Agenda reports pack
Argyll and Bute Council · 24 August 2022
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 24 August 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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17 August 2022 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) will be held BY MICROSOFT TEAMS on WEDNESDAY, 24 AUGUST 2022 at 1:00 PM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST (IF ANY) 3. MINUTES (Pages 5 - 12) Argyll and Bute Integration Joint Board held on 25 May 2022 4. MINUTES OF COMMITTEES (a) Finance and Policy Committee held on 27 May 2022 (Pages 13 - 16) (b) Strategic Planning Group held on 9 June 2022 (Pages 17 - 20) (c) Audit and Risk Committee held on 28 June 2022 (Pages 21 - 24) (d) Finance and Policy Committee held on 5 August 2022 (Pages 25 - 28) 5. CHIEF OFFICER REPORT (Pages 29 - 36) Report by Chief Officer 6. NATIONAL CARE SERVICE (SCOTLAND) BILL (Pages 37 - 42) Report by Chief Officer 7. PUBLIC HEALTH UPDATE (Pages 43 - 50) Report by Interim Associate Director of Public Health 8. PRIMARY CARE MODERNISATION PLAN UPDATE (Pages 51 - 72) Report by Head of Primary Care 9. STAFF GOVERNANCE REPORT FOR FINANCIAL QUARTER 1 (2022/23) (Pages 73 - 92) Report by People Partner 10. INTEGRATION JOINT BOARD - PERFORMANCE REPORT (Pages 93 - 100) Report by Head of Strategic Planning, Performance and Technology 11. FINANCE Reports by Head of Finance and Transformation (a) Budget Monitoring - 3 months to 30 June 2022 (Pages 101 - 114) (b) Medium Term Financial Plan 2023-2026 (Pages 115 - 130) Public Document Pack
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13. ARGYLL AND BUTE HSCP COMMITTEES ANNUAL REPORTS 2021/22 (a) Audit and Risk Committee Annual Report 2021-22 (Pages 131 - 138) Report by Chair of the Audit and Risk Committee (b) Clinical and Care Governance Committee Annual Report 2021-22 (Pages 139 - 142) Report by Chair of the Clinical and Care Governance Committee (c) Finance and Policy Committee Annual Report 2021-22 (Pages 143 - 152) Report by Chair of the Finance and Policy Committee 14. DATE OF NEXT MEETING 21 September 2022 Argyll and Bute HSCP Integration Joint Board (IJB) Contact: Hazel MacInnes Tel: 01546 604269
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MINUTES of MEETING of ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) held by MICROSOFT TEAMS on WEDNESDAY, 25 MAY 2022 Present: Attending: Sarah Compton-Bishop, NHS Highland Non-Executive Board Member (Chair) Councillor Amanda Hampsey, Argyll and Bute Council (Vice Chair) Councillor Kieron Green, Argyll and Bute Council Councillor Gary Mulvaney, Argyll and Bute Council Councillor Dougie Philand, Argyll and Bute Council Jean Boardman, NHS Highland Non-Executive Board Member Graham Bell, NHS Highland Non-Executive Board Member Fiona Davies, Chief Officer, Argyll and Bute HSCP Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Linda Currie, Lead AHP, NHS Highland Jillian Torrens, Head of Adult Services, Argyll and Bute HSCP David Gibson, Chief Social Worker/Head of Children, Families and Justice, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Rebecca Helliwell, Associate Medical Director, Argyll and Bute HSCP Elizabeth Higgins, Lead Nurse, NHS Highland Kenny Mathieson, Public Representative Angus MacTaggart, GP Representative, Argyll and Bute HSCP Julie Hodges, Independent Sector Representative Kevin McIntosh, Staffside Lead, Argyll and Bute HSCP (Council) Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Dr Nicola Schinaia, Associate Director of Public Health, Argyll and Bute HSCP John Stevens, Carers Representative, NHS Highland Fiona Thomson, Lead Pharmacist, NHS Highland Stephen Whiston, Head of Strategic Planning and Performance, HSCP Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Jane Fowler, Head of Customer Support Services, Argyll and Bute Council Graeme McMillan, Transformation Programme Manager, Argyll and Bute Council Fiona Hogg, Director of Human Resources and Organisational Development, NHS Highland Kristin Gillies, Senior Planning Manager, Argyll and Bute HSCP Geraldine Collier, HR People Partner, Argyll and Bute HSCP David Ritchie, Communications Manager, Argyll and Bute HSCP Lorna Jordan, Principal Accountant, Argyll and Bute Council Alison McGrory, Health Improvement Principal, NHS Highland George Morrison, Head of Finance, NHS Highland Councillor Garret Corner, NHS Board Member Patricia O’Neill, Governance Manager, Argyll and Bute Council Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council Page 3 Agenda Item 3
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1. APOLOGIES FOR ABSENCE The Chair opened the meeting and extended a warm welcome to Councillors Kieron Green, Amanda Hampsey, Gary Mulvaney and Dougie Philand who were recently appointed by the Council as representatives on the Integration Joint Board (IJB), following the local election on 5 May 2022. She also took the opportunity to welcome Julie Hodges in her capacity as primary member of the Independent Sector. She advised that Julie had recently taken over the role from Margaret McGowan and thanked Margaret for her services to the IJB over the years. Apologies for absence were intimated on behalf of:- Susan Ringwood, NHS Highland Non-Executive Board Member Betty Rhodick, Public Representative Kirstie Reid, Carers Representative, NHS Highland Pam Dudek, Chief Executive, NHS Highland 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The Minute of the meeting of the Integration Joint Board, held on 30 March 2022 was approved as a correct record, subject to the following amendments:- Sederunt Remove Angus McTaggart, who is listed twice as being present. Agenda Item 7 – Staff Governance Report for Financial Quarter 3 – 2021/2022 Amend bullet point two within the decision to read as follows – “Endorse the overall direction of travel noting that it would be helpful to have comparative information from both the NHS and the Council at future meetings.” 4. MINUTES OF COMMITTEES (a) Audit and Risk Committee held on 12 April 2022 The Minute of the meeting of the Audit and Risk Committee, held on 12 April 2022 was noted. (b) Clinical and Care Governance Committee held on 28 April 2022 The Minute of the meeting of the Clinical and Care Governance Committee, held on 28 April 2022 was noted. (c) Finance and Policy Committee held on 18 March 2022 The Minute of the meeting of the Finance and Policy Committee, held on 18 March Page 4
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2022 was noted. (d) Finance and Policy Committee held on 29 April 2022 The Minute of the meeting of the Finance and Policy Committee, held on 29 April 2022 was noted. (e) Special Strategic Planning Group held on 27 April 2022 The Minute of the special meeting of the Strategic Planning Group, held on 27 April 2022 was noted. 5. CHIEF OFFICERS REPORT The Board gave consideration to a report from the Chief Officer which provided information on the Joint Strategic Plan 2022-2025; the National Care Service and a number of staff changes, including the retirement of the Depute Chief Officer, George Morrison and the success of the Associate Director of Public Health, Dr Nicola Schinaia in securing another post within NHS Highland. The report also provided an update on changes to the Covid-19 guidance as well as a number of ongoing projects such as the opening of the Lorn and Islands Hospital Macmillan Day Bed Unit. Decision The Integration Joint Board noted the report by the Chief Officer. (Reference: Report by Chief Officer, dated 25 May 2022, submitted) Dr Rebecca Helliwell; David Gibson and Fiona Thomson joined the meeting during discussion of agenda item 5. . 6. APPOINTMENT OF ELECTED MEMBERS TO THE IJB AND REPRESENTATION ON THE IJB COMMITTEE STRUCTURE Consideration was given to a report which outlined the requirement for the IJB to make new appointments to each of the three Committees and to the Strategic Planning Group. The report also presented the Terms of Reference which had been updated to reflect Member job titles. The Board noted that Councillor Amanda Hampsey had been co-opted to the role of Vice Chair of the IJB on a two year rotational basis, by virtue of her Care Services Policy Lead role. Decision The Integration Joint Board: 1. Noted the changes in the membership of the IJB and the impact on the representation throughout the Committee structure. 2. Appointed Councillors Kieron Green and Dougie Philand to the Argyll and Bute HSCP Audit and Risk Committee. Page 5
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3. Appointed Councillors Amanda Hampsey and Dougie Philand to the Argyll and Bute HSCP Clinical and Care Governance Committee. 4. Appointed Councillors Amanda Hampsey and Gary Mulvaney to the Argyll and Bute HSCP Finance and Policy Committee. 5. Appointed Councillor Amanda Hampsey to the Argyll and Bute HSCP Strategic Planning Group. 6. Approved the updated Terms of Reference which reflects member job titles. (Reference: Report by IJB Standards Officer/Executive Director, dated 25 May 2022, submitted) 7. STAFF GOVERNANCE REPORT FOR FINANCIAL QUARTER 4 (2021/22) The Board gave consideration to a report on staff governance performance covering financial quarter 4 (January to March 2022) and the activities of the Human Resources and Organisational Development teams. Decision The Integration Joint Board:- 1. Noted the content of the quarterly report on the staff governance performance in the HSCP. 2. Took the opportunity to ask any question on people issues that were of interest or concern. 3. Endorsed the overall direction of travel, including future topics that they would like further information on. (Reference: Report by HR People Partner, dated 25 May 2022, submitted) 8. WHISTLEBLOWING REPORT QUARTER 4 - 1 JANUARY 2022 TO 31 MARCH 2022 The Board gave consideration to the fourth quarterly Whistleblowing Standards report for NHS Highland covering the period 1 January to 31 March 2022. Decision The Integration Joint Board noted the content of the report. (Reference: Report by Director of People and Culture, dated 25 May 2022, submitted) 9. HEALTH AND SOCIAL CARE WORKFORCE STRATEGY: THREE YEAR WORKFORCE PLAN Consideration was given to a report which summarised the requirements pertaining to the development of the HSCP workforce plan, which is required to be in place by the Scottish Page 6
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Government by 31 July 2022 and provided reassurance of the processes being undertaken to achieve the ambitious time frame. Decision The Integration Joint Board:- 1. Noted the content of the report, advising the IJB of the HSCP approach to meeting the timeframes of the workforce planning deadlines recently set by the Scottish Government. 2. Took the opportunity to ask questions relating to the content of the report. (Reference: Report by HR People Partner, dated 25 May 2022, submitted) The Chair ruled and the Board agreed to take a short comfort break from 2:33pm. The meeting reconvened at 2:40pm, with all those present as per the sederunt. In order to facilitate officer attendance, the Chair ruled and the Board agreed to reorder the remaining business. This minute reflects the order in which business was discussed. . 10. INTEGRATION JOINT BOARD - PERFORMANCE REPORT (MAY 2022) Consideration was given to a report which highlighted the work to date with regards to improved performance against remobilisation and waiting time targets. Information was also provided in relation to the potential impact of the new Omicron variant, specifically in regards to future performance reporting and prioritisation of service delivery. Decision The Integration Joint Board:- 1. Considered the HSCP performance progress regarding remobilisation of activity in line with the NHS Highland performance target for 2021/22 agreed with the Scottish Government to 70%-80% of 2019/20 activity as at November 2021. 2. Considered Waiting Times Performance and a further reduction in Consultant and Nurse Led Outpatient breaches >12 weeks. 3. Acknowledged performance with regards to both Argyll and Bute and Greater Glasgow and Clyde current Treatment Time Guarantee for Inpatient/Day Case Waiting List and activity. 4. Noted future performance reporting arrangements relating to the HSCP’s Integrated Performance Management Framework. 5. Noted the Scottish Government’s advice on timescales for the publication of the 2021/22 Annual Performance Report (APR). (Reference: Report by Head of Strategic Planning, Performance and Technology, dated 25 May 2022, submitted) Page 7
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11. COVID-19 PUBLIC HEALTH UPDATE The Board gave consideration to a report reviewing the work of Public Health in relation to Covid-19. The report built on accounts provided in earlier reports and presented the most up to date information as possible on how the pandemic was unfolding in Argyll and Bute as well as how the next phase of the pandemic response was developing in Scotland. The Health Improvement Principal provided an update on the rebalancing approach to the proactive delivery of health improvement core business and the Covid-19 response. Decision The Integration Joint Board:- 1. Noted the Covid-19 current status in the Argyll and Bute community, in terms of:- Distribution of infection rates; Covid-19 testing programmes. 2. Assessed the remobilisation plan following the Covid19 responses in the Argyll and Bute Community, in terms of Health Improvement. (Reference: Report by Associate Director of Public Health dated 2 May 2022, submitted) 12. JOINT STRATEGIC PLAN (2022-2025) Consideration was given to a report which presented the Argyll and Bute HSCP Joint Strategic Plan covering the period April 2022 to March 2025. Having recognised the work involved in the production of the Joint Strategic Plan, the Board commended the Strategic Planning team and all involved in its production. Decision The Integration Joint Board approved the Argyll and Bute HSCP Joint Strategic Plan (2022-2025) for implementation. (Reference: Report by Head of Strategic Planning, Performance and Technology, dated 25 May 2022, submitted) Councillor Green left the meeting at 15:23pm and re-joined at 15:24pm by telephone. . 13. FINANCE (a) Provisional Year End Finance Position 2021-22 The Board gave consideration to a report which provided a provisional summary of the financial performance of the HSCP for 2021/22. It noted a positive financial position with a small underspend against available resources, the repayment of the debt balance owed to Argyll and Bute Council and increased reserves. Decision Page 8
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The Integration Joint Board:- 1. Noted that the provisional financial outturn for 2021/22 is an underspend of £682k against available resources. 2. Noted that the full debt balance of £2.8m owed to Argyll and Bute Council has been settled during the year. 3. Noted that the IJB is expected to carry forward £21.2m as earmarked reserves. 4. Noted that the figures contained within the report are provisional and subject to external audit. 5. Requested that the Argyll and Bute HSCP Finance and Policy Committee consider a reduced frequency of meetings now that the IJB no longer holds a debt liability due to the Council. (Reference: Report by Head of Finance and Transformation, dated 25 May 2022, submitted) 14. UPDATED MODEL CODE OF CONDUCT AND ARGYLL AND BUTE IJB STANDING ORDERS Having noted that an updated Model Code of Conduct was approved by the IJB in January 2022, incorporated into the Standing Orders, the Board gave consideration to a report which highlighted that further guidance from the Scottish Government had been provided which outlined the need for a revised Code of Conduct to be submitted to them separately as an excerpt for consideration by 10 June 2022. The report contained details of the revisions made. Decision The Integration Joint Board:- 1. Agreed and noted the amendment to the Standing Orders on the basis of the guidance from the Scottish Government. 2. Noted the excerpt Code of Conduct will be submitted to the Scottish Government on 10 June 2022 for review. (Reference: Report by Business Improvement Manager, dated 25 May 2022, submitted) 15. ADOPTION OF MODEL COMPLAINTS HANDLING PROCEDURE OF THE SCOTTISH GOVERNMENT, SCOTTISH PARLIAMENT AND ASSOCIATED PUBLIC AUTHORITIES IN SCOTLAND FOR THE INTEGRATION JOINT BOARD Having noted that the current Model Complaints procedure does not reference the complaints handling of each partner body in relation to service provision, the Board gave consideration to a report which outlined the actions required by the IJB to adopt the sectoral Model Complaints Handling Procedure of the Scottish Government, Scottish Parliament and Associated Public Authorities in Scotland for the IJB. Page 9
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Decision The Integration Joint Board:- 1. Noted that the Model Complaints Procedure does not reference the complaints handling of each partner body in relation to service provision. 2. Formally adopted the sectoral Model Complaints Handling Procedure for the Scottish Government, Scottish Parliament and Associated Public Bodies for the Integration Joint Board. (Reference: Report by Business Improvement Manager, dated 25 May 2022, submitted) 16. DATE OF NEXT MEETING The Integration Joint Board noted that their next meeting was scheduled to take place on Wednesday, 24 August 2022. Page 10
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on FRIDAY, 27 MAY 2022 Present: Sarah Compton-Bishop (Vice-Chair) Kenny Mathieson Graham Bell Elizabeth Higgins Councillor Gary Mulvaney Attending: Fiona Davies, Chief Officer, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Stephen Whiston, Head of Planning, Performance and Technology, Argyll and Bute HSCP Jillian Torrens, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Gillian Maidment, Senior Improvement Officer, Argyll and Bute HSCP Councillor Kieron Green Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council Having noted the absence of the Chair, Councillor Amanda Hampsey, the Vice-Chair Sarah Compton-Bishop assumed the role of Chair for the duration of the meeting. . 1. APOLOGIES FOR ABSENCE Apologies for absence were intimated on behalf of:- Councillor Amanda Hampsey (Chair) Kevin McIntosh, Staffside, Argyll and Bute Council 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The minute of the Finance and Policy Committee, held on 29 April 2022, was approved as a correct record. 4. PROVISIONAL YEAR END FINANCE POSITION 2021-22 The Committee gave consideration to a report which provided the provisional year- end financial position for 2021/22. The report also summarised the final position in Page 11 Agenda Item 4a
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respect of the savings programme for the year and provided analysis of the reserves that the HSCP is carrying forward into future years. Decision The Finance and Policy Committee:- 1. Noted that the provisional financial outturn for 2021/22 is an underspend of £682k against available resources. 2. Noted that the full debt balance of £2.8m owed to Argyll and Bute Council has been settled during the year. 3. Noted that the IJB is expecting to carry forward £21.2m as earmarked reserves. 4. Noted that the figures contained within the report are provisional and subject to external audit. (Reference: Report by Head of Finance and Transformation, dated 27 May 2022, submitted) 5. TRANSFORMATION AND SAVINGS UPDATE Consideration was given to a report which summarised the progress reported to the May meeting of the Integration Joint Board and provided an early summary of progress with the savings programme in the current year. Decision The Finance and Policy Committee:- 1. Noted that the Transformation Board is now meeting on a two monthly basis. 2. Noted progress with the Transformation Programme and provided scrutiny in connection with progress and direction of the programme and its priorities. 3. Noted progress to date with the savings programme for 2022/23. (Reference: Report by Head of Finance and Transformation, dated 27 May 2022, submitted) 6. FINANCE & POLICY COMMITTEE ANNUAL REPORT 2021-22 - DRAFT The Committee gave consideration to a report providing an assessment of their work throughout the last financial year. The report contained information on the activity of the Committee; the progress in respect of the improvement agenda arising from the self-assessment exercise carried out in April 2021 and the Committee membership and remit. Decision The Finance and Policy Committee:- Page 12
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1. Considered the draft annual report for 2021/22. 2. Requested that the final version of the annual report is placed on the agenda for the next meeting of the IJB. (Reference: Report by Chair of the Finance and Policy Committee, dated 27 May 2022, submitted) 7. PROGRESS UPDATE - LEARNING DISABILITY AND MENTAL HEALTH PROGRAMME BOARD Consideration was given to a report which provided a summary of the Learning Disabilities and Mental Health services financial and savings position as at 30 April 2022; the current challenges to delivery of savings and an overview of the planned actions to progress the outstanding savings. Decision The Finance and Policy Committee:- 1. Noted the progress in respect of the Learning Disability and Mental Health savings programme as at 30 April 2022. 2. Noted the challenges affecting the delivery of savings. 3. Noted the actions planned to recover the outstanding savings proposals. (Reference: Report by Head of Adult Services Mental Health, Learning Disability and Lifelong Conditions, dated 27 May 2022, submitted) 8. REVIEW OF MEETING SCHEDULE AND FREQUENCY Having noted that they have been meeting on a monthly basis, largely due to the financial challenges which have faced the HSCP in recent years, the Committee gave consideration to a report which highlighted the early repayment of the debt owed to Argyll and Bute Council and the improved financial position as at the end of financial year 2021/22. The report also proposed a reduced meeting schedule going forward. Discussion was had in relation to the budget process and the possibility of retaining the scheduled meeting of the Committee on 25 November 2022 on the basis that it could be cancelled if business dictated that it was unnecessary. Decision The Finance and Policy Committee:- 1. Noted that the IJB requested that the Finance and Policy Committee review their meeting schedule in light of the improved financial position and repayment of the debt to Argyll and Bute Council. 2. Approved the proposed revised meeting schedule for 2022/23 as attached at Appendix 2 to the report, subject to the re-addition of the meeting scheduled for Page 13
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25 November 2022 with the opportunity to review whether this is required at the meeting on 28 October 2022. (Reference: Report by Head of Finance and Transformation, dated 27 May 2022, submitted) 9. DATE OF NEXT MEETING The Finance and Policy Committee noted that the next meeting was scheduled to take place on Thursday, 4 August 2022. Page 14
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MINUTES of MEETING of ARGYLL AND BUTE HSCP STRATEGIC PLANNING GROUP held BY MICROSOFT TEAMS on THURSDAY, 9 JUNE 2022 Present: Stephen Whiston, Head of Strategic Planning, Performance and Technology (Co-Chair) Jean Boardman, Non-Executive Director of Highland NHS Board & Member of the IJB (Co-Chair) Kristin Gillies, Senior Service Planning Manager Alison McGrory, Health Improvement Principal Charlotte Craig, Business Improvement Manager Julie Hodges, Independent Care Providers Sector Leader Councillor Amanda Hampsey, Vice Chair of the IJB Kirsty MacKenzie, Carers Strategy Officer Alison Ryan, Service Planning Manager Sarah Compton Bishop, Chair of the IJB Takki Sulaiman, Chief Executive of Argyll and Bute TSI Jillian Torrens, Head of Adult Services, Mental Health, Learning Disabilities and Lifelong Learning Stephen Morrow, Deputy Head of e-Health David Gibson, Head of Children and Families Margaret Jacobsen, Chair of the Dochas Carers Centre and all the Carers Centres in Argyll. Nicola Gillespie, Service Manager, Mental Health and Addictions (Adult Services) Douglas Whyte, Area Housing Manager Emma Mason, Planning Department Secretary 1. WELCOME, INTRODUCTIONS AND APOLOGIES The Non-Executive Director of Highland NHS Board & Member of the IJB, Jean Boardman, Chair, welcomed everyone to the meeting and introductions were made. Apologies for absence were received from Caroline Cherry, Elizabeth Higgins, Fiona Broderick, Fiona Davies and Douglas Hunter. 2. MINUTES AND MATTERS ARISING (a) Meeting held on 3 March 2022 The Minutes of the meeting held on 3 March 2022 were agreed as a correct record. Page 15 Agenda Item 4b
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(b) Special Meeting held on 27 April 2022 The Minutes of the Special meeting, held on 27 April 2022 were agreed as a correct record. 3. JSP: PLAN ON A PAGE; TEASER AND COMMUNICATION PLAN Senior Service Planning Manager, Kristin Gillies gave an update on the Joint Strategic Plan (JSP) approved at the IJB on 25th May 2022. Kristin advised that the social media teaser was created to attract public interest to read the full JSP. The ‘plan on a page’ is to be used as a tool for all Service Leads, and their teams, to feed into the priorities, strategic objectives and commissioning intentions going forward within their areas, individual strategies and work streams. Kristin asked the group to note the social media post within the agenda has some errors which have been corrected before being posted on social media. The group welcomed the one page plan, teaser and communication plan. The following comments were made - 1. Sarah Compton Bishop suggested to remove the overall budget pie chart, as the overall budget covers a vast area. 2. Jean commented four out of five of the engagement quotes are from staff, and would like to see more quotes from the public as a better balance. 3. It was suggested that the #Keepthepromise hyperlink be added to the one page plan as has been done within the JSP. 4. Alison McGrory advised that the offer of support to create an animated format of the JSP is still there. Decision The Strategic Planning Group approved the Plan on a Page, the Teaser and Communication Plan, subject to the amendments requested being considered and actioned as appropriate. 4. JSP AND JSCS: NEXT STEPS There was discussion on the implementation and delivery stage of the JSP and JSCS. Kristin Gilles highlighted areas that the plans will be fed through to inform operational plans. Charlotte Craig informed the group that a template is currently being developed for operational plans. This will be piloted with a small group of managers in the first instance. Nicola Gillespie asked to note that the Mental Health Service is currently working on priorities set by the Scottish Government for delivery. Page 16
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Decision The Strategic Planning Group noted the discussion and the operational template in progress. 5. CO-PRODUCTION WORKSHOP The Chief Executive of Argyll and Bute TSI, Takki Sulaiman, gave an overview of the workshop held on 7th June 2022. He stated that the feedback will be collated and shared with the group. Decision The Strategic Planning Group agreed that a future development session on co- production would be useful. 6. HSCP DIGITAL HEALTH AND CARE MODERNISATION STRATEGY 2022-2025 Deputy Head of e-Health, Stephen Morrow, presented the HSCP Digital Health and Care Modernisation Strategy 2022-2025. The strategy contains in-depth plans and ambitions for the next three years to improve and address some of the challenges for staff and service users. Sarah Compton Bishop asked if the workforce requirement was achievable due to recruitment challenges within Argyll and Bute. Stephen Morrow suggested that with flexible conditions, such as remote working, we can have some confidence that posts will be filled. Alison McGrory noted that there has been no reference for the need for an EQA to be completed. She suggested that an EQA is appropriate and should be considered. Decision The Strategic Planning Group noted the strategy, with consideration to be made for an EQA to be completed. 7. TRANSFORMATION AND SAVINGS UPDATE The Head of Finance and Transformation was absent from the meeting as, due to an error, he did not receive the invitation. Decision The Strategic Planning Group agreed for this agenda item to roll over to the next SPG meeting on 8th September 2022. 8. ANY OTHER COMPETENT BUSINESS Discussion was held on Locality Planning Groups (LPGs). Charlotte confirmed that the LPGs are recommencing in June 2022. Membership gaps continue to be reviewed. The first meeting will be a listening exercise to gather ideas and plan how these will work for each area. Page 17
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Sarah Compton Bishop suggested to continue links with groups which sit under the LPG’s and to be aware of those who may not be present for the purposes of inclusion. Decision The Strategic Planning Group noted and welcomed the recommencement of LPG’s and acknowledged the processes to be undertaken. 9. DATE OF NEXT MEETING The Strategic Planning Group noted that the date of the next meeting was Thursday, 8 September 2022. Page 18
