APPROVED
MINUTE of MEETING of the ABERDEENSHIRE CHP COMMITTEE held on THURSDAY 20 NOVEMBER2013 in the Front Room, Hopeville Social Club, Inverurie from 10.00am
PRESENT
Raymond BissetChair / NHS Grampian Non Executive
Ewan BlackFinance Manager
Cllr Karen ClarkAberdeenshire Council
Adam ColdwellsGM, Aberdeenshire &Moray CHPs
Cllr Isobel DavidsonAberdeenshire Council
Philip EnglishHead of Adult Services
Cllr Alison Grant Aberdeenshire Council
Cllr Jim GiffordAberdeenshire Council
Pam GowansDeputy GM – Operations & PC
Lesley MeldrumSenior Communications Officer
Mike OggDeputy GM – Strategy
Robert PatonPatient Representative
Kim PenmanActing Public Health Lead
Ian PowellProgramme Manager
Iain RamsayJoint Project Manager – Integration
Alan Young3rd Sector Interface
IN ATTENDANCE
Pat Alexander PA to Deputy GM – Strategy / Committees
Item No / Discussion / Action1 / APOLOGIES
Apologies were noted from Cllr Anne Allan, Eunice Chisholm, Ritchie Johnson, Bob Liddell, Martin McCrone, Patricia Maclachlan and Maria Walker
2 / MINUTE
Minute of Meeting of the Aberdeenshire CHP Committee held on 10 June 2013 was submitted and subsequently approved.
3 / MATTERS ARISING
3.1Heart Failure Nurse
The CHP had provided funding for heart failure nurse activity over the years after British Heart Foundation funding had ended. This had become difficult to sustain with year on year funding. The turnover of staff was high due to the lack of stability. Support had been sought from the Cardio Vascular Disease Managed Clinical Network, which works on a Grampian wide partnership basis about the process regarding heart failure nurses. This discussion has now concluded with a very positive outcome. A cohort consisting of 5.5 posts will support NHS Grampian and will be funded on a continuing basis to ensure a stable cohort of very valued staff.
Robert thanked the Committee for their help with this matter and was pleased by the good news.
4 / EARLY YEARS COLLABORATIVE
There had been brief discussion on this item at last meeting. The Chief Medical Officer (CMO) for Scotlandis keen in investing in Early Years.
There is good representation from health and the local authority and all have a good grasp. There are 4 workstreams which cover pre-birth through to school age.The programme uses the PDSA methodology getting people to test small changes.There are meetings held on a regular basis in Glasgow where good practice is shared across Scotland. Aberdeenshire also meets on a regular basis with Kim Penman taking the lead for the toddler age group.
A new post of Programme Manager will increase the infrastructure and the focus of attention will be directed towards Peterhead given the greater need in that area. This will be adopted and applied geographically in areas with a range of staff whose role is to support a clinical focus. Workstreams are in place to deal with continuing work and with better and quicker impact would become more focussed in each geographical area.
The EYC is a recent innovation working in partnership to establish pathways with GIRFEC across Aberdeenshire to reconfigure representation in the 6 areas from health and local authority. The Collaboration serves well to remind NHS Grampian of the importance of the Children’s Service and the need for equal balance alongside Older People’s Services.
This initiative has been welcomed by the local authority for the improved clinical outcomes in deprived areas. Cllr Davidson queried whether the CHP would meet equality legislation and what the outcomes would be as there was no comment in the paper about equality regarding the new legislation. This matter would be discussed further outwith the meeting; Mikewill pursue.Work would be progressed around impact and extended to health improvement regarding equality aspects and broader concepts.
Aberdeenshire CHP Committee supported the 4 recommendations in the paper which is to be submitted to the Community Planning Partnership (CPP).
5 / INTEGRATION
Since last meeting there has been the creation of the Transitional Leadership Group (TLG) and the 4 Short Life Working Groups (SLWGs) which will take forward business. Next meeting of the TLG will take place on 4 December 2013 and will be co-chaired by Cllr Karen Clark and Raymond Bisset.
Adam reported that the Bill is progressing through the system and will be law by April 2014. Considerable Governmental work around the detail is underway to deliver on this deadline. Both local organisations agreed on formal progress with appropriate steps for the TLG to be combined locally and comprise of 5 elected members and 5 NHS Grampian Board members. .
Discussion followed about the 4 SLWGs and Adam gave a brief overview of function.
Leadership Group – will provide governance, on behalf of the two parent organisations,to the work of the SLWGs.
Resource Group–is about funding and includes wider aspects of resource ie IT, buildings etc.
