Agenda and minutes

The Chair asked for Declarations of Interest. No interests were declared.

Statement on Equalities:

(1)       Consider, and if so decided, adopt:- “In line with the Joint Board’s legal  duty under section 149 of the Equality Act 2010 the Joint Board, in making decisions on the attached reports, shall have due regard to the need to”:-

(i)                 eliminate discrimination, harassment and victimisation;

(ii)               advance equality of opportunity between those who share a protected characteristic and persons who do not share it; and

(iii)              foster good relations between those who share a protected characteristic and persons who do not share it; and

(2)       where an integrated impact assessment has been provided, to take its contents into consideration when reaching a decision.

In taking decisions on the undernoted items of business, the Committee agreed, in terms of Section 149 of the Equality Act 2010:-

(1)       To have due regard to the need to:-

(a)  eliminate discrimination, harassment and victimisation;

(b)  advance equality and opportunity between those who share a protected characteristic and persons who do not share it; and

(c)  foster good relations between those who share a protected characteristic and persons who do not share it, and

(2)       to consider, where an Integrated Impact Assessment has been provided, its contents and to take those into consideration when reaching a decision.

Exempt Information

          Consider and, if so decided, adopt the following resolution:

       “That under paragraphs 1, 4, 6 and 7 of the Categories of Exempt Information, found at Appendix 2 of the Standing Orders of the Integration Joint Board, the public and media representatives be excluded from the meeting for Items 15, 16, 17 and 18 of the business below, on the grounds that it involves the likely disclosure of exempt information of the classes described in the relevant paragraphs.

The Joint Board agreed, that under paragraphs 1, 4, 6 and 7 of the Categories of Exempt Information, found at Appendix 2 of the Standing Orders of the Integration Joint Board, the public and media representatives be excluded from the meeting for Items 15, 16, 17 and 18 of the business below, on the grounds that it involves the likely disclosure of exempt information of the classes described in the relevant paragraphs.

There had been circulated and was approved as a correct record the Minutes of the Meeting of 10 May, 2023.

There had been circulated and was noted a report by the Chief Officer providing updates on progress with actions which had still to be completed and advising when these were scheduled to be reported to the Joint Board.

There had been circulated a report by the Chief Officer, providing an update of the ongoing work of the Health and Social Care Partnership, including an update on (1)  the tendering of Aberdeenshire GP practices; (2) national negotiations on the rate for the National Care Home Contract (NCHC); (3) the Junior Doctor’s Strike; (4) recent trends in delayed discharge and ongoing work to cover gaps in service and to ensure that processes are as efficient as possible.

By way of update, the Chief Officer advised that the tender contract for the Inverurie GP practice had been rescinded which would allow the Practice to continue as Inverurie Medical Practice. Work was ongoing to consider business case submissions in respect of a number of other practices. The Chief Officer advised that national negotiations were ongoing around the rate for the National Care Home Contract (NCHC) and a local working group had been formed to support the ongoing negotiations. She highlighted the implications of the Junior Doctor’s Strike in Aberdeenshire and the arrangements that would be put in place to ensure the provision of care. She noted the trends in relation to delayed discharges, which had been increasing over the last few months and advised that operational teams were working hard to support discharges as soon as possible, and it was her intention to provide regular updates to the Joint Board.

After discussion, the Joint Board agreed to note the terms of the updates provided.

There had been circulated a report dated 6 June, 2023 by the Chief Officer which informed the Joint Board of a number of changes to the membership and sought the appointment of one member to the IJB Audit Committee, and two members to the IJB Appointments Committee.

The Chair, on behalf of the Joint Board, welcomed Councillor Seamus Logan, who had been appointed as a substantive member of the Board to replace Councillor Reynolds. She asked to put on record her thanks to Councillor Reynolds for his contributions to the work of the Integration Joint Board over the previous years and for his work on the IJB Audit Committee.

The Chief Officer asked the Joint Board to note an amendment to recommendation 1.4 of the report, and that the Joint Board should appoint a Vice-Chair of the IJB Audit Committee, as required in terms of Standing Order 15.2 of the Integration Joint Board.

