi-disciplinary group was set up by drawing on existing resources, to undertake the monitoring role should any care home be identified as requiring additional support to manage COVID-19 positive residents and staff. In addition to understanding how a care home is responding and managing COVID-19 care, it is equally important to continue to monitor general care standards, which brings a deeper understanding and analysis of their coping mechanisms and resilience. As such, the incident team being led by Public Health is meeting daily with management and clinical leaders from across HSCP, care inspectorate, environmental health, acute, infection control and others. Ensuring that the group can assess and take action with care homes that have identified risks relating to COVID-19 infection and risks that affect the resilience to continue to deliver safe, high quality care.
Page 5 of 9 Agenda Item 9.1
4. Personal Protective Equipment (PPE)
4.1 The continuous community transmission of COVID19 has resulted in a challenging position nationally in relation to the provision of Personal Protective Equipment (PPE) for health and social care staff within the community as well as the provision of PPE to commissioned care services e.g. residential care homes, support providers and carers/personal assistants.
4.2 The HSCP has been in the fortunate position in being able to maintain a robust supply of fluid resistant masks, disposable gloves, disposable aprons and eye protection as advised by Health Protection Scotland for managing COVID19 with community health and social care settings. The HSCP has also been able to maintain a supply of hand sanitiser and soap to allow staff, carers and service users to adhere to the national hand washing guidance.
4.3 Stirling Council and Clackmannanshire Council have maintained the supply chains on behalf of the HSCP, and where there has been pressure on deliveries on individual items of PPE, the Councils have been proactive in sourcing this directly from the supplier/stores. They have, in line with national guidance, established PPE supply hubs for social care providers, commissioned services, care homes, carers and personal assistants where they locally obtain a supply of PPE when their normal supply chain has been unable to deliver PPE to them. This allows services to maintain their support to service users whilst protecting care staff and services users as per Health Protection Scotland infection control advice.
5. HSCP Mobilisation Plan Costs Update and Impact on the Budget
5.1 The Scottish Government currently requires cost and expenditure approvals submissions on a fortnightly basis, though there are discussions regarding moving this to a monthly basis. Guidance on compiling the returns is provided by Scottish Government and is updated regularly. The compilation and completion of the returns continues to be a necessary but labour intensive process, though a move to monthly reporting would reduce the burden.
5.2 The submissions are made on a consolidated NHS Board wide basis with individual tabs relating to the Health and Social Care Partnership specific returns. Cost estimates are made using the best available information alongside management judgement. The process is managed by the Chief Finance Officer and discussed with the HSCP Senior Leadership Team regularly.
5.3 The latest return was made on 18 May 2020 and included an estimated cost impact for 2020/21 of £12.405m. This quantum includes an estimated £3.265m of savings and efficiency plans viewed to be at risk of delivery in the current financial year.
5.4 The costs also include the estimated costs of financial support to social care providers in line with national procurement advice, the Convention of Scottish
Page 6 of 9 Agenda Item 9.1
Local Authorities (COSLA) guidance on commissioned services and principles agreed by COSLA leaders. This covers exceptional additional costs for PPE and sickness/isolation pay and provides for sustainability payments for Care Home Providers linked to the National Care Home Contract. The arrangements for this support is to be further reviewed by the end of June 2020 and is likely to be extended thereafter for the following financial year quarter with further subsequent review at end of September 2020.
5.5 Significant further work is required to ensure exceptional costs related to COVID19 are captured and quantified and the impact of whole system activity, performance and finance is monitored.
5.6 There is a need to closely interlink financial planning to work on recovery / renewal including the shape of the future transformation programme, review of strategic needs assessments, medium term delivery and financial planning.
6. Decisions Taken Under Emergency Powers
6.1. In response to the COVID-19 pandemic and to ensure swift decisions could be taken on Partnership services response to rapidly changing circumstances the IJB agreed an Emergency Powers paper at its March 2020 meeting. The arrangement provided emergency decision making powers to the Chief Officer (or deputy) subject to documented consultation requirements and reporting back to the IJB on decisions taken.
