Meeting Details

The Chair welcomed everyone to the meeting and apologies were noted.

Mr Robertson, as a former manager of North East Sensory Services and having continued links, declared an interest in respect of a number of items on the agenda where there is reference to adult care services.

Having declared an interest the Chair agreed there was no requirement for Mr Robertson to leave the meeting during discussion of the items.

There were no other declarations of Members' Interests in respect of any item on the agenda.

The Minute of the meeting dated 31 October 2019 was submitted for approval.

The Clerk highlighted that the minutes of the Clinical and Care Governance Committee and the Audit, Performance and Risk Committee were not put to the Board for approval and therefore wording should be changed to noting.

Under reference to paragraph 7 of the Minute, Mr Riddell advised it was Mr Robertson who had asked for a change of wording and not Mr Riddell as stated.

Subject to the changes noted above, the Board agreed to approve the minute.

The Action Log of the meeting dated 31 October 2019 was discussed and updated accordingly at the meeting.

A report by the Chief Officer (CO) provided the Board with an update on Community Hospitals and Care at Home services in upper Speyside, the Scottish Health Awards and Self-Assessment action plan for integration.

Mrs Dudek informed the Board that The Scottish Health Awards took place on 14 November 2019.  Moray teams/individuals were finalists in 4 of the 17 categories, with Distress Brief Interventions winning on the night in the Care for Mental Health Category.  The Board wished to formally record their congratulations to those making the finals.

Mrs Dudek reminded the Board that after October’s Board meeting members were alerted, informally outside of formal business, of the potential interim closure of Fleming Hospital to inpatients.  On 1 November 2019, further admissions to Fleming Hospital were stopped on an interim basis and the Minor Injury Unit temporarily closed.  All inpatients at Fleming Hospital have now either transferred to Stephen Hospital or another appropriate facility or have gone home with a care package.  Public meetings have been held and a number of staff meetings.  Although there are concerns, the public understand the difficulties and are keen to be part of the solution.  Mrs Dudek stressed there are the same number of beds available as it has now been possible to open all the beds at Stephen Hospital.  Mrs Harper confirmed the staffing situation is now better, adding staff are also able to assist Turner Hospital as they continue to recruit. Day case services are still provided from Fleming Hospital.

Mrs Dudek continued, stating this change allows the senior leadership team to explore new ways of working and challenge what is possible.  Two workshops have taken place around flow and actions from there are being expedited.  There are Health Care Support Workers in place supporting home carers and further discussions are ongoing around discharge packs and care at home. 

Mr Robertson asked for assurance that staff members are being supported through these changes.  Mrs Dudek responded advising staff have been involved in many discussions and although upset realise changes require to be made.  Hospital staff and doctors are very supportive and in constant dialogue.  Mrs Dudek informed the Board that managers will be more visible in Speyside and supporting care at home staff through healthy working lives initiatives.

Communication pieces around temporary closure of Minor Injury Unit, drop in sessions and Q&As have been prepared.  It was agreed to copy in Board members to the communications.  The Chair and Vice-Chair will also meet with staff in the area in due course.

In response to a question from Councillor Morrison, Mrs Dudek advised an additional pool car has been given to the team in Speyside.  Also secured some additional support from volunteering team in that area which will contribute to assessment around changes for individuals regarding travel. 

Councillor Eagle asked if there is a barrier in the recruitment process.  Mrs Harper advised there is a new process in place which does take a bit longer, however, this is a Scotland wide issue.  Mrs Dudek added she is liaising with Highland and Islands Enterprise and local Business Leaders around what Moray has to offer in a bid to attract more people to Moray for work.

A report will come the January 2020 Board meeting to provide an update on progress with the situation in Speyside.

As stated in the CO report, the improvement action plan developed from the integration self-evaluation submission requires to go through a number of different groups and as such the Chair agreed it will be presented to the Board in January 2020.

A report by the Chief Officer informed the Board of proposed changes to the membership of the Moray Integration Joint Board

Mrs Dudek advised that due to changes in public health, it may not be Mr Littlejohn who would join the Board, as stated in the report.  The Board agreed having public health expertise input would be valuable.

