07 - 2023-06-15 Directions Int Scheme
North Ayrshire Council · 15 June 2023
Back to Integration Joint Board — 15 June 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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PUBLIC INFORMATION PUBLIC INFORMATION Integration Joint Board 15th June 2023 Subject: Directions and Review of Integration Scheme Purpose: • Awareness • Discussion Recommendation: It is recommended that the IJB notes the recommencement of work in relation to the implementation of Directions and associated pan-Ayrshire workstreams and considers the requirement to review the Integration Scheme in 2023. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required x 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MSG Ministerial Steering Group NRAC National Resource Allocation Committee PSMT Partnership Senior Management Team SPG Strategic Planning Group 1. EXECUTIVE SUMMARY 1.1 Pan-Ayrshire work to progress a number of key aspects of integration has recently been recommenced, following a pause due to the pandemic. 1.2 This work covers the use of Directions, the development of a Joint Commissioning Plan and large hospital Set Aside budgets, and the review of the Integration Scheme. 1.3 This report provides IJB with an update on progress with these workstreams. 2. BACKGROUND 2.1 In February 2019, the Scottish Government Ministerial Steering Group (MSG) for Health and Community Care published the findings of it’s review of progress with the integration of health and social care services across Scotland.
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PUBLIC INFORMATION PUBLIC INFORMATION 2.2 This review included 25 proposals to build on the good practice which was already being developed, to ensure that challenges were addressed and to drive forward health and social care integration. 2.3 Many of these proposals were implemented following the publication of the report but some required more significant work on a pan-Ayrshire basis to ensure that they were fully delivered on a consistent basis across the three Integration Joint Board areas. 2.4 A pan-Ayrshire working group was established to take these proposals forward. This work was paused in 2020 due to the need for health and social care services to prioritise their operational response to the pandemic. 2.5 The working group has recently been re-established with representatives from NHS Ayrshire and Arran and the three IJBs, chaired by the Head of Service (Finance and Transformation) of the North Ayrshire IJB. This group is progressing a number of workstreams and an update on each of these is provided below. Directions 2.6 The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) places a duty on Integration Authorities to develop a strategic commissioning plan for integrated functions and budgets under their control. This sets out how the IJB will plan and deliver services over the medium term to achieve the National Health and Wellbeing Outcomes prescribed by Scottish Ministers. The strategic plan for North Ayrshire IJB was most recently approved in March 2022 and covers the period from 2022 to 2030. 2.7 Integration Authorities require a mechanism to action their strategic commissioning plans, and this is laid out in sections 26 to 28 of the Act. This mechanism takes the form of binding directions from the Integration Authority to one or both of the Health Board and Local Authority. Directions are also the means by which a record is maintained of which body decided what and with what advice, which body is responsible for what, and which body should be audited for what, whether in financial or decision-making terms. 2.8 Directions are also the legal basis on which the Health Board and the Local Authority deliver services that are under the control of the IJB and are a key aspect of the governance and accountability arrangements between the partners. 2.9 A direction should always be prompted by a decision made by the IJB. The following should be considered when thinking about when a direction requires to be issued and what it might include: • Scope and scale of the function • Finance involved • Scale and nature of change • Those impacted by the change
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PUBLIC INFORMATION PUBLIC INFORMATION • Timescale for delivery 2.10 The Scottish Government published statutory guidance on the issuing of directions in January 2020 but full compliance with this has been delayed by the pandemic. 2.11 Through the pan-Ayrshire working group, agreement has been reached on the format of directions and a mechanism for recording and tracking their implementation. Each of the three IJBs has now implemented the use of directions from the beginning of the 2023-24 financial year for decisions made by the IJB. Joint Commissioning Plan and Set Aside Budgets 2.12 Integration Authorities are responsible for the strategic planning of those hospital services most commonly associated with the emergency care pathway, alongside primary care, community health care and social care. The objective is to create a cross-sector system for local joint strategic commissioning of health and social care services and to support a shift in the balance of care towards community settings. 2.13 Fundamental to this is a clear understanding of how large hospital services are being consumed and how that pattern can be changed by whole-system redesign. There needs to be clarity about the financial impact of any changes which are agreed and there needs to be an overarching strategic plan for delegated large hospital services, co-ordinated by the Health Board. The hospital capacity included in the strategic plans must evolve from the existing capacity for those services. 2.14 The funding for these large hospital services is referred to as the ‘set aside’ budget – it is excluded from the payment to the Integration joint Board but is ‘set aside’ for direction by the IJB through the Strategic Plan. Legislation requires that the method for determining the amount to be set aside should be included in the Integration Scheme. 2.15 It is recommended that the consumption of hospital services by partnership populations should be determined by analysis of hospital activity and cost information. The cost can be based on standard rates or by local costing methodologies. 2.16 Health Boards and Partnerships should identify what the ‘fair share’ of large hospital resources should be for each, based on NRAC (National Resource Allocation Committee) methodology which utilises population and other data to determine an appropriate share. This will then enable a determination of whether Partnerships are consuming more or less than their ‘fair share’ of large hospital resources. 2.17 The Joint Strategic Commissioning Plan should set out what large hospital services will be commissioned by Integration Joint Boards and the planned activity changes which will reduce the consumption of these services over a period of time alongside the movement of resources to support services in the community.