6.2. Decisions taken under these powers were
· Updates and submission of the HSCP Mobilisation Plan to Scottish Government in response to changing circumstances, Partnership performance issues and developing Scottish Government policy and guidelines. · Establishment of the Care Home Assessment & Response Team (CHART) to Support Care Homes · Establishment of Arrangements Financial Assistance for Providers in response to COVID19 and in line with Scottish Government procurement policy and COSLA approved approach on Social Care Sustainability Payments
7. Workforce issues
7.1. The issues in terms of workforce availability and confidence are crucial. Clackmannanshire Council, Stirling Council and NHS Forth Valley HR teams alongside the HSCP managers have been reviewing workforce statistics, illness / absence rates and working from home rates throughout the period of lockdown. This information is being collated at a national level and is helping to inform discussions between senior leaders in SOLACE (Society of Local Authority Chief Executives and Senior Managers), COSLA and the Scottish
Page 7 of 9 Agenda Item 9.1
Government regarding the impact of COVID-19 on service provision, and the key staffing issues that require some form of national consideration.
7.2. Locally, employee attendance information is being gathered on a daily basis by managers across the employing agencies to allow managers to assess resource implications for delivering essential services and also to maintain contact and support those unable to attend work.
8. Conclusions
8.1. The HSCP continues to deliver high quality support and care to communities across Clackmannanshire and Stirling within these unprecedented times; this paper provides an overview of some of the key activity being undertaken across the sector but in no way reflects the totality of the hard work of officers and staff across the HSCP and wider partners.
8.2. Whilst the HSCP, operationally, continues to respond to the emergency situation of the pandemic, is also beginning a planned approach to renewal and recovery which will be shared with members at future meetings of the Board for discussion and comment.
9. Appendices
9.1. None
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities Mental Health Supporting people living with Dementia Alcohol and Drugs
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications Detailed within body of report. Finance:
Page 8 of 9 Agenda Item 9.1
Detailed within body of report. Other Resources:
Legal: COVID 19 is reflected in the IJB Strategic Risk Register. The Risk & mitigation: actions detailed in this report form the service response and mitigation actions to date. Equality and The content of this report /does not require a EQIA Human Rights: Data Protection: The content of this report /does not require a DPIA
Page 9 of 9 Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 9.2
Delayed Discharge Performance
For Noting & Approval
Paper Approved for Submission by: Annemargaret Black Paper presented by Carolyn Wyllie Authors Wendy Forrest, Carolyn Wyllie, Carol Johnson, Jennifer Baird. Exempt Report No
Page 1 of 15 Agenda Item 9.2
Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
To ensure the Integration Joint Board fulfils its ongoing responsibility to ensure effective monitoring and reporting on the delivery of services, and relevant targets and measures Purpose of Report: included in the Integration Functions, and as set out in the current Strategic Plan.
The Integration Joint Board is asked to:
· Note the content of the report. Recommendations: · Approve the management actions and ensure they continue to be taken to address the issues identified through these performance reports.
1. Background
1.1. The Integration Joint Board has a responsibility to ensure effective performance monitoring and reporting relating to services delegated to the Health and Social Care Partnership.
1.2. The purpose of this paper is to update the Integration Joint Board [IJB] on the performance of the Clackmannanshire and Stirling Health and Social Care Partnership in relation to the national delayed discharge target of 2 weeks, and occupied bed days, and local targets agreed during 2019 winter planning.
1.3. A delayed discharge is experienced by a hospital inpatient who is clinically ready to move on to a more appropriate care setting but is prevented from doing so. Delays can occur for a variety of reasons, but are usually due to a lack of capacity of care or services available within the community. For example, there may not be a place available in a local care home, or a person's house may need altered or adapted before they are able to return home. A “Code 9” delay and its various secondary codes are used by HSCPs that are unable, for reasons beyond their control, to secure a patient’s safe, timely and appropriate discharge from hospital.
