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APPROVED

MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP

FRIDAY 15 March 2013

Spynie Dental Centre, Elgin

Present

Councillor Anne McKay (Chair)The Moray Council

Ms Christine Lester, Non Exec Board MemberNHS Grampian

Mr Adam Coldwells, General Manager MCHSCP

Mrs Jane Mackie, Head of Community CareMCHSCP

Mr Jim Walker, Community RepresentativeMCHSCP

Mr Ken Hamilton, Business ManagerMCHSCP

Mr George McLean, Interim Business ManagerMCHSCP

Mr Sean Coady, Community Health Services ManagerMCHSCP

Mr Sandy Thomson, Pharmacy ManagerMCHSCP

Mrs Tracey Gervaise, Public Health LeadMCHSCP

Mr Lloyd Griffiths, OpticianMCHSCP

Mrs Deborah O’Shea, Principal AccountantThe Moray Council

Mr Fabio Villani, Chief Officer TSIThird Sector

In Attendance

Ms Emma Pettis, Corporate Communications; Mrs Isla Whyte, Minuting Secretary, and representatives from local press.

Apologies

Apologies were intimated on behalf of Mr Charles Muir, Chair MCHSCP; Mr Sandy Henderson, Community Representative; Mr Bob Sivewright, Finance Manager;Ms Brigid Aitken, R.C.N. Accredited Steward & Safety Rep; Dr Graham Taylor, Clinical Lead; Dr Mark Houliston, Clinical Lead; Mr Ali Walker, Clinical Directorate Services Manager; Mrs Liz Tait, Professional Lead for Clinical Governance; Mrs Anne McKenzie, AHP Lead; Mr Sandy Dustan, Hospital Manager; Mr Gordon Smart, Dentist; Ms Karen Birse, Area Service Manager; Dr Jamie Hogg, Deputy Medical Director; Mrs Elaine Brown, Programme Manager, and Ms Anne Duncan, Inclusion Development Manager.

  1. Welcome

The Chair welcomed everyone to the meeting and read out the apologies.

  1. Minute of the Moray Community Health and Social Care Partnership Dated
    14thDecember 2012

The minute was agreed as an accurate record of the meeting.

  1. Matters Arising

a)Changes in the Chair

Cllr Anne McKay informed the Committee she was chairing meeting today as Mr Charles Muir was unable to attend. The Committee were informed Mr Charles Muir has been offered the position of Chair of the Committee in AberdeenCity. The Chair advised that Ms Christine Lester, Non Exec Board Member, is now the new Chair of MCHSCP, the committee welcomedMs Lester in her new capacity. The Chair welcomed Fabio Villani to his first meeting;Fabio is representing the Third Sector. The Chair noted that two NHS Non Exec Board Members have been appointed.

b)Early Years Collaborative

National Early Years Collaborative was launched on 1st October. Aim to improve outcomes and reduce inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed. The Collaborative has adopted the service improvement model, led by Institute of Health Care Improvement. Not specific to one organisation; collaborative activity will be led and co-ordinated by Community Planning Partnerships. Away and Home teams will focus on early year collaborative priorities;

There are 3 Work Streams with Stretch Aims:

  1. Pregnancy – 1st Birthday. To ensure that women experience positive pregnancies which result in the birth of more healthy babies.
  2. 1st Birthday – 30 months. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. (27-30month review is a new assessment and will be implemented in Grampian next month).
  3. 30 months – PreSchool. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

Tracey advised she is the Programme Manager for Moray. Workshop planned for 17th April to discuss how to take Work Stream Stretch Aims forward. Tracey to provide update to Committee later in the year. In answer to Fabio’s question, Tracey confirmed there is input from voluntary sector via Action for Scotland. Will discuss further out with meeting.

c)Joint Commissioning

Joint Commissioning Plan was discussed at December’s Committee; was in early draft and going through consultation, consultation has now concluded and plan is available online (Moray Council website and will soon be available on NHSG’s website). Adam advised three groups have been established:

1.Health and Social Care Leadership Team (NHS (acute and community) and Moray Council staff). The group meets monthly and is the operational group that will drive agenda.

2.Joint Commissioning Group – in its infancy but will drive and put in place Joint Commissioning Plan.

3.Joint Performance Group – group will review how everything works.

Please see attached Joint Commissioning Plan - Living Longer Living Better - which sets out the 1-3 year and 10 year targets; sets out the direction that CHSCP wants to pursue. Jane added she feelsthe CHSCP now have an infrastructure in place and identified key challenges.