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MINUTES of MEETING of ARGYLL AND BUTE HSCP AUDIT AND RISK COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 28 JUNE 2022 Present: Councillor Kieron Green (Chair) John Stevens Susan Ringwood Sarah Compton-Bishop Councillor Douglas Philand Attending: Fiona Davies, Chief Officer, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Moira Weatherstone, Interim Chief Internal Auditor, Argyll and Bute Council Paul MacAskill, Chief Internal Auditor, Argyll and Bute Council Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council Dafydd Jones, Audit Scotland 1. APOLOGIES FOR ABSENCE There were no apologies for absence intimated. 2. DECLARATIONS OF INTEREST (IF ANY) There were no declarations of interest intimated. 3. MINUTES The Minute of the previous meeting of the Argyll and Bute HSCP Audit and Risk Committee, held on 12 April 2022, was approved as a correct record. 4. UNAUDITED ANNUAL ACCOUNTS 2021/22 Consideration was given to a report which summarised the draft accounts and provided an opportunity for Members to comment on the accounts prior to their publication. Decision The Audit and Risk Committee: 1. Approved the Unaudited Annual Accounts and Report, including the Annual Governance Statement for issue. 2. Noted that the IJB is reporting a surplus for the year and that it has repaid the balance of debt due to Argyll and Bute Council. Page 19 Agenda Item 4c
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3. Endorsed the earmarking of reserves being carried forward, as outlined in note 7 of the Annual Accounts. (Reference: Report by Head of Finance and Transformation, dated 28 June 2022, submitted) Councillor Dougie Philand joined the meeting at 10:35am, during discussions of agenda item 4 (Unaudited Annual Accounts 2021/22). . 5. INTERNAL AUDIT UPDATE The Committee gave consideration to a report which provided an update on the work carried out by Argyll and Bute Council’s Internal Audit Team on audits which are of operational relevance, namely Complaints Handling and Workforce Planning. The report also provided an update on the actions from audit reports already presented to the Committee which were still open as at April 2022. Decision The Audit and Risk Committee reviewed the progress on completion of the internal audit plan and recommendations. (Reference: Report by Interim Chief Internal Auditor, dated 28 June 2022, submitted) The Chair, Councillor Green advised that due to a conflicting appointment, he required to leave the meeting at 11:00am. The Vice-Chair, while in attendance, advised that she was unable to carry out the role of Chair, due to illness and as such, the Committee agreed that for the remainder of the meeting, Councillor Philand assume the role of Chair. . . 6. INTERNAL AUDIT ANNUAL REPORT 2021/22 Consideration was given to a report which outlined the work undertaken by Internal Audit in respect of the Annual Audit Plan 2021/22. The report also provided the Interim Chief Internal Auditor’s independent annual opinion on the effectiveness of the Integrated Joint Board’s risk management, internal control and corporate governance processes. Decision The Audit and Risk Committee endorsed the content of the report and the associated annual opinion of the Interim Chief Internal Auditor. (Reference: Report by Interim Chief Internal Auditor, dated 28 June 2022, submitted) Councillor Green left the meeting during discussion of agenda item 6 (Internal Audit Annual Report 2021/22). . Page 20
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7. STRATEGIC RISK REGISTER REVIEW Having noted that the Risk Register is reviewed every 6 months, the Committee gave consideration to a report which summarised the outcome of the recent management review of the Strategic Risk Register and the review undertaken at the Board Development event held on 25 May 2022. The report also outlined some suggested changes to the Risk Register. Decision The Audit and Risk Committee: 1. Noted that the Strategic Risk Register had been reviewed by management and at a Board Development event in May 2022. 2. Considered and approved the proposed changes to the Strategic Risk Register. (Reference: Report by Head of Finance and Transformation, dated 28 June 2022, submitted) 8. COMPLAINTS HANDLING Consideration was given to a report which outlined the level of assurance over compliance with complaints procedures within the IJB. Decision The Audit and Risk Committee reviewed and endorsed the Internal Audit report on Complaints Handling. (Reference: Report by Interim Chief Internal Auditor, dated 28 June 2022, submitted) 9. WORKFORCE PLANNING Consideration was given to a report which outlined the level of assurance over the progress being made to meet the deadline of 31 July 2022 for the draft 3 year Workforce Plan to be submitted to the Scottish Government. Decision The Audit and Risk Committee reviewed and endorsed the Internal Audit report on Workforce Planning. (Reference: Report by Interim Chief Internal Auditor, dated 28 June 2022, submitted) 10. NEW EXTERNAL AUDIT CONTRACT The Committee gave consideration to a report which outlined the appointment of Mazars as the external auditor for the Argyll and Bute IJB for the financial years 2022/23 to 2026/27 following the completion of a tender exercise by Audit Scotland. Page 21
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Decision The Audit and Risk Committee noted that Audit Scotland have confirmed the appointment of Mazars as the External Auditor for financial years 2022/23 to 2026/27 following a tender exercise. (Reference: Report by Head of Finance and Transformation, dated 28 June 2022, submitted) 11. DATE OF NEXT MEETING The Audit and Risk Committee noted that the next meeting would be held on Tuesday, 13 September 2022. Page 22
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held in the BY MICROSOFT TEAMS on FRIDAY, 5 AUGUST 2022 Present: Councillor Amanda Hampsey (Chair) Kenny Mathieson Graham Bell Sarah Compton-Bishop Councillor Gary Mulvaney Attending: James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Stephen Whiston, Head of Planning, Performance and Technology, Argyll and Bute HSCP Jillian Torrens, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Evan Beswick, Head of Primary Care, NHS Highland David Gibson, Chief Social Worker/Head of Children, Families and Justice, Argyll and Bute HSCP Kirstie Reid, Carers Representative, NHS Highland Fiona Thomson, Lead Pharmacist, NHS Highland Fiona Broderick, Staffside, Argyll and Bute HSCP Hazel MacInnes, Committee Services Officer, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Fiona Davies and Elizabeth Higgins. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The Minutes of the meeting of the Finance and Policy Committee held on 27 May 2022 were approved as a correct record. 4. BUDGET MONITORING - 3 MONTHS TO 30 JUNE 2022 The Committee gave consideration to a report providing a summary of the financial position of the Health and Social Care Partnership as at 30 June 2022 and an early forecast for the year. The report also provided an update in respect of the delivery of the savings programme and utilisation of reserves. Decision The Finance and Policy Committee – Page 23 Agenda Item 4d
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1. Noted that the transition to a new ledger system within the Council has had an impact on the Quarter 1 financial reporting as transaction processing has been prioritised. 2. Noted that the current position is a small overspend in respect of NHS budgets. 3. Noted that there is a small forecast revenue overspend of £346k as at 30 June 2022 and that it is anticipated that the HSCP will operate within budget in the current year. 4. Noted progress with the savings programme and confirmation of £3.5m in savings delivered, 42% of target. 5. Noted that earmarked reserves of £2.6m has been committed to date for spend in 2022/23. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) 5. MEDIUM TERM FINANCIAL PLAN 2023-2026 The Committee gave consideration to a report providing the current medium term financial plan for the HSCP covering 2023/24 to 2025/26. The report provided the basis for detailed financial planning which would be used to inform the savings target for 2023/24. Decision The Finance and Policy Committee – 1. Noted the draft Financial Plan and budget outlook for 2023-24 to 2025-26. 2. Noted the risks and uncertainties regarding the Financial Plan. 3. Noted the forecast budget gap and endorsed the proposal that the HSCP seeks to develop a Value for Money Strategy aimed at addressing the budget gap. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) 6. TRANSFORMATION PROGRAMME UPDATE The Committee gave consideration to a report providing a progress overview and update in respect of the Transformation Programme following on from the July meeting of the Transformation Board. Decision The Finance and Policy Committee noted the progress with the Transformation Programme and provided scrutiny in connection with progress and direction of the programme and its priorities. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) Page 24
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7. FINANCIAL RISKS The Committee gave consideration to a report providing an update on the perceived financial risks facing the HSCP which could have an impact upon financial performance during 2022/23. Decision The Finance and Policy Committee – 1. Noted the 2022/23 financial risks identified for the HSCP as at 30 June 2022 and noted the mitigations. 2. Noted that financial risks would be reviewed and reported every two months. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) 8. SAVINGS PROGRESS UPDATE - CORPORATE The Committee gave consideration to a report providing a summary of the Corporate Services savings 2021/22 year end position, the 2022/23 position as at 26 July 2022, the current challenged to delivery of savings, and planned actions to progress the outstanding savings. Decision The Finance and Policy Committee – 1. Noted the year end position 2021/22 of the corporate savings programme. 2. Noted the progress in respect of the 2022/23 corporate savings programme. 3. Noted the challenges to achieving savings in 2022/23. 4. Noted the Digital Modernisation Newsletter. (Reference: Report by Head of Strategic Planning, Performance and Technology dated 5 August 2022, submitted) 9. PRIMARY CARE DEEP DIVE REPORT - TO FOLLOW The Committee were advised that no report would come forward for this meeting and noted that the Head of Finance and Transformation had provided an update on this under item 6 of the agenda (Transformation Programme Update). 10. AUDIT SCOTLAND IJB FINANCIAL ANALYSIS 2020/21 - FOR INFORMATION ONLY The Committee gave consideration to a report providing a summary of findings from Audit Scotland’s analysis of the financial performance of IJB’s across Scotland based on data relating to the 2020/21 financial year. Page 25
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Decision The Finance and Policy Committee noted the Audit Scotland Financial Analysis report for the year ended 31 March 2021, published in June 2022. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) 11. UNAUDITED ANNUAL ACCOUNTS 2021/22 - FOR INFORMATION ONLY The Committee gave consideration to a report providing an opportunity to review the unaudited annual accounts for the year 2021/22 which had been produced in line with the agreed timetable. Decision The Finance and Policy Committee – 1. Noted that the Audit & Risk Committee had approved the Unaudited Annual Accounts and Report. 2. Noted the unaudited accounts and the opportunity to feedback any suggested amendments. 3. Noted the earmarking of reserves being carried forward (note 7 of the Annual Accounts) as endorsed by the Audit & Risk Committee. (Reference: Report by Head of Finance and Transformation dated 5 August 2022, submitted) 12. DATE OF NEXT MEETING The date of the next meeting was noted as Friday 28 October 2022. Page 26
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1 Integration Joint Board Agenda item: Date of Meeting: 24 August 2022 Title of Report: Chief Officer Report Presented by: Fiona Davies, Chief Officer The Integration Joint Board is asked to: Note the following report from the Chief Officer Introduction I would like to welcome you to the new format of my Chief Officer’s Report which has been updated to more fully reflect the wide range of activity that is taking place both within Argyll and Bute and nationally as well. I hope you find the new style easy to read and the topics included informative and of interest. In this month’s report I have included some updates on the formal launch of our Strategic Plan, Ministerial thanks for the amazing work that staff are doing every day and a report back from the NHS Scotland Event which took place from 21-22 June in Aberdeen. The report also includes some examples of the really good work that our staff are doing day in day out for the people of Argyll and Bute as well as information on some new colleagues who are joining the HSCP. Our staff really are our greatest asset and I would like to thank them all for everything they are doing every day for their local communities. Finally, there is also a great deal of work going on nationally across both the health and social care sector and I have included information on a range of topics including the Open with Care Guidelines, the National Review of the Breast Screening Programme and the latest developments on the Scottish Government’s plans for a National Care Service. Page 27 Agenda Item 5
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2 HSCP Updates Ministerial thanks - The Chief Officer and Pam Cremin, Deputy Chief Officer, Highland Community, recently met with Kevin Stewart MSP, Minister for Mental Wellbeing and Social Care. The Minister expressed his sincere thanks and gratitude to all staff and partners delivering care in complex and difficult circumstances across all systems in Highland and Argyll and Bute. We would like to pass on this feedback to all colleagues and add our own thanks and appreciation for the fantastic work colleagues do every day. Strategic Plan - The HSCP’s Strategic Plan, which was approved by the IJB on 25 May, was formally launched on 30 May. The Plan sets out the Partnership’s strategic direction for the next three years, our priorities and commissioning intentions, our strategic objectives, how we will get there, what we will spend and how we will monitor and measure to ensure that every staff member and every service works towards our vision to support people in Argyll and Bute to lead long, healthy, independent lives. Further information is available online here. NHS Scotland Event 2022 - The annual NHS Scotland Event took place from 21-22 June in Aberdeen and was the first time it had been held in person since 2019. The title of the event this year was Pandemic Recovery and Reform for the Future. The HSCP was well represented at the event with the Chief Officer speaking at a plenary session on the National Care Service as well as participating in the judging of posters which were submitted by staff across Scotland highlighting aspects of work they were undertaking. The HSCP’s Head of Strategic Planning, Stephen Whiston, also attended the event and presented an ‘Experience Day’ visit at Aberdeen Airport where delegates could see first-hand how drone technology has the potential to positively contribute to the delivery of person centred care, tackle health inequalities and contribute to our climate change ambitions. Delegates were able to watch a live flight demonstration and Stephen explained the work that has been taking place in Argyll and Bute in relation to drone technology. AHP Fellowship - Linda Currie, Associate AHP Director, has been successful in being awarded a NES National AHP Fellowship to progress NHS Highland wide work to implement the Health & Care Staffing Act involving workforce establishment setting across the professions. Carers Week - This year Carers Week took place from 7 – 13 June and is part of the annual campaign to raise awareness of the challenges carers face and recognise the contribution they make to families and their communities. We would like to thank all unpaid carers for the work they do within their own communities. Our appreciation also goes to the Carers’ Services for the work of their teams in each locality. Change to Senior Management Responsibilities within Adult Care Across Argyll and Bute, Adult Care is provided via a wide range of NHS and Local Authority services. These services are delivered collaboratively by a range of Page 28
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3 health and social care professionals functioning in teams that are managed and supported by two Heads of Service. Heads of Service have functioned as Head of Adult Care for Older People and Community Hospitals and Head of Adult Care for Mental Health, Learning Disabilities and Lifelong Conditions. Given the breadth of Adult Care services, the ongoing need for transformational change to ensure services are evidence based and contemporary, and our commitment to deliver on the HSCP’s Strategic Plan for the people of Argyll and Bute there has been a recent review of the Head of Service portfolios. The outcome of the review is that:- Heads of Service will now be titled o Head of Health and Community Care – Caroline Cherry o Head of Acute and Complex Care – Jillian Torrens Dementia Services and the Rural General Hospital have moved across to Acute and Complex Care Services Service Updates The HSCP was informed in the middle of May by the owners of Lochside Care Home in Helensburgh that they were planning to close the home. There were 27 residents in the home at the time. We worked very closely with the residents and their families and by the second week in June all of the residents had been found alternative accommodation. Thanks go to the staff and local teams in Helensburgh for progressing this work so quickly and ensuring the best outcome for residents and their families. It has also shown great partnership working across health and social care, the care home, procurement and the Care Inspectorate. Operational Challenges Lorn & Islands Hospital Medical Deanery Report A report was published on the 27 July 2022 by the Medical Deanery (who oversee trainee doctors) on behalf of NHS Education for Scotland. This report relates to a visit carried out by representatives from the Deanery to Lorn & Islands hospital on 17 May 2022. A copy of the report is available here. The HSCP would like to thank NHS Education for Scotland for the report they produced following their recent visit to Lorn & Islands hospital and we accept their findings in full. Difficulties in recruiting trained clinical staff, especially consultants, has undoubtedly led to significant additional pressures on the clinical teams working within the hospital and the training and peer support available for junior clinical staff Page 29
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4 has not been as robust as we would have liked. We would also like to thank those colleagues who raised concerns about these issues. An action plan has been put in place to implement the recommendations listed in the report and this plan has been shared with NHS Education for Scotland. The recruitment issues we face as an organisation are shared by other Health Boards and we are actively looking into using more innovative methods of marketing and promoting NHS Highland as an attractive place to work. One element of this has been the launch of the Aim High Aim Highland recruitment campaign and we are hopeful that this will help us in the recruitment of key staff. We have a great team at Lorn & Islands hospital and we recognise that the last couple of years have been an extremely difficult and challenging time for them and we would like to thank them, and all our colleagues across the HSCP, for the work they are doing for their local communities every day of the week. Recruitment Like many other HSCPs across the country Argyll and Bute is facing significant recruitment challenges and we are continuing to be more innovative in our marketing of the HSCP as a great place to live and work. We are working with colleagues at Lorn & Islands Hospital in Oban to produce a video with staff discussing why they like working in Argyll and Bute and the benefits of living in a rural area with the wide range of leisure activities that are on our doorstep. A Facebook page has also been created to help with the promotion of care at home and care home vacancies in Argyll and Bute and you can view it here. NHS Highland has also launched the ‘Aim High, Aim Highland’ recruitment campaign to encourage people to come and work in the Highlands and Argyll and Bute. This campaign is currently being promoted on the Underground in London and on buses across the central belt, as well as across our usual channels including social media. Adult Social Work Social work pressures within adult services have been building for some time and there is a short life group to meet these challenges. On the 17 June an Adult Support and Protection central team was established to screen and investigate adult protection concerns to provide a more consistent and timely response. This is welcomed by social work staff and will be a test of change for service redesign. Page 30
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5 National Updates New National Targets to Tackle Long Waits for Planned Care New targets have been set out for NHS Scotland to address the impact of the pandemic on long waiting times for planned care. The Health Secretary has also announced that NHS Scotland will aim to eradicate waits of more than two years, and then one year in most specialities by September 2024. Further information is available here. National Care Service The Scottish Government lodged a Bill in Parliament on 21 June 2022 in relation to their plans for a National Care Service (NCS) for Scotland. The Bill provides for the Scottish Government to become accountable for the delivery of adult social care and social work, in addition to their accountabilities for the NHS. It also includes powers to consult on including children and justice services. The Bill introduces the setting up of Local Care Boards to plan, commission and deliver services for their local area. Health services will continue to be delivered by the NHS in partnership, as commissioned by the Care Board. The Bill process will last at least a year and no change is expected before 2026. A lot more detail needs to be decided in that time, and we understand that there will be opportunities for people who deliver and use services to get involved in designing the NCS. We realise that this announcement will bring uncertainty at what is already a difficult time for many social work and social care services and we will continue to share updates whenever we receive them. Further details of the Bill are available on the Scottish Government website here. Open With Care Guidelines New guidance reinforcing the expectation that people in adult care homes should be able to see their friends and family without restrictions has been published. The refreshed Open with Care guidelines say that people in care homes should be able to see their friends and family without restrictions such as limits on how often visits can take place or on how many different visitors a person can have. Further information is available here. Review of Breast Screening Programme A major review of Scotland’s breast screening programme which makes 17 recommendations to strengthen and improve it has been published. The report recommends ways to make the breast screening programme more accessible, resilient and sustainable, to drive improvements and build upon successful delivery of services. The full report is available here. Page 31
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6 Good News Helensburgh Reablement Team Sarah Taylor and Sandie Shaw are both part of the Reablement Team supporting patients in Helensburgh and Lomond. Sarah is a Reablement Occupational Therapist and Sandie is part of the Reablement Support Team, they’ve been working for the HSCP for 18 months after starting within a few weeks of each other. Reablement is an Occupational Therapy led service across Argyll and Bute, providing wide ranging support options to patients within the community and at their homes. It’s designed to help patients gain or regain their confidence and necessary skills to live independently after an illness, deterioration in health or injury. Support is usually provided for up to 6-8 weeks and is tailored to individual needs. Working together alongside patients and their families, the service aims to provide effective intervention for patients receiving reablement within the community. The team in Helensburgh includes occupational therapists, physiotherapists and health care support workers, and is supported by community nurses and social workers. You can find out more here. Struan Lodge Struan Lodge Care Home for older people was inspected by the Care Inspectorate in June 2022 and we are delighted to note that it received Grades of 5 (very good) across supporting well-being and leadership. All credit to all the hard work of the staff. Reducing the Carbon Footprint of the HSCP Commercial Fleet The HSCP has been awarded £494,000 from Transport Scotland to install 30 additional electric vehicle charge points in 9 of our hospital sites and replace some of our diesel vans by March 2023. This important increase in our electrical infrastructure will allow the HSCP to replace a further 40 vehicles with electric ones as we move towards achieving the target of net zero CO2 emissions by 2025. Long Covid Service NHS Highland is working closely with the Scottish Government Long Covid team and is in the final stages of planning to launch a board wide Long Covid service in the next few weeks. We are currently recruiting OT and Physiotherapy staff to support rehabilitation and are the first board in Scotland to adopt the C19-York Rehab Scale App which will assist triage and self-management. Page 32
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7 New Colleagues Assistant Clinical Dental Director We are delighted to announce that Gillian Rees has been appointed to the post of Assistant Clinical Dental Director to lead the Argyll and Bute Public Dental Service. Gillian will start in her new role at the beginning of August and we look forward to welcoming her to the Argyll and Bute team. New Trainee Health Psychologist Giulia Spaltro is thrilled to be Argyll and Bute’s first ever Trainee Health Psychologist. Her role is funded by NHS Education for Scotland and the HSCP for two years. Health Psychologists aim to understand patient’s changing thoughts, emotions and behaviour related to health, illness and healthcare and they work in a variety of settings such as working directly with patients or groups, supporting other staff and providing support for awareness campaigns. Giulia will be working jointly between the Public Health and Dietetics teams and in her role she will focus mainly on weight management and Type 2 Diabetes management and prevention. Page 33
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1 Integrated Joint Board Date of Meeting: 24 August 2022 Title of Report: National Care Service (Scotland) Bill Presented by: Fiona Davies The Integrated Joint Board is asked to: Review and note the proposed Bill and timeline Note the formation of an operational working group 1. EXECUTIVE SUMMARY The National Care Service (Scotland) Bill was introduced on 20 June 2022. The Bill is currently at Stage 1 which allows the Scottish parliament to debate and consult publicly on the general principles of the Bill. The timeline seeks to transform and be operational by 2026 pending approval of the Bill through the legislative process. 2. INTRODUCTION A Bill is a proposed Act of the Scottish Parliament. It might be a new idea, or change or remove part of an existing law. A Bill that is introduced in the Scottish Parliament is scrutinised and debated by MSPs. Further to national consultation the Scottish Government has introduced a National Care Service Bill. Each Bill must go through several stages before it can be passed and become an Act. The Bill will require to go through three stages. Stage 1 - consideration of the general principles of the bill by parliamentary committee (s), and a debate and decision on these by the Parliament. Stage 2 - detailed consideration of the bill by parliamentary committee (s) Stage 3 - final consideration of the bill by the Parliament and a decision whether it should be passed or rejected. The Bill is at Stage 1. 3. DETAIL OF REPORT 3.1 Overview Page 35 Agenda Item 6