2. Analysis Of Reasons For Delay
2.1. As at the April 2020 census date (30th April 2020), the Partnership had 8 patients delayed awaiting standard discharge from hospital, and only 1 of who was delayed more than 2 weeks. This was an improvement on previous months. Page 2 of 15 Agenda Item 9.2
GRAPH 1 Standard delays at census with FV agreed target - winter planning 19/20
C&S HSCP FV target
40
35
30
25
20
15
10
5
0 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20
2.2 The graph above shows a clear reduction in delays prior to the COVID 19 crisis, despite an overall rising trend in the number of new admissions becoming delayed discharges. Significant collaborative effort was put in over this period by HSCP staff and commissioned care providers to reduce the number of delayed discharges, for example:
· Planned increase in care at home provider recruitment pipeline after December 2019; · Planned implementation of additional care at home provider routes to build local capacity; · Implementation of the Bellfield Transitions Team to support an individual’s discharge from hospital.
2.3 There has been significant reduction in individuals being delayed in hospital since the start of the pandemic; there have been a number of reasons including increased community capacity as a result of some individuals who voluntarily chose to reduce, suspend or cancel their care packages. In addition, COVID-19 funding through the Mobilisation Plan from the Scottish Government has also enabled an increase in care home placements, both on an interim and permanent basis.
Page 3 of 15 Agenda Item 9.2
GRAPH 2 New Delay Admissions (Baseline 15/16)
15/16 18/19 19/20 20/21
70
60
50
40
30
20
10
0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar
2.4 The national target for patients waiting over 2 weeks from the time they are ready to be discharged is 0 and the HSCP has had a variable performance in this area, but as the graph below demonstrates, has reduced most dramatically during the COVID 19 crisis.
GRAPH 3 HSCP Standard Delays Over 2 weeks
25
20
15
10
5
0 14 15 16 17 18 19 13 13 14 14 15 15 16 16 17 17 18 18 19 19 14 15 16 17 18 19 20 ------Jun Jun Jun Jun Jun Jun Mar Mar Mar Mar Mar Mar Mar Sep Sep Sep Sep Sep Sep Sep Dec Dec Dec Dec Dec Dec Dec
2.5 The graph below shows that performance during autumn and winter months seems to suggest that the delays of more than 2 weeks delay have been caused mostly by those waiting on packages of care. However, this has improved considerably in the spring and the push to reduce delayed discharges during the COVID 19 crisis for the reasons outlined above.
Page 4 of 15 Agenda Item 9.2
Graph 4 DD waits over 2 weeks
Package Of Care HSCP Care Home HSCP
16
14
12
10
8
6
4
2
0
2.6 Within the overall national context the HSCP remains below both national comparators and Scottish average in the numbers of patients delayed due to place availability, however this continues to be a an area of work prioritised by the HSCP.
GRAPH 5 DD Due to Place Availability
HSCP Comparators scot av
16
14
12
10
8
6
4
2
-
2.7 The waiting times for packages in the Stirling area is longer as a result of the greater challenge across urban and rural areas where recruitment and retention of staff is an issue. However, it is expected that the implementation of the new Care and Support Framework contract, previously described to members, across the region will enable capacity building over time.
2.8 In addition, the HSCP has commissioned Stirling Council to undertake a Best Value Review primarily to assess internal, external and hybrid models of care
Page 5 of 15 Agenda Item 9.2
at home provision. This review will offer assurance that care at home business and delivery processes are robust as well as seeking to identify opportunities for improvement and innovation.
GRAPH 6 DD census waits - number waiting for packages of care
POC clacks POC stir
20
18
16
14
12
10
8
6
4
2
0
2.8 The graph below shows that the reduction in delayed discharges has meant a reduction in bed days occupied in the last quarter of the year. The HSCP continues to monitor this closely to ensure continued good performance.
Graph 7 Standard Bed Days Occupied at Census
Standard FV winter planning Target
900 800 700 600 500 400 300 200 100 0
2.9 Overall the HSCP has less bed days occupied for 19/20 than our national comparators or the national average. When ranked, it sits in the second highest quartile.