Thereafter the Board agreed to Co-opt Mr Chris Littlejohn, Deputy Director of Public Health and Head of Health Improvement, NHS Grampian, or another member of the Public Health team, to the Moray Integration Joint Board.

A report by the Chief Financial Officer (CFO) updated the Moray Integration Joint Board (MIJB) on the current Revenue Budget reporting position as at 30 September 2019 and provided a provisional forecast position for the year end.

Firstly, Mrs Abdy highlighted an error; the figure under 2.1 (i) is correct, this conflicts with the figure stated in the financial implications section of the report.

Mrs Abdy advised that there is a £1.6m end of year overspend forecast following use of strategic funds.

Mrs Abdy has offered to meet with budget managers to discuss discretionary spend, vacancies etc. to encourage managers to think differently.  The services reviews have proved valuable and Mrs Abdy plans to share the information from these more widely. 

The recovery plan is set out in the report.  Mr Robertson asked what the Board can do to support this process and asked members what the Board is prepared to do differently going forward, making reference to the Strategic Plan.  Mrs Abdy advised she aims to change the style of the report to allow more meaningful conversations, which perhaps a development session could be used to do that. 

In response to a question from Mr Robertson, the Chair advised of the approach taken to discuss set aside; there are quarterly meetings between the NHSG Chief Executive and Moray Council Chief Executive, Chief Financial Officer of MIJB, Deputy Director of Finance of NHSG, MIJB Chief Officer, MIJB Chair and MIJB Vice-Chair. 

Mrs Abdy highlighted that children transitioning to adult services has created a higher than normal financial pressure for the year.  Mrs Abdy continued advising she will be making case of in-year contribution for that and gives assurance to the Board that appropriate conversations are taking place.  Additionally, Health and Social Care Moray (HSCM) will be going out to tender for cost of care for a supported housing initiative which is a better approach.   

The Chair commended the work or Mrs Abdy and her colleagues in producing this report and plan.   

The Board acknowledged the financial position and recognised there may be difficult decisions to make.  Transformation of system in Moray, including Dr Gray’s Hospital, in terms of older people and unscheduled care is the focus, however, it was noted the scale of efficiency needed in-year is significant and clearly there is limited time available to introduce additional saving measures.

Further discussion took place around models of care and elderly medicine where the key is caring for the elderly who are on the verge of becoming acutely unwell and trying to prevent crisis admission.  Part of the Primary Care Improvement Plan is around devising methodologies to keep people safely at home and prevent admission, developing rapid response teams who are community based with Occupational Therapists having a key part to play.   Mr Walker informed the Board there have been no applications for the advertised Geriatric Consultant position. 

Mr Walker assured the Board measures are in place around prescribing and commended work of pharmacotherapy teams.  It was noted there is no control on price and tariffs.  The Board went on to discuss prevention and in particular exercise, to which services can signpost patients to.  Mrs Brown added there are a range of activities in Moray (51 projects) and noted how important it was they are continued to be invested in. 

Mrs Dudek concluded HSCM are key partners around community planning and continue to push those public health priorities around healthy eating, exercise, strengthening and movement.

After further discussion the Board agreed to:

1. note the financial position of the Board as at 30 September 2019, which shows an overspend of £1,453,329 on core services;
   
   
2. note the provisional forecast position for 2019/20 of an overspend of £2,791,556 on core services;
   
   
3. note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC0 and NHS Grampian (NHSG) for the period 1 July to 30 September 2019;
   
   
4. approve for issue, the Directions arising from the updated budget position; and
   
   
5. consider holding a development session to review style of report, narrative and inter-dependencies to allow more meaningful conversations at future meetings.

A report by the CFO asked the MIJB to consider the charges for services for 2020/21 financial year.

Mrs Abdy advised the Contributions Policy is currently under review and will be in place April 2020, the final policy will be presented to the Board thereafter.

