Councillor Jacqueline Cameron, Councillor Jennifer Adam-McGregor, Councillor Lisa-Marie Hughes, Councillor Jane Strang (substitute for Councillor Scott Kerr) (all Renfrewshire Council); Dr Donny Lyons, Morag Brown, Dr Linda de Caestecker and Dorothy McErlean (all Greater Glasgow & Clyde Health Board); Karen Jarvis (Registered Nurse); Alex Thom (Registered Medical Practitioner (non-GP)); Liz Snodgrass (Council staff member involved in service provision); David Wylie (Health Board staff member involved in service provision); Alan McNiven (third sector representative); Christine Melville (substitute for Helen McAleer) (unpaid carer residing in Renfrewshire); Stephen Cruickshank (service user residing in Renfrewshire); John Boylan (Trade Union representative for Council); Graham Capstick (Trade Union representative for Health Board); Dr Stuart Sutton (Registered Medical Practitioner (GP)); David Leese, Chief Officer and Sarah Lavers, Chief Finance Officer (both Renfrewshire Health and Social Care Partnership); and Peter Macleod, Chief Social Work Officer (Renfrewshire Council).

Dr Donny Lyons, Chair, presided.

Ken Graham, Head of Corporate Governance (Clerk) and Elaine Currie, Senior Committee Services Officer (both Renfrewshire Council); and Iain Beattie, Head of Health and Social Care (Paisley), Caroline Burling, Acting Head of  Mental Health, Addictions and Learning Disability Services, Fiona Mackay, Head of Strategic Planning & Health Improvement and Jean Still, Head of Administration (all Renfrewshire Health and Social Care Partnership).

In terms of Standing Order 4.1 (iii), the Chair intimated that he proposed to alter the order of business to facilitate the conduct of the meeting by considering item 7 of the agenda after item 2 of the agenda.

The meeting adjourned at 10.50 am and reconvened at 11.00 am.

Peter Macleod left the meeting prior to consideration of the following item of business.

Dr Stuart Sutton left the meeting prior to consideration of the following item of business.

Under reference to item 7 of the Minute of the meeting of the IJB held on 24 November 2017 the Chief Officer submitted a report relative to preparation for implementation of The Carers (Scotland) Act which would come into force on 1 April 2018.

The report provided information on a summary of the consultation results and the proposed eligibility for carers; the requirement for the Health Board and Renfrewshire Council to update their Integration Scheme to reflect the new Carers Act; progress developing Adult Carer Support Plans and ensuring that staff were appropriately equipped and trained to deliver on its requirements; Scottish Government funding to support preparations for the Act over the coming year and beyond; and an update on the management of the key risks identified by the Carers Act Strategic Steering Group.

DECIDED:

(a) That the report be noted;

(b) That the eligibility criteria for adult carers, as detailed in Appendices 2 and 3, be agreed;

(c) That it be agreed that Renfrewshire’s local allocation of the Scottish Government’s Carers Act funding, which had still to be finalised, be ring-fenced solely to fulfil its new duties and provisions under the new Act;

(d) That the Chief Finance Officer’s assumption that Renfrewshire’s provision under the Act would be met within this allocated funding be noted; and

(e) That a further report be submitted to the next meeting of the IJB to be held on 23 March 2018 to confirm that all required provisions were in place for the Act’s implementation on 1 April 208 and that Renfrewshire’s updated Integration Scheme had been approved by Renfrewshire Council and the NHSCC&C Board.

Councillor Scott Kerr (Renfrewshire Council) and Helen McAleer (unpaid carer residing in Renfrewshire).

There were no declarations of interest intimated prior to the commencement of the meeting.

The Minute of meeting of the Integration Joint Board (IJB) held on 24 November 2017 was submitted.  

DECIDED: That the Minute be approved.

