Item 3 - Minute of Meeting of IJB held on 22 June 2022
North Lanarkshire Council · 21 September 2022
Back to Health and Social Care Integration Joint Board — 21 September 2022 and its agenda
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 22nd June 2022 at 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Tracy Carragher (Chair) North Lanarkshire Nominated Councillor Neil Findlay NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Kirsten Larson North Lanarkshire Council Nominated Councillor Councillor Jordan Linden North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Alison Gordon (Left at 3pm) Head of Children & Families & Justice Services CSWO of NLC Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative Officer in Attendance: Stacey Connor Minute Secretary Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddie Halliday Chief Exec, VANL Third Sector Rep Nicola Lynch (Item 5) Business Finance Manager Christine Jack IJB Board Secretary Trudi Marshall Nurse Director NLHSCP Gillian McCreadie Audit Scotland Marie McFadden Audit Scotland Lucy Munro Medical Director NL Des Murray (Left at 3pm) Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communication Manager
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2 Euan Dickson Audit Scotland Heather Knox Chief Executive NHS Lanarkshire Marie Moy Section 95 Finance Officer James Muir NHS Lanarkshire Nominated Non Exec Director John Watson Employee Representative NLC Unison ACTION 1. Welcome and Apologies Christine Jack welcomed everyone to the meeting and introductions were made; apologies were as noted above. She then passed the meeting over to the new Board Chair, Councillor Tracy Carragher. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB 23.3.22 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ IJB Action Log There were no matters arising. Christine Jack shared an updated action log to reflect the progression of work since the last committee. Some actions have been deferred to the PFA meeting but they will remain on the IJB action log until resolved. The following updates were noted by the committee: Item 5- Category 1 Responder- Awaiting Scottish Government guidance, through West of Scotland RRP have agreed an audit of the local resilience partnerships (LRPs) who will do a review of IJBs against all 7 asks within the Act which needs to be completed by August. An update will be brought back to the Board in due course. Item 9 PCIP- The committee previously queried details for any further engagement events. Dr Lucy Munro advised just starting to stand up programme after covid so this is on-going. Item 10 Mental Health Continuing Care Contracted Beds - Plan to bring update to the next IJB in September. Item 11 Reserves Strategy- An update will be brought to the August IJB PFA.
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3 Item 14 Integration review - Chief Financial Officer – Recruitment process is ongoing with a preferred candidate chosen and going through appointment process. Items deferred due to Covid Item 7 Primary Care Implementation/GP OOH - Ross McGuffie advised there has been work undertaken with Scottish Government and NHS, plan to hold a joint IJB session to brief all members, to review challenges and look at future direction of the service. Details will be shared with the committee when available. Brian Moore noted need to capture outstanding action around reserves and exit strategy. Ally Boyle also noted to add community alarms update to action log as per discussion at previous committee. Christine Jack to update action log. CJ 5. Unaudited Accounts A report was shared with the committee which provides an overview of the unaudited IJB Annual Accounts for the financial year 2021/2022 in line with the legislative requirements. The IJB is specified in legislation as a “section 106” body under the terms of the Local Government Scotland Act 1973. It is therefore expected to prepare Annual Accounts in compliance with the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the “Code of Practice”) and the International Financial Reporting Standard (IFRS). The main risk associated with the IJB is that one or both partners could overspend. The risk has been closely managed by each partner during the financial year under review. The budget monitoring arrangements in place ensured that corrective action could be taken including the use of the contingency reserve as appropriate to address increases in demand for health and social care services. Nicola Lynch presented the report in the absence of Marie Moy. She drew the committee’s attention to pages 9-12 of report which outlines the annual accounts for 2021-2022. The final year end underspends at 31st March 2022 is £74.670m which will be transferred into reserve funding; full details of this is outlined on page 58 of the report. It is anticipated that a further report will be brought to the September IJB committee to detail the plans for the ear marked reserves, this report will review current uses of reserves and if any changes are required.