Governance Group – will write the “rule book” for the partnership to operate by and progress. A series of chapters have been agreed and names attributed to various areas. A draft will be available in the New Year and will be circulated for comment.
Care Pathways–will set a framework in place for people from the two organisations and the public to engage with and work by.
A seminar held in May 2013 involving a significant number of Cllrs as well as NHS Grampian Board members had been deemed a success and will be repeated on 31 January 2014. This seminar will be highly interactive with small groups of attendees rotating round the 4 workstreams to gain greater insight to how the SLWG will operate and will also provide an opportunity for attendees to pose questions.
Raymond highlighted that all 3 organisations (Aberdeen City CHP, Moray CHP and Aberdeenshire CHP) had agreed on the same body corporate route and to appoint a Chief Officer. The process to recruit is currently in train. Cllr K Grant added that the key message was that we both organisations were moving forward together in a very positive. Noted that representatives from Moray and AberdeenCitywill be invited to the Integration Workshop.
Discussion followed about the newsletter jointly produced and rolled out across both organisations. It was noted that impact was good and information well received throughout all levels although still learning about what is the most effective way to disseminate information. The second edition is to be circulated next week. Other briefings are Local Team Brief on a monthly basis. The staff governance standards require both the organisations to keep people informed and also for staff to seek out information.
Clarification was sought about the Care Pathways Working Group and its impact on targets, performance indicators and patient’s expectations that it might be deemed better because of integration than it might be otherwise have been and in which case not achieved for the benefit of patients. In response, Pam reported that work was at an early stage working generally with standards and seeking for local teams to deliver. Some form of measurement would be required but the system is cumbersome and has not been developed. A preference would be to develop a framework over the year and share with the partnership. Pathway packs would be developed and local teams would be asked to organise resource and themselves around the principles in joint agreement. Noted that national groups assess outcomes and measure how the shift is demonstrated in Scotland. Heather Kelman, GM, AberdeenCity sits on this group.
Ian Powell felt it was important that care be taken not to gather statistics endlessly to prove something that might not be provable. Alan outlined 2 reactions: 1) tangible to deliver to the population at large and 2) given the large amount of public funding and other resources invested in terms of time, people etc what might be the return on investment and how rigorously would this be evaluated. A measure suggested might be whether integration had taken place or not. There is a great belief that this is the way forward to ensure society is sustainable. Noted that when the Bill is passed integration to the Health & Social Care Partnership will become law to which both Health and Local Authority will have to adhere.
Pam suggested that good care happens when people work together. Iain Ramsay felt reassured that work undertaken by the workstreams, as opposed to working with databases and numbers, would produce the outcomes required. The shift in numbers approach would assess the quality of the service.
The Chair summarised by reporting that the CHP Committee was pleased with progress to date and would await the Workshop on 31 January 2013.
6 / DELAYED DISCHARGE / CHANGE FUND
The Chair reported that the original standard for delayed discharge had been 6 weeks but in April 2015 this will be reduced further to 2 weeks. The Performance Governance Committee is very concerned about delayed discharge numbers increasing across Grampian and this will become a challenge for NHS, Local Authority, 3rd Sector, Voluntary Service, Patients and the Public to influence cultural change.
Noted that Aberdeenshire performs well around delay discharge targets in comparison to AberdeenCity.
Discussion followed about DDs in the system and the need for more joined up working between health, local authority and 3rd Sector to get an idea of unscheduled care into the system and manage more effectively to make sure that no-one loses sight of the bigger picture and that the solution involves everyone. Discussion moved to the mental health area and its specific problems. It was felt tighter control across all agencies would assist in the fundamental change required to make people work in a more joined up way for patients across Health and Social Care.
Referring to the new 2 week target to be introduced in April 2015 it was put to the committee that when making a life changing decision for a patient this should not be rushed and that Aberdeenshire should collectively work around the Government’s well intentioned initiative.
Cllr Alison Grant sought clarity about patient’s at home and whether there was a waiting time for OT assessment. Shona advised there was no waiting time in this respect from health assessment but was less sure about the Council’s OT service and their waiting times for modifications..
Pam went on to report on emerging work with unscheduled care across Grampian to assist with rapid response from GPs within one hour using only one telephone number to access this immediate support. This would be used where appropriate to manage patients at home. There was a belief this had to happen due to the differences in decision making. Noted the clinical decision response from the Medical Officer would be crucial. A key challenge of the CHP integrated body will be engaging with the public and taking account of the changing expectations of what can and cannot be done.
Anticipatory Care Planning has been discussed with patients, carers and families to optimise decisions and equate to lower admissions and reduced length of stay. However, many people will still require admission however good the anticipatiory care plan is, for example, if you have a stroke. Pam felt that good systems are in place for the length of stay project and are making a significant difference.
