NHS GRAMPIAN
Health and Social Care Integration
Integrated Joint Board Integration Schemes
1. Actions Recommended
Draft Integration Schemes have been prepared by the Moray, Aberdeen City and Aberdeenshire Transitional Leadership Groups (TLGs) on behalf of NHS Grampian and the Councils in the Grampian area. The Schemes describe at a high level how the Integrated Joint Boards (IJBs) will operate based on a model integration scheme published by the Scottish Government in October 2014.
The Integration Schemes have been the subject of wide consultation within NHS Grampian and the Councils, and have been reviewed by the Executive Team of NHS Grampian. The Integration Schemes are recommended by the Executive Team for approval by the Board.
It is recommended that the Board:
· Approves the Integration Schemes for Aberdeenshire, Aberdeen City and Moray
· Agrees to the submission of the Schemes to the Scottish Government by 1 April 2015
· Agrees the delegation of authority to make minor amendments to the Chief Executive and representatives of the shadow IJB/TLGs/Councils as appropriate
2. Strategic Context
The Public Bodies (Joint Working) (Scotland) Act was enacted on 1 April 2014 and set out the legislative framework for the formal integration of adult health and social care in Scotland. Regulations and Orders associated with the Act were released for consultation over the summer of 2014 and were published in October and November 2014.
3. Key Matters Relevant to Recommendation
Background
The Integration Schemes have been the subject of consultation prior to formal approval and submission to the Scottish Government by the required date i.e. by 1 April 2015. The Scottish Government has advised that each Scheme should follow the format of the model scheme and must include the matters prescribed in the regulations associated with the Public Bodies Act. The Schemes require to be submitted formally to the Scottish Government by NHS Grampian and the relevant local authority. The specific issues included in the Scheme are set out below:
· Model of integration
· Scope of functions and services that are to be delegated
· Integration Joint Board membership and governance
· Local governance arrangements
· Corporate support services
· Targets and performance
· Clinical and professional governance
· Financial management
· Chief Officer
· Workforce and organisational development
· Information sharing
· Complaints handling
· Liability and indemnity
· Risk management
· Dispute resolution
Papers Submitted
This covering paper relates to the specific IJB Integration Scheme documents included in the Board agenda as follows:
Aberdeen City – agenda item 3.1
Aberdeenshire – agenda item 3.2
Moray – agenda item 3.3
The Integration Scheme documents include a covering paper, details of the consultation and feedback on the consultation process, an environmental impact assessment (required by the councils) and the final draft Integration Scheme for the IJB.
Decision Making Process and Timescales
The process of formal decision making requires the TLGs/shadow IJBs to approve the Schemes followed by formal approval and subsequent joint submission to the Scottish Government by the parent organisations i.e. NHS Grampian and the relevant Council, by 1 April 2015. The dates for TLG/IJB and Council Approvals are as follows:
Aberdeen City Shadow IJB- 24 February 2015 / Aberdeen City Council
- 4 March 2015
Aberdeenshire TLG
- 18 February 2015 / Aberdeenshire Council
- 12 March 2015
Moray TLG
- 26 February 2015 / Moray Council
- 4 March 2015
The Aberdeen City Shadow IJB and the Aberdeenshire and Moray TLGs have approved the Scheme documents as submitted.
As part of the final decision making process, and given that the Schemes need to be considered separately by the NHS Grampian Board and the Councils, it is recommended that delegation of authority to make minor amendments is provided to the Chief Executive and representatives of the shadow IJB/TLGs/Councils as appropriate.
The Schemes will be reviewed by the Scottish Government following formal submission. As part of this review it is possible that the Scottish Government will seek amendments to ensure consistency with the legislation. If there is a requirement to make amendments the Schemes will be reported to the Board.
Review of the Integration Schemes
The draft Integration Schemes have been the subject of extensive consultation undertaken by the IJBs on behalf of the Councils and NHS Grampian. The consultation period ended on 2 February and the papers submitted with each of the Schemes detail all of the comments and their consideration in relation to the final draft of the Scheme documents.
The Schemes have also been the subject of scrutiny by the Executive Team in conjunction with the Chief Officers. The Schemes were also reviewed by the Board at its meeting on 16 January and comments were submitted to the IJBs by the Executive Team as part of the consultation and feedback process. Most of the comments have been reflected in the final drafts as submitted except for those that are regarded as invalid in terms of the legislation. NHS Grampian’s legal adviser has been involved in the drafting of the Schemes and the draft Schemes have also been informally reviewed by the Scottish Government officials.
Delegation of Services
The delegation of health services to the IJBs has been considered in detail by the Executive Team and advice has been taken from senior managers and clinicians in relation to the services that will be delegated which provide a service across partnerships. The principle in the Public Bodies (Scotland) Act is that all services included in the legislation should be delegated but those hospital based services that are embedded within larger hospitals e.g. Aberdeen Royal Infirmary, will remain directly managed by NHS Grampian. The IJBs will, however, be responsible for the strategic planning of those services and for the whole pathway of care.