Page 6 of 15 Agenda Item 9.2
Average daily number of beds occupied 2019/20 including a national and comparator average for benchmarking. 180 160 140 120 100 80 60 40 20 0 Fife Other Moray HSCP Angus Falkirk Stirling Orkney Scotland Highland Shetland Midlothian Inverclyde EastLothian Dundee CityDundee Comparators Bute & Argyll West Lothian West Glasgow CityGlasgow Renfrewshire EastAyrshire Aberdeen CityAberdeen North Ayrshire North Aberdeenshire South Ayrshire South Perth & Kinross & Perth ScottishBorders CityEdinburgh of North Lanarkshire North South Lanarkshire South EastRenfrewshire Clackmannanshire EastDunbartonshire Dumfries & Galloway &Dumfries West Dunbartonshire West Comhairle nan nan SiarEilean Comhairle
2.10 In addition to the noted standard delays, there are patients whose discharge from hospital is complex (code 9) and whose discharge is part of a longer discharge planning process (code 100). The graph below shows a reducing trend for Code 9’s although some delays are being caused by COVID 19 (Infection Codes) and this will impact on data in the short term. The table (table 1) below shows the more complex cases delayed in Forth Valley Royal Hospital, Larbert at the April Census date.
Table 1 Code 9 and Code 100 Local Authority Guardianship Code Infection Total Code 9 Code 100 9_Other Codes
Clackmannanshire 0 0 1 1 1 Falkirk 11 0 1 12 1 Stirling 1 3 2 6 3 Glasgow City 0 1 0 1 0 West Lothian 0 1 1 2 0 Total FV 12 5 5 22 5
Page 7 of 15 Agenda Item 9.2
Graph 9 Code 9 (at census point)
12 Stirling Clacks
10
8
6 People
4
2
0 15 16 17 18 19 15 16 17 18 19 15 16 17 18 19 15 16 17 18 19 15 16 17 18 19 20 16 17 18 19 20 ------Apr Oct Apr Oct Apr Oct Apr Oct Apr Oct Apr Jun Jun Jun Jun Jun Feb Feb Feb Feb Feb Aug Aug Aug Aug Aug Dec Dec Dec Dec Dec
2.11 Analysis of Code 9 data over the previous year shows the HSCP slightly higher than our comparators, but overall our performance is better than comparators and national averages.
Table 2
Health, Delayed social % of discharg Average Delayed % of Delayed % of care, total Code 9 e daily discharge total discharge total patient reasons % of bed days number bed days bed days and total 2019/20 of beds 2019/20: 2019/20: family occupied ages age 75+ related 2019/20 18 to 74 reasons Scot Average 16,944 46 5,671 33% 11,273 67% 13,589 80% 3,355 20% Comparator Average 13,752 38 4,099 33% 9,653 67% 11,314 83% 2,438 16% HSCP 12,630 35 4,185 35% 8,445 65% 10,090 80% 2,540 20% Clackmann anshire 2,412 7 1,073 44% 1,339 56% 1,746 72% 666 28%
Stirling 10,218 28 3,112 30% 7,106 70% 8,344 82% 1,874 18%
3 Preventing Delayed Discharges
3.1 The graph below shows that the HSCP has been increasing the number of patients discharged every month; however, the trend of new patients has also been rising every month. Work is therefore ongoing to evaluate the current pathways and thus develop new models of care within the HSCP to reduce the number of new admissions, through the development of a prevention agenda. Page 8 of 15 Agenda Item 9.2
Graph 10 HSCP Monthly Delays V Discharges COVID Mar/Apr 2020
Total Discharges in the month. Graphs using this data 7/9/9c/9e (Source: monthly report tab 3 table 4 column F) New delays Graphs using this data 7, 8,9, 9d (Source: monthly report tab 3 table 4 column G) 80
70
60
50
40 People
30
20
10
0
3.2 The HSCP continues to work to reduce delays to peoples discharge by retaining some of the rapid redesigns and commissioning new models of care. For example, in response to the pandemic consultant geriatricians joined the community enhanced care team to provide assessment, management and care to frail elderly people across Forth Valley. Their activity has focused on assessments of those referred to the Rapid Access Frailty Clinic, assessment and management of residents in care homes, education and training to the enhanced care team nursing staff and provision of step up care to community hospitals. However most importantly this team is providing an alternative to admission to FVRH, a more detailed data analysis of impact will be provided in future performance reports.
