Agenda and minutes

The Chair made the following announcement at the start of the meeting –

Welcome to this meeting of the Argyll and Bute Integration Joint Board.

This meeting is being held remotely on an audio only basis following the announcement by the Prime Minister and the First Minister, and the associated guidance in relation to gatherings of more than two people.

Furthermore arrangements have been put in place to support audio recording of the meeting, which will subsequently be hosted on the IJB website as a Public Record. This is a previously untested arrangement so please do bear with us in the event of any technical issues.

I would remind all members that this is the first time we have convened a meeting under these conditions, and members should use the instant message function in the call to indicate if they wish speak, or if they are joining by phone then wait until they are invited to.

In the public interest and to fulfil our public obligation to ensure openness and transparency members of the press have also been invited to attend the meeting remotely and furthermore we have 2 councillors, Councillors Philand and Horn who have requested to listen in.

As this is an audio meeting for the purposes of the Sederunt we will read out the names of the members and officers invited to participate or support the meeting and ask them to confirm their attendance.

In the event of a vote, names will be called out and a roll call vote will be taken.

Apologies for absence were received from Rebecca Helliwell, Angus MacTaggart, Kirsteen Murray and Fiona Thomson.

There were no declarations of interest.

Integration Joint Board held on 29 January 2020

The Minutes of the meeting of the Integration Joint Board held on 29 January 2020 were approved as a correct record.

There were no matters arising from the action log.

The Chair referred to an email from Kirsteen Murray raising governance issues with the Minutes of the meeting of 27 November 2019.  The Chair advised that these issues were similar to those raised previously and suggested that as this meeting was audio only, the Board defer this to another meeting.  This was agreed by the Board.

The Minutes of the meeting of the Finance and Policy Committee held on 24 January 2020 were noted.

The Minutes of the meeting of Audit and Risk Committee held on 6 December 2019 were noted.

The Chair proposed as the meeting was audio only and there was a need to prioritise the business considered, that the Board consider items 6 (Covid-19 Update), 7 (Delegated Authority for the Chief Officer), 8 (Culture Fit for the Future), 9 (Dementia Services Redesign Update) and 16 (Finance) first and if time allowed then other items of the Agenda would be considered.  This was agreed by the Board.

Report by Associate Director of Public Health

The Board gave consideration to a report that provided factual information on the Coronavirus that caused Covid-19 and advised that as it had been identified as a pandemic, partners were required to take the appropriate response and implement business continuity planning.

The Associate Director of Public Health provided a verbal update on Covid-19 advising that the position had moved forward considerably since the report had been published.  He advised that the number of cases in Scotland had almost doubled in that time, with confirmed cases in the NHS Highland area rising to 13 from 5.

The Chief Officer advised that operationally they had stood up a Bronze meeting which met daily and which fed into Silver and Gold meetings.  She advised that they were liaising closely with Argyll and Bute Council colleagues and that staff were working and planning for the worst case scenario.

The Head of Finance and Transformation advised that assurances had been given by the Scottish Government that additional costs in relation to Covid-19 would be reimbursed.  She advised that all costs were being tracked and would be discussed at the Finance and Policy Committee.

Decision

The Integration Joint Board -

1.    Noted the COVID-19 information and public health response in the context of Argyll and Bute contained within the submitted report.

2.    Noted the verbal update from the Associate Director of Public Health and the Chief Officer of the Health and Social Care Partnership.

3.    Thanked all local staff in Health and Social Care, including unpaid carers, commissioned and third sector colleagues, for their ongoing dedication and commitment.

(Reference:  Report by Associate Director of Public Health dated March 2020, submitted)

Report by Chief Officer

The Board gave consideration to a report that sought delegated authority for the Chief Officer to take operational decisions that would normally require Board approval in the light of the ongoing Covid-19 situation and the strong possibility that the Board would be unable to meet as normal.

Decision

The Integration Joint Board –

1.    Agreed to grant the Chief Officer power in an emergency to instruct executive action on any matter for the duration of the Covid-19 emergency in consultation with the Chair or Vice Chair of the Board. 

2.    Agreed that the Chief Officer would consult with both the Chair and Vice-Chair before exercising but that an inability to consult either Chair or Vice Chair would not invalidate any actions taken.

