1

APPROVED

MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP

THURSDAY 13 March 2014

Green Room, Forres Community Centre

Present

Ms Christine Lester, Non Exec Board Member (Chair)NHS Grampian

Mrs Jane Mackie, Head of Community CareMCHSCP

Mrs Tracey Gervaise, Public Health Lead MCHSCP

Councillor Lorna Creswell Moray Council

Mrs Deborah O’Shea, Principal AccountantMoray Council

Mr Bob Sivewright, Finance Manager MCHSCP

Mr Ian Francis, Partnership Rep

Mrs Liz Tait, Professional Lead for Clinical Governance;

Mr Adam Coldwells, General Manager; NHS Grampian

Mrs Val Thatcher, Public Partnership Forum Member

Sir Lewis Ritchie, Public Health DirectorNHS Grampian

In Attendance

Miss Emma Pettis, Corporate Communications

Ms Sally Hall, Clinical Governance Co-ordinator, Shetland

Mr Mark McEwan, Service Planning Lead

Mr C Saunderson, Deputy Editor from Northern Scott

Mrs Naomi Zair Rep from Forres B.A.L.L.Group

Rev Donald Prentice, St Leonards Church, Forres

Mrs Rosemary Reeve, Minuting Secretary.

Apologies

Apologies were intimated on behalf of:

Mr Sandy Riddell, Corporate Director

Mr Ali Walker, Clinical Directorate Services ManagerNHS Grampian

Lloyd Griffiths, Optometrist.

Mr Jim Walker, Community RepresentativePPF

Ms Brigid Aitken, R.C.N. Accredited Steward & Safety Rep

Mr Sandy Henderson, Community Representative

Mr George McLean, Interim Business Manager

Karen Birse, Area Service Manager SAS

Ann Irvine, Staff side rep

Mr Sandy Thomson

Mr Fabio Villani, Chief Officer TSIThird Sector

  1. Welcome

The Chair welcomed everyone to the meeting and advised the members of the public present as regards to the format of the meeting and protocol for asking questions. Apologies were noted as above.

  1. Minute of the Moray Community Health and Social Care Partnership Dated5 December 2013

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

  1. Matters Arising

There were no matters arising.

  1. Director of Public Health NHS Grampian Annual Report

The chair welcomed and introduced Sir Lewis Ritchie, Director of Public Health NHS Grampian to the meeting.

Sir Lewis opened his presentationwith an informative background to his career to date.

Sir Lewis informedthe group that there were challenging times in the future for preventing and caring for old people and that going forward would involve a concentrated effort where leadership for all sectors was important. Sir Lewis warned that there would be difficulttimes ahead where the group would need to continuing achieving results that was relevant for Moray.

Sir Lewis advised that the Director of Public Health Annual Report was a picture of Grampian’s health. Sir Lewis advised thataid this health intelligenceneeds to be addressed and measured.

Sir Lewis advised that Public Health was everyone’s business and explained that to achieve this partnership working, improving health, protecting the population from harm, healthcare/designing health services and Health Intelligence were all important elements.

Sir Lewis brought the groups attention to the Moray situation by looking at life expectancy within Moray - where the average life expectancy for males is 76.9 yrs and for females is 81.3 yrs; for Scotland it is 75.8 yrs and 80.4 yrs respectively; for Grampian the average life expectancy for males is 77.3 yrs and for females it is 81.3 yrs. Sir Lewis advised the group that Moray is amongst the highest life expectancy in Scotland and our healthy life expectancy (years lived whilst healthy) is also high. Sir Lewis drew attention to the variation in life expectancy across Moray, from well below the Scotland average e.g. Buckie Central East (72.6 yrs) and Forres South West Mannachie (73.3 yrs) to well above the Scotland average e.g. Rafford, Dallas, Dyke to Dava (80.7 yrs), Elgin Central West (78.4 yrs).

Sir Lewis discussed the challenges which are being tackled by NHS Grampian and partners, both through existing programmes and in the planning of programmes and services for the future. Sir Lewis went on to highlight some of these challenges from an aging population. Lifestyles, demands on services, health inequalities, improving well-being to protecting public health and the ways in which Moray can work together.

Sir Lewis informedthe group that to reduce inequalities in health that the MCHSCP Committee and Community Planning Partnership has an important role in taking action regarding the determinants of health for example housing, employment, access to services, green space, environment.

Sir Lewis informed the group regarding a recent audit of health inequalities in Scotlandand drew attention to thereality that health inequalities are influenced by a wide range of factors including access to education and good housing, equitable access to healthcare, individuals’ circumstances and behaviours, such as their diet and how much they drink, smoke or exercise and income levels.

