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REPORT TO: THE NHS GRAMPIAN HEALTH BOARD ON 5 MARCH 2015
SUBJECT: THE INTEGRATION SCHEME FOR MORAY ADULT HEALTH AND SOCIAL CARE SERVICES
BY: THE CHIEF OFFICER (MORAY)
1.REASON FOR REPORT
1.1 The purpose of this report is to seek approval from the NHS Grampian Health Board for the Moray Health and Social Care Integration Scheme.
- RECOMMENDATION
2.1It is recommended that the NHS Grampian Health Board:-
i) Notes the findings of the consultation exercise in relation to the draft Integration Scheme for Moray (Appendix1);
ii) Agrees that following the completion of this consultation, that the Board approves the revised Health and Social Care Integration Scheme for Moray (Appendix 2);
iii) Agrees that this Integration Scheme can be submitted to the Scottish Government for approval;and
iv) Following submission, agrees that any minor amendments to the Integration Scheme proposed by the Scottish Government, will be agreed for the NHS Grampian Health Board by the Chief Executive in consultation with the Chair and the Vice Chair of the Transitional Leadership Group.
- BACKGROUND
3.1 The purpose of this report is to inform the NHS Grampian Health Board of the findings of the consultation exercise conducted in relation to the draft Moray Integration Scheme and to seek approval of the revised Health and Social Care Integration Scheme for Moray.
3.2 This report is in two parts. The first part will present the findings of the consultation exercise and the second part will outline the consequent changes that have been made to the Moray Integration Scheme.
3.3 The Consultation Exercise
3.4 The Board will be aware that the Public Bodies (Joint Working) (Scotland) Act 2014 requires that all local authority and heath boards consult on their draft Integration Schemes prior to submission to the Scottish Government for final approval.
3.5 The Moray consultation exercise has now been completed and a report concerning the findings is an appendix to this report (Appendix 1).
3.6 In summary, the report notes that the consultation period ran from mid November to 6 February 2015.
3.7 The report also notes that the consultation was extensively promoted. This included press coverage in the Northern Scot, Press & Journal, Forres Gazette, Radio Scotland, Moray Firth Radio, social media (facebook and twitter accounts) and through the Council’s and NHS Grampian’s internet and intranet sites. Information on the consultation was also sent directly to over 130 independent and third sector organisations.
3.8 In aiming to ensure that this consultation was accessible, an easy read version of the Integration Scheme was circulated with the full version of the draft Integration Scheme that was previously presented to Council. In addition, with assistance from North East Sensory Services, a braille version was produced.
3.9 During this period, the Engagement and Communication Officer and the Chief Officer also supported the consultation process by offering briefing sessions with both the public and the joint workforce.
3.10 Using a feedback form, which could be submitted electronically, the public and the joint workforce were asked for opinions on the key elements of the Integration Scheme and their views regarding 3 different locality options for Moray. An opportunity to state an alternative locality arrangement was also provided as ‘option 4’.
3.11 The Board will note that while the determination of locality boundaries is not required to be stated within the Scheme, it is a key element of the Public Bodies (Joint Working) (Scotland) Act 2014 and will be referred to as part of the Strategic Plan for Moray. Determining locality boundaries at this stage will therefore assist in the development of this plan.
3.12 In total, 92 feedback responses were received and the following table summarises the number and percentage levels of agreement or disagreement in relation to each of the questions posed in the feedback form.
Question / I support it / I support some of it / I do not support it / I am not sureThinking about the vision statement, do you / 63 (68%) / 14 (15%) / 3 (3%) / 0
Thinking about our purpose, do you / 60 (65%) / 18 (20%) / 1 (1%) / 2 (2%)
Thinking about our principles, do you / 57 (62%) / 18 (20%) / 0 / 4 (4%)
Thinking about our values, do you / 66 (72%) / 14 (15%) / 1 (1%) / 2 (2%)
Thinking about Governance, do you / 49 (53%) / 14 (15%) / 5 (5%) / 12 (13%)
Thinking about Information Sharing, do you / 59 (64%) / 13 (14%) / 2 (2%) / 6(6%)
Thinking about Complaints, do you / 65 (71%) / 10 (11%) / 2 (2%) / 3 (2%)
Thinking about Claims and Liability, do you / 63 (67%) / 10 (11%) / 2 (2%) / 8 (9%)
Question / Option 1 / Option 2 / Option 3 / Option 4
Thinking about Localities do you support / 4 (4%) / 29 (32%) / 42 (46%) / 6 (7%)
3.13 Overall, the consultation exercise revealed a strong endorsement for the Moray Integration Scheme. The areas of strongest approval were the vision and values statement and the areas showing a lower level of approval were in relation to the sections concerning governance and information sharing.