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PUBLIC INFORMATION PUBLIC INFORMATION 2.18 Work is being take forward around the development of a Joint Commissioning Plan by colleagues from NHS Ayrshire and Arran and the three HSCPs. This will be brought to a future meeting of the IJB. 2.19 Alongside this, Finance Leads are developing a set aside model to determine the cost of large hospital services which are being used by each of the HSCPs. This will be based on actual activity and actual costs being incurred by the Health Board. Integration Scheme 2.20 The Integration Scheme is the legal agreement between North Ayrshire Council and NHS Ayrshire and Arran which sets out the arrangements for integration of health and social care, including the governance and financial arrangements and the functions which are delegated to the IJB. It is intended to achieve the National Health and Wellbeing Outcomes prescribed by Scottish Ministers. 2.21 There is a requirement under the Public Bodies (Joint Working) (Scotland) Act 2014 to review the Integration Scheme at least every five years. This was last done in 2018 so is required again in 2023. 2.22 Preparatory work has commenced locally to review the Integration Scheme. It is important that this is done in close liaison with East Ayrshire and South Ayrshire to ensure that the 3 documents remain consistent to support the Health Board to work with all the IJBs. 2.23 Following consultation with Legal Services and with colleagues in East Ayrshire and South Ayrshire, a timeline has been set out which will include appropriate consultation and engagement. 2.24 The initial phase of the consultation is ongoing at present and this focusses on the need to review the Scheme. This has already been discussed through the Partnership Senior Management Team (PSMT) and the Strategic Planning Group (SPG) during May and IJB is also being consulted on. Both North Ayrshire Council and NHS Ayrshire and Arran, as the ‘constituent authorities’ and taking account of the views of the persons consulted, must then decide whether changes to the Scheme are necessary. If so, they must work together to prepare an updated Scheme. 2.25 An updated Scheme will require to be approved by both the Council and Health Board, as well as endorsed by the IJB, by December 2023, prior to submission to Scottish Ministers. 3. PROPOSALS 3.1 It is proposed that the IJB: • Notes the recommencement of work in relation to the implementation of Directions and associated pan-Ayrshire workstreams
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PUBLIC INFORMATION PUBLIC INFORMATION • considers the requirement to review the Integration Scheme. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 4.3 Legal Reviewing the Integration Scheme will help ensure ongoing compliance with the Public Bodies (Joint Working) (Scotland) Act 2014. 4.4 Equality/Socio-Economic None. 4.5 Risk Add information on the risk implications and how it compares to the agreed risk appetite (Low, Moderate or High). 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 Consultation has taken place with colleagues from East Ayrshire, South Ayrshire and NHS Ayrshire and Arran through the various workstreams and with Legal Services in relation to the requirement to review the Integration Scheme. Caroline Cameron, Director Author: Paul Doak, Head of Service (Finance and Transformation), pdoak@north-ayrshire.gov.uk Appendices • None.