A short piece of work is underway via the OMT around audit.
The Chair summarised discussion by highlighting the great challenge ahead and that considerable work is ongoing via the projects in place.
CHANGE FUND
Members had before them the JIT mid year survey about the Partnership’s use of the Change Fund. The submitted paper had previously been discussed at the Health & Social Work Committee. It was noted that more Change Fund resource would be available to achieve what Aberdeenshire wanted to achieve. The challenges for social work regarding the Change Fund would be the non continuation of this financial resource and the issues created as a result of this. After the 3 years of injected additional funding to act as leverage it was not thought any Partnership would be able to continue to fund initiatives at the same level. This issue to be discussed with Directors of Finance from Health and Local Authority.
The accompanying paper which listed initiatives operated on behalf of the Government was noted by the Committee.
Cllr Alison Grant sought clarity about government funding for the acute sector. In response Adam advised that this issue remains an interesting challenge for the Government. Over the past few years rhetoric has indicated a continued disinvestment in the acute sector with more going to the community; however the ever increasing demand to chase waiting time targets made this very difficult for the NHS. This remains a question for MSPs and MPs to raise. He felt this shift in resource was the correct thing to do but agreed that the change in funding streams was not visible at the same level.
Alan felt that the public should be made aware of the situation and of the reality over the next 15 years. He argued that if people were aware of the facts they might be more able to respond but if left in ignorance and denied the magnitude of the problem it would be disastrous. Cllr Grant reported that funding long term had been discussed and given that the Change Fund projects had been of great value these would continue to be funded from the new integration budget.
The Chair summarised by highlighting the great challenge ahead and the need to face up to the future. Regardless of shifting the balance of care the acute service costs remain high and there is little expectation of the shift in financial resource to the community.
7 / INVERURIE PATHFINDER
Mike updated the Committee on progress since last meeting.
The Initial Agreement (IA) was submitted to the Scottish Government and following approval an Outline Business Case (OBC) is to be developed as part of the process. Membership and function of the Project Board / Team will change due to Hubco involvement. Jackie Bremner, Modernisation Team, will take the role of Project Lead. The OBC to be completed by February / March 2014. If approved a Full Business Case will be developed by Hubco. The project should come to a conclusion at end of 2016 with the £10.8M used to deliver a new health centre, X-Ray and a Community Maternity Unit. Several new functions will then be available for the Inverurie population.
The Inverurie Pathfinder Project will be bundled with another in Lochgilphead to make a more sizable investment from Hubco’s perspective.
Cllr Isobel Davidson raised concern at the level of maintenance to be paid for the development over the next 20 years, it being at a higher level than the local authority would expect to pay. Following discussion on this matter it was noted this would be part of contract negotiation. It was highlighted that the Hubco route was the only mechanism available for capital builds.
8 / WINTER PLAN
Noted that NHS 24 Winter Plan had been circulated in error. Pam to provide correct copy and this would be circulated to members.
8.1Verbal Update of the recent AECC Workshop on Unscheduled Care
The Chair had been very impressed by the recent workshop and felt it had been very practical. He highlighted that Grampian is leading the way and many people from outwith have visited the area to gain insight to developments.
9 / FINANCE
Ewan provided detail to the submitted finance report.
Noted that the Resource Sub Group would make the necessary recommendations for the integrated total and representation will be sought from health and the local authority.
Discussion followed about the major risk referred to in the dental service. Adam provided background to this issue. Due to poor levels of registration over the years the salaried dentists’ initiative had been launched in Grampian to address this issue. Due to these efforts there is now a very high level of registration in Grampian. It is now felt by the Chief Dental Officer for Scotland that there is an over supply of dentists and her intention is to remove funding from health boards over the next 3-4 years to stimulate the private market. This presents a risk for boards. Allan Sharp, Deputy Director of Finance is currently in negotiation with the CDO about this funding.
The new Dental Contract is awaited which will involve pieces of work about job plans, pay awards, change management and service redesign.
Cllr Alison Grant sought clarity about making appointments at a nearby dental practice. Mike would pursue this on her behalf.
10 / PUBLIC HEALTH REPORT
Noted that last year’s Director of Public Health Report had been circulated in error. Kim to provide current copy which will be circulated to membership.
Kim highlighted the 4 main challenges in the DPH Report
11 / AOCB
11.1Team Brief
Agreed the CHP Committee will be included in the Team Brief circulation.
12 / DATE OF NEXT MEETING / S
Wednesday 5 February – 2.00 pm