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4 Ally Boyle queried for the details of the underspend should a link be provided to the finance report tabled under the next item, as if read in isolation it will not illustrate the full circumstances. Ross McGuffie and Nicola Lynch will work together to amend the wording prior to the final version being submitted. The IJB committee agreed the following recommendations: (1) that the Annual Governance Statement and the continuous improvement actions included in the IJB Annual Accounts for 2021/2022 are endorsed; (2) that the unaudited IJB Annual Accounts for 2021/2022, as appended to this report, be noted; (3) that the arrangements for publication of the IJB Annual Accounts for 2021/2022 in line with the legislative requirements be noted; and (4) that authority is delegated to the Acting Chief Financial Officer to amend the IJB Annual Accounts for 2021/2022 before the publication date of 30 June 2022 to reflect feedback from the IJB. RMcG/NL 6. Finance Report-2021/22 The report shared provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 31 March 2022. Based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. This is the final financial monitoring report presented in respect of the financial year 2021/2022. The financial position as at 31 March 2022 is summarised as follows: there is a net underspend of £58.697m on the core budgets within Health Care Services; details of which are provided at Appendix 1. there is a net underspend of £15.973 on the core budgets within Social Care and Housing Services; details of which are provided at Appendix 2 The total underspend of £74.670m represents approximately 9% of the total financial envelope available. Ross McGuffie advised additional funding has been included to allow services to over recruit but there have been significant recruitment challenges across all areas which is a Scotland wide issue.
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5 The IJB committee agreed the following recommendations: (1) Note the contents of the report; (2) Note the confirmation of the additional non-recurring Scottish Government funding to respond to the Covid-19 pandemic and to recover and remobilise health and social care services during 2021/2022; (3) Endorse the principle that uncommitted 2021/2022 Covid-19 funding will be transferred to a ring-fenced reserve to address ongoing Covid-19 costs in 2022/2023; (4) Note that the financial outturn at 31 March 2022 is an underspend of £74.670m (NHSL - £58.697m; NLC - £15.973m). 7. Covid Update As at 8th June, the seven-day case rate within North Lanarkshire is 103 per 100k population, which is a significant decrease to the figures last presented to the IJB PFA on 15th March when it was 1,334 per 100k. Ross McGuffie noted the reporting mechanisms for tests has changed so it is more challenging to monitor numbers- today is at 153.6 per 100k. There are 90 covid positive inpatients and a further 19 in off-site facilities, 0 deaths and 0 in level 3 ITU. On 4th May, NHS Lanarkshire moved out of black status back to red, with the supporting command structure stood down. This has been replaced with a Service Remobilisation and Oversight Group, with the aim of: Overseeing service remobilisation approaches Identifying unintended consequences of service recovery and remodelling Taking a whole system approach to the resolution of issues Providing assurance on progress In care homes starting to see some degree of impact today 4 care homes have outbreaks which is affecting 17 residents and 35 staff. Delayed discharge number have improved as of today the numbers are in the 70s, this is mainly due to issues around care home discharges and impact of covid absence. Further 22 discharges planned for today, there is a positive flow of discharges across all hospital sites. Work is being undertaken as part of the discharge without delay programme to review how many patients are discharged on time. Vaccination programme continues to deliver – awaiting future JCVI guidance on autumn programme for boosters, which is thought to be aimed at those in the immunosuppressed category.
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6 Cllr Kirsten Larson queried if any uptake issues with the vaccination programme. Ross McGuffie advised can see lower uptake in younger age group with 5-11year olds being the lowest uptake group. Cllr Paul Kelly asked is there is any indication of when the JCVI will confirm future arrangements as if the programme only focuses on immunosuppressed categories as may start to see an impact on staff absence levels if their protection is reduced. Issues around communicating and supporting immunosuppressed patients. Ross McGuffie was unable to give any concrete indication around timescales for JCVI to confirm the content of the Autumn programme, but noted it is expected soon. It was noted that funding within care homes ends in June in the report but Ross McGuffie advised funding has been confirmed until next year now so care home assurance work will continue for the financial year ahead. The IJB committee noted the below recommendations: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 8. Equalities Mainstreaming Report The Equality Act 2010 stipulates that all public bodies across Scotland are required to produce and deliver a set of equality outcomes to further one or more of the three needs of the Public Sector Equality Duty (PSED/also known as General Duty). The duty has two parts – a General Duty and Specific Duties. The General Duty came into force in April 2011 and applies to any organisation which carries out a public function, requiring due regard to be given to the need to: Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited under this Act Advance equality of opportunity between persons who share a relevant characteristic and persons who do not Foster good relations between people who share a protected characteristic and those who do not Morag Dendy noted the report is acknowledging the impact of Covid 19 and making services more accessible for communities. The refresh of priorities is detailed within the report they will be reviewed in line with the new SCP. Maddy Halliday offered to link with Morag Dendy to provide additional information on community’s solution for inclusion in the report. Also Maddy Halliday noted the impact of cost of living crisis and the impact on inequalities in future. She queried if this is something for consideration on the IJB risk register, the committee noted this and will discuss further under the risk item.