3.3 Within adult social care, this preventative work can be developed through a Step Up or Step Down model of care where teams work collaboratively to deliver care in the community rather than in an acute setting. For example, Step Up involves clients being admitted to the community hospital or provide a higher level of support in their own home. A Step Down model involves a rapid discharge from hospital with assessment, rehabilitation and or support continuing in the clients own home.
3.4 The data in the graph below includes intermediate bed-based care provided within the Bellfield and Ludgate, and re-ablement short-term enhanced home care in Clackmannanshire. Work is ongoing to identify re-ablement step up data in Stirling.
Page 9 of 15 Agenda Item 9.2
HSCP Step up total 25
20
15
10
5
0
16 17 17 18 19 19 20
16 17 18 19
16 17 17 18 18 19 19 20
16 17 18 19
18
------
- - - -
------
-
Jul Jul Jul Jul
Jan Jan Jan Jan
Sep Sep Sep Sep
Nov Nov Nov
Mar Mar Mar Mar
May May May May BellfieldNov
3.5 Health care provided in the community includes District Nursing, REACH, and the Enhanced Community Team. They, too, undertake a preventative role within the community. The graphs below show the beginnings of an attempt to identify and collate data that measures some of this work, and work is ongoing to develop data gathering processes within the new data management resource called MORSE.
3.6 The graph below shows some of the work identified by the community-based teams to prevent delayed discharges.
Page 10 of 15 Agenda Item 9.2
Admission To ReACH Services
ReACH Clacks ReACH Rural ReACH Stirling CCHC In Patients Bellfield Patients
90 80 70 60 50 40 30 20 10 0 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19
Page 11 of 15 Agenda Item 9.2
4 Conclusions
4.1 There has been significant improvements in the number of delays reported by the HSCP over the past 3 months, which despite the current pandemic is attributed to a number of key factors such as:-
· Planned increase in care at home provider recruitment pipeline in December 2019; · Planned implementation of additional care at home provider routes; · Implementation of the Bellfield Transitions Team to support discharges; · Allied Health Practitioners working over a 7-day period; · Streamlining pathways and processes; · Oversight of delays under one manager.
4.2 This evaluation will continue in the coming months in order to promote integration and sharing of resources and skills between teams to provide an improved service for patients in a homely setting.
4.3 As the HSCP moves into a planned recovery and renewal phase the learning from the pandemic, service managers will continue to use the lessons learned and good practice developed during the emergency phase of COVID-19.
Page 12 of 15 Agenda Item 9.2
5 Appendices
Appendix 1 shows performance against Winter Planning trajectories agreed with NHS Forth Valley in 2019. It shows that demand for packages of care continue to be greater than what is actually provided. This is only in relation to delayed discharges and does not include those waiting for packages within the community or those who received a package who remained at home during this period.
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities
Mental Health Supporting people living with Dementia Alcohol and Drugs
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications Services are provided within existing resources, unless action Finance: was taken through the Mobilisation plan. Other COVID 19 Mobilisation Plan Resources:
Legal: COVID 19 – reduction of delayed discharges to ensure Risk & capacity within Forth Valley Royal to deal with COVID 19 mitigation: Pandemic. Equality and The content of this report does not require a EQIA Human Rights: Data Protection: The content of this report does not require a DPIA
Page 13 of 15 Agenda Item 9.2
APPENDIX 1 Delayed Discharge Trajectory Winter 2019
Table 1 Delayed Discharges Bed Days Lost Census Ex code 9 EX code 9 Month Target Actual Waits Target Actual Waits >2 weeks