Mrs Abdy highlighted Moray is below the Scottish average for community alarm charges and suggest over the next few years they be brought in line with national average.  The Board noted it was very useful to see what Moray is charging and subsidising compared to other areas and agreed failing to set reasonable charges impacts on overall budget.

Thereafter the Board agreed to:

1. adhere to the request of the Moray Council that the MIJB recommend to them, the charges for the services delivered within the delegated functions;
   
   
2. approve the changes for recommendation to Moray Council for approval and inclusion into their budget setting processes; and
   
   
3. note the recommended charges will be subject to assessment for the socio-economic impact and reported back to the MIJB where there is significant impact and no mitigation.

A report by the CO presented the draft MIJB Climate Change Duties Report submission for 2018/19.

Following discussion the Board agreed to approve the draft submission to Sustainable Scotland Network for the reporting year 2018/19.

A report by Isla Whyte, Interim Support Manager, informed the Board of the Health and Social Care Moray (HSCM), Dr Gray’s Hospital and GMED Winter/Surge Plans for 2019/20.

Mrs Dudek advised NHS Grampian have already approved their winter plan.  Content is now in place for Moray.  Mr Metcalfe advised of the mandatory requirement to have a winter plan but noted this is called a surge plan.  Mr Riddell added there will be requirements for a surge plan to be needed all year round but that specific detail / initiatives will be required for over the winter period.

Mrs Dudek advised the allocation of winter funds will be used for additional capacity for discharge coordinator at Dr Gray’s Hospital and for unscheduled short stay accommodation at Loxa Court.

Mrs Dudek advised the operational plan was produced collectively and further work on flow is underway. 

The Board asked that some consideration be given to the timing of the report being presented to the Board and terminology.

After discussion the Board agreed to note that the HSCM, Dr Gray’s Hospital and GMED (the NHS out of hours service) have robust and deliverable plans in place to manage the pressures of surge at any time of the year including the festive period.

A report by the CO provided the Board with further information on the process and estimated timeline for the delegation of Children and Families Social Work Services and Criminal Justice Services.

The Moray Council, at its meeting on 25 September 2019, agreed to proceed with the next steps to implementation in the potential delegation of Children and Families Social Work services and Criminal Justice Social Work Services to the MIJB.  The process of delegation requires the Council to agree on the proposed delegation and a paper went to Moray Council on 27 November 2019 and a similar paper will go to NHS Grampian on 5 December 2019.

Mrs Dudek asked the Board members to state any comments or observations.

Mr Riddell gave his support and commended the Council on this vision.  Mrs Abdy has confirmed discussions will take place around assurance of transition of adequate financial resources. 

The Chair shared his thoughts on the proposal which included, due diligence for short term finance and long term settlement, status of improvement plan and who owns it during transition and thereafter, governance challenges around Chief Social Work Officer (CSWO) and legislative accountability, capacity and expertise (leadership / model), performance and quality assurance, consideration of a shadow period, time needed to review and adjust all supporting plans.

Mrs Dudek confirmed that as part of partnership arrangements in place for children’s services there has been significant involvement already with the improvement plan.  Mrs Dudek continued, stating this move is about line management arrangements for children’s services and not about separating; multiagency plans still set the direction regardless of structure.

Mrs Dudek agreed a shadow arrangement is a good idea for this shared endeavour to allow shared decision making.

Councillor Eagle highlighted the staffing implications and that communication is vital to give assurance to staff.

Mrs Gervaise suggested using some development time to focus on the statutory requirements and children’s services planning arrangements.  Mr Riddell suggested including the wider elected members.  The Board agreed.

After further discussion the Board agreed to:

1. note the proposal by the Moray Council at its meeting on 25 September 2019 (para 5 of the Minute refers) to proceed with the next steps to implementation in the potential delegation of Children and Families Social Work services and Criminal Justice Social Work services to the MIJB;
   
   
2. explore potential of a shadow period during transition if Health Board and Council agree to proceed; and
   
   
3. have a number of development sessions dedicated to children's services including all elected members.

A report by the CO provided the Board with additional key documents supporting the Moray Strategic Plan – Partners in Care 2019-2029 to be published December 2019.