3.14 In terms of localities, the Moray Transitional Leadership Group’s stated preferred model (option 3) received the most support. This is an east/west split of Moray which is also subdivided into 4 GP practice cluster group areas. This is illustrated on page 139 of the Consultation Feedback Report.
3.15 While the sample size was small and responses were not received from all protected characteristic groups, Officers nevertheless consider that the results of the consultation have been informative.
3.16 The Board will note that the Consultation Feedback Report (appendix 1) provides a response to each critical comment made by consultees. Officers in Moray will send the Consultation Feedback Report to everyone who has requested a copy and will arrange feedback sessions to discuss the findings of the consultation exercise with both the joint workforce and the public.
3.17 Revisions to the Moray Integration Scheme
3.18 Based on the comments received from this consultation and ongoing guidance from the Scottish Government, The Moray Council and NHS Grampian, a revised Moray Integration Scheme document has been produced (Appendix 2).
3.19 In order to support the Board to approve the revised Integration Scheme, this section of the report will outline the amendments made to the draft Scheme. These changes have been collated by Geraldine Fraser, Senior Solicitor, Health and Social Integration, who has also supported Aberdeenshire and Aberdeen City in finalizing their respective Integration Scheme documents.
3.20 Vision Statement
3.20.1 The vision statement (including, purpose, principles and values) had been developed through engaging with servicer users, patients and the joint workforce using a co-production approach during 2014. Before inclusion within the draft Integration Scheme, the statement had been refined following feedback from the Citizen’s Panel for Moray. The responses from the consultation exercise have been helpful in supporting further refinements to be made. The overarching vision statement now reads; “To enable the people of Moray to lead independent, healthy and fulfilling lives in active and inclusive communities where everyone is valued, respected and supported to achieve their own goals.”
3.21 Governance
3.21.1 The Integration Scheme now specifies who the voting and non-voting memberships of the Integrated Joint Board (IJB) are. Arrangements for nominating the first Chair have also been clarified. Arrangements to ensure that each parent body has parity in terms of chairing the IJB have also been addressed, by reflecting in the Scheme the requirement contained within the Regulations that the parent organisations must alternate which of them is to appoint the Chair in respect of each successive appointing period.
3.21.2 The responsibilities of the Chief Officer have been clarified in relation to the IJB and the parent bodies, in particular regarding the Chief Officer’s “operational role” in the management of integrated health and social care services.
3.21.3 In relation to this section of the document, one of the common feedback response themes expressed by members of the joint workforce was a degree of anxiety regarding being line managed by a colleague from the other parent body (e.g. a Council member of staff being line managed by a NHS member of staff). The specific concern expressed was regarding professional competence to provide line management support and the dilution of professional identity under this arrangement. The Chief Officer has identified that it is important to address these anxieties and concerns. It is proposed that this will be one of the key areas of discussion during the feedback sessions with the joint workforce and when progressing work in relation to preparation of the Moray Strategic Plan.
3.21.4 Informal feedback received from the Scottish Government also suggested that these arrangements would be better set out in a separate document, rather than within the scheme itself. For all of these reasons, this part of the scheme has been removed and placed in a separate “Annex 5 – Additional Local Information”.
3.21.5 The section on “Clinical and Professional Governance” has been significantly extended to ensure that the arrangements are clear and robust.
3.21.6 Concerns regarding a lack of clarity of the roles of lead professionals in the new arrangements were noted, such as the Chief Social Work Officer and Nursing and Medical Directors. This has been addressed by outlining their respective statutory responsibilities and how these will continue despite the new arrangements for integrated services. In developing these arrangements, regard was given to the Scottish Government’s Clinical and Care Governance Framework and further consideration of the existing local arrangements.
3.22 Finance
3.22.1 In terms of the Finance Section, an amendment has been made in relation to IJB overspend against payments from each parent body. In the event of an overspend during the first financial year, the overspend will be met by the parent body with operational responsibility for delivering this service.
3.23 Information Sharing
3.23.1 Ensuring that patient/service user consent to share is always secured was another recurring theme of many of the consultation responses.
3.23.2 Since this section is focused on the development of an information sharing protocol, it was considered by the Chief Officer to address people’s anxiety and concerns through the face to face feedback sessions with the joint workforce and the public. No changes have therefore been made to this section of the document.
3.24 Complaints
3.24.1 Many of the consultation responses requested clarity regarding how a new complaints procedure for the IJB would operate.
