Councillor Jacqueline Cameron, Councillor Jennifer Adam-McGregor, Councillor Lisa-Marie Hughes and Councillor Bill Binks (substitute for Councillor James MacLaren) (all Renfrewshire Council); John Matthews, Margaret Kerr, Dorothy McErlean and Frank Shennan (all Greater Glasgow & Clyde Health Board); Karen Jarvis (Registered Nurse); Dr Shilpa Shivaprasad (Registered Medical Practitioner (non-GP)); Louise McKenzie (Council staff member involved in service provision); David Wylie (Health Board staff member involved in service provision); Fiona Milne (unpaid carer residing in Renfrewshire); John Boylan (Trade Union representative for Council); Amanda Kelso (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 John Trainer, Chief Social Work Officer (Renfrewshire Council).

Councillor Jacqueline Cameron, Chair, presided.

Ken Graham, Head of Corporate Governance (Clerk) and Elaine Currie, Senior Committee Services Officer (both Renfrewshire Council); Christine Laverty, Head of Mental Health, Addictions and Learning Disability Services, Carron O’Bryne, Head of Health and Social Care (Paisley); Jackie Dougall, Head of Health and Social Care (West Renfrewshire), Shiona Strachan, Acting Head of Health and Social Care (Paisley), Frances Burns, Head of Strategic Planning and Health Improvement, Jean Still, Head of Administration; James Higgins, Project Officer; and John Miller, Communications Officer (all Renfrewshire Health and Social Care Partnership); and Mark Ferris, Audit Manager (Audit Scotland).

John Trainer joined the meeting prior to consideration of the following item of business.

Councillor Jennifer Adam-McGregor and Frank Shennan joined the meeting prior to consideration of the following item of business.

Margaret Kerr left the meeting during consideration of the following item of business.

John Matthews declared an interest the in the following item of business as he was Chair of the NHSGGC Public Health and Wellbeing Committee.

Fiona Milne left during consideration of the following item of business.

Prior to the commencement of the meeting the Chair intimated that this meeting of the IJB would be recorded and that the recording would be available to watch on both the Council and HSCP websites.

Councillor James MacLaren (Renfrewshire Council); Alan McNiven (third sector representative); and Stephen Cruickshank (service user residing in Renfrewshire).

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


Prior to the start of the meeting the Chair welcomed both John Matthews and Frank Shennan to their first Renfrewshire Health and Social Care Integration Joint Board meeting. John Matthews introduced himself to those in attendance.  

The Chair intimated that Frank Shennan had not as yet joined the meeting and that he would introduce himself at a later point in the meeting.

The Minute of the meeting of the Integration Joint Board (IJB) held on 26 June 2020 was submitted.

DECIDED: That the Minute be approved.

The rolling action log for the IJB was submitted.

By reference to the item in the rolling action log relating to loneliness and isolation , it was agreed to confirm Councillor Cameron, the Chair of the IJB, as the Social Isolation and Loneliness Champion.

It was noted that the status of some actions required to be updated and that this would be undertaken prior to the next meeting of the IJB to be held on 28 August 2020. 

 

DECIDED: That the status of actions be updated and that the rolling action log be submitted to the next meeting of the IJB to be held on 28 August 2020.

The Head of Administration submitted a report providing an update on the voting membership of the IJB.

The report intimated that Dr Donny Lyons ceased to be a member of the NHS Greater Glasgow and Clyde (NHSGGC) Board on 30 June 2020 and as a result also ceased to hold his position of voting member representing NHSGGC and Vice Chair of Renfrewshire IJB from the same date. Dr Linda de Caestecker had also ceased to hold her position of voting member of Renfrewshire IJB.

At the meeting of the NHSGGC Board on 30 June 2020 all non-executive membership of IJBs had been agreed.  Rev John Mathews had been confirmed as the replacement for Dr Donny Lyons and it had also been recommended that he assume the position of Vice Chair of Renfrewshire IJB for the remaining duration of the current chairing arrangements of the IJB, in terms of the Procedural Standing Orders. Francis Shennan had been confirmed as the replacement for Dr Linda de Caestecker and both changes were effective from 1 July 2020 and would be for a period of three years.

DECIDED: That the membership changes, as recommended by NHSGGC, be noted.

There was submitted a presentation providing operational services updates in relation to COVID-19.

Members then heard from the Heads of Service who provided updates in relation to their specific service.

DECIDED: That the presentation and verbal updates by the Heads of Service be noted.


At this point in the meeting Frank Shennan introduced himself to those in attendance at the meeting.

The Chief Officer submitted a report providing an update on care homes in Renfrewshire during the pandemic from a social care perspective. 

The report intimated that there had been considerable focus in the preparation phase and in the early stage of the pandemic to ensure that NHS acute services had enough capacity to manage the then expected influx of seriously unwell patients. While decisions were made based on the information available at the time there had been some national acknowledgement of the impact the decisions to cancel elective procedures and key services had had on both individuals and the wider health and social care system. 

A key part of the national strategy to protect the NHS was to ensure that any delays to discharge were minimised. It was important to acknowledge that our understanding of COVID-19 and the impact on individuals, NHS and community- based services such as care homes and care at home, had developed during the pandemic. While the report had a considerable amount of data and analysis there was not necessarily a linear connection between care home standards, discharge patterns, outbreaks and subsequent levels of death. Some of the homes with the highest numbers of deaths following outbreaks were also the homes with the highest Care Inspectorate gradings. 

It was noted that the virus may have been circulating in the community at an earlier stage than previously thought. Data collection did not start across Scotland and locally until mid-March and continues to develop to date. 

