APPROVED
MINUTE of MEETING of the ABERDEENSHIRE CHP COMMITTEE held on WEDNESDAY 5 FEBRUARY 2014 in the Front Room, Hopeville Social Club, Inverurie from 10.00am
PRESENT
Raymond Bisset Chair / NHS Grampian Non Executive
Ewan Black Finance Manager
Cllr Karen Clark Aberdeenshire Council
Adam Coldwells GM, Aberdeenshire &Moray CHPs
Cllr Isobel Davidson Aberdeenshire Council
Philip English Head of Adult Services
Cllr Alison Grant Aberdeenshire Council
Cllr Jim Gifford Aberdeenshire Council
Pam Gowans Deputy GM – Operations & PC
Lesley Meldrum Senior Communications Officer
Mike Ogg Head of Integration & Strategy
Robert Paton Patient Representative
Kim Penman Acting Public Health Lead
Ian Powell Programme Manager
Iain Ramsay Joint Project Manager – Integration
Alan Young 3rd Sector Interface
IN ATTENDANCE
Pat Alexander PA to Head of Integration & Strategy / Committees
Item No / Discussion / Action1 / WELCOME
The Chair opened the meeting and welcomed those attending. Kate Livock and Jamie Hogg were in attendance to give a short presentation about Unscheduled Care
2 / APOLOGIES
Dr Chris Allan, Eunice Chisholm, Cllr Karen Clark, Dr Martin McCrone, Janice Rollo, Shona Strachan, Lesley Thomson, Kevin Dawson and Maria Walker
3 / MINUTE
Minute of Meeting of the Aberdeenshire CHP Committee held on 20 November 2013 was submitted and subsequently approved.
4 / UNSCHEDULED CARE
Kate Livock, Project Manager, Unscheduled Care and Jamie Hogg, Clinical Lead, Modernisation gave an informative and interesting presentation on progress made so far with the Unscheduled Care Project.
The slide provided detail on the areas concerned with delivering excellence by organising resources around the person’s needs:
· Unscheduled Care Advanced Clinical Practitioners
· Real Time Decision Support
· Action / Follow Through
· Re-enablement / Discharge
· Self Care / Management
The attached slide illustrates the decisions taken to support funding by the organisation around patient’s needs and wishes.
A short video, one of three, was played to the Committee. This has been a useful training tool which demonstrates how a palliative patient may have been treated previously and how, through the work of this project, will be in the future.
The Chair was encouraged by the move away from the traditional route of care and thought the work being done by the project was excellent.
Although palliative care has improved over the past 10 years, GPs still communicate by phone and people are still admitted to hospital. With more co-ordination everything would be more joined up. GPs and Nurses would plan the palliative care with the patient and family and this can be changed according to circumstances. The problem in the past has been the relationship over the years with the same GP who would put arrangements in place with the social care team but now it is anticipated it will be much easier to tailor the service for good anticipatory care.
Members broadly supported the project and agreed it was a very real challenge to get legal aspects right when dealing with patients suffering mental health issues.
The Chair thanked Kate and Jamie for their presentation.
4 / INTEGRATION
4.1 Update on Seminar
The seminar held last Friday had been attended by CHP and Aberdeenshire Council management; NHS Grampian Non Executive, and Councillors. The numbers attending had been high and feedback has been positive. Discussion groups had functioned well and issues tabled were taken to the wider group to inform. Good sets of notes were taken by each group and these will be collated into a report by Iain in due course and made available.
There had been several themes of discussion all of which had been very interesting. Key messages were clear and strong and gave the community a sense of value.
Staff continue to understand the complexities of integration.
4.2 Chief Officer Appointment
The Chair reported that Adam Coldwells had been appointed Chief Officer for the new Aberdeenshire Integrated Health & Social Care Partnership and would take up his duties at the beginning of March 2014. The announcement was met with tumultuous applause.
4.3 Updates from Sub Committees
Members had before them a paper, previously copied, which listed the TLG Sub Committees and which provided a short update on each.
Iain reported on the key points:
4.1 Resource Working Group – Sub Workstream which deals with ICT and is a very important area in dealing with joint procurement and co-location.
4.4 Engagement – This is divided into 3 sub workstreams and is part communication and part engagement; consultation process and HR
In response to a query about whether systems were compatible with Aberdeen City and Moray regarding access of information, Iain reported they were not at the moment and were on different systems. A considerable amount of work will be required and a solution would take some time to achieve. Finding a better way to share information would remain part of a significant challenge.
Discussion followed about the costs related to a new ICT interface and the huge challenge this was for the health board and the 3 local authorities. This situation is somewhat unique in Grampian with other boards dealing with only one local authority. With different local authorities having different views and ideas it will be difficult going down the corporate route when the other 2 partnerships have not appointed a Chief Officer. Ideally a pan Grampian approach would be better.
