APPROVED

MINUTE of MEETING of the ABERDEENSHIRE CHP COMMITTEE held on WEDNESDAY 3 OCTOBER 2012 in the HOPEVILLE SOCIAL CLUB, INVERURIE from 10.30am – 12noon

PRESENT

Prof V Maehle Chair / Non Ex NHS Grampian

Cllr A Allan Elected Member, Local Authority

Dr Chris Allan Deputy Clinical Lead - North

Ewan Black Finance Manager

Eunice Chisholm Lead Nurse

Cllr K Clark Elected Member, Local Authority

Cllr I Davidson Elected Member, Local Authority

Cllr A Grant Elected Member, Local Authority

Dr Jennifer Hall Public Health Lead

Ritchie Johnson Director of Social Work & Housing

Dr Bob Liddell Clinical Lead

Mike Ogg Deputy General Manager - Strategy

Robert Paton Patients’ Rep

Douglas Rae Lead Podiatrist

Linda Reid Joint Project Manager – Integration

Shona Strachan Lead AHP

Alan Young 3Rd Sector Interface – Aberdeenshire

ATTENDING

Pat Alexander PA to Deputy General Manager – Strategy & Integration

Prof Maehle opened the first of the newly constituted CHP Committee formal meetings with Councillors in attendance.

A welcome was extended to Helen Summers who has taken up post as secretary to Adam Coldwells, General Manager and Shona Strachan, Lead AHP. Prof Maehle also welcomed Ewan Black, Finance Manager who was in attendance for discussion on item 9.

Round the table introductions were invited for the benefit of those attending their first meeting.

