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 2 and 3 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 Item 15 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 2 and 3 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 Item 15 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 Minute of the Meeting of 11 October 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 Consumer Duty for Public Bodies – Analysis of Consultation Responses and Coming into Force Date; (2) Community Hub Programme; (3) National Care Service – National Forum 2023; (4) Aberdeenshire Wellbeing Festival; and (5) Joint Inspection of Adult Support and Protection in the Aberdeenshire Partnership Area.

By way of update, the Chief Officer advised on the Consumer Scotland Act 2020 and the necessary legislation to allow the Duty to come into force on 1 April 2024 and Consumer Scotland was developing the guidance to support the Duty, in consultation with stakeholders, and advice was being sought from Legal and People in relation to the implications for the IJB; discussions were continuing around development of a Community Hub model, recognising that this would require further capacity to progress the initiation of a formal programme plan; that the Scottish Government remained committed to delivering a National Care Service, and provided a timetable of next steps for the next 12 months and beyond; provided feedback from the 2023 Wellbeing festival, with an increased participation with 166 events held in May 2023 and an estimated 1,500+ people participating; and formal notification had been received of a multi agency inspection of Adult Support and Protection, with a final report anticipated by April 2024.

After discussion, the Integration Joint Board agreed:

(1)           to welcome that next year’s report on the Aberdeenshire Wellbeing Festival considers an evaluation of the ongoing impacts; and

(2)           to note the terms of the updates provided.

There had been circulated a report dated 27 November, 2023 by the Chief Finance and Business Officer, providing an update on the financial monitoring information for the 2023/24 financial year, which covered the six month period up to 30 September 2023.

The Chief Finance and Business Officer provided an overview of the financial position as at the end of September 2023, the detailed position by service area, highlighted the areas which recorded the largest over budget positions and the largest underspends as at the end of September, 2023 and the budget virements proposed for approval, as contained in Appendix 3 to the report. He outlined the forecast position for 2023/24, based on the September results, which showed a forecast overspend of £12.48 million, and outlined a number of areas of forecast pressure. He advised that the information provided assumed the achievement of £4.7 million of efficiency savings in 2023/24 and the recovery plan communication to budget holders from the Chief Officer emphasised the requirement to ensure achievement of agreed savings which would continue to be monitored and reported to the IJB. The report provided an update on the current prescribing practice and strategy across Grampian, related to the current communications plans, planned efficiencies reporting and escalations to wider partner organisations. In terms of next steps, he confirmed that meetings were continuing to be held to review the current financial position and the impact on 2024/25 and beyond and IJB budget development sessions would continue, with work ongoing to identify areas of potential mitigation.

During discussion, Members commented on the following:

(a)           The Chief Officer provided an assurance of tight budgetary management taking place, with all areas of discretionary spending being closely monitored;

(b)           It was noted that there was a range of work ongoing relating to medicine management at a North East and national level and that officers were seeking comparative data on prescribing from other areas to consider areas of best practice, and to consider initiatives around waste, however any potential reductions were likely to be realised in the medium to longer term;

(c)           It was noted that budget monitoring work would continue through scheduled development sessions.

After further consideration, 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; and

(3)           to seek a further report on prescribing costs, including budget management, to understand what is the locus of the IJB in the management of prescribing costs.

There had been circulated a report dated 27 November 2023 by the Chair of IJB Audit Committee providing an update on key issues in relation to Audit which had been progressed since the last meeting of the IJB. The report advised that since the last meeting of the IJB, three reports had been presented to the Communities Committee and the Audit Committee as part of the Committee referral process, including a Stage 1 Referral – Assurance Review of IJB Governance, Stage 2 Referral – IJB Transformational Projects and Stage 1 – Assurance Review of Adults with Incapacity.

The Chief Finance and Business Officer introduced the report and advised that the final audited accounts for 2022/23 had been presented to the IJB Audit Committee on 29 November 2023 with a current, unmodified position, and subject to completion of a number of outstanding tests and assurances, and an update on the final outcome would be provided to the next meeting of the IJB. In addition, he provided an update of the work of the Risk Assurance Group and the regular review of the wider Risk Register, and concluded by providing details of current internal audit reports which were being conducted.