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2 The Bill establishes the National Care Service. The Bill allows Scottish Ministers to transfer social care responsibility from local authorities to a new, national service. This could include adult and children’s services, as well as areas such as justice social work. The Scottish Government would need to consult with the public before transferring responsibilities relating to children’s services or justice social work to the new service. Scottish Ministers are also able to transfer healthcare functions from the NHS and health boards to the National Care Service. Care or health services that are transferred to the new service could be delivered nationally or locally. New bodies called “care boards” would be responsible for delivering care locally. As well as establishing the National Care Service, the Bill makes other changes including: allowing information to be shared by the National Care Service and the NHS introducing a right to breaks for carers giving rights to people living in adult care homes to see the people important to them (known as “Anne’s Law”) Why the Bill was created The Scottish Government has introduced the Bill to improve the quality of social work and social care services in Scotland. The Scottish Government announced an Independent Review of Adult Social Care (IRASC) in September 2020. This is sometimes referred to as ‘The Feeley Review’, after its lead author, Derek Feeley. The review aimed to recommend improvements to adult social care in Scotland. In August 2021, the Scottish Government published a consultation on its proposals to improve social care delivery in Scotland, following the recommendations in the review. This Bill has been developed in response to the review’s recommendations and the responses to the consultation. Reference: Overview | Scottish Parliament Website The Bill is supported by a range of documentation Explanatory Notes Policy Memorandum Financial memorandum Page 36
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3 Delegated Powers memorandum Statements on Legislative Competence Each of these documents can be found at the link below: https://www.parliament.scot/bills-and-laws/bills/national-care-service-scotland- bill/introduced The National Care Service at this stage is seeking responses of people with lived experience to support the design and a co-production approach to the service. This document also notes where responsibility for decision may lie during this process in terms of the ultimate role of Ministers and the need for local bodies to continue to play a crucial role in the design and delivery of services. A document supporting how this will work was published by the government on 21 June and available at the link below: https://www.gov.scot/publications/national-care-service-co-design-national-care- service/ In summer 2022 the NCS Design School will be launched creating a space for collaboration and a Lived Experience Partners Panel will be open for people to register an interest in co-design activities. It is anticipated that this process will develop over a period of years and over multiple events. The National Care Service proposes the largest change to social care and social work in a considerable period of time. Proposed changes may have considerable change to the governance of the health and social care services to a new public institution call a Care Board and in the services delegated to that public institution. The Care Board will be a statutory public body. Currently Argyll & Bute HSCP has all care and health services delegated, care functions have not been allocated within the Bill but ministers will have powers to do so pending consultation. The National Care Service Bill provides increased accountability and powers at a ministerial level including the transfer of healthcare functions from the National Health Service as set out in the National Health Service (Scotland) Act 1978. The Bill supports reforms of support for unpaid carers, visits to Care Homes. The goes on further to outline the governance, duties and supporting acts and infrastructure most of which are currently applied to partners and the Integration Joint Board at present. As noted the Bill will follow a staged process to become an Act and outlines how it will work with the public to co-produce services. There is no specific instruction or process for IJB/HSCP at present but there is considerable national activity to ready Integration Joint Boards to prepare themselves for change. Page 37
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4 The HSCP will form an operational working group to support change management and monitor the flow of information to and from the Scottish Government and stakeholders during this period of change. 4. RELEVANT DATA AND INDICATORS Publication of research and public engagement undertaken by the Scottish Government. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The Integration Joint Board approved its new Strategic Plan in May 2022. This will be reviewed on an annual basis to ensure it is consistent with the changing national policy direction. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact There is no communication at this stage on any financial impact but it is anticipated that this will be the case during planning and implementation. 6.2 Staff Governance The Bill notes potential for the Care Board to be an employing entity. 6.3 Clinical and Care Governance This will be a central feature of any development to ensure the continued positive impact of integrated community services 7. PROFESSIONAL ADVISORY The HSCP is supported by a Professional Advisory Group of senior staff who will have an active role in reviewing impacts. 8. EQUALITY & DIVERSITY IMPLICATIONS The HSCP will work actively with the Equalities Commission and Health Improvement Scotland to ensure a proactive approach to design and delivery of services with all stakeholders. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data sharing and protection between agencies is currently covered by agreements which may require review. 10. RISK ASSESSMENT The Bill proposes considerable change. Risks and potential issues will be identified and escalated through the governance of the IJB where required. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The public are actively advised to comment on the Bill with dates available to join events available for registration online at the link below: https://www.gov.scot/policies/social-care/national-care-service/ Page 38
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5 12. CONCLUSIONS The IJB is asked to note the publication of the National Care Service (Scotland) Bill and note commencement of an internal working group to support change management. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Page 39
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Page 1 Integration Joint Board Date of Meeting: 24th August 2022 Title of Report Public Health update Presented by: Alison McGrory, Interim Associate Director of Public Health The Integrated Joint Board is asked to: Review the latest Covid-19 issues, in terms of: o Distribution of infection rates o The success of the Covid-19 testing programmes o The autumn vaccination programme Note and be aware of new legislation on smoke free hospital grounds Review latest statistics on deaths related to suicide, alcohol and drugs and work being undertaken 1. EXECUTIVE SUMMARY This paper outlines Public Health activity in relation to Covid-19 prevalence in Scotland. This remains high at an estimated one in 20 people but is a reduction from the peak of one in 15 in July 2022. Also included are details on new legislation for smoke free hospital grounds, and deaths statistics related to alcohol, drugs and suicide. 2. INTRODUCTION Covid-19 remains a public health concern with significant impacts on staffing and service sustainability. The recent pattern of peaks of infection every three months remains apparent in 2021 and this suggests ongoing impacts for health and social care as we move into the autumn. Covid-19 mitigation is driven by national strategy with a focus on infection prevention and control in health and care settings and a focus on personal responsibility in the wider community. We no longer have universal access to testing so it is difficult to gauge the full impacts on public health. Rates of hospitalisation from Covid-19 ill-health remain low when compared to the pre-vaccination period. The Public Health Team is now full remobilised to previous core business and no longer has an emergency response role. This allows more focus on prevention and the social determinants of Public Health. 3. DETAIL OF REPORT Page 41 Agenda Item 7
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Page 2 3.1 Covid-19 3.1.1 Epidemiology of COVID-19 (as reported up to 15th August 2022) The Office for National Statistics (ONS) infection survey (Figure 1) shows that the proportion of people in the community with COVID-19 has been falling. In the week 19th July to 26th July, it is estimated that 4.95% or 1 in 20 of the population would test positive. Rates remain among the highest reported during the course of the epidemic. Currently, the variants under surveillance in the UK are Omicron, including sub-lineages BA.1, BA.2, BA.3, BA.4 and BA.5. The current wave of infection has been driven by the BA.5 Omicron sub variant. In the week ending the 17th July, BA.5 made up 79.4% of all sequenced COVID-19 infections with BA.4 comprising 16.2%. Following a planned change to ONS data collection method, there was no ONS Infection Survey briefing on the 12th of August. Figure 1. ONS infection survey results – Trend in the estimated percentage of the Scottish population living in private residential households testing positive for coronavirus (COVID-19) on nose and throat swabs Source: Office for National Statistics, Coronavirus (COVID-19) Infection Survey (CIS), 5 August 2022 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditio nsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/latest COVID-19 levels in wastewater in the most recent week suggest viral levels in the population are decreasing. Page 42
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Page 3 https://www.gov.scot/collections/coronavirus-covid-19-modelling-the-epidemic/ The changed national testing policy from the 1st of May 2022 has resulted in a sharp reduction in the quantity and quality of data available for monitoring the transmission of the virus in the population. Nationally and locally the number of positive cases reported have reduced in recent weeks, as has COVID-19 related hospital occupancy. https://public.tableau.com/app/profile/phs.covid.19/viz/COVID- 19DailyDashboard_15960160643010/Overview 3.1.2 COVID-19 Testing in Argyll and Bute The Argyll and Bute Public Health Team delivered community asymptomatic testing on behalf of NHS Highland and a recent independent evaluation has recognised strong leadership and effective partnership working with the third sector, local authorities and local communities. This evaluation provides useful lessons for delivering national programmes at pace and contains recommendations for future emergency planning scenarios. This work will be shared widely in autumn 2022. The team also contributed to the Scotland wide evaluation of asymptomatic testing. 3.1.3 Planning for the Autumn/Winter Covid-19 & Flu vaccination programme From Autumn/Winter 2022, the COVID-19 and flu vaccinations will be delivered by Argyll and Bute HSCP vaccination teams. In the development and recruitment of this new service and the team, there has been a conscious decision to recruit flexible and mobile posts in anticipation of a different delivery model. The delivery model is now being rolled out across Argyll and Bute and planning is underway to ensure residents across Argyll and Bute receive their vaccinations quickly, safely, and efficiently. Further information on COVID-19 vaccinations can be found via the link below and is updated regularly https://www.nhshighland.scot.nhs.uk/COVID19/Pages/Vaccination-ArgyllBute.aspx 3.2 Wider Public Health Updates 3.2.1 Smoke Free Hospital Grounds Smoke free hospital grounds legislation will be implemented on 5th September 2022 following a 3-year delay. The legislation stipulates that an area of 15 metres from the entrances to the hospitals is required to be smoke free. Following the release of national communications resources, materials will be shared widely. Plans are in place to provide training for staff and promote the national communications material. The legislation requires NHS Boards to make people aware that it is illegal to smoke on Page 43
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Page 4 NHS grounds with individuals being fined £50 for breaches. This development provides an opportunity to promote local stop smoking services and further moves in the direction of non-smoking being the norm. 3.2.2 Suicide related deaths The National Records of Scotland published data on probable deaths by suicide for 2021 on 2 August 2022. This report found a 6% drop in suicides from 2020 to 753. The age standardised rate of suicide in Argyll and Bute is slightly higher than the Scottish average. Suicidality is strongly correlated to socio-economic deprivation but not exclusively linked. Every death by suicide is a tragedy and work carries on apace to develop effective approaches to suicide prevention in Argyll and Bute with an active multi-discipliary steering group. An updated national strategy for suicide prevention is awated in autumn 2022. The full report is available at the link below: Probable Suicides, 2021, Report (nrscotland.gov.uk) 3.2.3 Alcohol and Drug related deaths The rate of alcohol specific and drug related deaths fell in 2021 compared with 2020. The relative low numbers in Argyll and Bute can result in wide fluctuations year on year so not necessarily indicative of service improvement. It is important to note that the trendline for all these forms of death is upwards. Drug deaths are now published quarterly and there is significant expectation on services to identify and support people with drug problems. Page 44
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Page 5 Full reports are available here: https://www.nrscotland.gov.uk/files//statistics/alcohol-deaths/2021/alcohol-specific- deaths-21-report.pdf https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/21/drug-related- deaths-21-report.pdf 3 RELEVANT DATA AND INDICATORS Data about COVID-19 epidemiology has been reported above. 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 2014 2015 2016 2017 2018 2019 2020 2021 Rate per 100,000 of Population Calendar Year Argyll & Bute Alcohol-Specific Deaths registered in Scotland, 2014 to 2021 Data Source: National Records of Scotland These tables exclusively refer to alcohol-specific deaths as the primary measure. Earlier NRS publications referred to alcohol-related deaths as the primary measure of alcohol mortality. Statistics on alcohol-related deaths were last updated for deaths in 2019 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 2014 2015 2016 2017 2018 2019 2020 2021 Rate per 100,000 of Population Calendar Year Argyll & Bute Drug Related Deaths registered in Scotland, 2014 to 2021 Data Source: National Records of Scotland From 2011, 'drug abuse' deaths from 'acute intoxication' with undetermined intent that would previously have been counted under 'mental and behavioural disorders' are counted as 'poisoning', so some of them will be counted as 'probable suicides' Page 45
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Page 6 4 CONTRIBUTION TO STRATEGIC PRIORITIES This work supports/underpins the HSCPs strategic and operational response to promoting health and wellbeing and protecting public health. 5 GOVERNANCE IMPLICATIONS Financial Impact The activity outlined in this report does not require additional funding investment. Staff Governance Nothing significant to report. Clinical Governance Nothing significant to report. 6 PROFESSIONAL ADVISORY The Associate Director of Public Health oversees the work of the Public Health Team in Argyll and Bute and relevant activity is reporting to other professional advisors for governance, support and oversight. 7 EQUALITY & DIVERSITY IMPLICATIONS Equality and diversity is inherent in the delivery of public health business and is within the core competencies of the public health workforce. 8 GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Compliance with GDPR remains critical and is being considered within the various pieces of work supporting the sharing of information and data to protect health and wellbeing of staff and the public and patients. 9 RISK ASSESSMENT Not required for this report. 10 PUBLIC & USER INVOLVEMENT & ENGAGEMENT The Public Health Team works closely with communications colleagues to ensure opportunities to work with communities are maximised. This includes proactive press releases and responding to press queries in relation to drugs related deaths. 11 CONCLUSION Page 46
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Page 7 This report outlines some current areas of priority for the Public Health Team in Argyll Bute. A wide remit of activity is ongoing in relation to health improvement, health protection, service improvement and health intelligence/data analysis. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name Alison McGrory, Interim Associate Director of Public Health Email alison.mcgrory@nhs.scot Page 47
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1 Integration Joint Board Date of Meeting: 24 August 2022 Title of Report: Primary Care Modernisation Plan Update Presented by: Evan Beswick The IJB is asked to: Note progress in the delivery of the Primary Care Modernisation Plan 1. EXECUTIVE SUMMARY This report provides a high level summary noting the progress of the Primary Care Modernisation Plan to the Integration Joint Board. It notes the internal governance, progress in key areas and management of risk in the current operating environment. It reflects the focus of delivery of the General Medical Services Contract in Scotland 2018 in line with the needs of a diversely populated urban, remote and island area with a range of needs. 2. INTRODUCTION This Report has been prepared in relation to the progression in Argyll & Bute of the implementation of the 2018 General Medical Services Contract in Scotland. Since the inception of the NHS, the vast majority of General Practices have operated on an independent contractor model. Each practice holds a General Medical Services (GMS) contract with the NHS Board and receives an allocation of funding based on a nationally agreed formula. The GMS contract outlines the services which the Practice must provide but allows for flexibility in how this is achieved. Practices are therefore free to employ a variety of staff and set up services in a way which they feel best meets the needs of their patient population. Increasing pressure, particularly on urban practices, led to a wholescale redesign of the GMS contract. The delivery of the 2018 General Medical Services Contract in Scotland was a planned transition over 3 years extended to 4 years ending March 2022. Funding was provided for new staff who would be employed by Argyll and Bute HSCP. Staff would be attached to practices and clusters to reduce GP workload. Significant changes in the new contract included: Page 49 Agenda Item 8
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2 The role of the GP as an Expert Medical Generalist co-ordinating a multi-disciplinary community care team A new formula for calculating the core funding each practice receives Significant investment in a number of services which NHS Boards and Integration Authorities are expected to put in place to support the work of General Practice This strategic document is supported by a Memorandum of Understanding (MOU) which sets out a model for collaborative multi-disciplinary teams working alongside GPs in their role as Expert Medical Generalists. 6 key areas of priority were identified – Vaccination Transformation, Pharmacotherapy, Community Treatment and Care (CTAC), Urgent Care, Community Link Workers and Additional Professional Roles to include First Contact Practitioner Physiotherapists and Primary Care Mental Health Professionals. The MOU was revised in 2022 to highlight Vaccinations, CTAC and Pharmacotherapy for prioritisation against the background of the pandemic. It is anticipated that these new arrangements will see a reduction in GP workload and a substantial increase in practice sustainability. 3. DETAIL OF REPORT The Primary Care Modernisation Programme is delivered and governed internally by an operational board which ultimately reports to the IJB on the progress of delivery in Argyll & Bute. Argyll & Bute has specific needs in the delivery as specified. In February 2022 approval was obtained from the Scottish Government to exercise rural flexibility in Argyll and Bute: • Full Flexibility - 4 small island practices (Coll, Colonsay, Jura and Tiree) • Partial Flexibility - 14 remote and rural practices (Mull and Iona – 4 GP Surgeries, Islay – 3 GP Practices, Bute, Port Appin, Easdale, Lochgoilhead, Strachur, Kilmun, Tighnabruaich, Carradale, Kilcreggan and Arrochar) • Flexible options • Full – Practices continue to deliver vaccination and CTAC services • Partial – Co-delivery of services by the practices and HSCP Teams A snapshot of developmental work to date is presented to the board in appendix 1 and the current picture of demand on our GP services in appendix 2. The board is asked to note the progress made in a challenging environment for our primary care professionals. This is characterised by an ongoing Covid- 19 response, increased demand and challenges in recruitment. The board is asked to take assurance from the internal governance oversight. Page 50
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3 Vaccination Transformation and Community Treatment and Assessment Centres (CTAC) An approach to ensuring needs are met for remote, island and urban communities in Argyll & Bute is informing development and recruitment for the Vaccination Transformation and CTAC service. Vaccination was identified as an area of transformation prior to the pandemic and is now firmly within the public interest. This area is currently a focus for recruitment and some benefits are already being seen in the implementation of the CTAC teams and delivery of vaccination programmes. Pharmacotherapy (treatment using medication) Current pharmacotherapy resources including a new hub model based in Helensburgh. This has seen service delivery at Levels 1 and 2 for the majority of GP practice. However extending to Level 3 across practices is limited by available funding and recruitment challenges. Primary Care Mental Health service and First Contact Practitioner Musculoskeletal Physiotherapy Service The Primary Care Mental Health service and First Contact Practitioner MSK physiotherapy service are well established across Argyll & Bute within the limits of existing funding and recruitment. Community Link Workers Community Link Workers offer an opportunity to support individuals referred by their GP practice. We Are With You have been commissioned to provide the Community Link Workers service to 11 practices. This is a relatively new service and an update will be provided to the IJB in respect of evaluating the impact in our particular geography. Continuing development The internal board specifies key deliverables within a timeline and allocated a status. Progress is steady and the project has identified potential risks and issues for resolution and mitigating actions. These are reviewed regularly. Page 51
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4 4. RELEVANT DATA AND INDICATORS Progress is monitored through the programme board on collated performance data. General performance reporting to the IJB. 5. CONTRIBUTION TO STRATEGIC PRIORITIES In line with the delivery of the Strategic Plan. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact The developing services are being shaped by available national funding to address need, this is particularly relevant regarding vaccination and mental health. Sustainability post innovation funding is a key aspect of this. 6.2 Staff Governance The Primary Care Modernisation plan offers fantastic development opportunities for staff within a new model of delivery. 6.3 Clinical and Care Governance Direct systems links to governance structures. 7. PROFESSIONAL ADVISORY Active professional advisory within the project board. 8. EQUALITY & DIVERSITY IMPLICATIONS Principles of equal access to services are applied in any service deployment, particular care is taken in assessing access to services across the geography of Argyll & Bute. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Appropriate agreements in place to support compliance. 10. RISK ASSESSMENT The project board regularly reviews risk and mitigating actions. Some potential impact in respect of pool of staff in remote areas transferring to new posts, change management with practices and accommodation for the delivery of developed services. Risk in respect of recruitment and retention of Pharmacy trained staff. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Not applicable for this report. 12. CONCLUSIONS The Integration Joint Board is invited to note progress. Page 52
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5 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name Evan Beswick, Denise McDermott, Charlotte Craig Email evan.beswick@nhs.scot Page 53
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Primary Care Modernisation Update Evan Beswick, Head of Primary Care, Dr AlidaMacGregor, GP Principal, KylesMedical Centre and Clinical Lead – CowalLocality, Denise McDermott, ProgrammeManager – Primary Care Modernisation IJB Development Session, 24th August 2022 Page 55
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Historical Context • Since the inception of the NHS, the vast majority of General Practiceshave operated on an independent contractor model. • Each practice holds a General Medical Services (GMS) contract with the Board and receives an allocation of fundingbased on a nationally agreed formula. • TheGMS contract outlinesthe services which the Practice must providebut allows for flexibility in how this is achieved. • Practices are therefore free to employ a variety of staff and set up servicesin a way which they feel best meets the needs of their patient population. • Increasing pressure, particularly on urban practices, lead to a wholescale redesign of the GMS contract. Page 56
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2018 General Medical Services Contract • This phase of the new GP contract introduced in 2018 was a planned transition over 3 years extended to 4 years ending March 2022. • Funding was provided for new staff who would be employed by Argyll and Bute HSCP. • Staff would be attached to practices and clusters to reduce GP workload. • Significant changes in the new contract included: • The role of the GP as an Expert Medical Generalist co-ordinating a multi-disciplinary community care team • A new formula for calculating the core funding each practice receives • Significant investment in a number of services which NHS Boards and Integration Authorities are expected to put in place to support the work of General Practice Page 57
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Scottish Workload Allocation Formula • New funding formula which altered weighting for particular demographic factors • Removed the rural weighting, negatively impacting majority of Practices within Argyll and Bute • Income topped up to previous level with 'Practice Income Guarantee' • Significant damage to morale as perceived 'life support' funding and no recognition of complexities of providing Primary Care in Remote and Rural areas Page 58
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Memorandum of Understanding • The original MOU set out an agreement between GP practices andintegrated authorities to deliver a specified set of services across 6 KeyPriority areas with an expectation that they would transfer to theHSCP byMarch 2021. • Vaccination Transformation • Pharmacotherapy • Community Treatment and Care • Urgent Care • Community Link Workers • Additional Professional Roles • Musculoskeletal First Contact Practitioner • Community Clinical Mental Health Professionals Page 59
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Memorandum of Understanding 2 (2021) • Recognised the challenge of delivering all 6 key priority areas against the background of the Covid pandemic. • 3 key areas of implementation were highlighted in a revision of priorities • Vaccination Transformation and CTAC (Community Treatment and Care) • Pharmacotherapy Page 60
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Argyll & Bute HSCP 31 GP Practices, 28 are considered to be remote and rural. 103 GP principals, 25% of Argyll and Bute GPs are over 56 years of age. 89,400 Population 4 Localities/ Locality Planning Groups and 6 GP Cluster Groups 4 GP run Community Hospitals, including A&E Continued requirement for GP Out of Hours cover on Islands and Remote Areas Practice list sizes range from 142 patients on the Island of Colonsay to 11,149 patients in Lorn Medical Centre, Oban Argyll and Bute is challenged by recruitment and retention difficulties. 4 GP Practices, Kintyre Medical Group, Carradale, Kilcreggan and Garelochhead are now managed by the HSCP Page 61