Procurement Arrangements - Initially these had been different between the local authority and the board but recently Aberdeen City has amalgamated with the local authority in the Joint Procurement Unit. This is a new area to look into and to gather information for regular updates to the committee.
Alan queried the question of IT issues involving information sharing and protocols and wondered if there would be a joint body and a single point of management responsible for data sharing. Adam felt that by people working together, who are willing and able, they can help a cultural change with advanced technology enabling the system which is valuable as well as important.
It would be important for community planning budgeting to be open and transparent and with people being willing and able and more persuaded, success will be inescapable. Single shared access will be a statutory responsibility for people of the Health and Social Care Integration Partnership to share information about vulnerable people. It was noted that data sticks are the problem.
5 / DELAYED DISCHARGES
The Chair reported that delayed discharges had been on the agenda for last Performance Governance Committee when concerns had been raised about last October census which put Grampian 3rd highest in Scotland and just below Lothian and Greater Glasgow Health Boards for delayed discharges. In 2015 treatment time will fall from 28 to 14 days and there will be considerable obstacles to overcome to achieve this new target.
Members had before them a paper on recruitment and retention of care staff which had been submitted by Patricia Maclachlan for discussion. Patricia reported that Aberdeenshire were performing better than Aberdeen City and Moray in this respect but the issue of reducing delayed discharges and facilitating increased admissions to care homes had to be addressed.
A paper would be submitted to Aberdeenshire Council in June which will outline the acute shortage of health carers and provide reassurance that there will be much higher focus on the recruitment of healthcare staff. A working group has been set up to take this matter forward with membership comprising homecare management and representation from Unions. A high profile campaign will be embarked upon to target people who have not necessarily considered working in care previously but would now find it more attractive. In addition to this 5 modern apprenticeships were created in 2012 and the incumbents are now engaged in a structured programme. A further 10 modern apprenticeships are under development in care homes and very sheltered housing schemes. Evidence has shown that the majority of the care workforce is over 40 with a significant proportion aged 55years and over and there are 50 employees currently working in older people’s services aged 65 or over. Placements for younger people leaving care are being offered in care settings to improve opportunities and preparation for employment.
The Committee was asked to recommend acknowledgement of progress of special recruitment initiatives for social care staff in 2013/14.
The Chair congratulated Patricia on progress to date and requested that the paper be submitted to the NHS Grampian Performance Committee.
This item would remain a standing item on the Committee agenda.
By working together both organisations would learn more about recruitment / retention. Pam currently meets with colleagues in a daily huddle about delayed discharges which provides an opportunity to drill down and achieve good understanding. Issues are identified and tackled. Staff groups are then provided with feedback and challenged on issues. Mike and Rieta are currently undertaking a programme of MDT visits around Aberdeenshire to ensure rigour around the process to give the CHP a greater degree of assurance. Noted that JIT is leading on training sessions for Webex for each area. Aberdeenshire is booked for end March / beginning of April 2104. This training programme will help identify people early on and start the conversation between health and social care and the family to achieve better outcomes for the individual.
Discussion followed about the recruitment of carers and the perceived equal status and sense of professional status derived from the dementia training provided, which traditionally would have been undertaken by nurses.
6 / FUTURE NEXT STEPS
6.1 Change Fund
Members had before them a paper from Adam Coldwells which provided an update on the older people’s change fund. The paper seeks support from the Committee on the approach for the future and builds on the Change Fund performance report considered by the CHP Committee in December 2013.
The Change Fund was created 3 years ago to provide 4 year funding with the aim to leave the change created in the system. People had been empowered to take this forward. Over 60 schemes across the piece were invested in and the national and local outcomes have been bulleted in the report. OPSOG has overseen the investment fund and has monitored progress of the various projects.
Governmental direction in the new reiteration is the disinvestment in traditional hospital services and more investment in overall communication and discussion which are both largely achievable. A small group comprising Patricia Maclachlan, Bob Liddell and Pam Gowans would meet to discuss in more depth.
The Committee supports the real value of the Change Fund and the development of a business case for investment. The case to agree is Committee understanding; direction to be taken; risk based process and proposed value of investment.
Ongoing investment of £3M per year would sustain essential projects and activity currently funded by the Change Fund. It has been suggested by the Government that future investment in primary care might be reduced and with new theatres proposed in acute and taking waiting time targets into account, it was not conceivable there would be any reduction in acute. In order to access this funding, a business case would be required which would demonstrate positive results from projects over the last 3 years and the need for continuing them.
The CHP can either disinvest from these works or identify the funding for this work to continue. The CHP Committee was therefore asked to support the team to develop a robust case for these works to continue. The case would clearly set out the risk with either decision.