After discussion, the Integration Joint Board agreed to:

(1)        note that Councillor Seamus Logan had replaced Councillor Glen Reynolds as a substantive member of the IJB;

(2)       note that Councillors Neil Baillie and Ross Cassie had been appointed as substitute members, replacing Councillors Logan and Nicol;

(3)       appoint Councillor Logan as a replacement member to the IJB Audit Committee to replace Councillor Reynolds, as per the requirements set out in the Standing Orders for IJB;

(4)       appoint Councillor Logan to the position of  Vice-Chair of the IJB Audit Committee, as required in terms of Standing Order 15.2 of the IJB; and

(5)       to appoint Dr J Tomlinson and Councillor G Lang to the IJB Appointments Committee to fill vacancies on the Committee.

(a)  IJB Revenue Budget Update 2022/23 and 2023/24

(b)  IJB Medium Term Financial Strategy 2023-28

(c)  IJB Reserves Strategy

7A    Revenue Budget Update

There had been circulated a report dated 20 June, 2023 by the Chief Finance and Business Officer providing the draft final financial monitoring update for 2022/23, covering the twelve month period up to 31 March 2023.

The Chief Finance and Business Officer provided an overview of the financial position at the end of 2023/23, with the detailed position by service area for the financial year being shown in Appendix 1 to the report and highlighting that an overspend of £6.4 million was recorded against the revenue budget. The overspend was due to a number of contributing factors, as detailed in section 6.5 of the report.

He highlighted areas of material over and underspend and the movement in the reserves position during the 2022/23 financial year and advised that a review of the reserves strategy was being reported to the IJB in a separate report. He also highlighted an adjustment of £6.401 million to be funded from the general reserve relating to the overspend as of 31 March 2023 and advised that the reserves balance was subject to the approval of the use of the general fund reserve within the recommendations of the report.

During discussion, Members commented on the following:

(a)       the potential implications of the reported overspend on the 2023/24 budget;

(b)       with regard to the reported underspend in funding for unpaid carers, it was noted that funding had been identified to increase support in the carers support team, and the need for further communications to be issued to promote and improve the uptake of the current service for carers was highlighted;

(c)        the need to identify and move forward on achieving savings in order to ensure sustainability of services - this would be achieved through regular management and ongoing discussions with budget holders and through further discussions in development sessions;

(d)       the need for savings to be identified by September/October 2023 in order to allow execution before the start of the new financial year;

(e)       requested a briefing note on the steps being taken to target expenditure on occupational therapy services.

After discussion, the Integration Joint Board agreed:

(1)        to note the financial position set out in the report and Appendices 1 and 2;

(2)       to approve the budget adjustments detailed in Appendix 3;

(3)       to approve the use of general reserve to balance the overspend position as detailed in the report in section 7.5;

(4)       to note the update regarding the 2023-24 IJB Revenue Budget detailed in Section 9 and the approval of an update to IJB regarding Scottish Government earmarked funding for 2023-24 to a future meeting of the IJB per section 9.4;

(5)       that further communications should be issued to promote and improve the uptake of the current service from carers;

(6)       that a briefing be provided to the Joint Board on the underspend on occupational therapy services and steps being taken to target expenditure in this area; and

(7)       that a further development session be scheduled in September/October to  ...  view the full minutes text for item 7.

There had been circulated a report dated 26 June, 2023 by the Chief Officer providing an overview of a number of audit reports by the Chief Internal Auditor, together with an update on progress with recommendations and how they would be supported, actioned and monitored. The report advised that a member of the Senior Management Team (SMT) had taken responsibility for moving forward with each of the audit reports, and this was detailed within Appendix 1 of the report. The whole process was being overseen by the Chief Officer and a short life Working Group had been convened to support the work.

The Chief Officer gave an overview of the current position and advised that an assurance framework would be considered later today by the IJB Audit Committee, and the Committee would provide regular updates on progress to the IJB. She also advised that a review of the IJB Governance structure was ongoing and was being supported by the Interim Strategic Governance Review Manager, and support was also being provided by the Internal Audit service and Finance service of the Council.

There was discussion of the need to ensure that support was provided to officers in order to ensure that the planned actions could be carried through in a timeous manner and that there should be regular reporting from the IJB Audit Committee to each meeting of the IJB in order that any items of urgency could be escalated where necessary.

Thereafter, the Integration Joint Board agreed:

(1)       to acknowledge that Internal Audit have made a number of recommendations across different service areas within the Health and Social Care Partnership;

(2)       to note the timeline of when various recommendations were due to be implemented;

(3)       to acknowledge the focus on improvement in line with the audit recommendations and that a robust monitoring process was in place to ensure timely compliance;

(4)       to continue to monitor the progress of audit recommendations through the regular updates which should be provided by the IJB Audit Committee to each meeting of the IJB; and

(5)       the scheduling of IJB Audit meetings should be reviewed in order to prevent a lag in reporting timescales to the IJB.