April 19 18 Care Home 1, POC 13 , Assessment 4 137 237
May 19 19 Care Home 5, POC 9 , Intermediate 2, 137 356 Assessment 1, Adaptation 1, Support Acc 1
June 19 25 Care Home 3, POC 15 , Intermediate 4, 137 505 Adaptation 2, Support Acc 1
July 19 27 Care Home 0, POC 17, Intermediate 7 137 667 Assessment 1, Adaptation 1, Support Acc 1
August 19 17 Care Home 5, POC 8, Intermediate 1 137 336 Assessment 1, Adaptation 2
September 19 Care Home 2, POC 12, Intermediate 2 137 334 19 Assessment 1, Adaptation 2
October 19 21 Care Home 3, POC 15, Intermediate 0 137 482 Care Home 2 Assessment 2, Adaptation 1 POC 7
November 37 Care Home 9, POC 20, Intermediate 5 137 786 Care Home 7 19 Assessment 2, Adaptation 1 POC 11
December 30 28 Care Home ,2 POC ,19 Intermediate 4 137 701 Care Home 1 19 Assessment 3, Adaptation 0 POC 14 January 20 24 22 137 516 February 20 21 137 320 20 March 20 17 11 137 148 April 20 17 8 137 56
Page 14 of 15 Agenda Item 9.2
Table 2 All Delays Bed Days Lost Total Month Total Month Discharge NHS FV data includes code 9 includes code 9 Hospital Hospital Destination Month not admissions Discharges POC demand is actual & wait. census Month Target 19/20 18/19 Target 19/20 18/19 19/20 18/19 18/19 19/20 19/20 POC Demand
April 61 78 98 861 777 969 42 55 45 34 Care Home 8 37 POC 24 Intermediate 2
May 61 81 76 861 859 741 50 34 51 48 Care Home 4 50 POC 41 Intermediate
June 61 92 62 861 1029 810 47 29 20 35 Care Home 2 36 POC 21 Intermediate 11
July 61 97 68 861 895 40 32 23 37 Care Home 5 33 POC 16 Intermediate 16
August 61 89 86 861 1023 897 48 40 37 58 Care Home 4 46 POC 38 Intermediate 14
September 61 75 92 861 943 929 38 47 47 35 Care Home 5 35 POC 23 Intermediate 7
October 61 102 90 861 1146 982 64 45 30 61 Care Home 10 52 POC 37 Intermediate 12
November 61 109 100 861 1188 937 54 57 69 38 Care Home 6 41 POC 21 Intermediate 11
December 61 96 72 861 1287 903 42 39 30 49 Care Home 6 48 POC 29 Intermediate 14
January 61 102 102 861 992 972 53 50 53 55 Care Home 6 56 POC 39 Intermediate 9
February 61 95 79 861 795 879 49 43 33 52 Care Home 9 46 POC 33 Intermediate 10
March 61 94 92 861 804 863 56 41 45 68 Care Home 11 51 POC 44 Intermediate 13
April 61 37 861 269 22 42 34 29 Care Home 9 14 POC 13 Intermediate 7
Page 15 of 15 Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 10.1
Review of Integration Scheme
For Noting
Paper Approved for Submission by: Annemargaret Black Paper presented by Lesley Fulford Author Lesley Fulford Exempt Report No
Page 1 of 5 Agenda Item 10.1
Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
Advise on the Statutory Duty to review the Integration Scheme for the Clackmannanshire & Stirling Health and Social Care Partnership. Purpose of Report: Update on progress with the Statutory Duty to review the Integration Scheme for the Clackmannanshire & Stirling Health and Social Care Partnership.
The Integration Joint Board is asked to:
· Note the requirement to review the Integration Scheme (section 2.2). Recommendations: · Note the progress of the review (section 3). · Note the actions (section 4) being taken forward in June, if the emergency response to COVID-19 pandemic has reduced.
1. Background
1.1. The Public Bodies (Joint Working)(Scotland) Act 2014 sets the framework for integrating adult health and social care, to ensure a consistent provision of quality, sustainable care services for the increasing numbers of people in Scotland who need joined-up support and care, particularly people with multiple, complex, long-term conditions.
1.2. The Integration Scheme is a legally binding agreement between Councils and Health Board who are known as ‘the parties’ in the Integration Scheme. The scheme describes what the parties will do to enable the Integration Joint Board (IJB) to meet its responsibilities (or ‘delegated functions’). It does not describe what the IJB will do in detail. The IJBl became responsible for adult and older peoples services in April 2016. The scheme contains high level statements of commitment to ensure flexibility and accommodate future changes.