Under reference to item 2 of the Minute of the meeting of the IJB held on 24 November 2017 the Chief Officer submitted a report providing an update on the day care services for adults with learning difficulties operated by Capability Scotland, on behalf of the Renfrewshire Health and Social Care Partnership (HSCP), in Renfrewshire at Whitehaugh and West Lane Gardens, Paisley. 

The report intimated that Renfrewshire HSCP staff had been working to finalise individual service users’ assessments and SDS budgets over recent weeks and to ensure that service users and their carers/families had opportunities to establish a clear understanding about what alternative service options were available in Renfrewshire. 

The report detailed summaries of the key elements of the work programme including the market testing process for ongoing provision; the development of service user individual plans and SDS budgets and identification of alternative provision; and service user and family engagement.

It was noted that throughout this process, Renfrewshire HSCP had sought to ensure that staff worked in a supportive and positive way with service users and carers/family members.  This was central to how the HSCP worked and in the circumstances, where a service was closing and service users were to be supported through this change, this remained at the core of the HSCP approach.  It was important that the challenge that this change presented to service users and their carers/family members was recognised.

Renfrewshire HSCP had a structured workplan in place, a copy of which formed the appendix to the report, and the Chief Officer had established robust governance arrangements to personally oversee this challenging position for Capability Scotland service users.

 

 

 

The key priorities over the coming weeks would be to ensure that all service users had agreed Individual Plans, SDS budgets and that alternative service provision options were being considered and work continued to have these agreed; to establish a definitive position on Capability Scotland’s proposed new service model by mid-February 2018; to progress plans to extend the HSCP Community Networks Service as required; and to work with local providers to raise awareness of the key areas Capability Scotland service users highlighted as important to them and to promote choice and flexibility within SDS.

Over the next six weeks Renfrewshire HSCP would work with service users, their carers/families and Capability Scotland to develop Individual Plans to ensure the transition for service users moving to new services was as smooth as possible.  For each service user this would include an initial visit to the new service with their carers/families and a familiar member of staff, if possible these would be arranged as joint visits with any friendship group collectively looking to move to the same service; ensuring the new service provider had detailed background information and that there was a formal handover meeting with Capability Scotland to discuss the level of care required, availability of days to attend to suit friendship groups; supported test visit(s); independent test visit(s); subject to the service user and their carers being happy with the new service, agreement of a transition date; additional support to be made available to service users for a ‘bedding-in’ period and to ensure that any issues arising were escalated to Renfrewshire HSCP senior management for review; and support to service users and carers/family members to continue beyond the closure date of 30 April 2018 as required on an individual basis with all support plans being reviewed initially after six months and then at least on an annual basis.

Renfrewshire HSCP were working to support all service users to transition, or be in the process of transitioning, to new services by 18 April 2018.

It was proposed that the IJB agreed to remain open to flexibility to consider other models and opportunities that are developed; that the Chief Officer consider how best to communicate information regarding alternative service provision and what the next steps would be; that the Chief Officer submit a report to the next meeting of the IJB to be held on 23 March 2018 describing how services had been able to respond to matching the needs of individual service users; that officers be encouraged to do all they can as part of the transitional period to ensure no diminution of service to service users; that it be noted that the Audit Committee would consider requesting an independent report on the entire process and the IJB would request that the Audit Committee then share the report with the IJB; and that it be noted that a special meeting of the IJB may be called once Capability Scotland had advised of its proposals for alternative day service provision and that consideration should be given to hold an open meeting to discuss future service delivery arrangements to involve service users and their carers/family members.  This was agreed.