There had been circulated a report dated 14 April 2023 by the Chair of the Clinical and Adult Social Work Governance Committee, updating the Joint Board on the key issues arising from the Committee meeting on 5 June, 2023.

The Joint Board heard from Mr Lindsay, Chair of the Committee, on the recent work undertaken by the Committee, which included consideration of recent inspections undertaken by the Care Inspectorate, Healthcare Improvement Scotland (HIS) and the Mental Welfare Commission; a follow-up Risk Management Report; a report on Hosted Mental Health and Learning Disabilities Inpatient Specialist Services; a presentation on the Public Protection arrangements for Health and Care Service across the Grampian Health and Care System; and a report on Children’s Joint Inspection Update.

There was discussion of the scrutiny arrangements for the Hosted Mental Health and Learning Disability Services, and the need to find an assurance system to allow adequate scrutiny by each of the three IJB’s, to ensure accountability and reassurance.

After discussion, the Integration Joint Board agreed:

(1)        to note the key points and assurances highlighted in the report by the Committee in relation to governance matters; and

(2)       That the Chief Officer should refer the aspect of hosted services to the North East Steering Group to consider how to ensure that each IJB is able to be assured, and to report back to the Integration Joint Board.

There had been circulated a report dated 9 June 2023 by the Partnership Manager, North which asked the Joint Board to consider and approve the Aberdeenshire Autism Strategy for Children, Young People and Adults 2023-28 and the Aberdeenshire Autism Action Plan to support the strategy.

The report outlined the background to the development of the strategy; the work of the Autism Strategy Planning Group; a programme of engagement which had been undertaken to gather information and engage with stakeholders, which led to the drafting of the strategy, which was followed by a period of public consultation.

The Interim Mental Health and Learning Disability Manager introduced the report and advised that the Autism strategy was a five-year strategy jointly produced by the Health and Social Care Partnership and Education and Children’s Services, and the strategy supports a whole lifespan approach aiming to improve support and services for autistic people of all ages. He advised that the Draft Strategy report and action plan had been considered and approve by the Education and Children’s Services Committee on 25 May 2023.

During discussion, Members made the following comments on the draft strategy:

(a)       commented that an easy read version would be helpful for users of the strategy;

(b)       there was a need to consider expectations and what is achievable in view of budgetary constraints;

(c)        benchmarking and learning should be sought from other areas;

(d)       consider how to present outcomes to be assured that the strategy makes an impact; and

(e)       co-production and feedback were important and to be able to measure what is delivered.

After discussion, the Integration Joint Board agreed:

(1)       to approve the Aberdeenshire Autism Strategy for Children, Young People and Adults 2023-2028;

(2)       to approve the Aberdeenshire Autism Action Plan for Children, Young People and Adults 2023-2028; and

(3)       to commend staff on the work undertaken to develop the Autism Strategy and Action Plan.

With reference to the Minute of Meeting of the IJB of 1 March 2023 (Item 11), there had been circulated a report dated 12 June 2023 by the Chief Officer which provided a high-level overview of all projects within the Health and Social Care Partnership’s Strategic Delivery Plan and outlining overall progress and enabling exception reporting of any key barriers or delays. The report also included a more detailed update on the progress against delivery of the Medication Assisted Treatment (MAT) Standards.

The Interim Strategy and Transformation Manager introduced the report and provided an overview of the work that was ongoing and highlighted that since the last quarterly report the Strategy Team in conjunction with the Senior Management Team (SMT) had been carrying out work to review and further prioritise workstreams which were deliverable over the next 12 to 18 months, particularly in light of system pressures which had continued beyond the winter period. Moving forward, the SMT had agreed that Health and Social Care Partnership capacity would be focused on the three key areas of Social Care Sustainability, Community Hub, and Place-Based Approach, which would allow the effective prioritisation of resources and a focus on service redesign.

During discussion Members commented on the ambitious nature of some of the projects and timescales and the importance of engagement and co-production with stakeholders; the need to identify the financial implications of projects at an early stage in order to inform the budget cycle was highlighted; and it was noted that further engagement was proposed during a future development session.