The Committee agreed the proposal to build a case to identify funding for work this work to continue.
Community Planning Board
The Chair reported that Cllr Gifford had Chaired the Community Planning Board Workshop at end of January 2014 which focussed on a single outcome agreement regarding Aberdeenshire Partnership being transparent and contributing towards the community planning resource.
The Workshop had been well attended. Groups of 20/30 from community planning took part to agree the way forward. Notes from the workshop will be made available in due course.
Although aware of pressures of community planning there is a push to share resource across the piece, share information and physically share budget to achieve a much greater steer. Agreed that it would be a matter of finding a way to ‘share’ or have this move implemented upon Aberdeenshire.
6.1 New Planning Group
Graeme Smith, Executive for Modernisation was in attendance to advise the CHP Committee on the New NHS Grampian Planning Group.
It was felt by NHS Grampian that a different approach to planning was required to work more effectively in the Health and Social Care Partnership structure which will move to shadow status in April 2014 and then to permanent in April 2015. As noted in earlier discussion and in the paper submitted by Adam, there are real issues working with the 3 partnerships in NE Scotland which could affect real change in the acute service and Grampian service.
The Change Fund discussion could have potentially limited success in the short term but also potentially huge success if the 3 partnerships co-ordinated towards achieving real change for the acute service and real funding for community services if facilitated through a huge range of variables. The result could have huge impact or be soaked up by unmet demand. If however there is joint understanding of the issues, via a team approach, and with focus on the acute service great change could be achieved by the partnership itself.
The purpose of the New Group will be for the 3 Health and Social Care Partnerships of NHS Grampian to plan the Grampian service across the partnership services to create real change.
The Group would develop models of the system and try out various scenarios and reinvest in others. It would be the forum responsible for decisions about resource and be dynamic in any change consumed by unmet need. The need to meet unmet demand is very different and ideas on this issue would be shared and more senior colleagues may well be brought into the discussion. There is real motivation to change and NHS Grampian is very motivated to change and redistribute acute resource. Changes will however have to be sustainable.
It was queried whether the 3 partnerships would have the capacity to cope with the proposal given the new work will be done in addition to existing commitments. Graeme reported that capacity could be worked out but the fundamental aim will be fundamental change but the problem will be getting to that point.
Membership would comprise officers as opposed to Board and elected members from each of the 3 sectors, acute and modernisation. The TLG will morph into the Partnership Board role.
Members were encouraged by this proposal
Alan felt the new paper’s thrust was about looking back at the Change Fund and examining the innovations to identify savings made. The proposal would have to see innovations and plausible savings as part of a package and tested out across the whole system. Graeme agreed this was absolutely correct and that there was a need for great rigour in the very scientific approach to be taken across all 3 partnerships for this to work with everyone on the same page. The Committee was advised arrangements for the new group would be put in place shortly.
7 / FINANCE
Members had before them a paper on the financial position for Aberdeenshire CHP.
Adam reported on the challenge and resolution of nursing issues. NHS Grampian employees are paid on an incremental scale which is different from the local authorities and can span several £K and staff would move up the scale over time. Budgets are set at mid point but longer served staff are higher than mid point (referred to as incremental drift) and this is where the significant overspend lies within the nursing budget. Noted that NHS Grampian had been able to vire financial resource from one budget to another but this practice will not be possible in the future and will therefore become a greater challenge for the resource group.
Discussion followed about the procurement of high profile beds for people whose choice is to die at home. This has meant spend but is also a success and demonstrates a shifting of the balance of care. Issues about the drugs budget were discussed and it was noted some significant drugs will soon be off licence resulting in a reduction in costs for these particular medicines.
Adam and Alan to discuss, outwith the meeting, issues regarding the ageing population being taken forward by the 3rd Sector.
8 / WINTER PLAN
Pam reported that a full briefing would be available at end of week. All is going well at the moment. / PG
9 / WORKFORCE PLAN
Adam congratulated Ian, Pam and Eunice on the workforce planning to date. The latest workforce plan to be circulated for information. / PA
10 / AOCB
10.1 Newsletter – Pathfinder Issue 7
The above had been copied with papers to appraise members of the Inverurie Pathfinder Project progress.
10.2 CHP Committee Agenda Setting
Discussion followed about 3rd Sector involvement in agenda setting meetings. Agreed correspondence be sent to David Hekelaar / Sue Kinsey inviting them to become involved.
11 / DATE OF NEXT MEETING/S
Wednesday 7 May 2014
Wednesday 27 August 2014
Wednesday 12 November 2014
All to be held in the Hopeville Social Club, Inverurie, Harlaw Road, Inverurie
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