Paper 26
East Ayrshire Health & Social Care Partnership Integration Joint Board 29 August 2018 at 2pm The Open Space, Ayrshire College, Hill Street, Kilmarnock
Present: Councillor Douglas Reid, East Ayrshire Council (Chair) Mr Eddie Fraser, Director of East Ayrshire Health & Social Care Partnership Mr Alistair McKie, NHS Non-Executive Director Councillor Tom Cook, East Ayrshire Council Councillor Neil McGhee, East Ayrshire Council Councillor Ian Linton, East Ayrshire Council Ms Shirley Ferguson, Employee Representative, East Ayrshire Council Ms Hazel Borland, Nurse Director, NHS Ayrshire & Arran Mr Jim Baird, Stakeholder Forum Representative Ms Fiona Smith, AHP Senior Manager, NHS Ayrshire & Arran Prof. Ian Welsh, NHS Non-Executive Director Ms Yvonne Templeton, Stakeholder Forum Representative Mr Craig Stewart, Associate Nurse Director, NHS Ayrshire & Arran
In Attendance: Ms Amanda McInnes, Senior Manager Business Support Mr Alex McPhee, Senior Manager Finance Mr Erik Sutherland, Senior Manager Planning and Performance Ms Maxine Ward, Senior Manager Community Health and Care Ms Linda Surgeoner, Senior Manager Community Health and Care Ms Jacqui McNeil, SDS Peer Mentor Ms Susan Taylor, Head of Children’s Health, Care & Justice Ms Pamela Milliken, Head of Primary Care & Out of Hours Community Response Services Mr Pat Kenny, Delloitte Dr Phil Korsah, Associate Medical Director, NHS Ayrshire & Aran Ms Aileen Anderson, Committee Secretary (Minutes)
Agenda Discussion Action
1. Welcome & Apologies
Councillor Reid welcomed everyone to the meeting and noted apologies from Dr Alexia Pellowe, Dr Brian O’Suilleabhain, Mr Gordon McKay, Dr Alison Towning and Dr Crawford McGuffie.
2. Minute of Previous Meeting held on 13 June 2018
The minute of the previous meeting were agreed as an accurate record of discussions.
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3. Matters Arising
Equipment and Adaptations: Stair Lifts It was noted that the Stair Lifts adaptations work is underway and an update report will be brought to the Board in March 2019.
Financial Plan 2018/19 The Financial Plan was included in the agenda.
Finance Plan 2018/19 The finance plan will be presented to the Audit & Performance Committee in December 2018.
4. Annual Performance Report and Wellbeing Delivery Plan Annual Report
Mr Erik Sutherland presented the Annual Performance Report and Wellbeing Delivery Plan.
It was noted that the Draft Annual Performance Report had been published online on 31 July 2018 and was approved by the Audit & Performance Committee on 14 August 2018.
Discussion took place regarding the number of personal carers achieving SVQs and that this had reduced within the last year. It was highlighted that the Partnership had a strong partnership with Ayrshire College in delivery SVQs for personal carers which would include greater involvement from senior officers within the Partnership to provide input to ethos and values within future courses.
The Board noted and agreed the following recommendations: i. Note that the Annual Performance Report has been approved by the Audit and Performance Committee at its meeting of 14 August 2018; ii. Approve the onward progress of the Annual Performance Report to partners to the Integration Scheme, specifically East Ayrshire Council on 20 September 2018 and to Ayrshire and Arran NHS Board on 08 October 2018; iii. Note that the Annual Performance Report and Wellbeing Delivery Plan Annual Performance Report will be presented to the joint meeting of the Council and Community Planning Partnership on 20 September 2018 and to the Community Planning Partnership on 27 September; and iv. Ensure the Chief Officer ensures that accessible version of the Annual Performance Report are publicly disseminated.
5. Audited Annual Accounts
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Mr Alex McPhee presented the report to advise the IJB of requirements introduced by the Local Authority Accounts (Scotland) Regulations 2004; present the Annual Accounts for the financial year ended 31 March 2018 and for the Board to consider the external auditors ISA 260 Report.
It was noted that due to definitive management action to alleviate pressures and achieve cash releasing efficiency savings as well as an additional non-recurring allocation of £2.205m from East Ayrshire Council, the Partnership had spent les in 2017/18 than had been originally budgeted.
ISA260 Report – External Audit Report
Mr Pat Kenny confirmed that the ISA260 had been presented in full to the Audit and Performance Committee and that he was happy to sign the document providing reasonable assurance in the audit, advising that the financial statements of the Partnership were well executed and maintained.