After discussion, the Integration Joint Board agreed:

(1)       to note the high-level quarterly performance report on the HSCP Strategic Delivery Plan to end of May 2023, noting work ongoing regarding the prioritisation of workstreams and performance report format;

(2)       to approve the decisions taken to not progress specific projects under the Strategic Delivery Plan at this time, allowing focusing of resources on priority workstreams and deliverables, and for further engagement with IJB members to take place to shape and inform the priority programmes of work; and

(3)       to endorse the accompanying quarterly report on specific progress against the Medication Assisted Treatment (MAT) Standards Implementation.

There had been circulated a report dated 6 June 2023 by the Interim Strategy and Transformation Manager providing an update on the Aberdeenshire Health and Social Care Partnership Workforce Plan 2022-25 which had been submitted to NHS Grampian; outlining the progress made during the last 12 months on the delivery of the Workforce Plan and the proposed actions for the current year; and outlining initial work done to update the baseline data to monitor the Workforce Plan going forward.

The Workforce Transformation Programme Manager introduced the report and provided some background to the report. He provided a summary of the update of the Workforce Plan as submitted to Scottish Government, which detailed the progress the Workforce Plan Team had delivered during the seven months since publication, together with an indication of activity for the current financial year and beyond. He advised that the activity planned for the current financial year and beyond would be driven forward at an increased pace given the appointment of additional staff resources identified in the Workforce Plan, including the Digital Project Manager and the Workforce Transformation Programme Manager. Three thematic sub-groups had been formed to develop and deliver more detailed Action Plans for each of the seventeen actions, covering Recruitment, Staff Health and Wellbeing, and Training, Development and Succession Planning.

During discussion, Members commented on key issues which had been identified within the report, including the smaller proportion of young people employed within the workforce compared with older people; the levels of turnover of the workforce; the significant level of health and wellbeing issues for staff, including depression and anxiety and impacts on recruitment and retention; continuing high vacancies and high lengths of time for filling vacant posts. Members discussed the actions being taken to address these issues and the focus on priorities within the three sub groups that had been formed. It was noted that a development session was being planned for the Joint Board to consider the issues identified further and to consider the work coming out of the 3 sub-groups.

There was further discussion of the need to attract younger staff into the health and social care workforce, in view of the aging workforce, and to address the imbalance in the ratio of female to male staff. There was also discussion of completion rates for mandatory training and further training and the importance of ensuring that priority was given to ensuring that the appropriate training was completed by staff.

After discussion, the Integration Joint Board agreed:

(1)       to note the submission of the update on the Aberdeenshire Health and Social Care Partnership Workforce Plan 2022-25 (Appendix 2) to NHS Grampian to include within their own, co-ordinated update to Scottish Government on 1 June 2023;

(2)       to note the progress made during the last 12 months on the delivery of the Workforce Plan and the proposed actions for the current financial year; and

(3)       to note the initial work done to update the baseline data to monitor the Workforce Plan going forward (  ...  view the full minutes text for item 12.

There had been circulated a report dated 12 June 2023 by the Chief Officer requesting the approval of the Annual Performance Report for the Health and Social Care Partnership for 2022-23 and for the report to be shared with Aberdeenshire Council and NHS Grampian.

The annual report covered the period 1 April 2022 to 31 March 2023 and the structure of the report aimed to demonstrate how the Health and Social Care Partnership had delivered against its five agreed local strategic priorities, as well as the National Health and Wellbeing Outcomes. A summary of performance against the National Core Integration indicators was included, augmented by local performance data where available. The report noted that the performance and progress of the Health and Social Care Partnership had continued to be significantly impacted by ongoing system-wide pressures on health and social care services, and updates on the progress made against the key workstreams identified under the H&SCP’s strategic delivery plan as agreed in 2022 took this into context, acknowledging where the pace of implementation had been impacted or delayed.

After discussion the Integration Joint Board agreed:

(1)       to approve the Aberdeenshire HSCP 2022-2023 Annual Performance Report; and

(2)       that the Chief Officer share the Annual Performance Report with the Chief Executives of Aberdeenshire Council and NHS Grampian.

There had been circulated a report dated 22 June 2023 by the Partnership Manager, North containing the annual reporting survey for the Aberdeenshire Alcohol and Drug Partnership (ADP). The report advised that the annual reporting survey focussed on key areas which the Scottish Government wish to gather information from drug and alcohol policy monitoring and evaluation, and the Joint Board was being asked to agree to sign off the Aberdeenshire ADP Annual Reporting Survey.

The Partnership Manager, North and Criminal Justice and Substance Misuse Manager explained that the purpose of the annual reporting survey was to gather data at a national level to inform drug and alcohol policy monitoring and evaluation and the data collected across all ADPs would be analysed and published at an aggregate level as official statistics. At a local level, the expectation was to publish the Aberdeenshire return and use the information gathered to inform challenges and opportunities highlighting priority areas for future work.