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Argyll and Bute HSCP 2022-2023 Primary Care Improvement Fund Budget - £3,199,000 Immunisations and Community Treatment and Care (CTAC), 35% Pharmacotherapy , 29% First Contact Physiotherapy , 15% Primary Care Mental Health, 17% Community Link Workers, 4% Immunisations and Community Treatment and Care (CTAC) Pharmacotherapy First Contact Physiotherapy Primary Care Mental Health Community Link Workers The PCIF Budget outlined above is subject to additional investment of Scottish Government Sustainable Vaccine Funding of £1,804,000 which will supplement the Immunisation and Pharmacy Teams in addition to supporting Boardwide and Vaccine Venue costs. Page 62
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Rural Flexibility February 2022 – Approval was obtained from the Scottish Government to exercise rural flexibility in Argyll and Bute. • Full Flexibility - 4 small island practices (Coll, Colonsay, Jura and Tiree) • Partial Flexibility - 14 remote and rural practices (Mull and Iona – 4 GP Surgeries, Islay – 3 GP Practices, Bute, Port Appin, Easdale, Lochgoilhead, Strachur, Kilmun, Tighnabruaich, Carradale, Kilcregganand Arrochar) • Flexible options • Full – Practices continue to deliver vaccination and CTAC services • Partial – Co-delivery of services by the practices and HSCP Teams Page 63
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Transfer of Vaccination and CTAC Workload to HSCP from GP Practices Transferred on 01/04/2022 Transferring on 01/07/2022 Transferring on 01/09/2022 Partial Transfer by 31/03/23 Practice Name Partial Flexibility COVID Flu Childhood & Infant Adult Vaccination Maternity & Neo-Natal School Age/Young People Travel CTAC Taynuilt Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Lorn Medical Centre 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Port Appin Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Easdale Medical Practice Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Mull & Iona Medical Group Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Yes Campbeltown Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes The Furnace/Inveraray Surgery 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Tarbert Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Kintyre Medical Group 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Carradale Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Bowmore Medical Practice Yes No Port Ellen Surgery Yes No Rhinns Medical Centre Yes No Lochgilphead Medical Centre Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Dr G Hall & Partners 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Church Street Surgery 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Cowal Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Lochgoilhead Medical Centre 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet The Bute Practice Yes No Strachur Medical Practice Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Riverbank Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Kyles Medical Centre Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Garelochhead Medical Centre 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Millig Practice 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Dr B McLachlan & Partners 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Arrochar Surgery Yes 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Kilcreggan Health Centre Yes 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Page 64
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Primary Care Pharmacotherapy Service Argyll and Bute HSCP Pharmacotherapy Team – 7.80wte Pharmacists, 4.00wte Pharmacy Techniciansand 2.40wte Pharmacy Assistants Pharmacists Pharmacy Techniciansand Assistants Level 1 (Core Service – Partial Provision to 20 of 31 GP Practices) Authorise/Action Acute Prescribing Requests Repeat Prescribing Requests Hospital Discharge Letters Safety Reviews/Recall High Risk Medicine Monitoring Non Clinical Medication Reviews Arrange Clinics Manage Prescribing Requests Manage Repeats Manage Serial Prescribing Action Medicines Reconciliations Level 2 (Additional – Advanced Service – Partial Provision to 23 of 31 GP Practices) Medication Reviews Resolving High Risk Medicines Problems Level 3 (Additional – Specialist Service – Partial Provision to 6 of 31 GP Practices) Polypharmacy Reviews Specialist Clinics – Direct Patient Engagement Page 65
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Physiotherapy First Contact Practitioners (FCP) – 7.00wte providing a service to 9 of 31 GP Practices • Focused on Musculoskeletal (MSK) Conditions • MSK conditions frequently cause repeat appointments with GPs • Majority of GPs MSK Caseload can be Safely and Effectively Managed by FCPs • Extended Scope Physiotherapists in Each Locality Primary Care Mental Health Workers – 11.65wte providing a partial service to 26 of 31 GP Practices • Access to Expert Assessment and intervention for Adults with mild to moderate mental health difficulties • 1 in 3 GP Appointments involve a Mental Health Component – Common Alignment with Long Term Conditions • Locality Teams – Primary Care Mental Health Nursing, Occupational Therapists, CBT Therapists, Art Therapy and Guided Self-Help Workers Additional Professional Roles Page 66
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• Contract awarded to an independent service provider ‘We Are With You’ for engagement of 5.00wte Community Link Workers to provide a service to 11 of the 31 practices in Argyll and Bute • The service builds on Existing and Developing Relationships between the HSCP and Third Sector Organisations • Coordinates Social Prescribing Solutions supporting people to live well through strengthening connections between community resources and primary care • Interface with GP IT Systems to Enable Referrals and for GP to Monitor Patient's Progress Community Links Workers Page 67
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Next Steps • The Autumn/Winter Covid and Flu vaccine campaign will be delivered to the patients of 23 of the 31 Practices in Argyll and Bute by HSCP Primary Care Nursing Teams • ‘Week of Care’ audit analysis by Public Health Scotland to support and inform the development of local nursing teams • Transfer of further vaccination categories from GP practices to HSCP teams • Seek solutions for lack of space in GP practices to enable multi disciplinary teams to continue to remove workload from GPs • Further development of primary care teams to include the Mental Health and Wellbeing agenda • Address ongoing challenges of Covid-19 Page 68
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This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller of Her Majesty’s Stationery Office. © Crown copyright and database right. All rights reserved. 100010825 2022 Directorate of Public Health Public Health Intelligence Team Larch House, Inverness Date: August 2022 GP Practices in the Argyll & Bute HSCP area - by CHI registered practice population, April 2022 Argyll & Bute HSCP Over 5000 1500 to 4999 500 to 1499 0 to 499 Practice population - April 2022 General Practices Branch practices 0 10 205 MilesPlease note - some locations are representative to avoid overlaps Page 69
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1 Integration Joint Board Agenda item: Date of Meeting: 24th August 2022 Title of Report: Staff Governance Report for Financial Quarter 1 (2022/23) Presented by: Geraldine Collier, People Partner, A&B HSCP. The Integrated Joint Board is asked to: Note the content of this quarterly report on the staff governance performance in the HSCP Take the opportunity to ask any questions on people issues that may be of interest or concern; Endorse the overall direction of travel, including future topics that they would like further information on. 1. EXECUTIVE SUMMARY 1.1 This report on staff governance performance covers financial quarter 1 (April - June 2022) and the activities of the Human Resources and Organisational Development (HROD) teams. 2. INTRODUCTION 2.1 This report focuses on the staff governance actions that support the HSCP priorities and the Staff Governance Standard 2.2 In the context of health and social care integration, we also consider the following: Adopting best practice from both employers Development of joint initiatives that support integration Compliance with terms and conditions and employing policies 3. PROGRESS & CHALLENGES The following sections report progress and challenges against the Staff Governance Standard headings; Well Informed, Appropriately Trained and Developed, Involved in Decisions, Treated Fairly and Consistently and Continuously Improving. These themes overlap in parts with Culture and wellbeing as an overarching principle permeating all that we do in all areas of work. Page 71 Agenda Item 9
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2 3.1 WELL INFORMED 3.1.1 Since the last update the Chief Officer has launched their blog and continues with email updates. Staff communication updates continue weekly with information on key issues of interest to staff via Council and NHSH Staff Communications. 3.1.2 Work is underway to improve data capture and analytics across the partnership to better inform workforce decisions and data reporting. The focus is to provide integrated data sets with parity of data allowing for benchmarking and comparison, evidencing how the partnership is performing with the aim of showing progressive improvement. Future reports will show the workforce demographic across the partnership in the following areas; age, headcount, WTE, sex, contract type and working hours. Improved data will inform comparison, data analysis and workforce planning decisions. 3.1.3 To support improved employee engagement a working group has been established, to consider, implement and monitor all feedback received from Listening and Learning Survey, management reflections exercise and I matter Surveys (section 4). This is attended by the relevant Heads of Service and captures and informs the different services delivery plans. 3.2 APPROPRIATELY TRAINED Statutory and Mandatory Training 3.2.1 Improving compliance with Statutory and Mandatory training is essential to the safety and quality of services that the HSCP delivers and there is an NHSH wide focus on improving performance on completion of mandatory training. 3.2.2 The tables below show high levels results with more detailed analysis available in appendix 1. Page 72
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3 3.2.3 It is clear that over the year Equality, Fire Safety, safe Information handling, Moving and Handling and Violence at work have decreased while Why Infection Prevention Controls matter, Hand hygiene and Public protection have improved. Hand hygiene is the course with highest compliance at 80% but there is still work to be done to achieve the 95-100% compliance target 3.2.4 To address and improve this, statutory and mandatory training is being reported at SLT on a monthly basis and is an area of focus. Each Head of Service is focusing on their area and a dedicated session on statutory mandatory training is taking place with SLT in August. The areas of focus are: Cleansing data to ensure accurate data capture Separating out contracted employees and bank staff. These are different staff groups and management and barriers are different. Analysing data and discussing with managers and staff to establish compliance barriers. 3.2.5 For Council employees the Mandatory training picture continues to look similarly stagnant with no movement / improvement in Quarter 1. 3.2.6 As in previous quarters appendix 2 shows generally no change to the Appraisals Performance Data levels for completed staff appraisals for NHS staff within Argyll and Bute HSCP. This too requires to be reported monitored and improved and will also feature in the SLT monthly reporting. Leadership and Management Development 3.2.7 The NHS Leadership and Management Development programme, previously paused due to system pressures has now recommenced. This is also being supported by an evaluation of the overall programme to inform further modules and ensure resources are targeted to meet need. Page 73
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4 3.2.8 The Council management and leadership development programmes are all currently under review. The Third Tier Manager Leadership Development programme is being reviewed following feedback from participants and leaders with a view to developing a more personalised programme for participants. The Managing Teams programme is continuing this year but is being reviewed to align with the needs of managers and aspiring leaders. ‘Preparing to Manage’ is being delivered this year but is also under review for consideration as to how we can best deliver a cohort-based programme that prepares managers of the future. Mentoring Programme 3.2.9 There has been a callout across the organisation for mentors at all levels of leadership and management and workshops have been offered for those interested in being a mentor. These workshops have been positively received and it is hoped that the programme can enable all new supervisors, leaders and managers to be offered a mentor as they get established in post. This is a partnership wide initiative open to managers across NHS and Council. Face to Face Training 3.2.10 The Council provision of Face to Face Training is now occurring with more regularity as Covid restrictions have eased. Some statistics for the face to face training courses held during FQ1 are available at Appendix 3. 3.2.11 NHS are not currently delivering or seeing a demand for face to face training. They are satisfied the virtual provision is meeting the needs of the workforce with greater access to resources and improved attendance at sessions. 3.3 TREATED FAIRLY AND CONSISTENTLY Culture and Wellbeing Group 3.3.1 The Culture and Wellbeing Group has agreed the Term of Reference and refreshed membership. Meetings will now continue on a monthly basis to deliver against the agreed action plan, agreeing priorities for the coming year. These will be reported alongside the wider progress against the 6 established work streams. There is no Q1 report from the Cultural oversight group, this will follow next quarter. 3.3.2 Participation in the Virtual Sessions of Courageous Conversations has significantly improved across Highland with at least 75% of available places booked. Since May a steady increase in attendance has been evident, within Argyll and Bute and feedback is very positive. This is a very engaging and affective course. HSCP Guardian Service Page 74
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5 3.3.3 The Guardian Service contract was recently extended in line with the NHS provision until August 2023 when it will be due for review / renewal. 3.3.4 In the last financial year the guardian service has provided a service to 65 employees across the ABHSCP with 15 of these being Council employees and the remainder NHS (see Table 1 below). Table 1 Table 2 3.3.5 Table 2 shows Quarter 1 data and again illustrates a proportionate distribution of cases with the NHS cases accounting for over 2/3rds of the case load. This is in keeping with the workforce demographic with NHS making up 2/3rd of the HSCP workforce and the council accounting for 1/3rd. 3.3.6 Figures for Q1 are slightly lower than the same period last year. 3.3.7 A monthly meeting with the Guardian Service representatives allows for any issues or trends to be discussed and informs future actions. Attendance 3.3.8 HSCP NHS absence levels have increased slightly from last quarter and reflect the levels evident the same time last year, Appendix 4a. The percentage absence for NHS employees, for Quarter 1 are; April: 4.55% May: 4.70% June: TBC% (Confirm prior to committee when available) 3.3.9 The Council data at Appendix 4b, is showing a very slight increase in absence levels during FQ1. In March 2022 the average for HSCP was 2.27 days lost per FTE per month. This decreased in April to 2.13 but increased slightly to 2.30 in May, and again to 2.49 in June 2022. The June increase is likely connected to the increase in COVID cases Patient safety Behaviour Relationships System process B&H Management Total Council 0 5 5 0 5 15 NHS 1 11 7 6 25 50 HSCP 1 16 12 6 30 65 Patient safety Behaviour Relationships System process B&H Management Total Council 0 2 1 0 1 4 NHS 0 2 2 2 5 11 HSCP 0 4 3 2 6 15 Q1 2021 Q1 2022 Council 5 4 NHS 15 11 HSCP 20 15 Page 75
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6 Scotland/UK wide COVID cases. These continuing levels of absence are impacting on the resourcing of teams and services. 3.3.10 Further details are shown in Appendices 4a and 4b. There is an additional rolling graph at Appendix 4c, showing a comparison of Covid- related and non-Covid related absence within Council employees. The number of non-Covid related absence remains higher than that of Covid- related cases in FQ1, as was similar to FQ4. However, there was a significant dip in COVID related absences in May but this was has crept up again in June. Return to Work Interview Data (Council Staff) FQ1 2022/23 3.3.11 Return to work processes are another area of focus and compliance with an 100% completion target within 3 days of the employee returning to work. The overall average for FQ1 has been 52% in April, 44% in May and 36% in June. This gradual decline for the completion rates needs to be addressed with significant improvement and will feed into the compliance information given to managers and discussed at SLT. 3.3.12 Currently the data for NHS RTW is not available and this is linked with the roll out of SSTS, after which the information will be available. Redeployment 3.3.13 All NHS vacancies are considered for both Primary and Secondary redeployment lists as they arise. The HR team continue to work in partnership with the Area Manager and Staffside/TU Rep in securing permanent, temporary and shadowing opportunities. 3.3.14 The table below shows the trend over the last year and a relatively stable picture of people joining and being appropriately redeployed. 3.3.15 The council have one unified list, however there have been no council employees on the redeployment register in the last year. June 21 Sept 21 Dec 21 Mar 22 June 22 NHS - Primary 24 21 18 17 19 NHS - Secondary 27 24 24 23 25 Council 0 0 0 0 0 Employee Relations (ER) 3.3.16 Quarter 1 has shown an overall increase in NHS case management activity from Q4, although numbers are comparable to overall figures evident at the same time last year. Numbers remain relatively low across the workforce see table below with previous quarters shown for comparison purposes. June 21 Sept 21 Dec 21 Mar 22 June 22 Page 76
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7 Grievance 5 5 4 2 3 Conduct 1 2 2 1 4 Capability 0 0 0 0 0 Bullying and harassment 5 2 2 3 4 Total 11 9 8 6 11 3.3.17 HSCP Council Disciplinary and Grievance cases continued to be steady throughout Q1. There was 1 Grievance lodged in Q1 which is ongoing alongside another which has continued from the last quarter. There has been 1 new and concluded Disciplinary case alongside one which has been ongoing within Appeal timescale since last quarter. It is expected that the Appeal hearing will take place in Q2. 4. INVOLVED IN DECSIONS 4.1 Employee Engagement I matter Survey 4.1.1 The I-matter survey has concluded and A&B HSCP has a 31% response rate. While considered within the average response rates for surveys,(Department of National statistics), is lower than that achieved across NHS Highland (41%) NHS Scotland (55%) and is the lowest response rate reported against the HSCP (see below) 2018 2019 2021 2022 AB HSCP 49% 55% 46% 31% NHS Highland 51% 60% 51% 46% 4.1.2 The reduced response rate, evident board wide, could be related to survey fatigue or a feeling that views have already been captured through other means, listening and Learning survey etc but also indicates a disconnect with employee engagement initiatives. 4.1.3 Strong employee engagement is a priority for the HSCP and further analysis and action is required through the employee engagement working groups. 4.1.4 As detailed in appendix 5a, for those who did respond, the overall results were positive. While a lower return rate than highland and NHS Scotland there was a higher and improved engagement index. 4.1.5 Last year the engagement index was 74% and this year this has increased to 77%. All categories are in the green (strive to celebrate) or amber (monitor to further improve) categories. Appendix 5b shows the component report and the areas of focus going forward replicate those reported over the last 4 years and continue to be in the following areas: Performance management Visibility and trust in the board Page 77
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8 Involvement in decision making These general findings will feed into the Employee Engagement action group Quality Conversations 4.1.6 Within the council, Quality Conversations are also being surveyed to temperature gauge their usage and whether they are preferable to the more formal PDP process. This less formal, more continuous approach to personal development was an ask from employees that was responded to. Feedback will be analysed and will inform future actions. 5. CONTINUOUS IMPROVEMENT Resourcing: Recruitment and Redeployment 5.1 The Communications Team continues to support the recruitment challenges experienced across the Highland Board and Argyll & Bute area particularly with medical staffing. Actions include: social media campaign, primarily video, some boosted posts photography to accompany social and traditional media advertising on the tube in London and buses in Edinburgh and Glasgow in August and September, to attract people to the Highlands. support for job fairs, eg design of stands, merchandise, social media support 5.2 The role of International Recruitment Advisor is currently being short listed in the NHS Recruitment team which will assist international recruitment across the Highland Board including ABHSCP. 5.3 Appendix 6 shows the recruitment activity over the last quarter and those posts that are difficult to recruit. In recent weeks an Incident Management Team was established to assist the focus on staffing cover particularly in Oban, Lorne and the Isles and Campbeltown. This has led to the stepping up of a wider Recruitment Group to focus in on the HSCP specific recruitment challenges and actions feeding and linking with the wider NHS Highland and Council activities. 5.4 Executive Director Douglas Hendry is leading a partner group looking at the recruitment and retention challenges facing Argyll and Bute, with a view to understanding the complex factors at play and designing possible impactful solutions. It is proposed that the project will be loosely based around the double diamond approach set out in the Scottish approach to service design. A working group will be formed, made up of representatives from a wide variety of teams from within the council and HSCP are represented on this group. 6. RELEVANT DATA AND INDICATORS 6.1 Data provided in the relevant sections above Page 78
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9 7. WORK PLANNED FOR THE NEXT 3 MONTHS 7.1 Update on work for FQ2 Culture and wellbeing group expanded with more council representation. Action planning commences Q2 ELD focusing on the design and implementation of corporate induction for all new colleagues Q2 Continue delivery of Courageous Conversations and finalise design of eLearning and arrange for testing before launch across the organisation. Q2 Employee Engagement Group established, actions monitored and progressed Q2 Recruitment Group established – actions progressed Q2 SLT focus on Stat Man and appraisal compliance Q2 8. CONTRIBUTION TO STRATEGIC PRIORITIES 8.1 This report has outlined how the staff governance work contributes to strategic priorities. 9. GOVERNANCE IMPLICATIONS 9.1 Financial Impact A reduction in sickness absence will reduce costs. 9.2 Staff Governance This staff governance report provides an overview of work that contributes to this theme. 9.3 Clinical Governance None. 10. EQUALITY & DIVERSITY IMPLICATIONS Equality and Diversity implications are considered within the NHS People and Change and Council HROD teams as appropriate when policies and strategies are developed. 11. RISK ASSESSMENT Risks are considered medium. Individual HROD risks identified on the Risk Register. Risk assessments have been completed in relation to remobilisation. 12. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The Everyone Matters pulse survey was reported in this quarter. Page 79
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10 13. CONCLUSIONS It is recommended that the Integration Joint Board: Note this quarterly Staff Governance update; Take the opportunity to ask any questions on people issues that may be of interest or concern; Endorse the overall direction of travel, including future topics that they would like further information on. 14. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Jo McDill, HR&OD Officer, Argyll and Bute Council hr-hscp@argyll-bute.gov.uk Geraldine Collier, People Partner, NHS Highland geraldine.collier@nhs.scot Page 80
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1 Appendix 1a – Argyll & Bute HSCP Performance Compliance Data – Ongoing Monthly compliance data for each area can be access via Sway presentation (click here) and monthly reports published on intranet (click here). The charts below show the A&B HSCP compliance percentage at the end of June 2022. Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 142 1288 199 162 94 1885 Total Complete 76 815 146 108 71 1216 Percentage 54% 63% 73% 67% 76% 65% 0200400600800100012001400160018002000 Equality and Diversity Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 142 1288 199 162 94 1885 Total Complete 48 589 116 69 48 870 Percentage 34% 46% 58% 43% 51% 46% 0200400600800100012001400160018002000 Fire Safety Page 81
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2 Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 142 1288 199 162 94 1885 Total Complete 67 735 137 100 62 1101 Percentage 47% 57% 69% 62% 66% 58% 0200400600800100012001400160018002000 Safe information -Foundation Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 142 1288 199 162 94 1885 Total Complete 71 756 148 95 63 1133 Percentage 50% 59% 74% 59% 67% 60% 0200400600800100012001400160018002000 Moving and Handling - Module (A) Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 142 1288 199 162 94 1885 Total Complete 42 432 107 46 55 682 Percentage 30% 34% 54% 28% 59% 36% 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Public Protection: Everyone's Responsibility Page 82
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3 Monthly compliance data for new starts in each area can also be accessed via sway presentation (click here) and monthly reports published on intranet (click here). The new start information is included in the ongoing tables but this allows a more focused overview of the induction process. Appendix 1b – Argyll & Bute HSCP Corporate and Local Induction Data Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 84 67 16 9 11 187 Total Complete 23 24 6 1 5 59 Percentage 27% 36% 38% 11% 45% 32% 020406080100120140160180200 Violence and Aggression (Non-Clinical) Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSPC Total Total Staff 142 1288 199 162 94 1885 Total Complete 96 987 166 133 75 1457 Percentage 68% 77% 83% 82% 80% 77% 0 500 1000 1500 2000 Why Infection Prevention and Control Matters Page 83
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4 Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 18 168 35 26 13 260 Total Complete 5 52 17 15 9 98 Percentage 28% 31% 49% 58% 69% 38% 0 50 100 150 200 250 300 Corporate Induction Argyll & Bute Central A&B Older Adults & Hospital Services A&B MH LD & Addiction Services A&B Children Families & Justice A&B Primary Care HSCP Total Total Staff 18 168 35 26 13 260 Total Complete 3 40 16 8 8 75 Percentage 17% 24% 46% 31% 62% 29% 0 50 100 150 200 250 300 Local Induction Page 84
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5 Appendix 2 – Argyll & Bute HSCP Staff Appraisal Data Monthly appraisal performance data for each area can be access via Sway presentation (click here) and monthly reports published on intranet (click here). The chart below shows the completed appraisal within last 12 months at the end of June 2022. Appendix 3 – Argyll & Bute Council Face to Face Training FQ1 A&B Children Families & Justice A&B MH LD & Addiction Services A&B Older Adults & Hospital Services A&B Primary Care Argyll & Bute Central HSCP Total Total Staff 162 193 1221 77 139 1792 Signed-off Appraisal 22 40 238 39 21 360 Percentage 14% 21% 19% 51% 15% 20% 0200400600800100012001400160018002000 Annual Review Process (A4C employees only) 0 1 2 3 4 5 6 7 8 9 Action Learning Set 2 Elementary Food Hygiene First Aid Requalification First Aid Emergency at Work First Aid at Work Leading Virtual Teams Training FQ1 - Face to Face Children, Families & Justice MH, LD & Addiction Services Older Adults & Hospital Services Page 85