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7 Neil Findlay asked how will we evidence delivery of this work, Morag Dendy drew attention to appendix 1 within the report which provided a breakdown of key actions which involved development of matrix to look at quality control. Ally Boyle noted it’s about understanding the measurements of success with a focus on digital inequalities; the committee noted this. The IJB committee noted the following recommendations: Endorse the Mainstreaming Report Endorse the equality outcomes as agreed by the partner organisations Request progress updates via the Performance, Finance and Audit Committee Note the requirement to meet the 2 year cycle for future Mainstreaming Reports 9. Risk Register Christine Jack spoke to a report which provide a summary to the Integration Joint board (IJB) on risk management activity, noting any amendments or additions to the current risk register. There are currently three risks rated as Very High on the IJB risk register. IJB 08/21 – Financial Implications of Responding to Covid IJB 09/21 – Impact on the Strategic Plan due to Covid IJB 14/22 – Children and Adolescent Mental Health Services (CAMHS) and ability to recruit to service vacancies following investment in funding. These risks were reviewed in March 2022 having regard to the overall financial position and the additional confirmed Covid funding. At that point, it was agreed that the risks should remain as Very High due to the non-recurring status of the additional funding, the uncertainty in respect of the ongoing Covid-19 pandemic and the ongoing discussions with each partner about the allocation of the available funding to cost pressures. The risks will be reviewed as part of the financial planning exercise for 2022/23 with the new IJB Chief Financial Officer. There are four high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing One new risk has been added to the IJB Risk Register (IJB14.2022 – CAMHS service) following discussion at the last IJB meeting held in
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8 March 2022. Christine Jack advised due to CFO absence and not having budget information available have not been able to close off any financial risks and create new relevant financial risk. An updated position will be taken to the IJB PFA in August. As discussed under the previous item Maddy Halliday again raised the risk of the impact of cost of living which may lead to increased pressures for staff. The committee agreed will need to consider any mitigations. Cllr Jordan Linden queried if the IJB should have a similar risk as noted on the Heath Board risk regarding patient flow issues and any associated issues. Ross McGuffie advised doing planning work around urgent care with the health board and south IJB to manage this. so need to ensure the 3 plans are brought together in synergy. Brian Moore asked if the risk for services users losing service when community alarms move from analogue to digital should be added. Ross McGuffie advised have gone out to procurement to get digital compatible alarms to manage the risks. There is national work being undertaken around alarms which have also been connected, can bring a fuller report to a future committee. Maddy Halliday noted there is a risk for the community voluntary sector as there are a high number of factors beyond the HSCPs control. Particularly around the proposed transition to NCS should this be included in the risk register. Christine Jack noted need to review risks around 3rd sector funding and for NCS were awaiting more details so we could articulate a risk but will now look to add. Christine Jack will work up risks discussed. The IJB Committee noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. CJ 10. IJB Membership The rules about IJB membership are contained in statutory instruments and reflected in the Integration Scheme and Standing Orders. These state that Board members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. When a member resigns or otherwise ceases to hold office, the person shall be appointed for the unexpired term of the person being replaced.
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9 The Chair of the IJB should alternate between the voting representatives of North Lanarkshire Council and NHS Lanarkshire. Since 2019, the Chair has been nominated from NHS Lanarkshire from the cohort of Non-Executive Director members of the IJB. From June 2022 the chair of the IJB should be nominated from North Lanarkshire Council. The new chair for the IJB committee will be Councillor Tracy Carragher and Vice Chair will be Brian Moore. Christine Jacked noted we also need to update our stakeholder representation prior to the next meeting. The IJB committee agreed the following recommendations: 1. Note the handover of the IJB Chair from NHS Lanarkshire Board to North Lanarkshire Council from June 2022. 2. Note the revised membership of the voting members of the IJB from June 2022. 3. Approve the recommendations for Chair & Vice Chair of the Performance, Finance & Audit Committee (P, F&A). 11. Investment in IT Infrastructure to Support Care Delivery Contracts for the supply and support of GP Clinical Systems within Scotland are currently held separately by each territorial NHS Board. These are coming to end of life and in NHS Lanarkshire began to expire in May 2019. In the meantime, a National procurement/re-provisioning exercise has been undertaken with representatives from Scottish Health Boards. As a result, NHS Scotland has put in place a National GP IT Managed Services contract, signed and managed by NSS on behalf of the NHS Boards. This Multi- Supplier Framework Contract, which will replace the existing individual NHS Board contracts, was signed on 1st February 2019. Three suppliers, EMIS, Cegedim (Vision) and Eva Health Technologies were appointed to this framework. There have been significant delays and Eva have withdrawn from the framework, with a system from Emis not being available for at least another year. The current system poses significant challenges for the development of primary care services; in particular, the challenges of shared access to GP clinical systems has acted as a rate limiter on the implementation of the Primary Care Improvement Programme and remote access to GP clinical systems requires the exclusive use of a physical desktop PC in the practice, making efficient use of estate challenging. A process was therefore initiated in Lanarkshire in June 2021 to examine the feasibility of a Direct Award to Cegedim as soon as their system was available in Spring 2022 and a cohort of GP practices formed. All except two practices have agreed to join this cohort, which covers 99.5% of Lanarkshire’s population.
