Meeting of Integration Joint Board of Aberdeenshire Health and Social Care Partnership

The Integration Joint Board (IJB) of Aberdeenshire Health and Social Care Partnership met on Wednesday 12th October at Woodhill House in Aberdeen.

Membership of IJB

Raymond Bisset‘s term as Chair has come to an end and has stepped down from the role. The IJB formerly appointed Cllr Anne Allan as Chair and Dr Lynda Lynch as Vice Chair.

Cllr Anne Allan thanked Mr Bisset for all he had done in his time as Chair, saying the first term is always the hardest and that Raymond had steered the IJB well through the early days.

Cllr Linda Clark has resigned as a substitute member of the IJB following her appointment to NHS Grampian Board.

Cllr Anne Robertson, Dr Lynda Lynch and Eric Sinclair were appointed to the Clinical and Social Work Governance group. The IJB delegated the appointment of a Chair to the group.

There was a discussion on the future membership of the IJB. Members thought the balance was about right at present. The discussion then centred around service user representation and what form that would take. Cllr Anne Robertson amongst others wondered how representative a service rep could be and how the IJB would communicate with hard to reach groups and communities across Aberdeenshire.

Winter plan

The Winter Plan had been updated following comments from members of the IJB and members were asked to approve the plan for 2016/17.

Partnership Manager for Strategy and Business Services said they had learned lessons from last year’s floods and flexibility and resources were built in should they be required. Mike added that they were not complacent but believed they were in a better position this year than previous years.

Members asked where extra staff would come from if we had a repeat of last year’s floods or if significant numbers of employees were affected by flu. Adam Coldwells said a lot of work was ongoing to increase flexibility of staff in health and social care.

The IJB approved this year’s winter plan

Delayed Discharge

Member were told that the number of Aberdeenshire residents who were delayed in hospital at the end of August was 50, which is the highest since February. The figure is though down from 76 in August last year.

Mike Ogg said the Partnership was working hard to reduce admissions in the first place especially through Virtual Community Wards. Mr Ogg reported a significant increase in what are called Code 9 cases, these are complex cases where often the person is delayed due to guardianship issues.

The IJB agreed that there should be a campaign to encourage people to appoint a Power of Attorney which would help in reducing the number of delays due to legal issues.

Sharon Duncan asked if there was evidence that the current plan and resources on delayed discharge was making a difference.

Chief Officer Adam Coldwells said the best example was the intermediate beds where people are discharged from hospital to beds in a care home for enablement. As many as 80% end up going back home where before the expectation would be that they would move to a care home permanently.

Cllr Anne Robertson asked if the step down beds were in the right place and whether they were taking up beds for people waiting for a care home place.

Adam Coldwells said that it was a difficult balancing act but discussions are ongoing and at the moment it felt like they were getting it right.

Carers Act

Commissioning Services Manager Sheena McIntosh updated members on the implementation of the Carers (Scotland) Act 2016.

The Act introduces a new duty on local authorities to support carers who are assessed as needing support, at present local authorities only have a power to support unpaid carers. The Act also changes the definition of ‘carer’ from one who ‘provides regular and substantial care’ to ‘those who care or intend to care’

The Act further places a duty on NHS to inform and involve carers in the discharge planning of the person they care for.

The Scottish Government have indicated that the Act will commence on 1st April 2018. 

Sheena McIntosh highlighted funding which is being used to allow carers to gain SVQ qualifications as an example of support provided to carers in Aberdeenshire.

Members of the IJB asked about recognition for carers, including the many young carers across Aberdeenshire. Sheena McIntosh said that civic events were held for carers this year and they would be looking to do that again. Cllr Anne Robertson suggested some sort of awards event. Senior officers agreed to consider this.

Care at Home

Members heard that Care at Home is provided by Aberdeenshire Health and Social Care partnership and 24 external providers via a framework agreement.

External service providers range from very small businesses to large national corporate groups.

The care at home provision has broadly moved towards external providers, however internal provision remains the largest. External providers, especially smaller local providers, have found it challenging to sustain a robust business model claiming the dominance of the Partnership has deterred expansion.

The benefits of having an internal service includes the ability to have more control over the training and development of staff and to direct staff to particular areas of work.

The cost of the in-house service is though higher than that of external provision, but is well placed to focus on specialist areas, has a 24hr responder service and can deal with more complex cases.

The Partnership proposes to prioritise internal Care at Home service across four areas:

1. Enablement
2. Rapid Response
3. Complex cases, end of life, palliative care
4. Hard to reach, remote and rural areas

The requirement for externally commissioned care at home would continue to be based around the provision for longer term care for those following the SDS pathway.

Members felt that although this was the right sense of direction, they needed more reassurance that service levels would be maintained and care needs would be met by the external providers.

There was also concern that this would limit choice for service users. If people wanted the Partnership service they might not be able to get it and have to take an external provider.

Adam Coldwells said that people will still have a choice through SDS but also pointed out that sometimes at the moment the Partnership service is the only one for some people either because of locality or because of the complex care required.

Members of the IJB asked for the paper to come back to them in November and include case studies.

Financial Update

Chief Finance Officer Alan Wood presented his second financial monitoring report to the IJB. This covers the financial position to the end of August 2016.

Mr Wood reported that a number of overspends are currently forecast across the Health and Social Care budgets including Prescribing, Community Mental Health and NHS core service, however delayed discharge, the Integrated Care Fund and Scottish Government funding are all forecast to be within budget.

Mr Wood said that although the forecast breakeven position for the year represent a continued stable position from that of the last finance update challenges still remain this year, around balancing service delivery with a focus on reducing costs. Cost pressures of £6.388m are being forecast across Health and Social Care aspects of the service.

Members of IJB agreed to use the £9.504m funding from Scottish Government for adult social care.

 

Integration Joint Board reports for this meeting are available to view online at http://committees.aberdeenshire.gov.uk/committees.aspx?commid=486&meetid=18576