Sir Lewis took the opportunity to verbalizea thank you to everyone for all the work Moray has done to date but warned the group that there needs to be an approvedstrategy for reducing health inequalities by focusing interventions and how to monitor progress. Sir Lewis highlighted this by discussing local examples such as partnership working being well established across Moray and advising the group that this work will also have an effect on reducing inequalities. Tracey Gervaise updated the group regarding particular Moray undertakings

•Mobile Information Bus – The MIB is utilised by NHSG and Community Planning Partners to deliver an extensive range of services which primarily target areas of social disadvantage, a formal partnership review and commissioning of a new vehicle has been completed and they hope to get into the community soon.

•B.A.L.L. – The aim of the B.A.L.L. group(s) is to improve the health and well-being of older people in Moray by raising activity levels, improving confidence, self esteem and to foster friendships, which contribute towards mental health. There are currently 17 B.A.L.L. groups Moray wide.

•Walk, Jog, Run Moray – Via a partnership approach (NHSG, The Moray Council, Paths for All and Scottish Athletics), Health Walk and Jog Scotland Leaders have been trained and WJR Moray groups have been established acrossMoray . There are success stories throughout Moray.

In his summary Sir Lewis advised the group that Moray compares favourably to Scotland and Grampian. That there is a range of Public Health support in place to protect and improve health and well being and there are encouraging examples of partnership working within Moray. However, Sir Lewis advised re the continuing challenges from the care needs of a growing elderly population to the inequalities in health across Moray. That Moray needs to build on existing partnership working, to focus on prevention to reduce demand and agreed consistent approaches to reduce inequalities.

Questions were asked regarding the graph titled ‘Demands on Service’. This graph indicates that more was spend in deprived areas than was spend in more affluent areas. The cost of acute services provided to those in the deprived areas increased at a time of increased investment in the NHS by the Government and has continued to rise since then for the more deprived populations. Sir Lewis advised that some of this “demand” could be reduced by investing more heavily in prevention/early intervention to improve health and wellbeing and reduce demand on services which are required as a result of poor lifestyle such as obesity, drug misuse.

  1. Integration of Health and Social Care - update

Jane advised the group that there is a good process in Moray and this impacts on areas identified in Sir Lewis presentation.

Jane informed the group that a bid for transitional funding has to be submitted by 21st March 2014 for approval. Jane advised that the Moray bid is ready for submission.

Jane advised that the vacancy for Chief Officer of the ‘new’ organisationcloses on Friday 14th March 2014 and that it is hoped that the individual will be in place by the beginning of May.

Jane advised that both the Transitional Management and the Transitional Leadership groups are concerned with staff involvement and ownership of the whole integration process. To promote the integration work Vision is touring Moray where case studies are being show-cased. Nevertheless, there is still a lot of work to done.

  1. Prisoner Health & Prisoner Return to Community

The chair welcomed and introduced Mr Mark McEwan, from the Modernisation Department, NHS Grampian.

Mark advised the group that 5 years ago there were numerous different health services dealing with prisoners in Moray. This is to change by 1st November as NHS in Scotlandwill assume responsibility for the healthcare of all prisoners within the Scottish Prison Services.

HMP & YOI Grampian opened on the 3rd March 2014 and replaced HMP Aberdeen and HMP Inverness. HMP & YOI Grampian will be the first community-facing prison, housing prisoners from the Northern Community Justice Authority and will include men, women and young people. The philosophy of the community facing prison is to improve life chances, reduce inequalities and reduce re-offending.This new facility has 500 places with a maximum of 550, of which 347 will be males, 50 females and 75 YO. The total number of prisoners from Moray will be around 50. The service will still be using HMP Inverness and it will be postcode dependent.

The new facility offers an infrastructure opportunity to support the efforts of greater collaborative approaches in education, work experience, social and emotional development. This can be maximised if accompanied by full commitment of supporting partners in delivering health and social care. The major challenge therefore is to provide services and opportunities to Moray prisoners that are as close as possible to those provided within community settings and ensure through care arrangement are improved and in place in provided critical continuity of care. Examples of work/community reintegration opportunities that will be available at HMP Grampian include creative media; bike repair and maintenance; training kitchen.

Mark opened the session for questions from the group:

Adam asked how HMP Grampian would tackle/address issues of addictions and substance misuse in prison. Mark advised that there are nine (9) prisons in Scotland and without 3rd sector help this would have been difficult. Under the new provision this means that HMP Grampian comes under NHS Grampian and will have access to NHS Grampian’s resources which means that there will be one health care provider helping a prisoner whether they be in or out of prison. This additionally puts the control back to the prison.

Lorna asked about partnership working to which Mark advised that the new process allows for more partnership working between HMP Inverness and Moray, but they will be working to NHS Grampian’s standards and pulling together as far as resources are concerned.

Liz advised that this was assuring from a clinical governance aspect and asked what happens with GPs medical notes when someone is sent to prison. Mark advised that if the sentence is 6 months or more medical notes will be sent to the prison, to ensure prison medical staff are aware of prisoners’ health requirements. If the sentence is less than 6 months then the prison nurses will contact the GP to obtain relevant information.