Hard copies of the Strategic Plan were tabled during the meeting.  Mrs Dudek advised there has been minor editorial changes and the addition of the foreword since members last had sight of the plan and formal approval has been delayed until now. 

Board members confirmed they are content with the plan and the foreword.

The four additional documents circulated with papers for approval are:

• Performance Management Framework
  
  
• Organisational Development & Implementation Plan
  
  
• Workforce Plan 2019-2022
  
  
• Communication, Engagement and Participation Plan
  

It was agreed the Performance Management Framework requires further work to align with strategic targets.  It was agreed that the pyramid diagram at section 5 be updated to show MIJB at the top of the pyramid as opposed to vision.

Councillor Eagle made mention to the workforce transformation and effective change section of the Organisational Development & Implementation Plan, where it discusses opportunities for ‘no limits’ innovation.  Councillor Eagle would want this disseminated to all staff.  Mrs Abdy added, now HSCM have these plans it is important staff are sighted on them and are clear about what it means for them.

Mr Metcalfe said it would be good to have a section on realistic medicine – embraces innovation/effective use of resources.

Recruiting and retaining staff remains a key area of focus and approach is constantly being reviewed.  Mrs Dudek made mention again of the work currently underway with the business community.  Mrs Dudek agreed to keep the Board informed of progress with a proposal or update at the very least to the March 2020 MIJB meeting.

Mrs Dudek advised managers will be encouraged to develop and embed a culture that supports transformation and stated there will be further sessions with the Senior Leadership Group around this.  Mr Riddell asked to see some narrative included around how this will be resourced and supported.

After further discussion the Board confirmed they are content with these supporting documents as a starting point and agreed to hold workshops on each plan over the next 12 months to fine tune and take back to the Board in November 2020.  It was noted these are live documents.

Thereafter the Board agreed to:

1. approve the Strategic Plan and note Board members will be formally invited to the launch;
   
   
   
2. approve the suite of high level supporting documents to the Moray Strategic Plan - Partners in Care 2019-2029 with a view to holding a workshop on each over the next 12 months to refine the live documents;
   
   
3. note the strategic documents will be reviewed annually; and
   
   
4. receive a progress update from Mrs Dudek with regards to work underway with the business community in attracting people to live and work in Moray.

A report by the CO provided the Board with an overview of the current strategic risks, along with a summary of actions which are in place to mitigate those risks, updated November 2019.

Mrs Dudek confirmed the next iteration of the risk register will be more in line with the strategic plan.  There is lots of work underway on operational and strategic risk.  There is a scheduled Development session in February to discuss risk appetite.

Mr Metcalfe suggested showing were risks originate from and show how the risk changes.  To get consistency would require local authority and NHS Grampian to adopt one system.  It was agreed to discuss this further at the workshop.  The Chair noted the IJB Chairs meeting is taking place on 29 November 2019 and will agree the terms of reference.  Opportunity to discuss joint systems and coordination.   

Thereafter the Board agreed to note the:

1. amendments to the description of risk; and
   
   
2. the Strategic Risk Register being updated.

A report by Charles McKerron, Integrated Service Manager (Learning Disabilities-Acting) provided an update to the Board of the continuing progress being made in implementing the Learning Disability Transformation Project.

Mr McKerron stated a progression model is being used which focuses on improved outcomes and reduced need for services.  Mr McKerron talked to the report and highlighted section 4.3 which details the additional financial pressure incurred when people who have been placed out of area as children return to Moray as young adults to their own tenancies with support.   Mr McKerron went on to explain a Market Shaping Strategy is used giving an opportunity to have an ongoing conversation with local providers of accommodation to ensure the right model of housing is in place to meet need. The use of the CareCubed tool is being actively used which supports the achievement of personal outcomes for service users.

Mr McKerron advised the Overnight Responder Service has been delayed and will now be implemented in January 2020.  The high level of concern from some clients’ families around this strategy was highlighted to the Board.