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10 Brian Moore noted there is already an earmarked reserve for digital enabled tech so how does this link to this; being mindful we need to ensure developments relate to updates for NCS too. Ross McGuffie noted have already agreed need to review existing reserves to see what is still relevant. NHS Scotland funded 365 implementation which was not planned, funding was already in reserves as part of the digital enabled tech so this can be redirected to support this work. Neil Findlay queried will these be fixed price costs or will there be additional costs as the work progresses. Dr Lucy Munro advised national procurement work started a number of years ago. Would expect that these are the prices as the companies don’t get paid until they deliver. If NHS Lanarkshire signs up with another board signing up it would take it over 55% so costs would be covered. The IJB committee agreed the recommendations made: Note the progress which has been made in procuring a reprovisioned IT system for General Practice and the opportunity this provides for providing an infrastructure for the work of integrated teams Note the opportunity to improve the quality and co-ordination of care by further investment in broader IT infrastructure That a ring-fenced reserve is created of £1.5m, including 0.301m to fund shared services linked to General Practice IT systems until 2029/30 12. Strategic Commissioning Plan Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020 – 23. The 2023 – 2026 SCP will be the final plan within the ten-year strategy. Morag Dendy advised it is planned to have engagement events in late August to focus on the detail of the plan. It is an opportunity for committee members to also join and input; details will be shared with the committee in due course. Brian Moore noted the community nursing review has not been discussed at this committee, he asked if it will be in future as seen the other work outlined in the plan. It has been included in winter planning as part of the business case. Ross McGuffie noted can bring a more detailed report to a future committee when the work is ready. Ally Boyle questioned do we currently map out communities we have engaged with and look at some areas that are missed out and consider how to engage with them to improve their skill set. Morag Dendy noted we do this currently but also will work with universities to promote research work going forward.
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11 Recommendations agreed by IJB committee are: 1. Seeking endorsement of our approach from IJB 2. Seeking promotion of the approach to encourage wide participation in the development of the 2023 – 2026 Strategic Commissioning Plan 13. National Care Service- Progress Update Ross McGuffie advised the bill was published yesterday currently working on a briefing for Board members, IJB member and NLC colleagues. There will be a change for social work and adult social work to sit under care boards. It’s likely to be a Lanarkshire wide care board but it has not been confirmed. There is some provision in the act to move some health functions but no health staff will be managed via care boards. There will be co- production work undertaken over the summer to get into the detail of the plan; with a planned implementation date in 2026. Brian Moore noted it doesn’t directly refer to Primary Care services is there any indication of direction of travel for this. Ross McGuffie advised commissioning may be included but contractor arrangements remain unclear. Cathy McGinty asked where does this leave the IJBS and integration. Ross McGuffie noted there will be anxieties for staff with changing employment status so will look at supporting staff working with trade unions. The committee noted Ross’s updated and look forward to future updates. 14. Annual External Audit Plan The Public Bodies (Joint Working) (Scotland Act) 2014 established the framework for health and social care in Scotland and the formation of Integration Joint Boards (IJBs). Each IJB is required to prepare annual accounts and have them audited in accordance with Part VII of the Local Government (Scotland) Act 1973.Aduit Scotland was appointed by the Accounts Commission and the Auditor General as the external auditors of the North Lanarkshire IJB. Marie McFadden advised the report contains planned overview and scope of the work. It was noted no formal reliance on work of financial audit. She asked if any committee members have any knowledge of any fraud that Audit Scotland should be aware of. Ross McGuffie confirmed no fraud to report.
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12 The IJB Committee is asked to agree the following recommendations: (1) That the content of the report is noted; (2) That the proposed revised timescale for annual accounts is noted as referenced in page 11, paragraphs 29-31. (3) That the audit fee of £27,960 is approved. 15. Risk Christine Jack will update the risk report from the discussion under the risk item. 16. Date of Next Meeting 21st September 2022 @ 2pm