During discussion, it was considered that further consideration should be given to the risk element around the wider role of the IJB Audit Committee, which would be reflected as part of the self-assessment process to be undertaken by the IJB in terms of the ongoing governance review.

It was noted that a Stage 2 workshop had been delivered for the Communities Committee on the IJB Transformational Projects to allow for further exploration of the issue and identification of potential improvement actions, and the outcomes would be reported back to the Communities Committee on 14 December 2023 as part of the review process.

After further discussion, the Integration Joint Board agreed:

(1)           to note that an update would be provided at the next meeting on the status of the audit of the annual accounts;

(2)           that the IJB should be kept informed of any issues related to agreement of the final report on the annual accounts by way of briefing note in the interim;

(3)           to pay tribute to Amy Anderson for her work in the role of Chair of the IJB Audit Committee, and to welcome Joyce Duncan to the role of Chair.

There had been circulated a report dated 2 November 2023 by the Chief Officer which provided a summary of the main items of discussion at the most recent meeting of the Strategic Planning Group. The report advised that the main focus of the meeting was to undertake a self-assessment process in line with its Terms of Reference, and the outcome of the process would form part of the consideration of the IJB’s own self-assessment. The report also provided an update on the Analogue to Digital Strategy, which highlighted that by the end of 2025 the current analogue telephone service on copper wires would be switched off as the UK’s telecoms infrastructure was upgraded to digital fibre connectivity and work was ongoing to ensure that infrastructure for telecare users was carried out in a timely manner. In addition, there had been significant progress in ongoing work to support the workforce plan.

The Interim Transformation and Strategy Manager introduced the report, provided further background, and responded to questions in relation to the oversight for timelines, deliveries and project management of the projects.

During discussion, it was noted that work was ongoing to ensure resilience around the analogue to digital service, with each alarm having a 12 hour battery life and the ability to switch to other systems, in case of storm events. For the work to install the new alarms systems, there was discussion of the potential to seek support for the rollout from the Scottish Fire and Rescue Service, in their role as a community planning partner.

In relation to the Workforce Plan, there was discussion around the potential restrictions by government on the opportunities for Health and Social Care visas, which could have a negative impact on the current challenges around recruitment. Work was ongoing to participate in an international pilot for social care recruitment for adult social care posts and further work was ongoing with the HR services of Aberdeenshire Council and NHS Grampian to develop a streamlined process for recruitment to integrated posts.

After discussion, the Integration Joint Board agreed:

(1)           to acknowledge the report from the Strategic Planning Group (SPG) following its meeting on 31st October 2023, including the project update on the Analogue to Digital workstream and from the Workforce and Training Group;

(2)           to note the work undertaken by the SPG on a self-assessment process to be considered further as part of the IJB’s own self-assessment;

(3)           to note the relationship between the anchor role of the Council and Health Board as employers and the contribution of apprenticeships and health literacy around applications;

(4)           that Officers should explore the potential to seek support for the rollout of the new alarm systems from the Scottish Fire and Rescue Service in their role as a community planning partner; and

(5)           that further updates be provided as and when available, particularly in relation to staffing and recruitment.

There had been circulated a report dated 2 November 2023 by the Chief Officer which sought approval of a revised Organisational Governance Framework for the Aberdeenshire Health and Social Care Partnership (HSCP). The report advised that the aim of the Framework was to ensure clarity and transparency as to the organisational management structures and decision-making process in place within the HSCP that support and provide assurance to the IJB in relation to the governance and management of services, risk and performance. In accordance with the requirements for annual review, the Framework had been updated to reflect key changes or updates to organisational structures in the last year.

The Interim Strategy and Transformation Manager introduced the report and highlighted key areas of work that had been undertaken, which took cognisance of the various reviews and improvement work that had been carried out to date; advised that the Framework was a ‘high level’ overview of arrangements and in response to Internal Audit recommendations, additional information had been incorporated to ensure clarity as to the intended outcomes and delivery of objectives.

During discussion, Members raised a number of points of clarity, which officers undertook to review, and it was suggested that sight of the working document incorporating the changes made to the previous version of the document would be useful.