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6 Appendix 4 – Sickness Absence Tables Appendix 4a – NHS Employees Appendix 4b – Council Employees It should be noted that Strategic Planning & Performance only has 18 council employees hence any absence seems steep in comparison to other Services ROLLING PROFILE - A&B HSCP Operating Unit Total % May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 A&B Older Adults & Hospital Services 5.10 4.97 4.71 4.66 5.03 4.42 6.59 5.63 5.96 5.59 4.71 5.25 5.37 A&B Children, Families & Justice 5.52 4.21 3.35 3.5 5.26 8.28 9.88 7.83 5.19 4.4 3.99 5.09 5.18 Argyll & Bute Central 1.97 2.90 3.87 3.87 2.75 3.94 2.67 4.27 5.38 4.57 3.21 1.57 1.49 A&B MH, LD & Addiction Services 4.65 5.36 3.74 4.73 3.84 3.35 4.64 2.65 2.51 3.61 4.9 3.57 3.8 Operating Unit 4.66 4.66 4.34 4.44 4.59 4.61 6.16 5.23 5.36 5.07 4.45 4.55 4.7 NHS Highland 4.82 4.95 4.56 4.82 5.16 5.11 5.73 5.35 5.19 5.02 5.01 4.75 4.75 Page 86
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7 4c - HSCP Council Employees – Non Covid vs Covid Absences Page 87
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8 Appendix 5 – I matter Page 88
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9 Page 89
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10 Appendix 6 – Vacancies NHS Vacancies Council Vacancies The breakdown of Council vacancies for Q1 is detailed in the table below. Apr 22 May 22 Jun 22 Internal/RF External Internal/RF External Internal/RF External Older Adults & Hospital Services 5 17 6 21 3 9 MH, LD & Addiction Services 3 6 16 2 6 Children, Families and Justice 2 9 8 2 2 8 Strategy P&P HSCP PL3 DIRECTORATE 1 Totals 10 32 15 39 7 23 42 (Temp 17) (Perm 25) 54 (Temp 12) (Perm 42) 30 (Temp 7) (Perm 23) April May June New Re-Ad New Re-Ad New Re-Ad Adult Services EAST 6 4 16 4 13 3 Adult Services WEST 18 4 25 7 21 1 Children & Families 2 0 2 1 1 1 Corporate Services 0 0 2 0 0 0 Totals 26 8 45 12 35 5 Page 90
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1 Integration Joint Board Agenda item: Date of Meeting: 23rd August 2022 Title of Report: Integration Joint Board- Performance Report Presented by: Stephen Whiston - Head of Strategic Planning, Performance & Technology The Integrated Joint Board is asked to: Acknowledge the introduction of new Key Performance Indicators to improve long waiting times across Scotland and the move away from previous Remobilisation performance reporting Acknowledge Long Waiting Time Performance (over 26 weeks) with regards to the New Outpatient Waiting List by main speciality Note the Integrated Performance Management Framework- progress update Acknowledge the Treatment Time Guarantee (TTG) performance with regards to Inpatient/Day Case Waiting List 1. EXECUTIVE SUMMARY The NHS Scotland Chief Operating Officer has written to all NHS Boards identifying a new focus with regards to eliminating long waits in both inpatient and outpatients services. New Key Performance Indicators have been established with a series of challenging targets across both inpatient and outpatient specialities for 2022/24. This will replace the previously reported Remobilisation targets identified within the NHSH Remobilisation Plan. In line with these changes work is ongoing by the Performance and Improvement Team to establish baseline data for each of the new indicators and it is expected that from September onwards these new indicators will be reported to the Integration Joint Board and NHSH Board. As an interim position this report focusses on the current long wait performance for New Outpatients and will continue to report on Treatment Time Guarantee performance across Inpatient/ Day Case and Outpatient Waiting List. In addition a brief update on progress with regards to the work in relation to the Integrated Performance Management Framework. 2. INTRODUCTION A recent communication from John Burns, NHS Scotland Chief Operating Officer to NHS Boards across Scotland has identified a new set of Key Performance Indicators focussed on continuing to improve long waiting times across Scotland. This will build on previous remobilisation performance with targets and work to eliminate: two year waits for outpatients in most specialities by the end of August 2022 Page 91 Agenda Item 10
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2 18 month waits for outpatients in most specialities by the end of December 2022 one year waits for outpatients in most specialities by the end of March 2023 two years waits for inpatient/daycases in the majority of specialities by September 2022 18 month waits for inpatient/daycases in the majority of specialities by September 2023 one year for inpatient/daycases in the majority of specialities by September 2024 A new Operational Performance & Delivery Group (OPDG) will be established and will be chaired by the Deputy Chief Operating Officer: Performance & Delivery, NHSScotland. It will provide strategic direction for the programmes of work that will support local Board plans. This group will support ongoing planning to support waiting list reduction. Membership of this Group will include Directors of Acute Services and Chief Operating Officers. 3. DETAIL OF REPORT The report details performance for August 2022 with regards to the Health & Social Care Partnership and NHS Highland. 4. RELEVANT DATA & INDICATORS The Performance & Improvement Team are current working on producing the data baseline to support the new long waits performance indicators as an interim position the data below identifies Long Waits (+26 weeks) for New Outpatients. The new performance reporting will be established from September onwards. 4.1 Long Waiting Times Performance The tables below identifies Long Waits (Over 26 weeks) the New Outpatient Waiting List and times by main speciality as at the June 2022, Comparator data for April 2022 in red is used to identify changes across specialities and waits. A&B Group Totals Main Specialty April 2022 Long Waits Over 26wks June 2022 Long Waits Over 26wks Variance Consultant Outpatient 60 94 +34 AHP 131 147 +16 Mental Health 371 384 +13 Nurse Led Clinics 4 6 +2 Other/Non MMI 208 208 - Total OPWL 774 839 +65 Main Specialty Long Waits Over 26wks Long Waits Over 26wks Scopes * 58 67 +9 Main Specialty Long Waits Over 26wks Long Waits Over 26wks MSK ** 213 173 -36 Page 92
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3 Waiting Times Performance Assessment: With regards to the Total Outpatient Waiting List waits over 26 weeks there has been a there has been an total 8% increase from April ( 774) to June (839) Consultant Outpatients note a 44% increase in long waits for June (94) against April (60) Musculoskeletal physiotherapy long waits note a 21% reduction for June (173) against (213) in April 4.5 Treatment Time Guarantee (TTG) - Inpatient/Day Case Waiting List Argyll & Bute Inpatient/Day Case Activity The graph below identifies current performance with regards to Inpatient /Day Case -12 week breaches and current overall performance as at 4th August 2022 in Argyll and Bute at LIH, Oban Performance Assessment: Zero percentage breaches of total TTG Waiting List over 12 weeks 6.7% increase in August (38.9%) in the Booked Appointments of total TTG Waiting List against (32.2%) NHS Highland Board performance is noted in both Appendix 1 & 2 4.6 Integrated Performance Management Framework (IPMF) IPMF Development Sessions are continuing with Service Leads and Heads of Service, these will be completed by end of August Page 93
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4 Theses session are designed to support managers and local team to develop their own KPI’s aligned with key strategic objectives identified within the Joint strategic Plan. The sessions are supported with an Information & Resource Pack, IPMF Managers Overview, Guide to support the development of KPI’s and Homework Each Head of Service & Service Lead has been assigned an analysts to support the development of the KPI’s and return of homework 5. CONTRIBUTION TO STRATEGIC PRIORITIES The monitoring and reporting of performance with regards to Argyll & Bute HSCP, Greater Glasgow & Clyde and NHS Highland ensures the HSCP is able to deliver against key strategic priorities. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact NHS Highland remobilisation plan has received additional funding from the Scottish Government and this includes direct funding to the HSCP of £590,840. 6.2 Staff Governance There has been a variety of staff governance requirements throughout this pandemic which have been identified and continue to be progressed and developed include health and safety, wellbeing and new working practices within national Covid19 restrictions as part of our mobilisation plans. 6.3 Clinical Governance Clinical Governance and patient safety remains at the core of prioritised service delivery in response to the pandemic and subsequent remobilisation. 7. PROFESSIONAL ADVISORY Data used within this report is a snapshot of a month and data period, where possible data trends are identified to give wider strategic context. 8. EQUALITY & DIVERSITY IMPLICATIONS EQIA not required 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data use and sharing within this report is covered within the A&B & NHS Highland Data Sharing Agreement 10. RISK ASSESSMENT Risks and mitigations associated with data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Full access to this report for public is via A&B Council and NHS Highland websites 12. CONCLUSIONS The Integration Joint Board is asked to consider the transitional work ongoing with regards to the new Key Performance Indicators focussed on continuing to improve long waiting times across Page 94
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5 Scotland and the move away from previous Remobilisation reporting. Work ongoing to support the development of the Integrated Performance Management Framework across Heads of Service and Clinical Leads. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Stephen Whiston Email: stephen.whiston@nhs.scot Page 95
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6 Appendix 1- Board Level KPI’s – 18th July 2022 Page 96
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7 Appendix 2- Proportion of Outpatients Waiting Over 12 Weeks by Health Board (18/07/2022) Page 97
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1 Integration Joint Board Date of Meeting: 24 August 2022 Title of Report: Budget Monitoring – 3 months to 30 June 2022 Presented by: James Gow, Head of Finance and Transformation The Integration Joint Board is asked to: Note that the transition to a new ledger system within the Council has had an impact on the Quarter 1 financial reporting as transaction processing has been prioritised. Note that the current position is a small overspend in respect of NHS budgets. Note that there is a small forecast revenue overspend of £346k as at 30 June 2021 and that it is anticipated that the HSCP will operate within budget in the current year. Note the summary of financial risks. Note progress with the savings programme and confirmation of £3.5m in savings delivered, 42% of target. Note that earmarked reserves of £2.6m have been committed to date for spend in 2022/23. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary of the financial position of the Health and Social Care Partnership as at 30 June 2022 and provides an early forecast for the year. It also updates in respect of the delivery of the savings programme and utilisation of reserves. The contents of this report have been considered by the Finance and Policy Committee on 5th August. 1.2 There has been an impact on the Social Work figures as a result of the transition to a new financial ledger system. It is anticipated that reporting will return to normal for the period 4 reporting cycle, the figures provided in this report are consistent with those reported to Council. 1.3 The forecast for the current year is a small overspend of £346k, it is anticipated that this can be managed as the year progresses. The forecast Page 99 Agenda Item 12a
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2 is based on a number of assumptions and therefore there are risks associated with it. These are outlined in the Financial Risks report, inflation and pay settlements are key risks. It is assumed in the forecast that any nationally agreed pay settlement within the NHS will be fully funded. 1.4 The HSCP is still experiencing challenges in filling posts and as a result there remains some slippage in spend against specific allocations aimed at easing pressures within the health and care sector. The HSCP continues to be under pressure to maintain and increase capacity where possible in advance of the winter period. 2. INTRODUCTION 2.1 2.2 This report provides a summary of the financial position of the Health and Social Care Partnership as at 30 June 2022. Information is provided in respect of the year to date position and the forecast outturn. Summary information is provided in the detail of the report with further analysis provided within the appendices. Unfortunately Argyll & Bute Council have experienced some issues with the introduction of the new ledger system at the start of the financial year. This has meant that the figures reported, which are consistent with those reported to Council, are not as reflective of the actual position as would normally be the case. The NHS element of the report is unaffected. 3. DETAIL OF REPORT 3.1 Year to 30 June 2022 3.1.1 The table below summarises the position for quarter 1. This is distorted by the temporary issues associated with the implementation of the new ledger system within the Council, this has meant that adjustments to budgets have not been processed as normal and a large underspend which is not reflective of the actual position is reported. The NHS position is a small reported overspend of £170k (0.3% of the NHS budget). For Council services the year to date figure is reported on a cash basis whereas the Health figures are on an accruals basis. Service Actual £000 Budget £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 15,936 21,087 5,151 24% HEALTH SERVICES TOTAL 56,170 56,000 -170 -0.3% GRAND TOTAL 72,106 77,087 4,981 6.5% Appendix 1 provides an analysis of the variances against budget by service. 3.1.2 For Social Work budgets the favourable variance is not representative of the actual position. As with any major ICT related project there have been some difficulties encountered with the transition to a new ledger system within Argyll & Bute Council and the focus has been on ensuring transactions systems and processes transitioned smoothly. Budget monitoring processes Page 100
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3 have taken place but are not fully reflected in the ledger system. The only area of potential concern being investigated at present relates to the LD and PD budgets. 3.1.3 For Health Service budgets, a small overspend of £170k is reported. The main causes of the year to date overspend are shortfalls on savings, agency medical staffing particularly in Lorne & Islands Hospital and Oban, Lorne and the Islands out of hours services, and agency nursing costs across a number of our hospitals. 3.2 3.2.1 Forecast Outturn The forecast outturn position is summarised below. For social work services the outturn has been set to match budget. The Social Work finance team completed an off-ledger forecast which showed that services are currently on track to come in on budget overall, but were unable to reflect the forecast in the ledger. For NHS services a small adverse variance of £346k (0.1% of budget) is forecast, further detail is provided in appendix 2. Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 87,471 87,471 0 0% HEALTH SERVICES TOTAL 235,647 235,993 -346 -0.1% GRAND TOTAL 323,118 323,464 -346 -0.1% 3.2.2 The forecast variance is not a concern at this stage in the year as it is anticipated that spend will be managed within budget. Additionally, the HSCP carried significant levels of reserves into the current year. The main focus in respect of budget management at present is delivery of the savings programme. Within Social Work there is one early specific area of concern regarding Learning Disability spend. This has not been reflected in the ledger position at present and work is on-going to further analyse the position as significant additional resource was allocated as part of the budgeting process. The period 4 reporting is expected to provide improved quality of forecast information. 3.2.3 The forecast for Health budgets is a small overspend totalling £346k. Appendix 2 provides details on a service level basis. The main area of concern at present relates to spend on Community and Hospital Services. Forecast overspending here is at £954k with some of this being offset by underspending on other services. The main driver of the projected overspend relates to the steps that are having to be taken to seek to stabilise medical staffing at Lorne and Islands Hospital. Recruitment continues to be a challenge, however, given the level of pressure on services nationally we are accepting that increased spend is likely to be required to maintain services and avoid increasing pressures elsewhere in the system. Page 101
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4 3.2.4 The forecast takes account of anticipated shortfalls against recurring savings targets and emerging cost pressures with an expectation that these will be largely, but not fully, offset by non-recurring savings and underspends. It is assumed within the forecast that all additional costs associated with our direct response to Covid-19 and for both the Covid Booster & Flu Vaccination Programmes will be fully funded from IJB held Covid reserves and not additional funding allocations. Annual Budget (£’000) Forecast Outturn (£’000) Forecast Variance (£’000) Explanation Health Services 235,647 235,993 (346) Hospital staffing, inflation and expected slippage with savings. With nine months of the financial year remaining, there is sufficient scope for to address the modest forecast year-end overspend and deliver a break- even outturn position. The intention is to continue to ensure that the HSCP operates within budget, delivers on the savings programme and increases capacity where it can with its growth funding. 3.3 Savings Delivery 3.3.1 3.3.2 3.3.3 The Service Improvement Team and the Project Management Office, co- ordinated by NHS Highland, continue to work with managers to progress, monitor and report progress on the savings project. This is done in conjunction with the management accounting teams. As at the end of June, £2.5m (42%) of the £6m savings target has been achieved and declared: 2022/23 Savings Year to 30 June 2022 Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 2,213 2,213 0 Remaining Programme 3,789 287 3,502 Total 6,002 2,500 3,502 42% Appendix 3a lists the projects that have been fully delivered and declared. The projects which are declared on a non-recurring basis will be addressed as part of the capital project at Cowal Community Hospital. Appendix 3b provides further detail in respect of the remaining balance of £3.5m, risk rated per below: Savings Perceived as Low Risk £784k Savings anticipated to be difficult to achieve in full in 2022/23 £2,227k Savings unlikely to be deliverable in 2022/23 £491k It is not proposed that the IJB are asked to consider the removal of projects from the plan at present. The appendix provides an explanation in respect of progress and the detailed service deep dive reports provided to the Finance & Policy Committee give further detail. Page 102
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5 3.3.4 3.3.5 3.3.6 3.4 3.5 3.5.1 4 4.1 One of the biggest challenges relates to the Cowal Community Hospital project, this is being project managed by NHS Highland and is subject to delay as additional costs have been identified. If the funding issue is resolved quickly then the best outcome available will be for construction work to start in November for March completion. Engagement with the local community also needs to be progressed in the coming months. We are also in the process of seeking to bring in additional resource to support the work on catering, cleaning and hotel services, some slippage with these projects is expected to continue. The medical staffing structure at LIH in Oban is not stable at present, work is on-going, with support from NHS Highland to stabilise the situation and establish a stable staffing model which is compliant with the medical staff training requirements, there is no possibility that plans to deliver additional services can be implemented in the current year. Overall good progress has been made, however, slippage will require to be covered by non-recurring savings as the year progresses, the NHS forecast now take this into account and Social Work Forecasts will be updated for the period 4 reporting. Financial Risks A separate report on financial risks faced in the current year is provided to the Finance and Policy Committee. A summary of the August report is provided below: Likelihood / Range Remote Unlikely Possible Likely Almost certain Total £100k - £300k 0 0 0 0 1 1 £300k - £500k 0 0 1 1 0 2 £500k - £1.5m 0 1 1 2 2 6 >£1.5m 0 0 0 0 0 0 Total 0 0 2 6 2 9 These risks are quantified at £3.3m in total and the most concerning ones relate to inflation, pay increases and the likely additional costs associated with current service providers withdrawing or reducing services within the area. Earmarked Reserves The IJB carried forward earmarked reserves of £21.2m at the end of financial year 2022/23. During the first quarter, £2.6m has been allocated to specific projects / costs. Appendix 4 provides a summary. Reserves are now considered monthly as part of the SLT financial reporting process. RELEVANT DATA AND INDICATORS Information is derived from the financial systems of Argyll and Bute Council and NHS Highland. Page 103
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6 5 5.1 6 6.1 6.2 6.3 CONTRIBUTION TO STRATEGIC PRIORITIES The Integrated Joint Board has a responsibility to set a balanced budget which is aligned to the Strategic Plan. It is required to ensure that financial decisions are in line with Strategic Priorities and the delivery of high quality services. GOVERNANCE IMPLICATIONS Financial Impact – the forecast outturn positon is currently an overspend of £346k. It is anticipated that the HSCP will be able to manage this during the year. It is noted that it has carried forward substantial levels of reserves. Staff Governance – None directly from this report but there is a strong link between HR management and delivering a balanced financial position. Clinical Governance – None. 7. 7.1 8. PROFESSIONAL ADVISORY Professional Leads have been consulted with in respect of the implications of the budget and savings programme. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None directly from this report at present. 9. 9.1 10 GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 There are a number of financial risks which may impact on the forecast outturn. These are reviewed regularly and are reported separately. There remains a small risk in respect of the financial reporting data within the Argyll and Bute Council ledger system as the new system is implemented. There is an increasing risk that funding streams will be reduced whilst significant reserves are held. NHS Highland also continue to experience a particularly challenging financial situation in 2022/23 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 None directly from this report, engagement on activities relating to savings and transformation forms part of the project plans where appropriate. 12. CONCLUSIONS 12.1 This report provides a summary of the financial position as at the end of quarter 1. A small overspend against budget is currently forecast, however it is anticipated that the position can be managed during the remainder of the year. On-going high levels of demand for services and the additional Page 104
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7 12.2 costs associated with agency and locum cover are contributing to budget pressures. Good progress has been made in delivering 42% of the savings programme in the first quarter although some challenges with savings delivery have been identified. Additionally, efforts are on-going to ensure that progress with allocating reserves continues as there is a risk that in-year allocations will be reduced until reserves are utilised. Continued action to address delayed discharges, the autumn covid vaccination programme and efforts to increase capacity in advance of the winter are likely to add to financial pressures and spend later in the year. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board APPENDICES: Appendix 1 – Year to Date Position Appendix 2 – Forecast Outturn for 2022-23 Appendix 3a – Fully Achieved Savings Appendix 3b – Live Savings Programme Appendix 4 – Earmarked Reserves AUTHOR NAME: James Gow, Head of Finance and Transformation EMAIL: james.gow@argyll-bute.gov.uk Page 105
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ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 2 REVENUE BUDGET MONITORING FORECAST OUTTURN - AS AT 30 JUNE 2022 Reporting Criteria: +/- £50k or +/- 10% Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer 3,804 3,804 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Service Development 453 453 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Looked After Children 7,724 7,724 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Child Protection 3,402 3,402 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Children with a Disability 927 927 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Criminal Justice 85 85 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Children and Families Central Management Costs 3,277 3,277 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Older People 43,136 43,136 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Physical Disability 3,464 3,464 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Learning Disability 17,394 17,394 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Mental Health 3,355 3,355 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated Adult Services Central Management Costs 450 450 0 0.0% Outwith Reporting Criteria - Forecast ledger to be updated COUNCIL SERVICES TOTAL 87,471 87,471 0 0.0% HEALTH SERVICES: Explanation Community & Hospital Services 57,491 58,445 (954) (1.6%) Overspend due to locum and agency staffing costs and unachieved savings Mental Health and Learning Disability 15,250 15,116 134 0.9% Saving due to vacancies within the service. Children & Families Services 8,437 8,187 250 3.1% Saving due to vacancies within the service. Commissioned Services - NHS GG&C 69,020 69,020 (0) (0.0%) Outwith Reporting Criteria Commissioned Services - Other 4,126 4,154 (28) (0.7%) Outwith Reporting Criteria Head of Primary Care 24,544 24,408 136 0.6% Saving due to vacancies mainly within dental services Other Primary Care Services 12,254 12,254 0 0.0% Outwith Reporting Criteria Prescribing 20,855 20,931 (77) (0.4%) Adverse variance due to slippage against the savings target. Public Health 2,027 2,027 0 0.0% Outwith Reporting Criteria Lead Nurse 1,697 1,635 62 3.8% Vacancies Management Services 1,992 1,992 0 0.0% Outwith Reporting Criteria Page 107
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Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance Explanation Planning & Performance 2,440 2,648 (208) (7.9%) Adverse variance due to anticipated slippage against the savings target. Budget Reserves 8,351 7,851 500 6.4% Anticipated slippage on inyear SG allocations Income (1,758) (1,858) 100 (5.4%) Favourable variance is due to an increase in the number of visitors requiring emergency hospital treatment Estates 8,921 9,183 (262) (2.9%) Increases in cost of utilities and PFI charges due to increase in inflation funding to be confirmed. HEALTH SERVICES TOTAL 235,647 235,993 (346) (0.1%) GRAND TOTAL 323,118 323,464 (346) (0.1%) Page 108
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Appendix 3a ‐ 2022/23 Fully Complete Savings Target Ref. Savings Description £' 000 Social Work 2122‐01 C &F Align business model for staffing for the 3 children's homes 6 2122‐03 C&F ‐ Do not replace independent chair of panel 2 2223‐22 Older Adults ‐ Remove current year underspend and anticipated unfunded growth from budget. 390 2223‐23 Older Adults ‐ Funding to cover care home contract uplift. 193 2223‐11 MH ‐ Reduction in value of 3rd Party Contract 10 2223‐13 C&F ‐ Redesign and review of Justice services to become fully funded by specific grant. 60 2223‐15 C&F ‐ Printer and Paper cost reduction 4 2223‐20 LD&PD Transport costs ‐ Day Services. 12 2223‐21 Corp ‐ Hold programme manager post vacant. 76 2223‐10 Corp ‐ Additional non‐recurring vacancy savings to be removed from budget in year as they arise. 250 Health 2122‐10 Redirect Oban Integrated Care Funding to pay for day responder service as in other areas 14 2223‐3 MH ‐ Review of specific high cost care packages. 115 2223‐4 Ensure that funding for pay rate uplifts are passed through to Health Budgets 50 2223‐24 Primary Care ‐Ensure national funding is fully utilised to cover eligible costs ‐ Denistry. 22 2223‐26 Public Health ‐ Review of Living Well grants 18 2223‐6 Estates ‐ Reduce Energy Usage 60 2122‐37 Campbeltown hospital catering 2 2223‐2 Corp ‐ Additional non‐recurring vacancy savings to be removed from budget in year as they arise. 750 2223‐25 Public Health ‐Reduce specific engagement budget which is now subsumed into mainstream PH activities 9 Declared on non‐recurring basis at present: 1920‐35 Bed reduction savings : Cowal Community Hospital 150 2021‐29 Dunoon Gum clinic ‐ underspend 20 2,213 Total Savings Programme 6,002 % Fully Complete 37% Page 109