DECIDED:

(a) That the proactive action being taken by Renfrewshire HSCP regarding Capability Scotland day care services, as detailed in section 4 of the report, be noted;

(b) That it be noted that the outcome of the recent market testing exercise was unsuccessful in identifying a provider to take over the current service;

(c) That it be noted that Capability Scotland had until the end of January 2018 to submit an alternative day service model and Renfrewshire HSCP expect to have a definitive position on this by mid-February 2018;

(d) That it be noted that given the tight timeline, and to mitigate any risk of service disruption, Renfrewshire HSCP would continue to work with service users and carers/family members to identify alternative provision arrangements in line with their Individual Plans and SDS budgets; 

(e) That it be noted that Renfrewshire HSCP were working to support all service users to transition to new services by Wednesday 18 April 2018; 

(f) That the IJB agreed to remain open to flexibility to consider other models and opportunities that are developed;

(g) That the Chief Officer consider how best to communicate information regarding alternative service provision and what the next steps would be;

(h) That the Chief Officer submit a report to the next meeting of the IJB to be held on 23 March 2018 describing how services have been able to respond to matching the needs of individual service users;

(i) That officers be encouraged to do all they can as part of the transitional period to ensure no diminution of service to service users;

(j) That it be noted that the Audit Committee would consider requesting an independent report on the entire process and the IJB would request that the Audit Committee then share the report with the IJB;

(k) That it be noted that a special meeting of the IJB may be called once Capability Scotland had advised of its proposals for alternative day service provision and that consideration should be given to hold an open meeting to discuss future service delivery arrangements to involve service users and their carers/family members.

The Chief Finance Officer submitted a report relative to the revenue and capital budget positions from 1 April to 8 December 2017 for Social Work and from 1 April to 30 November 2017 for the Health Board, as detailed in appendices 1 and 2 to the report.  

The report provided an update on the implementation of the Living Wage for 2017/18.

The overall revenue position for the HSCP was a breakeven position as detailed in the report.  The achievement of the in-year and year-end breakeven positions was dependent on the application of reserves carried forward from 2016/17 for both the adult social care budget and the health services budget.

Overall, social work adult services were currently reporting a breakeven position.  However this had only been achieved from the application of reserves carried forward from the 2016/17 budget allocation and a proportion of the additional £4.4m of resources made available by Renfrewshire Council as part of their 2017/18 budget allocation to the IJB for adult social care.

The key pressures were highlighted in sections 4 and 5 of the report.  Appendices 3 and 4 to the report provided a reconciliation of the main budget adjustments applied this current financial year; Appendix 5 to the report detailed the GP prescribing position; and Appendix 6 to the report detailed the reserve balances as at 30 November 2017.

DECIDED: 

(a) That the current revenue budget position be noted;

(b) That the progress of the implementation of the Living Wage for 2017/18 be noted; and

(c) That the current position and application of the Partnership’s reserves, as detailed in paragraphs 4.1 and 5.1 of the report, be noted.

The Chief Officer submitted a focus report on unscheduled care which provided an overview of performance at the HSCP’s interface with acute services at the Royal Alexandra Hospital and other acute sites.

The report intimated that an unscheduled care update report had been presented to the NHSGG&C Board meeting held on 19 December 2017 which showed progress resulting from a raft of initiatives and collaborative working across NHSGG&C on the key recommendations for 2017/18 made by the Unscheduled Care Improvement Programme in May 2017.  

In Renfrewshire a joint Acute and Partnership Unscheduled Work Plan had been developed which focussed on alternatives to admission; Emergency Department processes; management of current in-patient capacity; reduction in demand; e-health; and governance.  All HSCP’s reported monthly to the NHSGG&C Unscheduled Care Steering Group on progress against delivery and improvement plans and Renfrewshire HSCP’s improvement plan formed Appendix 1 to the report.

It was noted that the heading in the table in paragraph 3.7 of the report should read ‘A&E % seen, discharged, admitted or transferred within 4 hours.

A copy of the HSCP’s Winter Plan 2017/18 formed Appendix 2 to the report.

DECIDED: 

(a) That Renfrewshire HSCP’s Performance Management Focus Report on Unscheduled Care 2017/18, as detailed in Appendix 1 to the report, be approved; and

(b) That an update report on progress in reducing reliance on unscheduled care during 2018/19 be submitted to a future meeting of the IJB.