3.    Agreed that the delegation of powers to the Chief Officer would be the subject of ongoing review and normal Board meeting arrangements would be re-introduced as soon as practicable.

4.    Noted that a record would be kept of all actions taken and reported to the Board when possible. 

(Reference:  Report by Chief Officer, Health and Social Care Partnership dated March 2020, submitted)

Alex Taylor left the meeting at this point.

Report by Director of HR and Organisational Development

A report providing an update on progress with the Culture Fit for the Future Programme plans and delivery was given consideration by the Board.

Decision

The Integration Joint Board noted the updates contained within the report.

(Reference:  Report by Director of Human Resources and Organisational Development dated March 2020, submitted)

Alex Taylor re-joined the meeting, and Kevin McIntosh left the meeting, during the consideration of the following item of business.

Report by Head of Adult Services

Prior to consideration of the report, the Chief Officer read out the following statement advising of an operational decision to relocate patients within the Knapdale Ward, Mid Argyll and to designate the ward for potential Covid-19 patients in order that the decision could be separated from the policy decision of the IJB.

NHS Scotland has instructed Health Boards and Integration Joint Boards to reduce delayed discharges and increase bed capacity immediately.

This has been discussed at the Gold Command across the Health Board, which co-ordinates the response to COVID-19 and supports the need for immediate capacity and to delay the spread of COVID-19 amongst the population.

As a result, the Knapdale Ward within Mid Argyll hospital in Lochgilphead has been designated for potential COVID-19 patients.  This ward is currently a dementia assessment ward and the patients who are being cared for within Knapdale will be provided with alternative care arrangements.

This decision has been taken in light of the demand for bed capacity as a result of the COVID-19 pandemic and we have been working with the families of the patients about the change to their care arrangements.

This operational decision is taken for clinical grounds and any permanent decision on the future of the ward remains with the IJB, which will be discussing the dementia services redesign at its meeting on the 25 March.

The Board gave consideration to a report that provided an update on the initial consultation, provided reassurance on the consultation process and outlined the next steps in relation to the dementia services redesign.

Decision

The Integration Joint Board –

1.    Noted the operational decision to designate the Knapdale Ward, Mid Argyll for potential Covid-19 patients.

2.    Approved the planned closure of Knapdale Ward, Mid Argyll in order to move to implementation planning of the Enhanced Community Dementia Model, noting that this process may take a year or more to implement.

3.    Approved the development of detailed implementation plan by way of a Dementia Steering Group, giving the Board assurance that risks are managed as a result of the process of transition.

4.    Noted the feedback from the consultation.

(Reference:  Report by Head of Service, Older Adults and Community Hospitals dated March 2020, submitted)

The Chaired ruled and the Board agreed to take a 5 minute comfort break from 3.20pm.

The meeting resumed at 3.25pm.

Report by Head of Finance and Transformation

The Board have consideration to a report that provided a summary of the financial position of the Health and Social Care Partnership as at 31 January 2020.

Decision

The Integration Joint Board –

1.    Noted the forecast outturn position for 2019-20 is a forecast overspend of £1.165m as at 31 January 2020 and that there is a year to date overspend of £1.365m as at the same date.

2.    Noted the above position excludes any provision for the ongoing dispute with NHS Greater Glasgow and Clyde.

3.    Agreed further steps will be taken in relation to the ongoing dispute with NHS Greater Glasgow and Clyde by the Chief Officer in line with delegated powers.

(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)

Report by Head of Finance and Transformation

The Board gave consideration to a report that summarised the budget outlook for the period 2020-21 to 2022-23 taking into consideration the budget decisions taken at the Integration Joint Board on 27 March 2019.  A full update on the budget outlook was presented to the Board on 29 January 2020.

Decision

The Integration Joint Board noted -

1.    The current estimated budget outlook report for the period 2020-21 to 2022-23.

2.    That there was a separate report on the agenda detailing savings options to deliver a balanced budget on 2020-21.

(Reference:  Report by Head of Finance and Transformation dated March 2020, submitted)

Report by Head of Finance and Transformation

The Board gave consideration to a report that provided an update on the financial risks facing the organisation which had not been reflected in the forecast of the financial outturn.