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Appendix 3b ‐ LIVE SAVINGS PROGRAMME Target Declared M3 Remaining RISK NOTES Ref. Savings Description £' 000 £' 000 £' 000 Social Work 2122‐11 Remove funding for all lunch clubs 29 29 Saving declared last year non‐recurring, expected to be declared early in 2022/23 2021‐7b Review of provisioning of day services and remodel considering options of greater third sector involvement aiming for 10% reduction in cost, several targets under this project have been amalgamated. 146 146 Restructuring completed ‐ no further action required 2021‐32 Review housing support services and remove where not required for LD and PD clients ‐ several targets under this project have been amalgamated. 86 4 82 Expect to declare early in 2022/23 1819‐19b Review and Redesign of Learning Disability Services ‐ Sleepovers and Technology Argyll Wide 50 50 Member of staff now appointed to progress this work 2223‐12 Shift the balance of care across fostering, kinship and out of area residential placements. 100 100 Good progress being made, expect to declare early in 2022/23 2223‐16 Day Services ‐ Internal Staffing 20 20 Restructuring completed ‐ no further action required 2122‐15b End grants paid to link clubs, some of which are no longer providing services 2 2 2223‐18 Increased utilisation of new housing capacity for service users. 31 31 Dunbeg project nearing completion, full savings target unlikely to be realised due to changes in care & support needs, and tenants 1819‐33 Catering, Cleaning and other Ancillary Services 70 70 Catering related project ‐ proposal to work with Argyll & Bute Council under development TBC MH/LD/PD 225 225 Specific projects still to be developed 2223‐17 Reduce the number of individual sleepovers and utilise TEC 78 78 Project underway ‐ Expecting half of target to be declared in Q3 2223‐19 Implement reviews of care packages to ensure these are equitable across the area and transition to older adult care packages were appropriate 80 80 Project delayed as staffing resource has been deployed to assist with severe service pressure and unmet need in Oban area 2122‐02 Carry out hostel review to achieve best value in admin and catering 23 23 Changes to contracts to be phased in to reduce term time contracted weeks ‐ expect saving to be delivered by August 2023 per SLT decision to phase contract changes. Health 2021‐1 Mental Health redesign of dementia services 200 200 Declared on a non‐recurring basis last year, structure to be confirmed and expected to declare soon. 2122‐35 Mid Argyll hospital removal of surplus budgets on hotel services £20k, comms £4.3k; GMS out of hours £2k; equipment £1.5k 4 4 Small balance to be declared 2122‐33 centralise lab ordering £20k and theatre stock ordering £5 along with North Highland 20 20 Expect to declare early in 22/23 2122‐43 Oban Patient travel £25k; staff travel £10k 10 10 Expect to declare early in 22/23 2122‐60 Planning & Performance team ‐ reduce budget for travel & printing £3k; Consultant Travel £10k 10 10 Expect to declare early in 22/23 2122‐36 Campbeltown hospital patients travel £30k 30 30 Expect to declare early in 22/23 2122‐38 Campbeltown hospital sundry underspends comms £6k; portering £1; pharmacy £6k; general management discretionary £5k, transport £2k; GMS out of hours £1.5k 13 13 Expect to declare early in 22/23 2122‐42 Islay: saving on local outreach clinics and accommodation through more remote clinics 15 15 Expect to declare early in 22/23 2223‐27 Children & families 130 112 18 Plan in place for balance of saving, low risk 1819‐44 Advanced Nurse Practitioners ‐ Oban 14 14 Complete & declared M4 1920‐38b Lorne & Islands Hospital staffing 21 21 Complete & declared M4 1819‐32 Catering & cleaning review 20 20 Catering related project ‐ proposal to work with Argyll & Bute Council under development 2021‐2 Standardise procurement of food across all sites and expansion in conjunction with Council for early years 69 69 Catering related project ‐ proposal to work with Argyll & Bute Council under development 2021‐19 Redesign of hotel services to reflect reduction in inpatient numbers 99 99 Catering related project ‐ proposal to work with Argyll & Bute Council under development 2021‐23 Catering & domestic ‐ spending below budgets 30 30 Catering related project ‐ proposal to work with Argyll & Bute Council under development 2122‐32 1% general efficiency requirement across all hospital budgets 186 89 97 Carried forward saving ‐ work on‐going 2122‐46 Helensburgh outreach clinics £8k; casualty payments £14k, 14 14 Negotiations underway ‐ requires variation to GP contract 2122‐30 Introduce more re‐use of walking frames and improved procurement of musculo‐skeletal supplies 20 20 Work underway to develop project 2021‐4a Admin & clerical general productivity / efficiency enhancement via shift to digital working in 2020/21 and 2021/22 100 100 See Corporate Services Report 2021‐4b Right size admin budgets Mid Argyll and LIH 27 27 See Corporate Services Report 2021‐20 Centralised booking of medical records ‐ reduction in admin costs 97 97 See Corporate Services Report 2223‐7 Transfer Switchboard Services to Highland Health Board from Glasgow. 54 54 See Corporate Services Report 2223‐1 Management and review of prescribing processes and products to ensure best value is being achieved. 589 32 557 Work on‐going ‐ saving anticipated to be challenging due to on‐going supply chain disruption ‐ £360k of savings identified. 1920‐4 Review of Service Contracts 20 20 Specific savings to be identified as part of contract management processes 2223‐5 Ensure that all staff are deployed to substantive roles within the HSCP staffing structure. 129 129 Subject to identification of appropriate roles in structure and HR support required to progress due to long standing nature of issue. 2223‐8 1% reduction in hospital budgets. 470 50 420 Approximately half of the target has been identified to date 2021‐64 Review of Forensic Medical Examiner Costs ‐ Bute & Cowal and Out of hours 50 50 Negotiations underway ‐ dependent upon Dunoon contract 2223‐9 Reduction in Forensic Service Contract costs. 20 20 Negotiations underway 2122‐66 Savings from building rationalisation following increase in home working 72 72 Saving is subject to Cowal Community Hospital Capital Project ‐ This has not yet been formally signed off and completion is now March 2023 at best 1920‐22 Dunoon Medical Services (see also 2021‐16) 100 100 As Above 2021‐3 AHP ‐ carry out workforce planning and establishment setting to find efficiencies in posts and realign services provided to match 86 86 Workforce Establishment Setting Underway ‐ this is not now expected to result in a net saving 2021‐16 Rationalisation of medical services for Dunoon (adds to 1920‐22) 20 20 Subject to Dunoon GMS procurement and capital project 2122‐04 Bring back urology services from NHS Greater Glasgow & Clyde and offer from Oban Hospital instead 110 110 Unable to progress as Medical Staffing in LIH is not stable at present. 3,789 287 3,502 900 116 784 Saving perceived as low risk 2,398 171 2,227 Saving anticipated to be challenging to deliver in full within year 491 0 491 Saving now considered unlikely to be deliverable in 2022/23 Page 110
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Appendix 4 - Earmarked Reserves Reserves Balance 31 March 22 Reserves Allocated Q1 Balance 31 June 2022 £ £ Primary Care Improvement fund 3,061,992 386,600 2,675,392 Other Primary Care Projects 74,521 74,521 Action 15 of the Mental Health Strategy 2017-27 289,661 289,661 Technology Enabled Care (Near Me) 142,230 142,230 Additional ADP Funding 185,238 185,238 Best Start - Maternity Services (Board re-provision) 86,000 86,000 Supporting Improvements to GP Premises 178,441 178,441 Scotgem Funding 20,701 20,701 Covid-19 support 10,489,150 1,546,300 8,942,850 Childrens Mental Health Services (CAHMS) 645,170 645,170 Community Living Change Fund 300,000 300,000 ACT Aros Residences Upgrade 184,200 184,200 - Primary Care OOH Funding 231,870 231,870 Insulin Pumps correction including VAT 70,220 70,220 ASC Nurse Director Support IPC 61,066 61,066 Trauma Network Tranche 1 (70%) / Tranche 2 (30%) 62,525 62,525 PFG School Nursing Tranche 2 166,783 166,783 District Nurse Posts 127,015 127,015 E-health Strategy Funding 72,400 72,400 Perinatal MH Funding 160,679 160,679 Mental Health Officer Training 28,221 28,221 Type 2 Diebetes Framework (70%) & (30%) 31,803 22,600 9,203 Trauma Training Programme 69,444 69,444 Wellbeing Funding 85,028 85,028 Oban Accomodation 145,000 145,000 Primary Care Education Fund 250,000 250,000 Fleet Decarbonisation 86,520 86,520 Additional Band 2-4 Staffing 258,971 93,000 165,971 Nursing Support for Care Homes 151,386 151,386 Remobilisation of Dental Services 89,604 37,700 51,904 Mental Health Facilities 285,284 285,284 Diabetic Technologies 205,114 205,114 Waiting Times Funding 497,183 242,800 254,383 Interface Care Programme 133,032 133,032 Medical Assisted Treatment Standards 114,114 70,000 44,114 Psychological Therapies 55,923 55,923 Inequalities Project 26,369 26,369 - Dementia Post Diagnostic Support 66,566 66,566 Mental Health Funding for Pharmacology 17,869 17,869 Medical Equipment 128,885 128,885 Eating Disorders 69,238 10,000 59,238 Ventilation Improvement 81,900 5,800 76,100 Mental Health Recovery Services 38,931 38,931 Whole Family Wellbeing Fund 39,000 39,000 Care at Home Funding 287,913 287,913 Multi Disciplinary Teams 213,946 213,946 Interim Care 447,402 447,402 General Reserves - Service Transformation 681,528 681,528 Total 21,196,036 2,625,369 18,570,667 * Argyll & Bute Council Reserves allocation not posted in Q3 Page 111
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1 Integration Joint Board Date of Meeting: 24 August 2022 Title of Report: Medium Term Financial Plan 2023-2026 Presented by: James Gow, Head of Finance and Transformation The Integration Joint Board is asked to: Consider the draft Financial Plan and budget outlook for 2023-24 to 2025-26. Note the risks and uncertainties regarding the Financial Plan. Note the forecast budget gap and endorse the proposal that the HSCP seeks to develop a Value for Money and Savings Strategy aimed at addressing the budget gap. 1. EXECUTIVE SUMMARY 1.1 1.2 This report provides the Finance and Policy Committee with the current medium term financial plan for the HSCP covering 2023/24 to 2025/6. It provides the basis for detailed financial planning and will be used to inform the savings target for 2023/24. It is intended that the budget gap will be addressed through the development of a value for money strategy and savings plan. The financial plan will continue to evolve as funding and cost pressures are confirmed. The contents of this report have also been considered by the Finance & Policy Committee on 5th August 2022. The medium term plan aims to provide a clear budgeting framework for the development of the budget for 2023/24 whilst putting this in a longer term context. The Scottish Government have published a 3 year spending review which outlines their funding intentions for the Health and Care sector. It also confirms that the National Care Service will be established and is likely to be in its early implementation phase by the end of the planning period. 1.3 1.4 The HSCP is in a healthy financial position as at the end of 2021/22. This enables it to maintain a specific unallocated budget to support transformation at £900k per year. This is critical in enabling non-recurring investment in specific projects aimed at longer term service transformation and delivery of savings. The best, mid-range and worst case scenarios are presented for the next three years. Financial planning will be based upon the mid-range scenario which outlines a budget gap of £6.7m or 2% of spend for 2023/24. Page 113 Agenda Item 12b
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2 2. INTRODUCTION 2.1 The purpose of this report is to outline a draft medium term financial plan for the HSCP covering the period from the current year (2022/23) through to 2025/26. This document seeks to outline the current and expected financial context facing the HSCP with a view to ensuring that it continues to operate on a financially sustainable basis. The document includes the following sections: Financial & Strategic Context Current Financial Position Revenue budget modelling & assumptions Budget Gap and Savings Target Transformation & Investment Reserves Scenarios and Risks 3. 3.1 DETAIL OF REPORT Financial & Strategic Context The strategic context facing the HSCP at the time of writing is important: Draft legislation for the National Care Service (NCS) has been published. This does not provide the level of detail required to fully understand its likely implications for the Argyll & Bute HSCP. It is expected that the structural change associated with the NCS will be funded in addition to the allocations in the Spending Review. Recent reports by Audit Scotland on NHS and Social Care services outline a series of challenges including workforce, reduced activity, increasing demand and waiting times and increasing unmet need. Addressing these challenges are likely to be service priorities throughout the planning period. Inflation is in excess of 9% and expected to increase further in 2022/23. There are several risks associated with Government inflation assumptions including pay rate increases and the real terms value of medium term funding allocations. The key medium term financial planning document which informs high level policy and spending intentions is the Scottish Government’s Resource Spending Review. This was published in May 2022 and sits alongside a medium term financial strategy for the public finances. The full document is available at: https://www.gov.scot/publications/scottish-resource-spending-review. Additionally, appendix 1 provides a copy of a recent letter on financial planning from the Chief Operating Officer, NHS in Scotland. The Spending Review prioritises spending on Health and Social Care which accounts for around 40% of the total budget. It reconfirms the commitment to the National Care Service and outlines a 25% increase in social care investment. The Page 114
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3 high level Health and Social Care allocations per the spending review (at current prices) is: 22-23 £’m 23-24 £’m 24-25 £’m 25-26 £’m 26-27 £’m Health & Social Care 17,106 17,550 17,995 18,536 19,029 Increase on prior year 2.6% 2.5% 3.0% 2.7% Health & Social Care Capital 554 443 428 443 - Settlements for local government are frozen through most of the planning period. Additionally, Health and Social Care Capital Funding is set to reduce against the current year total reflecting the financial challenge faced by the Scottish Government. The Spending Review also confirms the intention to maintain a no compulsory redundancy policy for public sector workers and reiterates that pay negotiations should take account of public sector pay policy. It also recognises the pressure the public finances are expected to be under in the coming years and highlights that public sector staffing numbers require to be reduced to pre-pandemic levels and that further reform and efficiency improvement will be required. The Government also published a medium term financial strategy which provides further information on the outlook for the public finances and economic performance in Scotland. It again outlines an expected fall in living standards and disposable income as a result of the cost of living crisis and high inflation. It acknowledges that Consumer Price Index (CPI) inflation is at 9% for the 12 months to April 2022. The document sets out forecast inflation in line with the Office Of Budget Responsibility forecasts: 2021-22 2022-23 2023-24 2024-25 2025-26 2026-27 Actual Inflation Forecast Inflation 9.0% 8.0% 2.4% 1.7% 2.0% 2.0% The document models 1%, 2% and 3% pay increases from 2023/24 onwards using 2022/23 as a baseline. It is not clear what the underlying assumption for the April 2022 pay increase is in the context of current offers being well in excess of public pay policy. This is important as the cumulative effect of actual CPI inflation in 21/22 and forecast inflation in 22/23 is over 17%. 3.2 Current Financial Position The HSCP ended the 2021/22 financial year in a favourable position. It has repaid all of the debt it owed to Argyll and Bute Council and has operated within budget for the second year in succession. Total revenue spend on services for 2021/22 was £312m. In addition, the HSCP has earmarked reserves totalling £21.2m, including £0.7m of general reserves. The earmarked reserves are being held for specific purposes and are not generally available to the HSCP for purposes or priorities other than Page 115
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4 those for which the funding was allocated. The general reserves have been earmarked to support investment in transformation projects in 2022/23 and supplement the revenue budget. However, the HSCP has not been able to deliver all of its savings targets on a recurring basis and therefore it is carrying forward savings projects from prior years which still require to be delivered, this adds to financial pressures going forward. The HSCP does not have delegated responsibility for asset ownership or capital spend. This is an important issue as significant backlog maintenance and replacement needs have been identified and require to be addressed in partnership with NHS Highland and Argyll & Bute Council. Addressing investment need is a priority and represents a risk to the ability of the HSCP to deliver on its strategic objectives in the longer term. 3.3 Revenue Budget 2023/24 to 2025/26 3.3.1 Funding Allocations Services provided by the HSCP are largely funded by allocations made by the Scottish Government to Local Authorities and NHS Boards. They then pass on funding for delegated services to HSCPs. Actual funding allocations are predominantly based upon allocations formulas which take into account factors such as population and demographics, levels of deprivation and rurality. The table below provides a summary of the current funding allocations and assumptions for future funding uplifts: Funding Allocations 2022/23 2023/24 2024/25 2025/26 £m £m £m £m NHS Funding Baseline 201.7 205.7 210.9 217.2 Resource Transfer 7.2 7.3 7.5 7.7 Other Recurring Funding 37.9 38 38 38 Additional Inflation 22/23 6.3 6.3 6.3 6.3 Assumed uplift % 2 2.5 3 Total NHS Funding 253.1 259.3 265.2 272.2 Social Work Funding Baseline Funding 62.8 64.4 66 68 22/23 New Recurring Funding 11.4 11.7 12 12.3 Assumed uplift % 2.6 2.5 3 Total Local Authority Funding 74.2 76.1 78 80.3 Total Revenue Funding 327.3 335.4 343.2 352.5 Funding for Transformation 0.9 0.9 0.9 0.9 The key assumptions in respect of NHS funding are: Page 116
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5 Additional budget will be allocated in 2022/23 to fully fund pay increases and SLA increases which are set to be above budget; A 2% uplift planning assumption has been provided by Scottish Government for 2023/24 and the Spending Review uplifts have been used for the following years; and The Argyll & Bute funding share (NRAC) will remain at its present rate and NHS Highland will pass on the full value of any uplifts. Local Authority allocations are more difficult to predict as Spending Review intentions are particularly challenging for that sector. However, there is a commitment for increased funding for Social Care. The uplifts applied in the model mirror the Spending Review increases per the table at section 3.1.2. 3.3.2 These assumptions are critical to the HSCP medium term plan, particularly in the context of higher inflation. Alternative scenarios are outlined later. Expenditure Budget 3.3.3 There is a high level of uncertainty in respect of the expenditure budget, again largely as a result of high inflation. This impacts on direct staff costs through pay settlements (approximately one third of the revenue budget) and through increased contract values as minimum pay rates can be expected to increase significantly. Additionally, non-pay costs are expected to increase at a faster rate and are generally outwith the control of the HSCP. Key concerns relate to the PFI contract for the Mid-Argyll Hospital, energy, travel and transport and drug costs. In addition to inflationary pressure, it is anticipated that there will be further demand pressure and this is built into the expenditure estimates. This is expected to arise from the introduction of new services and treatments, the on-going demographic shift in the area and the increasing numbers of individuals who require additional support on the community. The baseline budget also incorporates the savings target for 2022/23 (£3.9m of new savings). It also includes additional recurring funding allocations which provided for significant growth in the overall budget for 2022/23. Baseline Expenditure Budget 2022/23 £m NHS Baseline Spend 236.2 SW Baseline Spend 88.7 Less Savings Programme -3.9 Additional Inflation for 2022/23 (NHS) 6.3 Total Baseline Expenditure Budget 327.3 Social Work Cost and Demand Pressures The table below summarises the cost pressures that have been modelled for Social Work Budgets: Page 117
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6 3.3.4 Social Work Cost and Demand Pressures 2023-24 £000 2024-25 £000 2025-26 £000 Additional unfunded pay inflation 22/23 660 660 660 Pay inflation @ 2% per year 675 1,360 2,060 Assumed incremental increases 100 200 300 Non Pay Inflation 3,300 6,090 8,490 Younger Adults Demand Growth 400 820 1,200 LD, PD and MH Cost and demand pressures 340 680 840 Continuing Care for Looked After Young People 200 400 600 Estimated net cost of KCC 750 750 750 Allowance for unknown cost and demand pressures 200 250 500 Total Social Work Cost and Demand Pressures 6,625 11,210 15,400 The key assumptions here are that pay inflation will be 2% per year, this is a significant risk to the plan but allowance is being made for the 2022/23 pay increase being higher than budget and it is assumed this will not be funded. Non- pay inflation is calculated line by line on a total baseline budget of £58m. This covers expected uplifts in national contract rates for care services and increases to the expected pay floor for social care staff. In addition to demand pressures for services to support people with lifelong conditions, mainstreaming the Kintyre Care Centre into Social Work Budgets is a further significant additional cost pressure for which no specific funding has been identified. Health Cost and Demand Pressures Cost and demand pressures identified for Health Services are summarised below: NHS Cost and Demand Pressures 2023-24 £000 2024-25 £000 2025-26 £000 Pay Inflation Uplift 2% pa 1590 3210 4800 Pay Increments & Uplifts 330 590 850 Prescribing & Hospital Drugs Inflation 650 1,310 1,970 Inflation on SLA's & Resource Transfer 1,980 3,900 5,990 Inflation on PFI Contract 535 800 1,065 Estimate for Additional Medical Staffing 400 400 400 Estimated allowance for Safe Staffing Act 300 400 500 Energy Inflation 790 1,810 2,960 Allowance for new drug approvals 260 510 770 Specific projects approved 100 150 230 Contingency 750 750 750 Allowance for unknown cost and demand pressures 500 1,000 2,000 Total Health Cost and Demand Pressures 8,185 14,830 22,285 Overall the cost and demand pressures modelled at present are based upon planning assumptions provided by Scottish Government as well as estimates of potential local cost pressures. The expectation that cost pressures and actual inflation will be in excess of funding uplifts add substantially to the budget gap. Page 118
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7 3.3.5 Summary and Budget Gap The table below summarises the aggregate HSCP financial position for the planning period and identifies the estimated scale of the funding gap in the mid- range scenario: Revenue Budget Summary 2022-23 £m 2023-24 £m 2024-25 £m 2025-26 £m Funding Total 327.3 335.4 343.2 352.5 Baseline Spend 327.3 327.3 327.3 327.3 Social Work Cost & Demand Pressures 6.6 11.2 15.4 NHS Cost & Demand Pressures 8.2 14.8 22.3 Estimated Expenditure 327.3 342.1 353.3 365 Mid Range Budget Gap / Savings Target 6.7 10.1 12.5 New Savings Target as % of spend 2% 2.9% 3.4% 3.4 The assumption in respect of 2023/24 pay increases is one of the most concerning as clearly this is substantially below predicted inflation for this year. The assumption used is based on guidance from Government. There is a general understanding the NHS pay increases are fully funded which mitigates the importance of this assumption to some extent. Budget Gap and Savings Targets The above modelling, based on a mid-range scenario results in a budget gap due to cost and demand pressures being in excess of anticipated funding. This is a new gap or savings requirement and assumes the existing savings plan is delivered in full. In order to enable the HSCP to set a balanced budget for 2023/24 and beyond it is likely new savings of the magnitude outlined above will need to be identified and delivered. The HSCP is therefore required to develop a Value for Money Strategy which outlines the approach to addressing the shortfall. It is intended that the 3 year financial plan and value for money strategy would form the basis of the budget consultation for 2023/24. It is acknowledged that the approach to budgeting outlined in the plan is largely incremental in nature. It is likely that more fundamental reviews of budgets and service delivery will be required, this may include the use of zero base budgeting techniques as the HSCP is finding it increasingly challenging to identify new savings within existing service delivery structures. 3.5 Transformation and Investment The budget figures assume that £900k in available funding will be held to enable transformation projects to proceed. One of the difficulties in delivering Service Page 119
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8 Improvement and Transformation has been the absence of a funding source to support projects. Maintaining this budget will facilitate this and will be allocated based upon business case submissions and strategic priorities. It will also enable work relating to infrastructure business case development to proceed. In respect investment in facilities, the HSCP does not have delegated responsibility or budgets but does need to progress important projects with partners. Long term asset replacement is required and work is underway to prioritise projects which including care home development and replacement and the need for investment in the NHS Estate. The Transformation programme and workforce plan outline other areas where infrastructure investment is required. The Transformation programme and budget will help facilitate this work without impacting upon service budgets. 3.6 Reserves This plan does not set a target for increasing general reserves held by the HSCP. It is intended that the resources available will be allocated to service delivery and transformation. As in recent years, it can be expected that there will be slippage and resources which will be carried forward for specific projects for use in future years, however, it is not proposed that this is a target or objective in the current context. The impact of the implementation of the National Care Service is not certain at the time of writing, however it would appear likely that the new Boards will be classified as Public Bodies and not able to generate or carry forward general reserves. It is also unlikely that they will be able to borrow to fund investment in infrastructure. Reserves carried forward into 2022/23 are intended to be spent during the period of this plan. This spend is in addition to the revenue budget outlined above and will also assist with the transformation and service improvement agenda. Capacity in the economy generally and within the workforce is likely to be the main constraint in progressing with projects and planned spend. An estimated schedule of spend in addition to the revenue budget is provided below: 2022/23 £m 2023/24 £m 2024/25 £m 2024/25 £m Reserves Spend Profile 12.5 5.1 3.0 0.6 The above profile assumes that the majority of the covid reserve will be spent in 2022/23 and spend will wind down sharply in 2023/24. Having this level of additional resource will contribute to improving services and facilities over the period of the plan. 3.7 Scenarios and Risk 3.7.1 There are risks associated with medium term financial planning. The key strategic risks associated with the plan are summarised below, using the HSCP’s standard assessment of probability and impact: Page 120