1.3. The current Integration Scheme can be found on the Clackmannanshire & Stirling Health and Social Care Partnership website here: https://clacksandstirlinghscp.org/about-us/integration-scheme/
2 Agenda Item 10.1
2. Integration Scheme Review
2.1. The current Integration Scheme was approved by all Constituent Authorities and endorsed by the then Partnership Transition Board in June 2015.
2.2. The Integration Scheme was submitted to Scottish Ministers on 1 April 2015, as required, and was approved by Ministers on 4 September 2015 where it was laid before Parliament before coming into force on 3 October 2015.
2.3. Under Section 44 of the Public Bodies (Joint Working)(Scotland) Act 2014 paragraph (5) the Constituent Authorities have a legal duty to formally review the Integration Scheme five years from its date of approval, in this case by October 2020.
2.4. If the Integration Scheme is not reviewed, the Constituent Authorities would be in breach of the Public Bodies (Joint Working)(Scotland) Act 2014. To mitigate this risk, the Integration Scheme must be finalised, approved by Constituent Authorities and submitted to the Cabinet Secretary for Health and Sport for approval.
2.5. There is no requirement for the Integration Scheme to be laid before Parliament going forward.
3. Progress With Review
3.1. On 21 January 2020 a session was held with:
o Chief Officer (HSCP) o Chief Finance Officer (HSCP) o Programme Manager (HSCP) o Chief Executive of Clackmannanshire Council o Section 95 Officer for Clackmannanshire Council o Chief Executive of NHS Forth Valley o Director of Finance for NHS Forth Valley o Chief Executive of Stirling Council o Section 95 Officer for Stirling Council o Chief Officer – Governance, Stirling Council o Senior Manager Legal and Governance, Clackmannanshire Council
3.2. The programme manager took the group through a presentation which set out the requirements (section 2 above) and identified areas for review and updating, these were:
o Local Governance Arrangements o Local Operational Delivery / Arrangements o Performance o Clinical and Care Governance o Finance o Participation and Engagement o Information Sharing and Data Handling
3 Agenda Item 10.1
3.3. This was the initial review of the Integration Scheme and an agreement had been made to have a session (mid April 2020) with wider representation (including IJB Elected Members, Non Executives and others) to make agreements as to how to proceed. However, due to our ongoing efforts to respond to the COVID-19 pandemic this work is currently not being prioritised and will be revisited. The existing Integration Scheme remains in place.
3.4. This session will require to be rescheduled.
4. Actions Required
4.1. Reschedule the planned session and ensure agreement has been reached.
4.2. An action plan to be developed; and ensure relevant leads are tasked with writing any required amendments to the Integration Scheme sections if required.
4.3. Chief Executives present the Integration Scheme (with any amendments if there are any) for approval by the Constituent Authority.
5. Conclusions
5.1. The paper outlines the Constituent Authorities statutory responsibilities to review the Integration Scheme as set out in section 44 of the Public Bodies (Joint Working)(Scotland) Act 2014 paragraph (5).
5.2. Actions identified in this report will enable the Constituent Authorities to meet their statutory responsibilities to review the Integration Scheme as set out in section 44 of the Public Bodies (Joint Working)(Scotland) Act 2014 paragraph (5).
5.3. Reports, similar to this one, will be presented to Constituent Authorities for noting.
6. Appendices
None to note.
Fit with Strategic Priorities: Care Closer to Home Primary Care Transformation Caring, Connected Communities Mental Health Supporting people living with Dementia Alcohol and Drugs
4 Agenda Item 10.1
Enabling Activities Technology Enabled Care Workforce Planning and Development Housing and Adaptations Infrastructure
Implications None to note. Finance:
Time of relevant staff members to attend a session and draft Other Resources: any potential changes to the Integration Scheme. The paper outlines the Constituent Authorities statutory responsibilities to review the Integration Scheme as set out in section 44 of the Public Bodies (Joint Working)(Scotland) Act 2014 paragraph (5). Legal: Actions identified in this report will enable the Constituent Authorities to meet their statutory responsibilities to review the Integration Scheme as set out in section 44 of the Public Bodies (Joint Working)(Scotland) Act 2014 paragraph (5). If the Integration Scheme is not reviewed, the Constituent Authorities would be in breach of the Public Bodies (Joint Working)(Scotland) Act 2014. To mitigate this risk, the Risk & mitigation: Integration Scheme must be finalised, approved by Constituent Authorities and submitted to the Cabinet Secretary for Health and Sport for approval. Equality and The content of this report does/does not require a EQIA Human Rights: Data Protection: The content of this report does/does not require a DPIA
5 Clackmannanshire & Stirling Integration Joint Board
17 June 2020
Agenda Item 10.2
Urgent Decision Making
For Approval
Paper Approved for Submission by: Annemargaret Black Paper presented by Lindsay Thomson Author Lindsay Thomson Exempt Report No
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Directions No Direction Required Clackmannanshire Council Stirling Council NHS Forth Valley
To seek Board approval to extend the urgent decision making Purpose of Report: authority which was delegated to the Chief Officer and Chief Finance Officers by the Board in March 2020.