Item No / Discussion
1 / APOLOGIES
Apologies were noted from Adam Coldwells, Cllr Gifford, Pam Gowans, Martin McCrone, Cllr McKail, Lesley Meldrum and Janice Rollo
2 / MINUTE
Minute of Meeting of the Aberdeenshire CHP Committee meeting held on 17 April 2012 was submitted and subsequently approved subject to the following amendment:
Page 1 – PRESENT - Amend Ian Watt – to read – Alan Watt also in the section related to the Joint Equipment Store.
3 / MATTERS ARISING
Referring to page 2, Minute of Meeting of the CHP Committee held on 17 April 2012, Cllr Grant sought clarity over feedback from the Maternity Consultation meetings in Aboyne. Prof Maehle advised she had attended one meeting in the evening when there had been considerable discussion but no protests. She recalled that she had been informed that the afternoon meeting had been similar and had been well attended by a greater number of people. Mike agreed there had been a positive outcome from these meetings.
Page 3
Cllr Grant queried the term ‘independent contractors’ and was advised this referred to GPs, Dentists, Ophthalmologists and Pharmacists who are not employed by the CHP.
Page 4
With reference to discussion about business cases, Cllr Grant queried where these business cases had ultimately been ratified. Mike Ogg advised things had moved on since April and only the Inverurie Pathfinder Project has progressed and would develop an outline business case with a full business case later.
4 / FUTURE ORANISATION OF CHP COMMITTEE
Referring to the paper submitted by Adam Coldwells and Ritchie Johnson, Prof Maehle advised members that in the future the agenda would be set around the new arrangements and membership would be reviewed accordingly. Members were asked to consider the purpose of the Committee.
The paper documented background the new legislation and what the proposal was for committee arrangements The committee was asked to consider Governance, Strategic Planning and Quality issues.
In order that Councillors continue to be fully briefed and informed it is proposed that meetings are held across the Shire at various locations so that Cllrs can meet and discuss local issues with Area staff as appropriate.
The new Governance arrangements may mean that some budgets will no longer be held centrally but will be considered jointly by NHS Grampian and the Local Authority. In response to a query about whether all budgets would be involved or just older people’s budget, Ritchie Johnson advised that this was a key issue. The Council’s position was to focus on the older people’s service and budget first, but recognise that this would be broadened over time.
It was queried whether there would be a need for an overarching direction of a joint accountable officer. Noted this had been a question asked in the recent consultation and there remains mixed views over what value such a post would add. This would be considered as the process evolves.
Allan Young queried how and where the 3rd sector related to community planning as complexities continue to grow. He highlighted that participation in meetings was very difficult for the 3rd sector because it was not feasible to have a meaningful relationship develop whilst keeping pace with the many tiers of Governance. With reference to decision making it would be a matter of selecting the most effective forum for the greatest influence in decision making. Key changes will provide clarity around who will be involved in the new arrangements. Mike Ogg highlighted the opportunity to have meetings in workshop format, which are area based and which will help Cllrs be more aware of service delivery, and also to have the more formal committee as being the way forward.
The submitted paper proposed changes to the structure of the CHP Committee so that it would become a shadow Health and Social Care Strategic Partnership. It was felt that this was a proactive step towards a shadow arrangement. Ritchie agreed to take members through the paper in Adam’s absence.
Ritchie reported that the consultation period had now closed for the Health & Social Care Integration and the Government response was awaited. Integration would reshape services locally and for the benefit of Aberdeenshire residents. Formal arrangements for the integrated service will be in place in 2014 but there was a need for a shadow / transitional CHP Committee to steer towards 2014 integration.
Discussion followed about membership of the CHP Committee and whether there was a requirement for a membership of 30 people attending on a regular basis. Proposals around integration noted in early summer had outlined different arrangements for the emerging changes but these had not been prescriptive. A sense of balance would be required around the Committee remit and agenda focus, and the role of the committee would have to be clarified.
The second page noted suggested areas for discussion by committee members around Governance, Strategic Planning and Quality.
It would be important that over time the agenda would evolve into an integrated agenda which would discuss joined up service delivery. Focus would initially be on older people services with a potential to roll out to adult services. This change would mean that part of the business of the new committee would be the financial position and budget as both organizations worked towards a joint budget of the future.
Strategic planning would be very important in influencing joint commissioning and critical in discussion around older people’s services.
Governance issues around finance would be a key role of the committee. It would be important to understand the 2 very different cultures of the 2 organizations where accountability is very different with the NHS being centrally controlled and the local authority by councilors.
With regard to governance and decision making, the views of the CHP Committee and Councillors would be part of the decision making process. The local authority and NHS Grampian could delegate decision making on finance issues to the new committee and in this way joint community services could be delivered.
Discussion followed about the inclusion of CHP area managers in the new CHP Committee membership and about whether their presence was more appropriate at the operational committee than the formal committee. It was suggested more clarity around the role of the committee was required before membership could be agreed, but the need to keep the group as tight as possible rather than turn the meeting into a seminar was emphasised.
Ritchie voiced sympathies for Allan around the many changes and reviews at a national level that impact on not only the third sector but all parties. The CHP can take a view in due course as some of these agendas become clearer.