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9 3.7.2 Risk Like. Impact Mitigations HSCP unable to identify and deliver sufficient savings. 4 5 20 Development of and consultation on value for money strategy. Utilisation of allocated reserves and progressing transformation. Demographic or population changes reduce the formula funding to the HSCP. 4 4 16 Review annually. One or both of the partners do not pass on anticipated funding allocated to Health and Social Care. 3 4 12 On-going partnership working and consultation. Inflationary pressures are not funded to the extent assumed in the model. 4 4 16 Engagement in sector networks, modelling based on Spending Review figures. Increases in pay rates or employer on-costs are in excess of those allowed for in the budget. 4 4 16 Monitor progress with pay negotiations, general commitment to fund within NHS. Implementation of NCS diverts attention from operational priorities and financial management 4 4 16 Seek to resource NCS appropriately. Service costs increase due to providers withdrawing from the market and / or ongoing workforce shortage 4 4 16 Commissioning strategy and engagement with partners and care providers. Workforce planning and management of agency / locum contracts Funding reduced due to level of reserves held in HSCP and across sector 3 3 9 Allocate reserves to projects and priorities Scenarios The figures presented within this plan are based upon modelling of the mid-rage financial outlook. The table below summarises a best and worst case outlook which reflects the risks highlighted above: 2023-24 £m 2024-25 £m 2025-26 £m Mid-Range Budget Gap 6.7 10.1 12.5 Health Worst Case Additional 6 12.4 18.5 Social Work Worst Case Additional 1.3 2.4 4.1 Worst Case Budget Gap 14 24.9 35.1 Health Best Case Improvement 2.1 4.1 5.5 Social Work Worst Case Improvement 1.2 2.4 3.4 Best Case Budget Gap 3.4 3.6 3.6 Page 121
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10 The use of the mid-range assumptions as a basis for financial planning is currently considered a reasonable and realistic approach. In the event that the outlook improves the HSCP would be able to scale back the savings target. 3.7.3 Workforce There is also a significant workforce risk associated with the financial plan. This is considered in detail in the Workforce Plan, however it is highlighted that on- going labour are likely to constrain the ability of the HSCP to deliver services and service improvement as planned. The financial plan outlined in this document assumes a level of growth in workforce numbers. This is difficult to quantify at present but includes: Increase in workforce size to narrow gap between current budgeted establishment and actual staffing (reduced vacancies); Reduce reliance on temporary and agency staff to implement more cost effective, stable and sustainable staffing models; Some transition from commissioned services to direct delivery of service; Additional growth in 2022/23 budget and use of non-recurring reserves balances not yet fully reflected in staffing establishment; and Cost and demand pressures allowed for will require additional staffing. It is likely to be the case that some of the savings programme will require reductions in staffing which will in part offset the increases referred to above. The Workforce plan seeks to outline how the HSCP can seek to address the workforce challenge over the medium term. 3.8 4. Alignment with Strategic Planning The medium term financial plan sits alongside a range of HSCP strategic and operational planning documents. These include the new Joint Strategic Plan and Commissioning Strategy. The HSCP has sought to ensure that these are all consistent. Specifically, the Transformation programme and the budget to support it are important in facilitating some of the targets and objects set out in these documents, particularly in respect of service improvement and redesign, beginning the shifting of resources towards the prevention agenda and closer working with communities and the voluntary sector. The development of the National Care Service will further transform the HSCP, this will change the way it is structured and operates fundamentally and as a project will need to be managed and resourced. It will also place even greater importance upon partnership working as the transition is likely to present challenges for partners as well as the HSCP. It is assumed that this will be funded in addition, per the Financial Memorandum which has been prepared by the Scottish Government as part of the legislative process. RELEVANT DATA AND INDICATORS 4.1 The budget outlook is based on a number of assumptions, using a best, worse and mid-range scenario. These assumptions are drawn from the Government’s Spending Review documentation, local modelling and guidance provided from policy teams. The assumptions used are considered carefully and will be regularly Page 122
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11 reviewed and updated as appropriate. However it is recognised that there are likely to variations between the assumptions made at this stage of the budget planning process and the eventual funding allocations and cost and demand pressures for 2023/24 and beyond. 5. CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 The Integration Joint Board has a responsibility to set a budget which is aligned to the delivery of the Strategic Plan and to ensure the financial decisions are in line with priorities and promote quality service delivery. This needs to be considered when options are developed to balance the budget and address the expected funding shortfall. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – There is expected to be a significant budget gap in future years that requires to be addressed as the HSCP is required to set a balanced budget. 6.2 Staff Governance – None directly from this report but there is a strong link between HR management and delivering financial balance. 6.3 Clinical Governance - None 7. 7.1 8. PROFESSIONAL ADVISORY There are no recommendations from this report which require to be consulted on with Professional Advisory leads. The development of any savings plans will require consultation with Professional Advisory Leads. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None directly from this report, proposals to address the estimated budget gap will need to consider equalities impacts. 9. 9.1 10 GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None directly from this report. RISK ASSESSMENT 10.1 There are significant risks associated with medium term financial planning. To some extent these are quantified within the worst case scenario and further detail is provided within the main body of the report. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 A public consultation relating to the HSCP’s financial planning is being developed. It is intended that this will take place earlier than it has in recent years and will be supported by the improvement service. 12. CONCLUSIONS This documents provides a draft medium term financial plan for 2023/24 to 2025/26. It outlines the key assumptions, cost pressures and risks associated with financial planning. It also provides an indication of the anticipated scale of the budget gap facing the HSCP in those years. The overall financial context for Page 123
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12 the HSCP is that it is in a healthy financial position with reserves available to help manage services pressures and priorities. The identified budget gap requires to be addressed through the development of a Value for Money Strategy and savings plan. Work on this will commence in the coming weeks and this in turn will enable consultation to take place. The scale of the challenge for 2023/24 is estimated at £6.7m or 2% of the expenditure budget. This level of savings is in addition to the delivery of the current programme. The budget for 2023/24 and beyond will continue to be updated as planning assumptions and assessment of risk is updated during the current year. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board APPENDICES: Appendix 1 – Priorities and Finance Planning AUTHOR NAME: James Gow, Head of Finance and Transformation james.gow@argyll-bute.gov.uk Page 124
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Health Finance, Corporate Governance & Value Directorate Richard McCallum, Director T: 0131-244 3475 E: richard.mccallum@gov.scot NHS Chief Executives cc: NHS Directors of Finance Integration Authority Chief Officers Integration Authority Chief Finance Officers via email ___ 14th July, 2022 Chief Executives 2022-23 Priorities and Finance Planning The purpose of this letter is to confirm priorities and funding allocations for 2022-23, reflecting discussions at the most recent Board Chief Executive meeting in June. Within the letter we set out: The priorities for the remainder of this financial year; The position regarding Agenda for Change pay and funding assumptions; and The steps being taken to confirm the remaining funding allocations for 2022-23 and expectations regarding Board’s operating within their revenue and COVID resource limits. Service Priorities As previously set out to NHS Chief Executives, there is a considerable financial challenge in 2022-23 alongside the operational and workforce pressures that each Board is experiencing. In view of this, consideration has been made to the areas we expect NHS Boards to prioritise in this financial year. These are as follows: Planned Care – reduction in outpatients waiting over one year and inpatients waiting over two years in line with our joint ambition to tackle waiting lists. The new targets confirmed in the letter of 6 July are to eliminate: two year waits for outpatients in most specialities by the end of August 2022 18 month waits for outpatients in most specialities by the end of December 2022 one year waits for outpatients in most specialities by the end of March 2023 Page 125
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot two years waits for inpatient/daycases in the majority of specialities by September 2022 18 month waits for inpatient/daycases in the majority of specialities by September 2023 one year for inpatient/daycases in the majority of specialities by September 2024. We will confirm initial allocations in the coming weeks to support these targets and further work will be undertaken to revisit your existing Board elective recovery plans, following which a revised allocation will be agreed with you. Cancer 31/62 day performance – we share a collective desire to enhance access to cancer diagnosis and treatment and will work with you to agree the steps that can be taken to improve performance, whilst acknowledging the increasing demand being placed on all elements of the cancer pathway. Unscheduled and Urgent Care – we have jointly agreed to take forward the new Urgent and Unscheduled Care Collaborative as the means to a whole systems approach to addressing the pressures on our unscheduled care pathways and improving the 4 hour emergency access performance. We will be liaising with you and Chief Officers regarding your plans, including steps to protect elective care capacity and address any further surges in COVID activity. The funding to support the unscheduled care collaborative will be in line with that announced in May, with winter plan funding to be confirmed shortly. Extended Flu and COVID vaccinations – we have been working closely with your Delivery Lead for the Vaccination Programme and would acknowledge the significant work that was been undertaken over the last two years and currently in preparing for the Autumn / Winter programme. The vaccination workforce and venue costs for 2022-23 should be met from within the COVID resource limit funding that has been confirmed previously. If additional surge capacity requires to be implemented to comply with JCVI guidance, we will revisit our planning assumptions with your local Delivery Lead. Reducing Drugs Deaths – we have recently written to confirm 2022-23 funding for ADPs and to confirm ministerial priorities, including the implementation of Joint Plans to ensure adherence with the MAT standards. We acknowledge the challenges that all Boards are experiencing and the impact that this is having on you and your staff. We remain committed to working with you on these priorities and supporting you and your teams to deliver the best outcomes for patients as we progress with the recovery of the NHS. The care and wellbeing of all our staff remains a key consideration and it is important that any plans we agree are developed in partnership with you. Agenda for Change Pay Offer 2022-23 Financial planning until now has been based on Scottish Public Sector Pay Policy. As the recent Agenda for Change offer exceeds these parameters, this is an additional cost that will need to be managed by the Portfolio. For planning purposes, Boards should assume that funding will be provided based on the additional cost associated with the recent Agenda for Change offer. Allocations will be confirmed following conclusion of pay negotiations. Page 126
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Board Core Position and Quarter 1 Review The letter to Chief Executives on 1 June set out the expectations on the actions required ahead of the formal financial Quarter 1 review. In terms of this year, we are expecting Boards to taking the appropriate steps to: Reduce COVID expenditure in line with the resource limits that have been allocated for 2022-23; and Deliver local savings plans to ensure that you are able to achieve a position of break- even without Scottish Government financial support by the end of the financial year. We acknowledge the challenge that this will present and whilst decisions should be made locally based on the feasibility of options that you will have risk assessed, we will arrange to discuss your Quarter 1 financial returns and Delivery Plans in further detail. The Directors of Finance, at their meeting on 16 June, agreed to work together with Scottish Government to progress a number of national actions that will further assist in addressing the financial challenge and we will keep you advised on the progress with this work. We have previously written to NHS Chief Executives in relation to COVID funding envelopes for non-delegated services in the current financial year. Work continues through the COVID Cost Improvement Programme to address the overall scale of challenge across delegated and non-delegated services in 2022-23 and beyond. It remains essential that activity across NHS Boards and Integration Authorities is fully aligned with this work and that costs are minimised as far possible. As you will be aware, we do not anticipate any further COVID consequentials in 2022-23 or in future years. Therefore any recurring costs will be met through confirmed recurring allocations (e.g. sustainable vaccination workforce) or from existing baseline budgets. To manage this pressure moving forward, Boards should actively be developing local COVID exit plans alongside the work of the national COVID Cost Improvement Programme. As previously confirmed, Boards will be provided with funding to meet the costs of delivery of the Test and Protect programme and you are not expected to cover these within your COVID resource allocation. 2022-23 Funding As colleagues will be aware, work continues on addressing the significant financial challenge across the Health and Social Care portfolio this financial year. As work continues across the Scottish Government’s Health and Social Care Directorates, it is important that a consistent and prudent approach is taken regarding funding expectations. For planning purposes, Boards and Integration Authorities should assume funding broadly in line with levels received in 2021-22, except where separate approval or confirmation has been provided by the relevant SG policy teams. Further clarity on the funding position will be provided to NHS Directors of Finance and IA Chief Finance Officers in the coming weeks. For ring-fenced amounts carried forward by Integration Authorities, it remains our general expectation that these are utilised in full before further funding is provided by Scottish Government. Page 127
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot 2023-24 and beyond In terms of the approach for 2023-24 and beyond, we are progressing the planning which will bring together the key priorities for future service delivery, in the context of the medium term financial framework and workforce plan. Given the anticipated challenges over the Spending Review period as recently set out by the Cabinet Secretary for Finance and Economy, it is important that we engage with you on the planning scenarios and options that we may need to consider in terms of both recovery and future reform, including planning for a new National Care Service. We would thank you for your support at this time and we will continue to work closely with you in taking forward the priorities for this financial year. Yours sincerely John Burns Chief Operating Officer – NHS Scotland Richard McCallum Director of Health Finance and Governance Page 128
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1 Integration Joint Board Date of Meeting: 24 August 2022 Title of Report: Audit & Risk Committee Annual Report 2021-22 Presented by: Chair Audit and Risk Committee The IJB is asked to: Note the annual report 1. EXECUTIVE SUMMARY 1.1 1.2 1.3 In line with the principles of good governance, an Annual Report is prepared by the Audit & Risk Committee for submission to the Integration Joint Board. The purpose of this report is to provide the IJB with assurance that the Audit and Risk Committee has evaluated its activity and performance. It also provides a further opportunity for the Committee to raise any matters of concern to the Board. This report provides the Annual Report of the Audit & Risk Committee for financial year 2021/22. The Committee has met on 5 occasions throughout the year, with all minutes submitted to the Integration Joint Board and published within those papers. The Committee has been supported throughout the year by the Council’s Committee services team and all papers and minutes have been published for members to access. This report provides both a summary of the work of the Committee, the auditors as well as an evaluation by the Chair. 2. INTRODUCTION 2.1 The purpose of this report is to provide the IJB with a summary of the work of the Audit & Risk Committee and assessment of how it has performed its governance role throughout 2021/22. Whilst there were a number of challenges faced by the Committee and the HSCP more widely, overall the Committee performed well in its oversight of audit and risk and is therefore pleased to be able to provide assurance to the IJB that the Committee has operated effectively throughout the year. 3. DETAIL OF REPORT 3.1 The report provides the following: Summary of the Committee Meetings Progress with the improvement agenda Page 129 Agenda Item 13a
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2 3.2 3.2.1 Committee Membership and Remit Evaluation by Chair Additionally, the key reports prepared by the Internal and External Auditors are included as appendices. Audit & Risk Committee Meetings This section provides a summary of the items of business considered at each of the meetings of the Committee held during the year. Meetings were held electronically throughout. Additionally, the on-going impact of Covid-19 resulted in some disruption to planned timing of audit work, implementation of audit recommendations and scheduling of meetings. The IJB is provided with the minutes of each meeting as a matter of course, this also provides members with the opportunity to raise issues or question the Chair in respect of the work of the Committee at any point during the year. Meeting 1 - 20 April 2021 3.2.2 3.2.3 The Audit & Risk Committee Annual Report 2020/21 was considered and approved with minor changes. The Annual Internal Audit Report was also considered and approved. The External Audit plan and timetable was approved, noting that the deadline for sign off had been pushed back to 30 November 2021. Audit Scotland – NHS in Scotland 2020. The Committee considered this report which related to the way in which the NHS had managed the Covid-19 pandemic. Audit Scotland – Tracking the implications of Covid-19 on Scotland’s Public Finances. Again this report was considered in detail along with the potential implications for public finance. The Internal Audit Plan, to be delivered by the Argyll & Bute Council Internal Audit Service was considered and approved. Internal Audit – Charging for Non-Residential Care Services. This report by the Internal Auditor was endorsed. Draft Financial Statements - Management Commentary and Governance Statement. The Committee had an early opportunity to review the contents of some sections of the draft Annual Report and Accounts. An updated Risk Management Strategy was considered and endorsed. The Committee also considered a report outlining progress made in respect of Workforce Planning. Meeting 2 – 29 June 2021 This meeting considered the un-audited accounts and governance statement in detail and approved these. The committee also formally thanked Judy Orr, Head of Finance and Transformation for her contribution to the Health and Social Care Partnership and for her contribution to the work of the Audit & Risk Committee specifically. Meeting 3 – 10 November 2021 Page 130
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3 3.2.4 3.2.5 This purpose of this meeting, which had been re-scheduled, was to approve the audited Annual Accounts and the Audit Report, presented by Audit Scotland. The committee welcomed the positive report by Audit Scotland and thanked the finance teams for their role in this. The Committee also welcomed the favourable outturn for the year but acknowledged that challenges in respect of financial sustainability remained. Upon conclusion of the formal meeting, members of the committee had the opportunity to have a private discussion with the Internal and External Auditor with no members of the executive team present. This is an important aspect of the role of the committee as it ensures that members are able to discuss issues freely with the independent auditors. Meeting 4 – 10 December 2021 Internal Audit Report – Care Programme Approach. The Committee considered this report in detail as it provided only limited assurance in respect of this area of activity. The management responses were accepted by the Committee, however, management were asked to accelerate their implementation if at all practicable. Internal Audit Report – Child Protective Services. This report was noted as it related to the Argyll & Bute Council internal audit programme. The report provided a substantial level of assurance, which was welcomed by the committee. Internal Audit Update – this report summarised progress in implementing Internal Audit Recommendations. It was requested that management updates be more comprehensive in future. Audit Scotland – Vaccination Programme. The Committee considered the positive report by Audit Scotland in respect of the national vaccination programme. The implications of the recommendations for the HSCP were discussed. A number of other relevant Audit Scotland reports were also highlighted. Strategic Risk Register – an updated Strategic Risk Register was reviewed and endorsed by the Committee, prior to its consideration by the IJB. It was noted that the risk environment facing the HSCP was perceived as worsening at this time. Meeting 5 – 15 February Internal Audit Update – TBC Draft Annual Report of the Audit & Risk Committee Audit Scotland – Social Care Briefing. This report highlighted a number of challenges facing the Social Care Sector at present with Audit Scotland suggesting that these were sufficiently severe as to be putting service delivery at risk. 3.3 Committee Self-Evaluation and Improvement 3.3.1 The self-assessment process was completed by the Committee in February 2021 and was reported in full in the Committee’s annual report for 2020/21. Page 131
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4 3.4 3.4.1 3.4.2 3.4.3 The exercise was not repeated in 2021/22. The table below summarises progress in respect of the improvement agenda arising from the self- assessment exercise: Training for new Committee Members Board Development Events are now held regularly, specific induction and training for new committee members will be required for new members due to join in 2022. More timeous reporting on performance concerns, policies and strategies & Risk Management Partially Complete – contextual reports are provided to the committee and the Strategic Risk Register is now considered regularly. Performance reporting continues to sit largely with the Finance and Policy Committee and the IJB. Minutes to highlight key issues Complete – minutes report key issues and actions. Action tracker to be established Tracker of progress in implementing audit recommendations now in place. Meetings to be held with independent auditors with no officers present. Complete – this is now scheduled for 1 meeting per year minimum. It is acknowledged that there were a number of challenges faced by management during the year, including the ongoing impact of Covid-19, a change in the Internal Audit providers and significant turnover within the senior team. Despite this, a number of improvements have been implemented during 2021/22. Committee Membership and Remit The Committee membership consists of six IJB members, the Committee chair may not be either the Chair or the Vice-Chair of the IJB. Only 4 places were filled during the year. The IJB is currently seeking to appoint to the vacant positions. In addition there are 4 required attendees – the Chief Officer, Chief Financial Officer, External Auditor (Audit Scotland) and Internal Auditor (Argyll & Bute Council Internal Audit Service). Other officers attend as required. Councillor Sandy Taylor stepped down from chairing the Audit & Risk Committee at the end of the year. The Committee wish to express thanks to Councillor Taylor for the role he has played in ensuring that the Committee has operated effectively, carried out its duties with diligence and driven the improvement agenda. The remit was last revised in January 2021, the Committee has ensured that its work is consistent with its remit and this enables the Committee to provide Page 132
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5 3.5 3.5.1 3.5.2 3.5.3 3.5.4 3.5.5 assurance to the IJB that it has fulfilled its role effectively throughout 2021/22. Evaluation by the Chair Despite on-going challenges arising from the Covid-19 pandemic, the committee has met regularly and has been able to operate effectively. In addition to Covid-19, there has been significant changes of management staff and a new Internal Auditor was appointed for 2021/22. Whilst there has been some loss of continuity as a result of these changes, the Committee has operated effectively and has contributed to ensuring that the management of risk and assurance has continued. Specifically, the committee would like to acknowledge the role the previous Head of Finance and Transformation has played in improving governance arrangements and in her role in supporting the Committee throughout the last 2 years. The work of the Audit and Risk Committee clearly evidences the IJB’s commitment to transparency, accountability and effective scrutiny of management. The committee has comprehensively fulfilled its remit in terms of consideration of internal and external audit reports, national performance reports and review of the annual accounts and the internal control environment. Financial performance for the year ended 31 March 2021 was welcomed. The HSCP underspent against its budget for and was able to repay a significant proportion of its debt to Argyll & Bute Council. It is acknowledged that the year was far from typical, however, it is hoped that this represents a turning point in the financial management of the HSCP. The Committee, its Auditors (and the IJB) do however recognise the significant financial challenges that face the HSCP and the sector more widely. The Committee was extremely pleased with the high level of assurance provided by the External Auditor that accounting and reporting arrangements within the finance teams are robust and appropriate. Internal Audit One of the key responsibilities of the Committee is to ensure that agreed management actions made in response to audit recommendations are implemented. The Committee scrutinises this in detail regularly, the on-going covid situation has had an impact upon the ability of the Internal Auditor to fully complete the work programme during the year. Some audits have therefore been carried forward into 2022/23, this was due to the ability of management to facilitate the audit fieldwork as some activity was stood down in December 2021. The table below provides a summary of progress: Recommendation Grade New Recommendations made during year Recommendations completed during year Outstanding at 31 March 2022 High 3 1 6 Medium 2 2 3 Page 133