After discussion, the Integration Joint Board agreed:

(1)           that Officers should clarify a number of points raised by Members including Page 91, section 2.6 relating to staff governance; Page 95 reference to Public Protection, and no reference to connecting into NHS Grampian; Page 22 inclusion of professional assurance pathways for public health;

(2)           that Officers should circulate the working document which covered the changes made to the previous version. Following consideration IJB Members to request any further information on the changes andrevisions made to the Governance Framework; and

(3)           to approve the revised Aberdeenshire Health & Social Care Partnership (HSCP) Organisational Governance Framework and to welcome annual updates.

There had been circulated a report dated 7 November 2023 by the Lead for Allied Health Professions (AHP) and Specialist Rehabilitation Services (Aberdeen City Health and Social Care Partnership) and the Transformation Programme Manager (Aberdeen City Health and Social Care Partnership), which outlined the findings of a strategic review of the neurorehabilitation pathway, which is a service which is hosted by the Aberdeen City Health and Social Care Partnership, for the delivery of Specialist Rehabilitation Services, including neurorehabilitation services, for Grampian, as part of the shared governance arrangements with Aberdeenshire and Moray Health and Social Care Partnerships.

The lead officers were in attendance and provided some further context to the report and responded to questions raised by Members.

During discussion, it was noted that a project team had been formed to take forward a review of the neurorehabilitation pathway ahead of a wider strategic rehabilitation review, and any learning from this would help inform both the wider strategic review work and any further specific pathway reviews to be undertaken. The review work by the project team had allowed for a wide engagement with a range of stakeholders including patient, family and carer input as well as a wide range of staff, both within the pathway and partners such as Health and Social Care Partnership colleagues, to gather views regarding priorities for the model of service delivery for current and future patients.

In respect of other pathways work that was underway it was noted that work was ongoing in relation to adult Mental Health and this work would be highlighted in future Chief Officer updates.

After discussion, the Integration Joint Board agreed:

(1)           to note the findings of the strategic review of the neurorehabilitation pathway;

(2)           that Aberdeen City IJB as host IJB for this service implements the proposed changes to the neurorehabilitation pathway in collaboration with Aberdeenshire HSCP and in a phased manner as set out in section 5;

(3)           that an evaluation of Phase 1 would be shared with Aberdeenshire IJB in September 2024 before Phase 2 commences;

(4)           to note the engagement to date with the Aberdeenshire and Moray HSCPs and support the continuation of the engagement to help ensure the redesign continues to meet the needs of all three Partnerships;

(5)           that the Chief Officer should include in future Chief Officer updates information on work underway on pathways, including in terms of hosted services; and

(6)           that officers should provide a briefing note in 6 months with an interim update on the work underway in respect of the neurorehabilitation pathway.

There had been circulated a report dated 30 October 2023 by the Chief Officer, which sought comments on the proposed definitions for transformational projects, improvement projects and projects under review; provided an updated categorisation of the projects within the Strategic Delivery Plan (SDP) and a risk management process for projects linked to the SDP; outlining a prioritisation framework to the project mandate and project charter to support SMT prioritise projects; and seeking approval to the removal of a number of projects as identified in 5.1.5 and 5.1.6 from within the SDP as part of the review process.

During discussion, Members noted that the report was part of an ongoing piece of work that was being supported by the Strategy and Improvement Teams and reflecting a lot of the recommendations and learning taken from recent internal audits, and was seeking a steer from the IJB in relation to ensuring there was a clear focus in priorities and deliverables within the Strategic Delivery Plan. It was noted that the Strategic Delivery Plan agreed by the IJB in December 2022, and capacity to deliver the extensive list of projects had raised some concerns. It was suggested that the SDP should focus on the key transformational projects of the Health and Social Care Partnership and through the clarification of definitions and project categories the focus could be directed to the key transformational projects. It was noted that work had also begun on embedding the risk management process through appropriate project management documentation, with escalation processes available if required.