Decision

The Integration Joint Board noted –

1.    The updated financial risks identified for the Health and Social Care Partnership.

2.    That financial risks will continue to be reviewed and monitored on a two monthly basis and reported to the Board.

(Reference:  Report by Head of Finance and Transformation dated March 2020, submitted)

Report by Head of Finance and Transformation

The Board gave consideration to a report that summarised the 563 budget consultation responses received when the consultation closed on 4 March 2020.

Decision

The Integration Joint Board –

1.    Noted the findings from the budget consultation.

2.    Agreed to consider the findings when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.

(Reference:  Report by Head of Finance and Transformation dated March 2020, submitted)

Report by Head of Finance and Transformation

The Board gave consideration to a report that outlined the work undertaken to ensure that due regard is given to equalities, islands and the Fairer Scotland Duty in the decision making process relating to budget savings.  The report presented a strategic equality and socio-economic impact assessment for the savings programme to advise on overall impact.

Decision

The Integration Joint Board noted the findings from the summary Equality and Socio-Economic Impact Assessment and agreed to ensure that these were considered when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.

(Reference:  Report by Head of Finance and Transformation dated March 2020, submitted)

Report by Head of Finance and Transformation

The Board gave consideration to a report that presented savings proposals identified by the Strategic Leadership Team in order to deliver a balanced budget in 2020-21.

Decision

The Integration Joint Board –

1.    Noted the management/operational savings amounting to £4.157m approved by the IJB on 29 January 2020 in 2020-21.

2.    Approved the changes to the Management & Operational savings set out at 3.2.4 to 3.2.5  amounting to £85k for 2020-21 and the revised list of savings now presented at Appendix 1 totalling £4.242m.

3.    Approved the removal of previously agreed saving 1920-6 £25k relating to ferry ticketing as set out at 3.2.6.

4.    Approved the policy savings at Appendix 2 amounting to £1.463m in 2020-21.

5.    Approved the proposed investment in financial sustainability totalling £318k in 2020/21 and 2021/22 set at 3.3.8.

6.    Noted that in endorsing the management/operational savings and approving the policy savings this will deliver a balanced budget in 2020-21. 

7.    Instructed the Chief Officer to accept the funding from NHS Highland and Argyll and Bute Council and issue formal Directions (see drafts at Appendix 3) delegating resources back to the Partners.

8.    Noted the high level timetable for the budget preparation 2021-22 set out at 3.5.1.

9.    Noted that there would be additional costs due to Covid-19, which should be recoverable from the Scottish Government, and that therefore the savings may need to be flexed accordingly.

(Reference:  Report by Head of Finance and Transformation dated March 2020, submitted)

The Integration Joint Board agreed to give consideration to the following two items of business as they required action to be taken following consideration by the Board.

Report by Associate Director of Public Health

The Board gave consideration to a report that presented the Argyll and Bute Alcohol and Drug Partnership Strategy and Action Plan for approval.  The Scottish Government requires every Health and Social Care Partnership to deliver a strategy for the reduction of harm from alcohol and drug use.

Decision

The Integration Joint Board approved the Alcohol and Drugs Partnership Strategy and Action Plan 2020-23 for Argyll and Bute.

(Reference:  Report by Senior Health Improvement Specialist, Alcohol and Drugs dated March 2020, submitted)

Report by IJB Standards Officer

The Board gave consideration to a report that provided a further update on progress with regard to the review of the Integration Scheme.

Decision

The Integration Joint Board –

1.    Noted the outcome of the 6 week consultation process.

2.    Noted that reports will be tabled at the NHS Highland Board on 31^st March 2020 and the Council on 16^th April 2020 to seek approval of the revised Scheme of Integration.

3.    Noted that further to agreement the revised Scheme of Integration will be jointly submitted by the Chief Executives of the two parent bodies to the Scottish Government by end April 2020 for their consideration and that a further update report will be provided to the IJB thereafter.

(Reference:  Report by IJB Standards Officer dated March 2020, submitted)

The Chair thanked everyone for their attendance and thanked Governance Officers for their support in arranging the meeting.

The following items were not considered by the Integration Joint Board due to time constraints given that the meeting was held on an audio only basis.

Report by Chief Officer

Report by Head of Strategy and Planning

Report by Head of Strategy and Planning

Report by Head of Customer Support Services

Report by Head of Customer Support Services

Wednesday 27 May 2020, 1.00pm, Council Chamber, Kilmory, Lochgilphead