The Integration Joint Board is asked to:
1 Continue the delegated authority to take such urgent measures or decisions as are required to
1.1 The Chief Officer (or the Chief Finance Officer or their substitutes) 1.2 for the period up until at least 23 September 2020 Recommendations: 1.3 and to take those decisions in consultation with the Chief Executives of the constituent authorities (as appropriate), the Section 95 officers of the Constituent Authorities and Director of Finance (NHS FV) and the Chair and Vice Chair of the IJB (if available) before exercising that delegated power.
1. Background
1.1. This paper seeks to extend the period of time for the additional decision making capacity delegation by the IJB to the Chief Officer in March. It is proposed that the delegation is extended until the date of the next Board meeting in September. This delegated authority has been used to date in order to allow the Clackmannanshire and Stirling Health and Social Care Partnership to respond quickly to the current coronavirus pandemic. Details of the decisions taken under this delegated authority are reported to the Board elsewhere on this agenda.
Page 2 of 4 Agenda Item 10.2
2. Considerations
2.1. At its meeting in March 2020 the Board granted delegated authority to the Chief Officer and Chief Finance Officer, in consultation with the Chair and with partners, to take urgent measures or decisions in connection with the Coronavirus pandemic. The Board also agreed that the delegated authority would be reviewed at the Board meeting in June 2020.
2.2. As indicated previously the Board operates a scheme of delegation which provides authority for the Chief Officer to make some decisions without formal Board approval. The extension to the period of delegated authority will allow the Chief Officer to continue to take decisions which would otherwise have been reserved to the Board in order to address urgent challenges and to ensure that the Health and Social Care partnership can respond timeously.
2.3. It is anticipated that this expanded delegation will continue to be exercised in accordance with the Board’s existing policy framework and governance structure unless there is an urgent requirement to depart from the Board’s existing policy or budget.
2.4. It is anticipated that the delegation will continue to be necessary throughout the summer period as the HSCP responds to the easing of lockdown measures, any increase in cases and the recovery process.
2.5. It is recommended that the requirement for consultation with the Chief Executives of the constituent authorities, the Section 95 officers of the Constituent Authorities and the Chair and Vice Chair of the IJB continues as that will ensure that there continues to be a degree of Board oversight of the exercise of the additional delegation where possible and a joint up approach to decision making with constituent authorities. In addition the September Board meeting will be able to review any decisions taken under this additional authority.
3. Conclusions
3.1. The coronavirus pandemic continues to pose a significant risk to the continuity of service delivery in the Partnership. Extending the period of delegated authority will allow the Chief Officer to continue to take urgent decisions to ensure that the Partnership can continue to deliver health and social care to our communities at this time.
4. Appendices
None to note
Fit with Strategic Priorities: Care Closer to Home x
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Primary Care Transformation x Caring, Connected Communities x Mental Health X Supporting people living with Dementia X Alcohol and Drugs x
Enabling Activities Technology Enabled Care x Workforce Planning and Development x Housing and Adaptations x Infrastructure x
Implications
Finance:
None Other Resources:
Legal: This report provides for delegated decision making to allow Risk & mitigation: business critical decisions to be made during the period when the Board will not meet Equality and The content of this report does not require a EQIA Human Rights: Data Protection: The content of this report does not require a DPIA
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