The Chief Officer submitted a report outlining the content of the proposed new 2018 General Medical Services Contract in Scotland and the Memorandum of Understanding between the Scottish Government, the British Medical Association, Integration Authorities and NHS Boards.

The report intimated that the benefits of the proposals in the new contract for patients were to help people access the right person, at the right place and at the right time in line with the Scottish Government Primary Care Vision and Outcomes. 

 

 

 

The new GP Contract would support significant development in primary care.  A Memorandum of Understanding (MoU) set out agreed principles of service redesign, ring-fenced resources to enable change to happen, new national and local oversight arrangements and agreed priorities.  The MoU recognised the statutory role of Integration Authorities in commissioning primary care services and service redesign; the role of NHS Boards in service delivery, employers and partners to General Medical Service contracts; provided reassurance that partners were committed to working collaboratively and positively in the period to March 2021 and beyond to deliver real change in local health and care systems that would reduce workload and risk for GPs and ensure effective multi-disciplinary team working for the benefit of patients.  

The aims of the new GP Contract and a number of key aspects of the new Contract and MoU requiring early action were detailed in the report.  

DECIDED:

(a) That the report be noted;

(b) That it be noted that following a positive result in the poll of GPs and GP trainees, the Scottish General Practices Committee had accepted the new Contract; and

(c) That it be agreed that the Chief Officer would now progress the necessary actions within Renfrewshire HSCP to develop the Local Primary Care Improvement Plan as set out in section 13 of the report and submit a report to the meeting of the IJB to be held on 29 June 2018 for approval.

The Chief Officer submitted a report providing an update on the draft five-year strategy for adult mental health services in NHSGG&C.

The report intimated that over the past two decades adult mental health services in NHSGG&C had been subject to transformational change with a pronounced shift in the balance of care significantly reducing the level of inpatient beds and reinvesting progressively in a spectrum of evidence based quality community and specialist services.  The current service delivery model for mental health within NHSGG&C was set out in an original framework and re-iterated in the subsequent NHSGG&C Clinical Service Review of 2012/13.

HSCPs in NHSGG&C were working together to develop a whole system five-year strategy for mental health and the key principles which underpinned the five-year strategy were detailed in the report together with the seven strands of work.

It was noted that the key next steps included the Chief Finance Officers for all HSCPs engaging in the near future to form the financial framework; finalising current work streams on unscheduled care review for adult mental health including mental health liaison, crisis and out-of-hours services and bed modelling; and developing a local HSCP action plan following the approval of the Mental Health Strategy.

Dr Michael Smith gave a presentation to the IJB on the draft NHSGG&C five-year Mental Health Strategy.

DECIDED:

(a) That the report be noted and that the strategic direction be agreed;

(b) That the full strategy be submitted to a future meeting of the IJB when available; and

(c) That the Chief Officer be authorised to engage with other HSCPs in the preparation of the implementation plan.

The Chief Officer submitted a report providing an update on the non-financial governance arrangements in place from 1 April 2017.

The report also provided performance information regarding Freedom of Information and complaints and covered the six-month period from 1 April to 30 September 2017.

It was proposed that future reports include information on the learning from complaints.  This was agreed.

DECIDED: 

(a) That the report be noted; and

(b) That future reports include information on the learning from complaints.

The Chief Officer submitted a report relative to the Renfrewshire Alcohol and Drug Partnership (ADP) Annual Report 2016/17, a copy of which formed the appendix to the report.

The report intimated that the ADP had key responsibility for implementing the National Policy Framework and driving forward local action to reduce the impact of alcohol and drugs.  ADPs in Scotland produced annual reports for submission to the Scottish Government and to ensure consistency, the Scottish Government had developed a standard template designed to allow consistent reporting on how ADPs were meeting national and local priorities.

DECIDED: That the report be noted.

DECIDED: That the next meeting of the IJB be held at 10.00 am on 23 March 2018 in the Abercorn Conference Centre.