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MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP
THURSDAY 12 JUNE 2014
MEETING ROOMS 1 AND 2, SPYNIE DENTAL CENTRE, ELGIN
Present
Mr Bill Howatson, Chair of NHSG Board (Chair)
Ms Judith Proctor, Interim General Manager
Mrs Tracey Gervaise, Public Health Lead
Councillor Lorna Creswell
Mrs Deborah O’Shea, Principal Accountant
Mr Bob Sivewright, Finance Manager
Mr Fabio Villani, Chief Officer TSI
Mr George McLean, Business Manager
Ms Elsie Watson, Community Representative
Mrs Val Thatcher, Community Representative
Ms Catriona Campbell, Joint Performance Officer
Ms Brigid Aitken, R.C.N. Accredited Steward & Safety Rep
NHS Grampian
MCHSCP
MCHSCP
Moray Council
Moray Council
MCHSCP
Third Sector
MCHSCP
PPF
PPF
Moray Council
NHS Grampian
In Attendance
Mrs Lorna Bernard, LiU Project Manager; Mr Roddy Huggan, Commissioning and Performance
Manager; Ms Eilidh Brown, Development Officer (TSI); Ms Emma Pettis, Corporate Communications
and Mrs Isla Whyte, Minuting Secretary.
Apologies
Apologies were intimated on behalf of Mrs Jane Mackie, Head of Community Care; Mr Jim Walker,
Community Representative; Mr Ian Francis, Partnership Rep; Mrs Liz Tait, Professional Lead for
Clinical Governance; Mr Sandy Thomson, Pharmacy Manager; Dr Mark Houliston, GP/ Joint
Clinical Lead; Dr Graham Taylor, GP/Joint Clinical Lead; Mr Sandy Dustan, Hospital Manager – Dr
Gray’s; Mrs Jennie Williams, AOM Children & Families and Mr Sandy Riddell, Director of Education
and Social Work.
1. Welcome
The Chair welcomed everyone to the meeting and noted that he would take the Chair for today’s meeting in
place of Ms Christine Lester who was on annual leave. Those around the table introduced themselves.
Apologies were noted as above.
2. Minute of the Moray Community Health and Social Care Partnership Dated
13 March 2014
The minute was approved as an accurate record of the meeting.
The following grammatical errors are to be amended:
Item 6, page 4, second paragraph – the word ago added to sentence.
Item 6, page 4, last word – apostrophe added.
Item 6, page 5, first paragraph – apostrophe added.
3. Matters Arising
Mobile Information Bus (pg3) – now in operation. The MIB preview recently took place for partners and staff,
received great reviews. The MIB is a community planning resource; partners gave a number of ideas of how
to utilise as well as NHSG.
Audit Commission Report (pg5) – this refers to the Joint Pilot Inspection of Care for Older People carried out
by Care Inspectorate. Judith advised that comments re accuracy have been collated and fed back to the
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Inspection agencies and that we now await the final report – due around June, will circulate widely when
released.
4. Integration of Health and Social Care - update
Judith reported a letter has been received from Kathleen Bessos, SG, detailing the next steps towards
integration (attached). The scope of service is wide ranging. More clarity has been received around the
draft Orders and Regulations – currently out for consultation – Ms Bessos’s letter advises they expect the
Orders and Regulations will be laid in Parliament in September and October 2014 and it is proposed to bring
them into force from December 2014.
By 1 April 2015 Health Boards and local authorities must submit an integration scheme for approval. Judith
reported model schemes are being made available.
1 April 2016 is the date by which all the integration arrangements as set out in the Act, Orders and
Regulations, must be in place and responsibility for the functions are delegated according to the integration
scheme. Judith confirmed those dates are fixed unless feedback from consultation suggests otherwise.
Judith noted the challenges around the timescales in relation to the actions required.
There is a Transitional Leadership Group (TLG) meeting next week, looking at timescale of what needs to be
done and update on work that is happening on the ground – including the community engagement taking
place.