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6 3.5.6 3.5.7 3.5.8 Low 3 VFM 1 Total 5 3 13 External Audit The External Auditor’s report has been considered previously. The report was a positive one and the auditor issued an un-qualified audit opinion in respect of the accounts for 2020/21. The report concluded that: The IJB has appropriate and effective financial management arrangements in place and returned an underspend of £1.089 million against a budgeted breakeven outturn. The IJB has appropriate governance arrangements in place that support the scrutiny of decisions by the Board. The IJB has put in place appropriate arrangements to demonstrate the achievement of Best Value. The External Auditor highlighted risks in respect of financial sustainability and the turnover of senior staff. They also made recommendations in respect of performance reporting and re-iterated previous recommendations in respect of the savings programme and workforce planning. Good progress has been made in respect of the Committee improvement agenda set out through the self-evaluation process, however further work is required in respect of better developing the scrutiny and assurance framework the committee operates within. Further development in respect of Best Value is also required as the HSCP moves into a period of structural change. There is also a requirement to fill the vacant member roles and ensure that members have access to the training and development they require to fulfil their roles effectively. The further development and improvement of the Committee should be considered an important priority for the coming year. I am pleased to commend the work of the Committee to the IJB and provide assurance, that in my opinion, the Committee has operated effectively throughout the year and has discharged its responsibility with diligence. This opinion is formed on the basis of the totality of evidence considered by the Committee throughout the year. I would also like to acknowledge the role committee members, committee services, officers of the HSCP and auditors have played in facilitating the work of the Committee. 4. RELEVANT DATA AND INDICATORS 4.1 Minutes of Audit & Risk Committee meetings and related papers. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Page 134
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7 5.1 This document contributes to good governance of the Integration Joint Board and provides assurance to the IJB that the Audit & Risk Committee is operating effectively and in a manner that is consistent with its terms of reference. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – The Committee has considered a number of reports relating to the financial sustainability challenges faced by the HSCP. It did however welcome the positive outturn for the year ended 31 March 2021 and the resultant repayment of debt owed by the HSCP. The Committee continued to ensure it was informed of the wider financial context within which the HSCP is operating. 6.2 Staff Governance – The Committee continues to scrutinise progress on workforce planning and associated risk. 6.3 Clinical Governance – None. 7. 7.1 8. PROFESSIONAL ADVISORY Consideration should be given to this report. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 9. 9.1 None directly from this report. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No issues arising directly from this report. 10. RISK ASSESSMENT 10.1 The Committee has commented on a number of occasions on key financial sustainability and workforce planning risks for the IJB. It has also reviewed and scrutinised the Strategic Risk Register and recommended changes in advance of its consideration by the IJB. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 The report draws from findings of 2021/22 internal audit and external audit reports. There has been no direct public or service user involvement in respect of the work of the Committee during the year. 12. CONCLUSIONS 12.1 The Audit & Risk Committee is asked to consider this report, request that it is updated once the Annual Internal Audit Report is available and amended Page 135
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8 for any changes agreed by the Audit & Risk Committee. The report should then be presented to the IJB. The report concludes that the Audit & Risk Committee has performed its role effectively throughout 2021/22. It recognises the challenges faced by management as a consequence of Covid-19 and the significant change in senior staff. The Committee has operated in line with its terms of reference and has received independent assurance from Internal and External Auditors throughout the year. It has scrutinised, in detail, the reports presented to the committee and has continued to seek to contribute to the development of the governance, assurance and risk framework of the HSCP. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Councillor Sandy Taylor, Chair of Audit & Risk Committee sandy.taylor@argyll- bute.gov.uk Appendix 1 – Annual Internal Audit Report (TBC) Appendix 2 – Annual External Audit Report Page 136
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1 Integrated Joint Board Date of Meeting: 24 August 2022 Title of Report: Clinical and Care Governance Annual report Presented by: Sarah Compton Bishop The IJB is asked to: Note the annual report 1. EXECUTIVE SUMMARY The Clinical and Care Governance Committee met on four occasions within the financial year April 2021-March 2022 to undertake its supporting role for the Argyll & Bute Integration Joint Board. 2. INTRODUCTION The Clinical and care Governance Committee undertakes the following responsibilities detailed in paragraph 5.8 of the Integration Scheme on behalf of the IJB: Mechanisms to measure quality, clinical and service effectiveness and sustainability. Compliance with statutory, legal and policy obligations strongly underpinned by human rights values and social justice. Service delivery will be evidence-based, underpinned by robust mechanisms to integrate professional education, research and development. Measure the quality of integrated service delivery by measuring delivery of personal outcomes and seeking feedback from service users and/or carers; Professional regulation and workforce development; Information governance Safety of integrated service delivery and personal outcomes and quality of registered services 3. DETAIL OF REPORT Page 137 Agenda Item 13b
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2 3.1 The Clinical and Care Governance Committee met on the following dates and was quorate: 18 March 2021 10 June 2021 9 September 2021 24 February 2022 The committee seeks to deliver assurance to the IJB on the delivery of clinical and care services and communicate that assurance to partners. Minutes of the committee are presented at the Integration Joint Board and available in the public forum. Reporting to the committee has included Quality and Patient Safety, Infection Control, reports by exception in areas the committee has asked for further scrutiny or risk review, inspections and preparation for inspection and localised reporting by exception. It has also considered the impact of incoming national policy or clinical guidelines and any advice/recommendation or impact which requires to be given to the Integration Joint Board including the Independent Review of Adult Social Care. The Committee has over the course of the year brought into review the membership of the committee and the wider clinical and care governance framework. This review has sought to ensure a robust approach to clinical and care governance and a test of the statutory structures and their effectiveness and reporting through both partners and the board. The process for Acute governance with NHS Highland is also being reviewed to support the sharing of information, reporting, best practice and ensure consistency in clinical approach. This was reconvened in December 2021 and activity postponed due to emergency response but has reconvened with a target date for completion by the end of the second quarter of 2022-23. The IJB has delegated scrutiny of the performance report to the Clinical and Care Governance committee with a recommendation of action planning and update to the IJB as required. 4. RELEVANT DATA AND INDICATORS Data and reports submitted to committee, performance reporting. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Delivers Strategic priorities and contribution to planning. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact None identified 6.2 Staff Governance Page 138
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3 Development of systems/initiatives to support staff 6.3 Clinical and Care Governance Oversight and scrutiny of the clinical and care governance framework and reporting by exception. 7. PROFESSIONAL ADVISORY Maintains professional oversight through membership and response. 8. EQUALITY & DIVERSITY IMPLICATIONS Oversight of equalities practices in clinical and care settings 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE The Committee is not held in public and any relevant learning from case assessment is not identifiable. 10. RISK ASSESSMENT Committee assurance contributes to review and assessment of risk. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT None required for this report 12. CONCLUSIONS The Clinical and Care Governance Committee has a function in gaining assurance on behalf of the IJB for the delivery of services. The Committee is continually reviewing and seeking the most effective way to gain this oversight across all services. It is noted that the deployment of the updated Clinical and care governance framework will support the committee to take a focussed approach to delivering this for the IJB but that this is a work in progress for the year 2022-23. We look forward to reporting to the IJB in May 2023 on the impact of this. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Page 139
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1 Integration Joint Board Date of Meeting: 24 August 2022 Title of Report: Finance & Policy Committee Annual Report 2021-22 Presented by: Chair of Finance & Policy Committee The IJB is asked to: Note the annual report 1. EXECUTIVE SUMMARY 1.1 1.2 1.3 In line with the principles of good governance, an Annual Report is prepared by the Finance & Policy Committee for submission to the Integration Joint Board. The purpose of this report is to provide the IJB with assurance that the Committee has evaluated its activity and performance. It also provides a further opportunity for the Committee to raise any matters of concern to the Board. This report provides the Annual Report of the Finance & Policy Committee for financial year 2021/22. The Committee has met on 10 occasions during the year, with all minutes submitted to the Integration Joint Board and published within those papers. The Committee has been supported throughout the year by the Council’s Committee services team and all papers and minutes have been published for members to access. This report provides both a summary of the work of the Committee as well as an evaluation of its effectiveness. 2. INTRODUCTION 2.1 The purpose of this report is to provide the IJB with a summary of the work of the Finance & Policy Committee and assessment of how it has performed its governance role throughout 2021/22. The finances of the HSCP remained a high risk throughout much of the year and required the committee to continue to scrutinise and challenge financial reports throughout the period. The turnover in respect of the Chief Officer and Chief Financial Officer roles at the same time added to the perceived risk in this regard. The Committee considers that it performed well in its oversight of Finance and is therefore pleased to be able to provide assurance to the IJB that it has operated effectively throughout the year. The Committee considers that its work over the past two years in particular has contributed to improved financial management and performance of the HSCP. Page 141 Agenda Item 13c
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2 3. DETAIL OF REPORT 3.1 3.2 3.2.1 The report provides and overview of the following aspects of the work of the Finance & Policy Committee: Summary of the Committee Meetings Committee Self Evaluation & Improvement Committee Membership and Remit Evaluation by Chair Finance & Policy Committee Meetings This section provides a summary of the items of business considered at each of the meetings of the Committee held during the year. Meetings were held electronically throughout the period and the Committee continued to meet more frequently than the other committees of the IJB. The IJB is provided with the minutes of each meeting as a matter of course, this also provides members with the opportunity to raise issues or question the Chair in respect of the work of the Committee at any point during the year. Meeting 1 - 23 April 2021 3.2.2 The governance arrangements for the Transformation Programme and Board were considered and approved, along with an update report and a summary of the work of the Service Improvement Officers. A progress report / deep dive report on the Older Adults and Community Hospitals Budget and Savings Programme was considered. The committee also completed its self-assessment. Meeting 2 – 21 May 2021 The favourable outturn position for 2020/21 was welcomed and the additional repayment of debt to Argyll & Bute Council agreed, along with a revised schedule for the repayment of the balance. A summary of the costs and funding associated with covid-19 was considered. Routine reports on Financial Risk, a Transformation update and the budget outlook were also presented. The annual report by the Chair of the Committee was noted and approved. A detailed paper on the Jura Respite Flat was discussed in detail. The Children and Families deep dive report on savings was considered. A proposal to relocate GP Premises and Services into the Cowal Community Hospital was discussed and approved to progress. The committee also formally thanked Judy Orr, Head of Finance and Transformation for her contribution to the Health and Social Care Partnership and for her contribution to the work of the Finance & Policy Committee and HSCP more widely. Page 142
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3 3.2.3 3.2.4 3.2.5 3.2.6 3.2.7 Meeting 3 – 25 June 2021 The Month 2 Management accounts were considered, these presented a significant forecast overspend position. A Transformation update based on the 4th June Transformation Board meeting was considered along with a detailed review of progress with Corporate Savings. Meeting 4 – 27 August 2021 The Committee considered the period 4 management accounts which still reported a substantial forecast overspend. As a consequence, the Committee requested the incoming Chief Financial Officer to prepare a recovery plan for the September IJB meeting. This was to ensure compliance with the terms of the Integration Scheme. Routine reports on the Budget Outlook and Financial Risks were considered. An update on the Transformation Programme was also reviewed along with a deep dive progress report on the Learning Disability and Mental Health Programme and Savings. The Committee also welcomed James Gow, the new Chief Finance Officer, to the IJB. Meeting 5 – 24 September The 5 month management accounts showed some improvement in the forecast position, this was welcomed by the Committee in the context of the Recovery Plan. A report indicating that there was a requirement to review historic savings plans as part of the financial planning process was considered in detail and endorsed. The Transformation update and a deep dive progress report on the Older Adults and Community Hospitals Programme were also considered. Meeting 6 – 22 October The 6 month management accounts showed further improvement in the financial position and forecast. The outcome of the review of the savings programme was considered in detail and endorsed, prior to approval by the IJB, the financial implications of this were debated at length. The budget outlook and financial risk update reports were considered. Transformation reporting focussed upon Children and Families as well as a paper reviewing the operation of the Transformation Board. Meeting 7 – 19 November Page 143
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4 3.2.8 3.2.9 3.2.10 The 7 month management accounts again reported an improving in- year financial position and highlighted expectation of significant additional resource to help manage winter pressures. The Committee agreed that the HSCP should implement the pay increase for care workers in line with Government policy. A budget outlook report was considered which also outlined the proposed approach and timetable for the preparation of the budget for 2022/23. The normal Transformation Update report was considered alongside detailed reports covering Corporate savings along with a deep dive report from the Care Homes and Housing Programme Board. Meeting 8 – 21 January The 8 month management accounts provided the committee with confidence that the financial position was improving although a small overspend was still forecast. A report on progress with the setting of a budget, savings proposals and the consultation process were all discussed in detail and endorsed. This report also provided the Committee with an overview of the Scottish Government’s Draft Budget. The Financial Risk register for the current year was considered. Social Work fee increases were endorsed prior to consideration by the IJB. Transformation Progress was reported in respect of the Learning Disability and Mental Health Programme Board and the Older Adults and Community Hospitals savings. A progress report on the development of joint strategic planning in respect of Learning Disability and Autism was noted. Meeting 9 – 25 February The Committee welcomed the Month 10 finance report which indicated that an underspend was now forecast and that this would enable an increased debt repayment at the year end. A progress report on the establishment of the budget for 2022/23 was considered. A report outlining some changes to the way in which the Transformation Programme was operating was discussed in detail and welcomed by the Committee. It was noted that some pieces of work had been temporarily stood down as a result of the Omicron response. An update on the Jura Community Care Flat was also considered, it was noted that this had been a substantial piece of work which had now been concluded. Meeting 10 – 18 March The 11 month management accounts showed further improvement in the financial position and the committee noted that an increased underspend was now forecast and that a significant additional debt repayment was now expected. Page 144
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5 The committee endorsed the budget and savings programme for 2022/23 with a detailed discussion on how the consultation process could be improved in future years. Transformation and savings reports relating to Children and Families and Corporate savings were also reviewed in detail. 3.3 Committee Self-Evaluation and Improvement 3.3.1 3.3.2 The self-assessment process was completed by the Committee in April 2021 and was reported in full in the Committee’s annual report for 2020/21. The exercise was not repeated in 2021/22. The table below summarises progress in respect of the improvement agenda arising from the self- assessment exercise: Training for new Committee Members Board Development Events are now held regularly, specific induction and training for new committee members will be required for new members due to join in 2022. Ensure Professional Leads are involved and consulted where necessary Complete, all reports now reference this and, for example, extensive discussions took place in respect of consultation on the budget and savings proposals for 2022/23. Sharing of best practice with other Committees and the IJB Partially Complete – Board Development events and inclusion of all minutes on the IJB agenda has provided opportunity for improvement in this regard. Action tracker to be established Tracker of progress with savings programmes and transformation projects now in place. More extended updates to IJB from the Committee and publication of papers Complete – papers now available to all Board Members and significant time allocated to Finance related matters at the IJB development events. Workplan to be presented regularly and refreshed Complete – workplan in place Committee to seek feedback from IJB and Accountable Officer Partially Complete – board development sessions and detailed discussion at full IJB meetings relating to the work of the committee provide specific opportunities for feedback. It is acknowledged that there were a number of challenges faced by management during the year, including the ongoing impact of Covid-19 and significant turnover within the senior team. Despite this, a number of improvements have been implemented during 2021/22. Most importantly, Page 145
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6 3.4 3.4.1 3.4.2 3.4.3 3.5 3.5.1 3.5.2 3.5.3 the Committee was able to hold 10 meetings during the year which, as outlined above, facilitated strategic oversight and scrutiny in respect of the financial position, the budget, budget outlook and the Transformation and Savings programme. The Committee were also required to make some difficult decisions during the year and did this appropriately, examples included approving the outcome of the review of the savings programme and pressing for the development of a Financial Recovery Plan in response to reports of an adverse in-year financial position. Committee Membership and Remit The Committee membership consists of six IJB members. New members were appointed and all places were filled throughout the period. In addition there are 3 required attendees – the Chief Officer, Chief Financial Officer and Staffside representative. Other officers attend as required. Councillor Kieron Green chaired the Committee throughout the year and the Committee wish to express thanks for the role he has played in ensuring that the Committee has operated effectively, carried out its duties with diligence and driven the improvement agenda. The remit was last revised in January 2021, the Committee has ensured that its work is consistent with its remit and this enables the Committee to provide assurance to the IJB that it has fulfilled its role effectively throughout 2021/22. Evaluation by the Chair Despite on-going challenges arising from the Covid-19 pandemic, the committee has met regularly and has been able to operate effectively. In addition to Covid-19, there has been significant changes in the senior management team. Whilst there has been some loss of continuity as a result of these changes, the Committee has operated effectively and has contributed to ensuring that financial management, financial risk management and oversight of the transformation and savings programme has continued. The Committee would like to acknowledge the work of officers in continuing to provide detailed and clear reports which have supported its work throughout the transitional period. Additionally the committee would like to acknowledge the role the previous Head of Finance and Transformation has played in improving governance arrangements and in her role in supporting the Committee throughout the last 2 years. The work of the Finance and Policy Committee clearly evidences the IJB’s commitment to addressing the financial challenges which have faced the IJB for a number of years. The committee has comprehensively fulfilled its remit in terms of oversight of finances, considered by the IJB to be a high priority strategic risk. The Committee have provided appropriate challenge to officers and has been able to take important decisions when required. It has also been effective in enabling more detailed discussion of financial matters prior to formal consideration and approval by the full IJB Page 146
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7 3.5.4 3.5.5 3.5.6 The Committee has continued to allocate significant time to the Transformation and Savings programme. This has included ‘deep dives’ in respect of each service and the work being progressed to make savings and transform the way in which services are delivered. Financial performance for the year ended 31 March 2021 was welcomed, the positive position enabled the IJB to repay some of its debt early which in turn reduced financial risk for future years. The Committee also welcomed further progress in this regard towards the end of 2021/22. This was due to a number of factors including delivery of savings, careful financial management and additional funding from the Scottish Government. The early repayment of debt is a significant priority for the Committee. It is recognised that the requirement to repay debt has placed additional financial strain on the HSCP which in turn has constrained investment and transformation. The improvement in the financial position is regarded by the Committee as an important achievement, however, there is a requirement to ensure that value for money is being delivered and further efficiencies and savings will be required in future to ensure that the HSCP continues to operate on a financially sustainable basis. I am pleased to commend the work of the Committee to the IJB and provide assurance, that in my opinion, the Committee has operated effectively throughout the year and has discharged its responsibilities with diligence. This opinion is formed on the basis of the totality of evidence considered by the Committee throughout the year. I would also like to acknowledge the role committee members, committee services, officers of the HSCP have played in facilitating the work of the Committee. 4. RELEVANT DATA AND INDICATORS 4.1 Minutes of Finance & Policy Committee meetings and related papers. 5. CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 This document contributes to good governance of the Integration Joint Board and provides assurance to the IJB that the Finance & Policy Committee is operating effectively and in a manner that is consistent with its terms of reference. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – The Committee has considered multiple reports relating to financial performance and planning. The Committee is extremely pleased that the position has improved over the past two years and risks in respect of finance are perceived to have reduced substantially as a result. 6.2 Staff Governance – The Committee has considered staff governance issues as part of its scrutiny of savings and transformation projects and the financial position which has indicated vacancies and recruitment are an on-going issue. 6.3 Clinical Governance – None. Page 147
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8 7. 7.1 8. PROFESSIONAL ADVISORY Consideration should be given to this report. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 9. 9.1 None directly from this report. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No issues arising directly from this report. 10. RISK ASSESSMENT 10.1 The Committee has reviewed financial risks in detail throughout the year. In terms of the wider strategic risk relating to financial management, it is perceived that this risk has continued to reduce throughout the last two years. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 The Committee scrutinised the proposed public engagement and consultation methodology in respect of the budget for 2022/23 in some detail. Whilst it was possible to make some improvements to this during the year, officers were requested to review the process and improve engagement processes further. 12. CONCLUSIONS 12.1 12.2 The Finance & Policy Committee is asked to consider this report and request that it is placed on the next agenda of the IJB, following any amendments requested by the Committee. The report concludes that the Finance & Policy Committee has performed its role effectively and diligently throughout 2021/22. It recognises the challenges faced by management as a consequence of Covid-19 and the significant change in senior staff. It has scrutinised, in detail, the reports presented to the committee and has continued to contribute to the improving financial position of the HSCP. The early repayment of debt, delivery of savings and reduced financial risk are considered to be important achievements in the last two years and provide a significant opportunity for the HSCP to focus on longer term transformation and planning. 13. DIRECTIONS Directions to: tick Page 148
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9 Directions required to Council, NHS Board or both. No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Councillor Kieron Green, Chair of Finance & Policy Committee kieron.green@argyll-bute.gov.uk Page 149
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