3.24.2 While a detailed description is not within the scope of this document, the wording of this section has consequently been revised to provide more information in terms of how complaints can be submitted and dealt with. The Scheme also now clarifies that any significant changes to the existing complaints procedures would require the integration scheme to be amended using the formal procedure required in the legislation (i.e. further consultation and re-submission to Scottish Ministers for approval). This will ensure that everyone is aware of any proposed changes to procedures.
3.25The Board will note that approval for the revised Moray Integration Scheme will also be sought from the meeting of The Moray Council on 4 March 2015 before being submitted to the Scottish Government by 1 April 2015.
4.SUMMARY OF IMPLICATIONS
(a) Moray 2023 A Plan for the Future
The integration of health and social care services is underpinned by 9 high level national health and well-being outcomes and a suite of underpinning performance indicators. A number of these outcomes and underpinning indicators, such as feeling safe and the proportion of people in permanent care are also part of the measures which are used to monitor progress against the Moray 2023 A Plan for the Future. This is specifically in relation to priority area; ‘adults living healthier, sustainable independent lives safeguarded from harm’.
These outcomes are referred to in the Moray Integration Scheme and will be used to monitor future progress in terms of integrating health and social care services.
(b) Policy and Legal
This report is in response to the requirements of The Public Bodies (Joint Working) (Scotland) Act 2014.
The legal requirement to formally consult with the groups noted in paragraph 3.4 of this report is identified in regulation 1(2) of The Public Bodies (Joint Working) (Prescribed Consultees)(Scotland) Regulations 2014.
(c) Financial Implications
The financial arrangements for developing an integrated service are outlined within the Moray Integration Scheme and the Board will appreciate that as the Partnership moves to a single integrated budget, there will be wide ranging changes to the financial arrangements of delivering adult health and social care services in Moray. Both The Moray Council and NHS Finance Teams will continue to work closely together to put in place appropriate financial arrangements for the IJB.
(d) Risk Implications
As noted in the Integration Scheme, arrangements for identifying and monitoring risks are now in place. The Risk Register is a standard agenda item at each Transitional Leadership Group Meeting. In general, as work is undertaken to progress the Integration Strategic Plan and support arrangements for the IJB, there will be a significant impact on both Council and NHS Officer time. This has been highlighted in the Risk Register and the Transitional Leadership Group are exploring how this risk can be addressed.
The specific risk in relation to this report is with regard to any changes required by the Scottish Government to the Scheme document. While it is possible that Scottish Ministers may advise that relatively minor changes may be made to the Moray Scheme, the Senior Solicitor (Health & Social Integration) has liaised with the Scottish Government to help ensure that no significant changes are required to the document after submission to this meeting. However, the final recommendation to this report would allow minor changes to made to the Integration Scheme without having to resubmit a revised version of the Scheme to this meeting for further approval.
(e) Staffing Implications
In line with the body corporate model for integration, there will be no changes to the terms and conditions of either NHS Grampian or The Moray Council workforce. However, the Integration Scheme has outlined that over time, staff will be working as part of multi-disciplinary teams where it is possible that line management will be provided by a colleague employed by the other parent body. The IJB and the Chief Officer will undertake to continue to engage and address any concerns raised by the joint workforce regarding this issue and will also work closely with trade union and employee representatives.
(f) Property
The Moray IJB will not own any property assets in its own name. Property will continue to be owned by each respective parent body.
(g) Equalities
Informed by this consultation, an Equality Impact Assessment (EIA) has been completed for the Moray Integration Scheme.
While no equality concerns were received from the public or the joint workforce, consultation responses were not received from all protected group categories (i.e. young people, sexual orientation, gender reassignment, civil partnerships and maternity/pregnancy and race).
While it is considered that due regard has been given to equalities in developing the Moray Integration Scheme and the consultation exercise was extensively promoted, it is recognised that efforts need to be taken to engage with people from the above protected groups in the future development of integrated services in Moray. It is therefore proposed that the consultation plan underpinning the Strategic Plan will be revised to help ensure a better level of engagement with people from a range of different protected characteristic groups.
5.CONCLUSION
5.1Within a challenging timescale, The Moray Council and NHS Grampian have worked together to develop and consult on an Integration Scheme for Moray. The Integration Scheme outlines the future arrangements for the delivery of health and social care services in this area.
The Board is requested to consider the recommendations made in this report and approve the submission of the Moray Integration Scheme to Scottish Ministers by April 2015.
Authors of Report: Robin Paterson, Integration Project Officer & Alistair Robertson, Engagement and Communication Officer. Appendix 2 prepared by Geraldine Fraser, Senior Solicitor (Health & Social Care Integration) Aberdeenshire Council.
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Signature: Date: 17th February 2015
Designation:Chief OfficerName: Pam Gowans