The Board noted and agreed the following recommendations: i. Note the audited final outturn position for the IJB for 2017/18; ii. Note the content of the Independent Auditor’s Report; iii. Note the content of the separate External Auditor’s ISA 260 report detailing the outcome of the audit as presented to the Committee; iv. Direct the Chief Finance Officer and Chief Auditor of the IJB to respond to recommendations for improvement as outlined in the Action Plan; and v. Approve the East Ayrshire Health and Social Care Partnership audited Annual Accounts.
6. Annual Budget Update Report
Mr Alex McPhee presented the report to provide details of the updated budget position for the East Ayrshire Health and Social Care Partnership.
The report presented the annual allocation from both integration partners and the financial savings from both NHS Ayrshire and Arran and East Ayrshire Council.
The total approved delegated budget for 2018/19 £222.828m including Lead Partnership adjustments, Set Aside and delegated functions will allow the Partnership to proceed with service planning whilst delivering cash releasing efficiency savings and meeting its commitments for service areas with demand pressures.
The Board were informed of an additional £199,000 Cash Releasing Efficiency Savings which had been allocated by the NHS to the IJB as a saving to address the current financial challenges.
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The Board noted and agreed the following recommendations: i. Note the 2017/18 budget delegated to the IJB by NHS Ayrshire & Arran £145.369m. This budget reduces to £135.295m when adjusted by £8.868m in respect of Scottish Government integration/ social care funding to offset Council commissioned service expenditure and by £1.206m in respect of Council commissioned mainlined Integrated Care Fund projects; ii. To Direct NHS Ayrshire & Arran to deliver services on behalf of the IJB within this £135.295m delegated resource in line with strategic planning priorities; iii. Approve the additional cash releasing efficiency savings proposal outlined; iv. Note the risks around delivery of additional cash releasing efficiency savings £0.400m on top of the initial £5.017m approved on 26 April 2018 including the impact of the exclusion of elements of Primary Care and Mental Health budgets from CRES and the wider risks; v. Note the additional risk on staffing budgets from the proposed £0.199m contribution to NHS corporate turnover targets; and vi. It was noted that there is an additional £3m NHs Ayrshire and Arran corporate staff turnover target of which it is proposed that £0.199m be allocated through a reduction of £0.199m in the NHS allocation to East Ayrshire IJB. The 2018/19 delegated budget does not include this recurring in- year adjustment at this stage. The IJB agreed that it is appropriate to approve this additional cash releasing efficiency saving pending the reduction to the budget whilst noting the operational risks associated with delivery of additional staff turnover savings going forward. vii. Note the programme of budget transformation and service reconfiguration being taken forward through the Strategic Commissioning for Sustainable Outcomes Programme Board including mitigating management action to achieve financial balance in the current financial year.
7. Financial Management Report to 31 July 2018
Mr Alex McPhee presented the report to provide details of the projected outturn position for the Partnership for 2018/19, based on the current financial position as at 31 July 2018.
The initial approved budget excluding hosted services adjustments £230.213m had increased to £232.133m at 31 July 2018. The net increase related to additional funding allocations partially offset by other movements for the year-to-date for both Council and NHS delegated budgets for directly managed services.
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The Board noted and agreed the following recommendations: i. Note the projected outturn position for East Ayrshire Health and Social Care Partnership at July 2018, including specific key actions on significant variances; ii. Note the continuing projected overspend on children’s outwith placements and the continuing financial risk for the IJB in the current financial year; iii. Note progress towards achievement of approved cash releasing efficiency savings; iv. Note the projected outturn position in respect of services managed under Lead Partnership arrangement; and v. It was noted that there is an additional £3m NHs Ayrshire and Arran corporate staff turnover target of which it is proposed that £0.199m be allocated through a reduction of £0.199m in the NHS allocation to East Ayrshire IJB. The 2018/19 delegated budget does not include this recurring in- year adjustment at this stage. The IJB agreed that it is appropriate to approve this additional cash releasing efficiency saving pending the reduction to the budget whilst noting the operational risks associated with delivery of additional staff turnover savings going forward. vi. Note the current position in respect of large hospital set aside budgets.
8. Kirklandside Hospital – Reprovisioning
Ms Amanda McInnes presented the report to update the Committee of the reprovisioning of Kirklandside Hospital and associated services from the current site in Kilmarnock.