  1. Integration of Health and Social Care

Institute of Public Care (IPC) have facilitated a number of workshops for the CHSCP to help focusthoughts, agree a way forwardand set up governance arrangements. A recent workshop, observed by Cllr Mckay, was facilitated and findings from the day were presented to Chief Executive Officers from both Moray Council and NHS Grampian. Broadly it was agreed to integrate adult mental health services, learning disabilities and maybe some aspects of housing (since the meeting it has been agreed not to include housing). Both organisations agreed not to include children services at present; keep separate for now. Practically, it was decided a small leadership group was required with members from this Committee. Christine asked who IPC were, Jane replied they are an academic based organisation (OxfordBrooksUniversity) who facilitated and supported CHSCP to develop the Joint Commissioning Plan. Jim asked if Moray waslinking with other parts of Grampian. Adam responded it is just Moray and consultation response to Scottish Government was given independently from each Local Authority area. Jim asked if there was any guidance about the degrees of differences; 32 different models did not seem ideal. Jane advised the guidance indicates discretion around housing and children services and indicates following a body corporate model. Together the CHSCP decided to follow the body corporate model. IPC then asked for CHSCP to gather evidence by testing out the model, thus having evidence to present to governing bodies backing up decision. Jim asked what is meant by body corporate. Jane replied it is the name for an organisation that is created and not completely separate from parent organisations, it is a separate entity, with separate legal identity. Fabio asked if there has been contact with Highlandto see how it is actually working in practice. Adam advised yes, informally, summary of main points – all the work CHSCP are doing now to get people to work together, Highland are now doing ie after transferring staff across. Fabio asked how does the CHSCP see the third sector feeding in to the model. Jane responded saying the third sector is involved by having a seat at this Committee and the Joint Commissioning Group. Adam added it is not clear at this stage if there would be a more formal committee which undertook a more political focus, still evolving. Jim said it is important to bear in mind how the public perceive the change / merge; important to reassure the public will continue to be at the forefront of decisions. Jane suggested developing / setting local indicators and consults with the community, can create greater public accountability. Jim suggested an independent person who’s not influenced by budget / performance reviews is an equal partner in decisions.

See attached presentation. Adam brought it to today’s meeting to give a feel of how NHS spends money. Questions to ask ourselves - is that how we want to spend our money in the future, if not how do we change.

  1. Performance

a)Exception Reporting – ‘At A Glance Summary’

Standing item on agenda to apprise Committee of service performance and risk management within CHSCP. Performance indicators to highlight today – large expenditure around emergency and unscheduled care. Want to continue to reduce emergency bed days by putting in a multitude of initiatives, will continue to monitor and scrutinise. 8% of those aged 85+ are readmitted,which compares reasonably favourably with rest of Grampian but Moray continues to monitor and try to reduce. Jim requested more information about DATIX. Ken informed the Committee that theDATIX system is used to manage significant events, incidents and complaints. Adam advised that Grampian was very well appraised for reporting and for investigating incidences and feeding back / closing the loop. An example of what may be recorded on DATIX is slips, trips and falls – Falls Strategy in place to rectify that / improve, plans to mitigate damage. George offered to show Jim the DATIX system and will take a DATIX report to the next meeting. In relation to the emergency bed days information Jim requested an understanding of the large discrepancy between practices. Ken said the figures only take into account emergency beds days at Dr Gray’s Hospital and not the community hospitals and there are some statistical anomalies. Kenwould like to reassure the Committee there are contract review visits every year and this discussion is had. Christine asked the Committee what work is being done in Moray in relation to delayed discharges. Performance overall for delayed discharges is good, other indicators are length of stay and multiple admissions; how we are utilising resources to best affect. Jane advised the best way of managing delayed discharges is constant attention and to micro manage which is time consuming but effective, there will always be peaks and troughs in performance. Christine asked if there were local issues around the festive period. Jane advised there can always be peaks and sometimes demand can exceed the service. There is not a great deal of margin, everyone is aware of difficulties and is focused on continually improving service.

b)Financial Performance 2012/13

Revenue budget reporting position as at 31 December 2012. The Partnership’s provisional position for 31 March 2013 is £1m overspent. Jim said the nursing pay issue should be subject to much scrutiny and queries how the budget is set. Adam said it is a big challenge and there is no easy answer, CHSCP does not directly manage Dr Gray’s Hospital. Adam added that broadly NHSG has got it right, got about correct complement of staff, budget getting closer at the end of each year. CHSCP shows an overspend that is 90% legacy, ie carried over overspend that is roughly 4/5 yrs old.

c)Finance – NHS and Moray Council Budget Setting for 2013/14

This item relates to the integration agenda, Adam would like to make Committee aware that this is probably the last time both Moray Council and NHS Grampian have set their respective budgets independently. Both organisations are aware of that and thinking about how will do in the future.

  1. Public Health – Physical Activity

The Scottish Charter for Physical Activity highlights physical activity as ‘the best buy in public health’. Physical inactivityremainsone of Scotland’s biggest public health challenges. There is a long term obesity strategy in place.

Christine said it is vital that healthy eating and physical activity is ingrained into young children; she added that cost of parking in woodland areas and costs to attend classes can put people off. Tracy said there was a lot of time spent on developing walks that people can access from their doorstep. Physical activity is more about needing a shift in culture / behaviour. Examples of local physical activity portfolio highlighted includedthe Play@Home programme which focuses on birth to5yrs. In response to a question from Christine, Tracey advised that obesity remains a Community Planning Partnership priority and that the local Physical Activity, Sport and Health Strategy is under review.

  1. AOCB

There was no other competent business.

  1. Date of Next Meeting

The next meeting of the Moray CHSCP Committee will take place on 14 June, 10:00am, Meeting Rooms 1 and 2, Spynie Dental Centre, Elgin.

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