In relation to delegated services provided across Grampian a condition of the delegation is the requirement for a memorandum of understanding agreed by the IJBs and NHS Grampian to ensure that all parties are satisfied with the management and coordination arrangements that will be put in place. This was considered at the North East Partnership Steering Group on 19 February and there was a consensus on this way forward. These arrangements will be developed by the Strategic Change Management Group and the North East Partnership Steering Group for approval by the parent organisation and the shadow IJBs. The aim is that this process will be complete early in 2015/16 to permit the IJBs to start developing the arrangements whilst working in shadow form.
The development of the budgets associated with the delegation of services will continue during 2015 and a process of due diligence will be agreed to ensure that the final budget allocations are fair and reasonable for all parties. The allocation of the delegated budgets and the arrangements for the formal establishment of the IJBs will be submitted to the Board for consideration in due course. The IJBs must be formally established by 31 March 2015 at the latest and the IJB strategic plans must be approved before formal establishment is permitted.
Appendix 1 summarises the services to be delegated.
Disestablishment of Community Health Partnerships
The Public Bodies (Joint Working) (Scotland) Act requires the disestablishment of the Community Health Partnerships on 31 March 2015. Arrangements will be put in place to ensure continuity of approach given that IJBs will not be formally established on 1 April 2015. From 1 April therefore the shadow IJBs will act as advisory groups for the services provided in their areas. The Chief Officers will remain accountable for service delivery to the Chief Executive of NHS Grampian and the standing orders of NHS Grampian will be amended accordingly. This accountability will also relate to CHP services that are not delegable including services for children such as health visiting. This approach is consistent with guidance received from the Scottish Government and was confirmed at the North East Partnership Steering Group on 19 February 2015.
Staff Involvement
There has been considerable staff involvement in the three IJB areas and this will continue as the integration arrangements develop. The involvement process for hospital services that will be delegated has commenced and an action plan is being developed with the relevant clinicians and managers
Integration has been considered by the ACF and its constituent committees. Integration has also been considered by Grampian Area Partnership Forum (GAPF) and specifically by the acute services partnership forum.
4. Risk Mitigation
This paper relates to corporate risk 1784 i.e. there is a risk that the Board does not maximise the potential to be gained from health and social care integration. The management of this risk requires a balance between ensuring full compliance with the spirit and provisions of the integration legislation whilst ensuing that the interests of Grampian wide service users are protected. The structures put in place, the representation of Board members on the TLG/IJBs and the regular involvement of the whole Board at seminars and formal Board meetings supports the mitigation of the risk.
5. Responsible Executive Director and contact for further information
If you require any further information please contact:
Responsible Executive DirectorGraeme Smith
Director of Modernisation
/ Chief Officers
Adam Coldwells, Aberdeenshire
Pam Gowans, Moray
Judith Proctor, Aberdeen City
Date: 26 February 2015
Appendix 1
Delegation of Health Services
1. Services as described in the legislation/regulations that will be delegated:
a) Community Health Services
District nursing services
Community substance misuse
AHP services in an outpatient department, clinic, and community
Public dental service
Primary medical services provided under a general medical services contract
General dental services
Ophthalmic services
Pharmaceutical services - community
Out of hours primary medical services - GMED
Services provided outwith a hospital in relation to geriatric medicine
Palliative care services provided outwith a hospital
Community learning disability services
Mental health services provided outwith a hospital
Continence services provided outwith a hospital
Kidney dialysis provided outwith a hospital
Services provided by health professionals that aim to promote public health
b) Hospital Based Services
Accident and Emergency services provided in a hospital*
Inpatient hospital services relating to the following branches of medicine—
· general medicine;*
· geriatric medicine;*
· rehabilitation medicine;*
· respiratory medicine;* and
· psychiatry of learning disability
Palliative care services provided in a hospital*
Inpatient hospital services provided by General Medical Practitioners
Inpatient addiction or substance misuse services
Mental health services provided in a hospital, except secure forensic mental health services
Note: The services marked * will continue to be managed by NHS Grampian as they are integrated with the management of other acute or hospital based services.
2. Existing CHP hosting arrangements to continue to be hosted by IJBs:
Service / Current HostSexual Health Services / Aberdeen City
Woodend Assessment of the Elderly (including Links Unit at City Hospital) / Aberdeen City
Woodend Rehabilitation Services (including Stroke Rehab, Neuro Rehab, Horizons, Craig Court and MARS) / Aberdeen City
Marie Curie Nursing / Aberdeenshire
Heart Failure Service / Aberdeenshire
Continence Service / Aberdeenshire
Diabetes community services / Aberdeenshire
Chronic Oedema Service / Aberdeenshire
HMP Grampian / Aberdeenshire
Police Forensic Examiners / Aberdeenshire
The services identified above will be delegated to the IJBs and the existing hosting arrangement will continue in the short term until a memorandum of understanding is agreed.
For all services that will be operationally managed by an IJB on a Grampian wide basis, or to more than one IJB, a memorandum of understanding will be agreed between the IJBs and NHS Grampian in relation to the hosting and coordination of services before the formal delegation is put in place. The services include:
· All existing hosted services as above
· Inpatient psychiatry of learning disability
· Mental health services provided in a hospital
· GMED Primary Care Out of Hours service (currently managed by the Acute Sector of NHS Grampian)
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