The Rowallan Ward which provided inpatient care at Kirklandside had been closed in 2016 due to environmental challenges which impinged on patient care. After carefully considering stakeholder feedback on how best to re-provision this service, the group agreed on a new ‘blended’ housing model which would allow services available closer to people’s homes and communities. In the interim 10 in-patient beds had been commissioned at Woodlands View from North Ayrshire Health and Social Care Partnership for the next few years to allow a feasibility study to be carried out and the housing options to be developed.
Kirklandside Site is a Service Base for Intermediate Care; Physiotherapy and OT Community Rehabilitation; Community Alarms; Health Promotion; Dietetics and Business Support Services. Plans had been made to relocate staff to four alternative sites within Kilmarnock and liaison was taking place with NHS and EAC HR services regarding Organisational Change Policies.
The Board noted and agreed the following recommendations: i. Note the proposals outlined in the report; and
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ii. Note that the report was being presented to NHS Ayrshire & Arran’s Corporate Management Team; Estates, Environmental and Sustainability Group and Capital Programme Management Group for budgetary approval.
9. Front Door Service
Ms Maxine Ward presented the report to update the Board on the recent investment approved to sustain the transformation on demand management for care at home facilitated by the Front Door model and to update the Board on progress.
The progress and results of achieved by the Front Door Service were recently analysed and it was highlighted that the significant staffing gaps were negatively impacting on the ability to sustain the high performance outcomes previously achieved.
A simulation modelling and analysis exercise was carried out and three options had been presented for consideration with Option 3 (detailed in the report) being the favoured model.
Recruitment was underway and a progress report would be completed in January 2019 to update on the performance achieved against anticipated savings and monthly reporting mechanisms would continue to ensure targets were achieved.
The Board noted and agreed the following recommendations: i. Note the simulation modelling and analysis as the evidence base for the investment; and ii. Confirm the previous Integration Joint Board approval of £216,548 on 13 June 2018 within existing budgets; and consequential Direction to East Ayrshire Council to commission the service.
10. Alcohol and Drugs Partnership – Finance
Ms Linda Surgenor presented the report to provide the Board with an update on Alcohol and Drugs Partnership (ADP) 2018/19 budget allocation and future funding.
During 2017 the Scottish Government consulted on the development of a new joint alcohol and drugs strategy which sought to build on the work achieved in the previous decade and took new developments into account. In 2016 funding allocations to ADP’s nationally were reduced by £15million, equivalent to 23% of ADP budgets.
At the end of 2017, Scottish Government announced an additional £20million for alcohol and drug treatment as part of their budget. It was hoped that the additional resource from Scottish Government would allow the ADP to respond to the changing landscape of drug and alcohol use.
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It was highlighted that the East Ayrshire Council Licensing Board had made the decision to decline new alcohol licenses for shops unless in extenuating circumstanced to try and tackle the increasing use of alcohol in the area.
The Board noted and agreed the following recommendations: i. Approve the current total allocations; ii. Delegate to the Alcohol and Drugs Partnership to establish a commissioning plan for services in East Ayrshire; iii. Direct NHS Ayrshire & Arran and East Ayrshire Council to commission services in support of the Alcohol and Drugs Partnership Action Plan; and iv. Note the timing of the launch of the national strategy and associated additional funding.
11. Alcohol and Drugs Partnership – Drug Related Deaths
Ms Linda Surgenor presented the report to highlight concerns about the number of deaths amongst people with problematic drug use across East Ayrshire and the response developing across Ayrshire & Arran. The Board were asked to endorse the new Strategic Framework: Preventing Drug related Deaths, which set out the overarching response of the three Alcohol and Drug Partnerships in Ayrshire.
In 2016 there were 85 confirmed drug related deaths recorded across Ayrshire and Arran of which 28 were from East Ayrshire with an increase occurring in 2017.
A local group had been established to ensure learning from the circumstances of every death and to identify ways in which responses could be strengthened.
Discussion took place regarding the use of unlicensed drugs and education required relating to these. Mr Alistair McKie highlighted that the Drug Liaison post was joint funded by Local Authority and Health Board to ensure the greatest impact.
The Board noted and agreed the following recommendations: i. Note the rise in the number of drug-related deaths in recent years in both East Ayrshire and Scotland; ii. Note that this report has been presented to NHS Board Ayrshire & Arran; iii. Endorse the Strategic Framework as the direction of travel for use in East Ayrshire; and iv. Agree to receive future updates from the East Ayrshire Alcohol and Drug Partnership about the actions which are being taken.