After discussion, the Integration Joint Board agreed:

(1)       to note the contents of the Aberdeenshire Alcohol and Drug Partnership (ADP) Annual Reporting Survey;

(2)       to give approval to sign off the Aberdeenshire ADP Annual Reporting Survey; and

(3)       that further information be sought from the service on the monitoring of alcohol and drug harms or deaths.

There had been circulated a report dated 6 June 2023 by the Chief Finance and Business Officer asking the Joint Board to note the approval of an Annual Procurement Work Plan and Procurement Approval Form, which was made via the Special Urgency Process.

The Integration Joint Board agreed:

(1)       to note the approval of the Annual Procurement Work Plan and Procurement Approval Form which was made via the Special Urgency process; and

(2)       to note the direction to Aberdeenshire Council to procure the works detailed in the Work Plan which was approved via Special Urgency process.

There had been circulated a report dated 11 July 2023 by the Chief Officer requesting consideration of a Supplementary Procurement Work Plan and one Procurement Approval Form and that the Joint Board directs Aberdeenshire Council to procure, via direct awards, the services detailed in the Supplementary Procurement Work Plan on behalf of the Integration Joint Board.

The Joint Board heard from the Strategic Procurement Manager and there was some discussion around the potential to adopt a more collaborative approach and to seek to encourage a number of smaller bidders rather than one large bidder to ensure a more collaborative approach and more than one provider.

After discussion, the Integration Joint Board agreed:

(1)       to defer consideration of the report and refer it to the Project Group to consider further to try to ensure that the contract would be open to multiple smaller service providers and to encourage multiple bidders; and

(2)       to report back the outcome of the further considerations to the next meeting of the IJB.

There had been circulated a report dated 9 June, 2023 by the Partnership Manager, North outlining the process undertaken with regard to the proposal to cease the Employability Service and asking the Joint Board to issue a Direction to Aberdeenshire Council, directing them to cease the Employability Service in order to achieve the budget savings required.

During discussions, the staff side representatives expressed some concerns with regard to the challenges around the redeployment process and hoped that all options would be explored to avoid the risk of redundancy of existing staff members.

The Chief Officer responded to questions raised by Members in relation to the redeployment process, and provided an assurance that each individual user of the service would have a continued route to support.

After discussion, the Integration Joint Board agreed:

(1)       that they were assured and acknowledge the process undertaken around budget savings with regards to the Employability Service;

(2)        to cease the Employability Service;

(3)       to issue a Direction to Aberdeenshire Council, which is additional to the Direction attached to the revenue budget, directing them to cease the Employability Service in order to achieve the budget saving required;

(4)       to note that further discussions would be held between officers and staff side representatives with regard to the redeployment process; and

(5)       that the Chair would discuss the concerns from the staff side on the Council’s Redeployment Policy with the Director of Business Services.

There had been circulated a report dated 22 June 2023 by the Chief Officer concerning the delivery of out of hours nursing care and proposals to address the current issues being experienced to ensure that there was a continuation of the service for vulnerable patients. The report also proposed that the IJB consider a phased approach to delivery of the service, and once stabilised, that a full review of the delivery of out of hours care should commence and be reported to the IJB within the current financial year.

The Chief Nurse introduced the report and provided some context to the proposals within the report, responded to questions raised and advised of the proposed timescales for developing an option appraisal for the future provision of the service.

After discussion, the Integration Joint Board agreed:

(1)        to note that notice has been given by Marie Curie in relation to the cessation of Rapid Response Out of Hours care under the current contract on 30 September 2023;

(2)        to direct NHS Grampian to vary the Marie Curie contract to remove the delivery of Rapid Response Out of Hours care from the existing contract and arrange interim measures to ensure continuation of service directly in line with this report;

(3)        to delegate to the Chief Officer following consultation with the Chair and Vice Chair and Chief Finance and Business Officer the detail of the budget required to be attached to the Direction;

(4)         to commission a full review of the delivery model and consider an options appraisal including quality of care delivery, cost, and workforce and to report back to the IJB with a recommendation within the current financial year;

(5)        to consider the Managed Care element of the contract with regards to Aberdeen City, Aberdeenshire and Moray, and the creation of a fit for purpose contract for the delivery of this service; and

(6)        that further updates should be provided to the IJB in due course.