Christine asked for clarity as the numbers from Moray which Mark advised would be 50 In total but this would be 25 Inverness and 25 Moray

Lorna asked about training facilities for getting prisoners back into the community. Mark advised that whilst a YO is in prison he/she may have the opportunity to work in the community on a day release which will be well monitored.

Ian asked for clarity regarding partnership working between staff at the prison and NHS Grampian to which Mark advised that any issues, he can be contacted

Jane asked that the prison give advance notices of short term so these can be organized in advance.

  1. Audit Commission Report – Reshaping Care for Older People

Jane advised that she felt everyone should read this report as it was very interesting.

The report is submitted to committee in terms of Section E III(1) of the Council’s Administrative Scheme relating to exercising the function of the council as Social Work Authority under the Social Work (Scotland) Act 1968.

Jane advised that the public sector of Scotland faces significant challenges in reshaping care for older people, as it involves challenging the way it provides services while continuing to meet current needs. Jane advised the group that there are key messages which are deliverable from this report for example in 2011/12 the NHS and councils spent approximately £4.5 billion on care for older people but still more needs to be done to target resources on preventing or delaying ill health and on supporting people to stay at home.

Christine asked Jane to provide clarity through reference to the exhibits in the report to enable the group to understandfurther. Jane referred the group to Page 22, exhibit 7 ‘Spending by NHS Boards and councils on care for people aged 65 or over, 2011/12’. Jane advised that this exhibit shows a variety of councils and health boards and reflects a close parallel to what’s expected following Sir Lewis’s presentation, in that Moray produces good results for low comparison costs.

Jane referred the group to exhibit 9 ‘NHS boards and council spend on services for people aged 65 or over, 2011/12’. This shows Moray in a good position with regards to how money is spent within the service. ShowingMoray & AberdeenCity to be at extremes of the exhibit. This is going to be hard for Moray as the future demands that we need to improve and it is likely that easy ‘wins’ may not be there for Moray toharvest. The Balance Of Institutional And Community Line within the exhibit shows moray to be in a good position.

Jane referred the group to exhibit 10 ‘Percentage of the older population using hospital and social care services by council care’. Moray’s occupied bed days reduced over the last 18 months and has become more community based. Which is good.

Jane reiterated that this is an important report and suggests that everyone takes the time to read the report.Jane advised the group that she was still awaiting the results from the Joint Inspection Report which was conducted but if the verbal feedback is anything to go by then it should reflect positively for Moray.

Ian asked about staffing levels as he feels the report should be regarded with some level of caution. Jane advised that it is important that partners and the 3rd sector gets this right.

  1. Person-centred care – a patients story

Christine gave a background as to why she felt the group should listen to this CD and advised that after listening to the CD she would open the session for discussion.

[CD played]

Comments received from the group as follows:

Lorna stated although it was a rare disease and staff could not provide help on that ground, the parent should still have been given support and not treated as she was by staff.

Adam reiterated that NHS Grampian want patients/parents to take responsibility for the management and control of their illness/health concerns. This may in turn mean that in the case of rare diseases that they will know more about that disease than the local staff. But NHS Grampian still needs to promote and engage in relationships with patients/parents. There needs to be a positive view regarding the partnership within health care profession.

Group agreed that communication and support was definitely lacking from this patients story and that steps need to be implemented to prevent this from happening again to another patient/parent. In particular it needs to be drawn to staffs attention if there are any special health care requirements or circumstances. Discontinuing is an issue as it leads to the break down in any relationship between patient/parent and the health care profession.

Christine advised that this same CD has been listened to by the NHS Board and wonders how we can cascade this down to staff. The group suggested a few avenues. Permission is to be sought from the ‘mum’ on the CD. Liz agreed to take this forward.

  1. Finance Update & Performance Measures

Bob advised the group that there is an overspend but this will be managed by the Joint Service. Bob then summarised areas of the overspend:

  • Dr Gray’s has an overall overspend of £1.306million as at 31 January 2014. Total pays were overspend by £0.582 million. This includes a £0.286 million overspend on Medical Staff mainly due to payment made for locum cover and adjustment to salaries.
  • Community Health Services, for community nursing and community hospitals, there were overspends in each of the four localities totalling £0.542 million
  • Learning Disability services for Moray Council is showing an overspend of £0.71million, where NHS Grampian has under-spent by £0.143million.
  • Providers services for the moray Council is currently showing an overspend of £0.214 million, this relates to the Home care Service, supported housing/respite and employment support service. This overspend is split between care at home £0.095 million, supported housing/respite £0.051million, ESS £0.078 million and various under-spends tallying £0.010million.

Adam advised the group that the Moray team does very well however reductions are very difficult to achieve particularly as economies of scale is harder to achieve. It is a difficult environment that the Moray team are in. Over the next 4-5 years senior managers will be looking at the monies and the rules as they do not equate to what Moray is setting out to achieve.