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12. Pan Ayrshire Intermediate Care and Reablement Service
Ms Maxine Ward presented the report to provide the Board with an overview of work being undertaken to meet the Pan-Ayrshire Enhanced Model for Intermediate Care and Rehabilitation as part of New Models of Care for Older People and People with Complex Care Needs.
Over the past 12 months the Intermediate Care and Rehabilitation Network had helped design a four tier model for Intermediate Care and Rehabilitation across Ayrshire. The model had been developed to provide a single point of access, with screening and clinical triage, ensuring the person was seen by the right service, first time.
Mr Eddie Fraser highlighted that there had been a recruitment event in July which attracted over 200 people with a number of jobs currently at the interview stage of the process. Work would continue to invest in services to reduce admission to hospital.
The Board noted and agreed the following recommendations: i. Note the positive progress being made in the implementation of the Model and to be assured that investment in service developments will allow progress to continue to support shifting the balance of care to communities; ii. Note the progress made since the investment proposal; and iii. Direct the Chief Officer to issue a Direction to NHS Ayrshire & Arran and East Ayrshire Council to commission services in support of the Intermediate Care and Rehabilitation Implementation Plan.
13. Pan Ayrshire Mental Health Services – Budget Update
Mr Eddie Fraser presented the report to seek Board approval for the high level Action 15 plan to develop and build capacity of the mental health workforce in key settings in alignment with national commitments for the delivery of the mental health strategy.
It was highlighted that Action 15 would provide an additional investment of £35million, for 800 additional mental health workers in key settings over the next five years.
Ms Susan Taylor advised that she welcomed the developments proposed however recognised the challenges. Discussion took place regarding the challenges relating to Children Services and it was recognised that the full strategy was not available at present.
The Board noted and agreed the following recommendations: i. Provide retrospective approval for the high level plan and proposal submitted to the Scottish Government on 31July 2018;
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ii. To direct the Chief Officer to issue a Direction to NHS Ayrshire & Arran to delivery services in support of the Action 15 implementation plan; iii. To support the continued development of the plan over the next four years; and iv. Note the report will be submitted for approval to the South Ayrshire Integration Joint Board on 12 September 2018 and North Ayrshire Integration Joint Board on 13 September 2018.
14. Inspection of HMP Kilmarnock
Ms Susan Taylor presented the report to advise the Board of the progress made with the implementation of the Healthcare Improvement Plan following Her Majesty’s Inspection of Prisons Scotland (HMIPS) Inspection of HMP Kilmarnock in November 2016, and to advise of additional improvement activity, including the outcome of the recent Mental Welfare Commission Local Visit.
It was noted that, as at 02 August 2018 the improvement plan had been significantly progressed with 29 actions completed; four actions in progress and one outstanding action requiring a multi- agency approach.
Discussion took place regarding the physical infrastructure of the Prison and the problems regarding HMP Kilmarnock being a private prison. The Board acknowledged the work carried out and improvements since the responsibility for Prison healthcare transferred to NHS Ayrshire & Arran.
The Board noted and agreed the following recommendations: i. Note progress made in implementing improvement actions in respect of the four standards; ii. Note the contents of the current status report in respect of the areas of continuing action; iii. Note the action taken to progress the lack of specialist services to the population of HMP Kilmarnock; iv. Note the action being taken in respect of the inappropriate accommodation within the Healthcare Centre at HMP Kilmarnock; and v. Note the broader range of improvement work taking place, including the Mental Welfare Commission Local Visit Action Plan and the management of prison based contracts for healthcare.
15. Key Developments in Fostering and Adoption
Ms Susan Taylor presented the report to advise the Board of key developments in adoption and fostering services 2015/2018; and to seek endorsement for arranged for enhanced foster care.
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Discussion took place regarding the parity payments being made to Adoption Carers and the financial implications this could have for the Board.
Attention was drawn to Continuing Care, a relatively new legal status which required local authorities to provide Continuing Care until eligible looked after young people were 21 years old. A Continuing Care Policy had been developed for approval, setting out the local approach to the implementation of the legislation and guidance.
The Board noted and agreed the following recommendations: i. Note the completion of the 2016-18 Adoption Service Improvement Plan; ii. Approve the Draft Adoption Services Improvement Plan 2018/20; iii. Approve the parity model for Adoption Allowance outlines in the report for implementation from 01 September 2018, with transitional protection for adopters who are adversely affected; iv. Note the position of the Intensive Fostering Service outlines in the report; v. Endorse the approach being adopted in providing Enhanced Fostering Care where assessed as required; vi. Note the development of the FFT service from Action for Children as outlines in the report; vii. Note the range of work undertaken by the Adoption and Permanence and Fostering and Resource Panels outlined in the report; and viii. Approve the policy paper for Continuing Care.