In relation to the role of Chief Officer for Moray - Judith confirmed that the interview panel did not appoint to
Chief Officer post; and that this will be going out to advert again at the end of this month.
A Memorandum of Understanding (MOU) is being developed which will support the TLG to consider its role
as shadow Integrated Joint Board– will go to Board Seminar for discussion. The Chair advised there is a
Board Seminar with Aberdeenshire tomorrow – keen to have joint meetings.
Robin Paterson provided a presentation about the broader engagement work being done to the Moray GP
Leadership Group. The GPs recognise the challenges and opportunity. It was agreed at that meeting Robin
and others would provide a 30min Q&A presentation and offer attendance at each GP Practice in Moray.
Cllr Creswell asked if there is a Patient’s Participation Forum in each ward. Tracy advised that members of
PPF attend a number of integration meetings and there are some PPF at practices. Brigid advised, on
behalf of staff side, they would welcome some more accessibility for staff understanding and engagement
Judith advised there will be further engagement work – second integration newsletter detailed this. Fabio
thought it would be helpful to explain the work Robin is doing. Judith advised Robin pulled together
beginnings of vision, work in progress, can bring to a future Committee meeting. The Chair thanked Judith
for the update and confirmed the Kathleen Bessos’ letter and the above mentioned paper be taken to the
next Committee meeting for discussion.
a)
5. Finance Update and Performance Measures
Exception Reporting – ‘At a Glance Summary’ and ‘Basket of Measures’
Moray scorecard circulated with papers. George advised there will be new measures to report against
in the future, those detailed in the current report are historical. George highlighted the following areas sickness absence reducing, diagnosis of dementia increasing – more support available. Delayed
discharges – remains low. Anticipatory Care Plans – over 1500 patients with plans in Moray. ACP data
will be circulated to GP Practices; will encourage practices to ensure ACPs are in place for those who
need one. George surmised that overall Moray is performing very well.
Data has shown that Moray has the highest number of terminally ill patients living in their own homes for
the last 6 months of their lives – this is what patients are asking for and is a positive indication for
preferences being delivered for end of life care and support. George also reported he is leading a
community profiling bed / equipment exercise this afternoon as there are a large number of people
being looked after at home – that’s what they want.
Brigid asked for clarity around the data for sickness absence asking if figures still exclude Dr Gray’s
Hospital staff. George confirmed that the data excludes Dr Gray’s as their sickness absence is reported
through the acute sector.
Basket of Measures - Catriona presented the ‘Basket of Measures’ circulated with papers, advising
those measures highlighted in yellow are incomplete – not yet got full measurement of.
Measure B2 - have 1 years worth of data, looking back further, want 3 years of data.
Measure B4 – have 2 yrs of data – have further info for people to see if they want.
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Measure B7 – no measure in place medical team is agreeing the content of the comprehensive geriatric
assessment.
A1 – Moray is the lowest in Scotland for emergency admissions. A2 – 3 delayed discharges that are
over 4 weeks for May 2014. A3 – not much change. A lot of work is being done in this area. As
previously reported Moray was successful in its bid to become 1 of 5 areas for pilot of the 8 Pillar Model.
A4 – above average. A5 – latest figures for 11/12 – still awaiting info for 12/13 and 13/14. A6 - carers
feel supported – still maintaining over 90% target. In Q3 – couple concerned about and fed back
through services. B1 - 2 figures will do 6 monthly from now on. Hoping to expand more with community
care side. B3 – Moray doesn’t look good however not all areas count the same ie some have set
packages put out for area, some charge, some don’t, some assess needs. Would be good to have a
set measure as currently all doing slightly differently, so not comparing like for like. B5 – same as last
time. B6 – falls work; causes, prevention – getting daily information from NHS Grampian now. B8 –
permanent care slightly up.