Noted from a presentation from a Joint Accountable Officer, NHS Lothian that a Lothian HCCP Board, with an aligned budget, had 4 NHS, 4 elected members and a sub committee for local input including voluntary sector, independent contractors and stakeholders. Those present were unsure how successful this arrangement was and it was suggested that an invitation be extended to colleagues in Lothian to visit Aberdeenshire in order that they might give some insight to their particular model.
Agreed that information about the Lothian arrangement would be very useful and Adam and Ritchie would pursue this in an attempt to source a variety of models for one which would best suit Aberdeenshire as opposed to one which was portrayed as working well. ACTION AC/RJ
5 / HEALTH & SOCIAL CARE INTEGRATION
Members had before them a tabled paper, which noted responses from NHS Grampian and the 3 sectors.
Ritchie reported there were a number of issues which required resolution from an Aberdeenshire perspective, as part of the new partnership committee. As a start point there was desire to look at the different cultures involved in integrated service delivery, including, around acute sector elements. There was a desire within Aberdeenshire to put in place better working arrangments with colleagues in the acute sector.
Ritchie introduced Linda Reid who had recently taken up the post of Joint Project Manager, Integration. This post has been jointly funded by the local authority and Aberdeenshire CHP. Linda has a background to this piece of work which will enable her to contribute to the task ahead. Discussion at Grampian level would be shared and Linda agreed there should be more consistency, that there should be more trust, more delegation and a greater awareness of the problems in secondary care. Members would be able to influence the next stages around uniformity and subsequent meetings will be used for this purpose.
Mike Ogg was asked to prepare a paper which would remind committee members of the top 10 points made by Aberdeenshire in their response to the Consultation.
6 / CHANGE PLAN – SIX MONTHLY REPORT
Mike introduced the Mid Year Progress Report for the Change Fund 2012 /13 and advised the report had been requested by the Scottish Government to provide reassurance that progress is being made in relation to Change Fund processes and performance. The Committee welcomd the report.
He led members through the paper and highlighted various areas of note.
Given that the Change Fund will only be available for a 2 year period to pump prime services there will be a necessity to ensure that services put in place can be sustained at the end of the Change Fund. OPSOG is the group which approves bids from the Change Fund and monitors performance and ensures funding available targets the right groups and provides agreed services.
The paper gave assurances that good work was being undertaken across Aberdeenshire but that it would be challenging to release money within the timescale.
Mike drew members’ attention to a proposal submitted to last OPSOG for Plain X-Ray on Deeside because default for the patient population is Aberdeen City and incurs considerable travel for those involved. More GPs would access the facility with health facilities and this would be one of many obvious wider benefits to the community. OPSOG recognized this need and has approved the bid and further discussion will take place about radiology.
Ritchie emphasised the risk involved in rushing to spend the change fund allocation and the need to ensure it was being spent in the right way and could ultimately be sustained after the Change Fund had ended after the 2 year period. This issue should stay on both the CHP agenda and for further discussion between local authority and NHS colleagues. ACTION AC
7 / ENHANCING CARE AT HOME SERVICES
The above paper had been submitted for information, to ensure the CHP were aware of the enhancement of local authority care at home servicves. It was noted the long term resourcing of this would continue to be considered on a partnership basis, reflecting the principles around the Change Fund.
8 / ABERDEENSHIRE CHP PLAN
Mike Ogg reported that the end of year plan had been discussed at last meeting but that the new plan was incomplete and discussion on this would be deferred to next meeting.
The main difference from last year is the 2 accelerated projects instigated by the Modernisation Executive; 1) Planned Care and 2) Unscheduled Care. The Unscheduled Care project is being undertaken by Buchan Area and is led by Lorna Watt and Dr Trish Donaldson. Planned Care is being undertaken by staff in Marr and led by Elizabeth Squires and Dr Lizzie Finlayson.
Discussion on progress with these projects will take place at next meeting.
ACTION AC
9 / FUNDING
Ewan led members through ‘A Financial Update – 6 Months to end of August 2012’ which had been previously circulated with papers and discussed earlier at OMT on 21 September 2012.
A second paper connected to the Joint Commissioning Agenda noted accounting for 2011/12 and 2012/13 regarding the joint budgets of the local authority and health around the older people’s services.
Discussion followed about expanding all adult services to the new arrangements which are now reasonably well developed but not always complete as the template develops for Aberdeenshire and applied to City and Moray CHPs. OPSOG would continue to be the driver for continued refinement leading towards integrated change management arrangements.
It was also agreed that it would be useful to develop the report to show spend profiles and to draw out any issues of joint interest connected with the budget monitoring. ACTION EB
10 / AOCB
10.1 Pathfinder Project – Inverure
Robert Patton advised that at a recent Doctors/Patients Participation Group there had been some discussion about the use of the field opposite Inverurie hospital’s main entrance and that he had been tasked with tabling this at today’s meeting for clarification.
In response, Ritchie Johnson advised that the land was local authority owned and had been the original site for a new care home, but had been deemed unsuitable by the Area Committee. This matter of future use of this piece of land is part of ongoing discussion with NHS Grampian and Local Authority and is very much a live issue. Discussions should continue between the respective property offices to ensure there is a clear understanding of the position.
11 / DATE OF NEXT MEETING
Date of next Formal Committee will be Wednesday 27 February 2013 in the Hopeville Social Club, Inverurie 10.00 – 11.30am

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