16. Community Payback Orders: Annual Report 2016/17
Ms Susan Taylor presented the report to advise the Board of the publication of East Ayrshire Community Payback Orders (CPO) Annual Report 2016/17, providing a summary of CPO activity undertaken in East Ayrshire 01 April 2016 and 31 March 2017.
It was recognised that there had been a reduction in the number of Community Payback Orders being issued however the number of hours being put on orders had increased.
The Board noted and agreed the following recommendations: i. Note the work taking place to implement CPOs in East Ayrshire as outlined in the Annual Report (2016/17); and ii. Note the overall reducing trend in CPOs, but with the increasing trend in unpaid work requirements.
17. Audit and Performance Committee Annual Report
Councillor Linton presented the report to present the Board with the 2017/18 Audit and Performance Committee Annual Report for
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consideration and to provide assurance to the IJB that governance arrangements and internal controls are adequate for the IJB.
Councillor Linton thanks the members of the Committee for the contributions throughout the year.
The Board noted and agreed the following recommendations: i. Note the IJB Internal Audit Annual Report for 2017/18; ii. Note and comment on the IJB Internal Audit Plan for 2018/19; iii. Note the External Audit Plan for 2017/18 and the subsequent draft report considered by Committee on 14 August 2018; and iv. Accept the assurance provided by the Audit and Performance Committee as outlined in paragraph 13 in respect of the adequacy of the Governance and Internal Controls of the IJB for 2017/18.
18. Strategic Planning Group Workshop
Mr Ian Welsh presented the Report to provide an update of the Strategic Planning Group Workshop which took place on 15 August 2018.
It was noted that the Strategic Planning Group and the Community Wellbeing Delivery Group had been aligned.
Mr Ian Welsh thanked Mr Erik Sutherland and his team for their work on the Annual Performance Report.
19. Participatory Budgeting
Ms Margaret Bain presented the report to update the Board on the recent Participatory Budgeting (PB) events which were delivered in partnership with the Health and Social Care Partnership Locality Groups.
Money had been made available from Scottish Government called ‘Community Choices’ for local authorities to raise awareness of PB and to hold community events. To take forward PB in localities, meetings were held in each of the Locality Planning Groups to establish a process to take PB forward.
PB events were held in March 2018 across the area with 129 bids being submitted’; of which 74 were shortlisted totally £120,000.
Mr Eddie Fraser highlighted the community empowerment achieved through the PB process.
The Board noted and agreed the following recommendations: i. Note and comment on the progress of the Participatory Budget initiatives;
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ii. Note the distribution of resources across the three locality areas; and iii. Note that lessons learned from the approach will be applied in other resources decisions.
20. Chief Social Work Officer Report
Ms Susan Taylor presented the report to present the Chief Social Work Officer Annual Report covering the period 01 April 2017 – 31 March 2018.
The Board noted and agreed the following recommendations: i. Note the Annual Report of the Chief Social Work Officer 2017/18.
21. Equality and Human Right’s Report Housing and Disabled People: Scotland’s Hidden Crisis
Mr Eddie Fraser presented the report to provide an overview of the Equality and Human Rights Report Housing and disabled people: Scotland’s hidden crisis and its implications for local authorities.
Information on the accessibility of properties was particularly poor in the private sector and the impact on mental wellbeing from living in unsuitable accommodation.
East Ayrshire Health and Social Care Partnership worked alongside the Strategic Local Programme to deliver award winning housing at Lilyhill Gardens in Kilmarnock. There were plans for three additional sites to be located in Hurlford, New Cumnock and Mauchline.
The Board noted and agreed the following recommendations: i. Note the contents of the EHRC report and recommendations; ii. Note the work undertaken by the Council and the Health and Social Care Partnership in relation to support people accessing suitable accommodation.
22. Papers available for Noting
The following papers were available for noting:
Governance Papers Corporate Parenting Integrated Children’s Services in Scotland: Practice & Leadership
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23. AOCB
Nothing to discuss
24. Date of Next Meeting
Development Day – 13 September 2018 at 2pm, Belford Mill, Brewery Street, Kilmarnock
Meeting – 01 November 2018 at 2pm within The Open Space, Ayrshire College, Hill Street, Kilmarnock
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