Mr Riddell thanked Mr McKerron for this useful and illuminating report and asked if the resources and capacity are in place to keep on track.  Mr McKerron responded advising this is not a short term project and lifelong care in required for these clients.  He went on to advise they are concentrating on the next 3-5 years and assured the Board focus is on sustainability.

Mr Riddell advised of the need to be able to have the wider view of all transformation change projects and see direction of travel.  Mrs Dudek responded advising this started pre-integration and was an early commitment of the change fund.

Mr Metcalfe said this was an excellent example of a transformation project that shows better care and a reduction of cost.  Mr McKerron advised that for those who support the model it is working satisfactorily but stressed that there are service users who are sceptical about the model and feel uncomfortable with this situation.  There are ongoing conversations with patients / carers, everyone has been given the opportunity to have a voice and everyone who was known to the service was communicated with. 

The Board gave thanks to Mr McKerron and restated their support for the Overnight Responder Service trial.  The Board confirmed they are comfortable with the communication carried out and safety measures in place.

After discussion the Board agreed that case studies should not be included in future reports even though permission from clients was granted.  They agreed it was better to depersonalise and allow Board members to make evidence based decisions.  

The Chair requested that the MIJB is not referred to as Committee in future reports.

Thereafter the Board agreed to:

1. note the continuing progress in implementing the Learning Disability Transformation Project Plan as outlined in The Learning Disability Transformation Project Plan as outlined in The Learning Disability Transformation Project Overview;
   
   
2. restate their support for the Overnight Responder Service trial; and
   
   
3. advise officers to not include client case studies in future reports.

A report by Lesley Attridge, Service Manager, informed the Board of the evaluation of the Jubilee Cottages.

Mrs Attridge directed the Board to the costs within the report, set out at 4.15 and 4.16.   An options appraisal is required to establish where else in the system would this client group go if the cottages weren’t available. 

The clients are supported in the cottages via existing workforce teams.  Mrs Attridge acknowledged there has been a shift in the intended use of the cottages.

Mr Walked asked if the cost per annum at 36% occupancy would be the same if 100% occupancy, Mrs Attridge confirmed it would.  In response to a further question from Mr Walker, Mrs Attridge advised HSCM would still cover the cost of these clients if they were not being supported in the cottages i.e. under Tier 2 crisis intervention. 

Mr Metcalfe enquired if the space could be utilised differently.  Mr Attridge advised if there was to be a change in the use of cottages a report would need to go to the Policy and Resources Committee of Moray Council to explore further.  Mrs Dudek advised there are limitations with the cottages i.e. no disabled access.  Longevity and maintenance of cottages to be explored.

The Chair suggested the entry criteria be changed to focus on the outcomes instead to maintain flexibility.  Mrs Attridge advised there have been various elements that have led to low occupancy i.e. age group, physical limitations and lack of knowledge of the resource.

Mrs Attridge sees a much more inclusive use of the cottages where clients have identified health and social care needs and outcomes identified.  Mr Walker added there needs to be a clear entry and exit strategy, not necessarily an end point but a transitions to next appropriate place.  Mrs Attridge advised Moray Council housing department would be part of options appraisal. 

Mrs Dudek concluded there is an opportunity to use this facility and the limitations were always known.  Further work will be carried out between now and March 2020 where all aspects will be considered.  A further report with a very clear position will be presented to the Board in March 2020.

After further discussion the Board agreed to:

1. note the evaluation of the Jubilee Cottages in the report and that the cottages are not being used for the intended use;
   
   
   
2. note the need that has been identified through the pilot for accommodation for those with an assessed health or care need and who do not have suitable accommodation;
   
   
3. instruct officers to progress in partnership with Housing Services, Moray Council, to consider suitable and cost effective options to meet the identified need outlined in the report; and
   
   
4. the outcome of the options appraisal be brought back to the Board in March 2020.

The meeting was chaired by Mr Passmore.

Under reference to paragraph 10 of the minute of the meeting of the Moray Integration Joint Board dated 26 October 2017 the Board agreed that the following items be brought to the attention of the public:

1. update on Speyside - communication; and
   
   
   
2. publication of strategic plan and supporting documents.