After discussion, the Integration Joint Board agreed:

(1)           to note the proposed definitions for transformational projects, improvement projects and projects under review;

(2)           to acknowledge the updated categorisation of the projects within the SDP as well as the development of a risk management process for projects linked to the SDP;

(3)           to acknowledge the addition of a prioritisation framework to the project mandate and project charter to support SMT prioritise projects;

(4)           to agree the removal of the projects as identified in 5.1.5 and 5.1.6 from within the Strategic Delivery Plan as part of the review process;

(5)           that Members be invited to provide their comments or questions on the project definitions for further consideration by Officers as work evolves;

(6)           to note that the ongoing work in this area aims to inform the overall strategic direction for the Health and Social Care Partnership, and to provide a sense of direction which would be reiterated through the next version of the Strategic Plan;

(7)           to note a correction at Section 5.2.5 – ‘Non clinical’ should read ‘Clinical; and

(8)           in terms of Section 5.3.8 of the report, that reference to anticipated financial savings be included within the outcomes box to ensure an understanding of the financial implications from the outset.

There had been circulated a report dated 9 November 2023 by the AHP Lead, Aberdeenshire Health and Social Care Partnership, which asked the IJB to agree to cease the commissioning of beds in Rosewell House, Aberdeen, which had been commenced during the Covid-19 Pandemic, as a result of work around the frailty pathway at that time.

The Chief Officer introduced the report and advised that the interim arrangement to commission 10 beds in Rosewell House was done whilst a Hospital at Home provision was being developed. This had proved problematic due to not being able to achieve geriatrician cover and had resulted in a rethink of the approach for the Health and Social Care Partnership. The revised approach proposed to build on the virtual community ward model and to continue to extend that to maintain people in the community, to enable a service to be developed to support the rural geography and existing resources.

After discussion, the IJB agreed to cease commissioning of beds in Rosewell House, that was commenced during the COVID 19 Pandemic, as a result of work around the frailty pathway at that time.

With reference to the Minute of Meeting of the IJB of 11 October, 2023 (Item 20), there had been circulated a report dated 10 November 2023 by the Chief Officer which outlined work being undertaken by the Aberdeenshire Health and Social Care Partnership in relation to resilience and surge planning for 2023-24, in respect of preparedness for winter 2023-24 and building resilience to surges in demand.

The Interim Strategy and Transformation Manager provided an update on the Resilience and Surge Plan which was informed by engagement with the partnership’s workforce and bringing together a frontline expertise to inform what maintains flow, what maximised capacity and improves both service user and staff experience. The Plan was intended to be a practical tool and able to be used by Health and Social Care teams to inform their local resilience and local continuity planning. It was also noted that the Plan dovetails with the principles and priorities of the Scottish Government’s Winter Preparedness Plan.

During discussion, Members commented on the significant level of work that was being done to prepare for the winter pressures across the whole of the healthcare system to ensure delivery of the Resilience and Surge Plan.

After discussion, the IJB agreed:

(1)            to recognise the ongoing work to ensure delivery of the Plan and the significant pressures across the whole system; and

(2)           to note the continuing preparation being undertaken by the Aberdeenshire Health and Social Care Partnership with respect to resilience and surge planning for 2023-24.

With reference to the Minute of Meeting of 23 August, 2023 (Item 16), there had been circulated a report dated 2 November 2023 by the Chief Officer which provided an update on the transfer of service delivery of the former Balhousie Huntly Care Home to a private provider.

The Partnership Manager, South provided an update on progress, with anticipated dates and arrangements for the transfer of the business, including terms proposed and associated funding arrangements. She provided details of transitional arrangements that would be instigated between the Aberdeenshire Heath and Social Care Partnership and the new provider, whilst the registration process was being completed.

After discussion, the Integration Joint Board agreed:

(1)           to note the progress with transferring the service delivery of the care home to a private provider;

(2)           to approve an extension of the funding to deliver the service from 11^th April 2024 up to 30^th of June 2024;

(3)           to approve the Direct Award of the contract to the private provider from 1 July 2024 in line with the National Care Home Contract duration (Procurement Approval Form Appendix 1);

(4)            to direct Aberdeenshire Council to negotiate the transfer of the business of Huntly Care Home to Parklands Limited (or a company within its group) and to transfer the said business on terms acceptable to the Chief Officer; and

(5)           the Chief Finance and Business Officer to seek clarification on a number of the figures withing the Financial Information section of the report, for clarity.