Care home staff and family members were also affected by COVID-19 and the reduction of staff within care homes, as a direct result of illness or due to underlying health conditions which placed them at higher risk, meant that care homes had needed to access a combination of their own bank staff, bank staff from the GGC NHS Bank and, in consultation with Public Health, transfer of staff between establishments. Many of the decisions made were as a result of balancing several risk factors including ensuring that there was sufficient trained staff to provide direct care to residents. 

The level of support provided to care homes both locally and in line with the enhanced support framework was outlined in the report. The independent providers were in the main operating within the Nursing Home sector and were a ‘with profit’ sector. The level of need of the people being placed in care homes had changed over the years, with placements now being made in the last 12-18 months of life essentially for end of life care. The staffing models and supporting health and social care services for care homes in general had not kept pace with the changes to resident groups and this had been further compounded by the challenges across the health and social care services of recruiting and retaining staff. Irrespective of any local enhanced arrangements this meant that the sector was highly vulnerable in the current situation.

Appendix 1 to the report provided the background data and analysis and the report provided a summary of the key points.

 

DECIDED:

(a) That it be noted that the IJB provided scrutiny to the content of the report; 

(b) That it be noted that no further areas for enquiry or exploration were instructed at this point in time; 

(c) That it be noted that work would continue to be undertaken to confirm the data available across all systems; and 

(d) That the National Social Care Inquiry be noted.

The Head of Strategic Planning and Health Improvement gave a presentation providing an update on the implementation of recovery and renewal plans in tandem with the response to COVID-19.

The presentation included the segmented approach developed by the HSCP to reflect the risks of short-term recovery activity being conflated with medium-term transformation or renewal activity and overloading available resources; the initial focus on managing linkages which detailed the approach to recovery; reflected on experiences through the COVID-19 response to date; identified core enablers for COVID-19 recovery and renewal; the guiding principles and strands of activity; the health and wellbeing discussions with the SPG: strand 1 activity; and the next steps to be taken by the HSCP to continue to develop the recovery and renewal planning approach.

DECIDED: That the presentation be noted.

The Chief Finance Officer submitted a report outlining the current estimated financial impact on the IJB’s delegated budgets arising from the COVID-19 pandemic.

The report highlighted that the financial implications for the IJB would become clearer over time as the impact and magnitude of the pandemic on the HSCP emerged.

The report intimated that Scotland, in common with all parts of the UK, entered lockdown on 23 March 2020. A range of constraints were implemented, then strengthened through the Coronavirus (Scotland) Act 2020 and the Health Protection (Coronavirus) (Restrictions) (Scotland) Regulations 2020. These constraints were reviewed at least every three weeks which ensured the impact of restrictions remained proportionate to the threat posed to wider societal and economic aspects. In addition, the Coronavirus (Scotland) (No.2) Bill became an Act on 26 May 2020. 

The relaxation of lockdown conditions is now proceeding at a different pace across the UK with the implementation of each Phase being determined by reductions in the rate on infection and the ability of the health and social care system to manage future infection peaks. 

The financial consequences of the pandemic are expected to be significant in the short term, with unprecedented financial interventions made by national governments to support the immediate COVID-19 response, the economy and businesses. The scale of government intervention to support the economy would inevitably have both short, and, longer-term implications for public finances across the UK and Scotland. This may therefore require the IJB to reconsider its 2020/21 budget and potentially reassess its medium-term financial planning as the full impact of the pandemic becomes clearer in the months ahead and as the IJB took forward its Recovery and Renewal Planning Programme. 

The report provided an initial estimate of the financial impact of the COVID-19 pandemic in the current financial year and it was noted that this position would be subject to change as the year progressed and greater clarity transpired.

DECIDED:

(a) That the current financial assessment of the potential revenue consequences of the COVID-19 pandemic, along with the anticipated disruption to the IJB’s planned savings in 2020/21, as outlined in sections 4 and 5 of the report, be noted; 

(b) That it be noted that the funding confirmed to date was significantly less than the estimated additional costs to the IJB;

(c) That it be noted that the financial impact of responding to the pandemic might continue to increase over the coming months as more increasing and changing demands were placed on the IJB; 

(d) That the Chief Finance Officer’s recommendation, as detailed in section 7 of the report, that the Chief Officer develop a range of proposals for the IJB’s consideration, which would support the IJB’s ability to deliver a balanced budget in 2020/21 and which would support a refreshed medium-term financial plan be agreed; 

(e) That it be noted that further updates on the developing financial position would be provided to the IJB on a regular basis as material developments emerged; 

(f) That the Chief Finance Officer’s recommendation, as detailed in section 6.12 of the report, that the Chief Officer write to the Cabinet Secretary of Health and Sport to seek a commitment of funding for the additional expenditure already incurred and the anticipated future expenditure as detailed on the local mobilisation plans to allow the IJB to fund the level of financial support requested from its suppliers to protect their sustainability and ensure the financial sustainability of the IJB be agreed; and 

(g) That the Chief Finance Officer’s recommendation, as detailed in section 6.13 of the report, that sustainability payments were not made until the partnership received confirmation of funding from the Scottish Government be agreed.

The Head of Administration submitted a report seeking approval for the updated Local Code and Sources of Assurance for Governance Arrangements which had been reviewed by the IJB Audit, Risk and Scrutiny Committee on 19 June 2020, a copy of which was appended to the report.

The report intimated that the Local Code included identified sources of assurance which enabled the IJB to review and assess its governance arrangements, against which it would measure itself in Annual Governance Statements from 2018/19 onwards

DECIDED: That the updated Local Code and Sources of Assurance for Governance Arrangements, as appended to the report, be approved.

DECIDED: That it be noted that the next meeting of the IJB would be held remotely by MS teams at 10.00 am on 28 August 2020.