Judith asked for clarity these are the basket of measures given to us by JIT? Catriona confirmed for
Change fund. It was noted that it will be very difficult to meet new delayed discharges target which is
going from 4 weeks to 2 weeks. Catriona spoke re measure B8 – there is a rising elderly population in
this area – saw this flat line where people were fitter, seeing a different generation now below that, that
are now putting pressure on care homes, can see that increase. Judith asked the appropriateness and
usefulness of measures ie falls – nothing shows the appropriateness of what we are doing and elderly
population – how do we reflect the appropriateness of the care once they fall? Catriona agreed, she
advised can get the patient CHI number to follow patient through to see what problem may be and how
to support ie some falls are with patients who have telecare but didn’t use it. Catriona would also like to
see consistency in recording of falls.
Cllr Creswell referred to a presentation on benchmarking given by SG to Moray and Highland
Councillors and had asked if we could measure on social accounting / auditing terms as well as
monetary and presenters agreed to explore this. Highland Councillors agreed in terms of care and
preventative work often cannot be measured easily, softer data indicators important. Cllr Creswell
asked how do we assess and measure in social terms as opposed to monetary terms ie with respite
care the benefits to whole family. Judith advised the discussion was a timely one, phrase used before
was social return on investment. Health and wellbeing measures – being outcome focused. The Chair
asked if the 3 delayed discharges recorded for May is the beginning of upward trend. Catriona
confirmed it was and it is being looked at seriously, formed a group to look at individual cases. Judith
advised there has been some work done with collegiate Moray – something we are working on all the
time. Fabio asked if Catriona knew the cause of those 3 delayed discharges. Catriona advised one
was recorded as other and two were patient carer or family related reason. That could mean it was not
convenient to go home ie family reasons or home carer sick.
b)
Financial Performance
Finance update circulated with papers – shows position end of financial year 13/14. Overspends
detailed in the report. Challenge for next financial year will be going into integration. Judith commented
there are continuing challenges in overseeing this budget; however, in terms of budget savings
additional efficiency savings have been identified. Committee noted the report and financial position
statement.
6. Sensory Impairment Strategy Implementation Funding
The Scottish Government has developed a National Strategy for Sensory Impairment called ‘See Hear: A
Strategic Framework for Meeting the Needs of People with a Sensory Impairment in Scotland’ – a copy of
which was circulated with papers. Roddy reported it is in good readable format with only 7
recommendations. Will take national strategy and incorporate with local work – links well with physical and
sensory. Point 3.7 of the report sets of the proposal on how to utilise Moray’s allocation of funding. Roddy
confirmed the two posts and process will support strategy – it is a partnership activity. Due to the staffing
issues involved the report will also go to Full Council. The Chair asked Roddy to advise of the level of
engagement. Roddy advised there are lots of methods of engagement and open to suggestions. There are
questionnaires, get groups of people together to get an idea of what’s important to them, engage with third
sector, potential providers, public and staff, will also go to established events / meetings. Public involvement
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officers will support. The Chair agreed it is important not to make assumptions before engagement. Judith
made two points, 1) format of engagement, how do we use technology for that in support of people with
sensory impairment and 2) if we have short term funding to help with engagement, need to identify support
needed after that. Awareness raising and training etc. Roddy acknowledged it is a small amount of money
and with it we won’t be able to fully support. Understand we need to invest in resources, working on, it will
be challenging. There is an implementation plan to take forward. George said he noticed national strategy
is sensory and we are including physical impairment – how can that be done without losing out on outcomes.
Roddy replied these pieces of work pull together, any work that needs to be done to support one links with
the other. The Chair and Committee are happy to support and agree to use of funding as set out in the
report. The Committee would welcome feedback further down the line to see how progressing.
7. ‘Living It Up’ – Project Update
Lorna Bernard joined today’s meeting to provide an update on the Living it Up (LiU) project and provide
awareness of the launch of Jimmy’s Blog and Facebook page. Unfortunately Jimmy was unable to attend
today. The report circulated with papers celebrates the wide range of community champions who support
this project. Jimmy has been writing a blog for LiU since the beginning of the year. The aim is to put the
human element back into the work that is being done. The blog has been very well received – lots of people
are connecting with it. Jimmy has lots of ideas, he meets with people informally about using technology;
some people who would benefit from this project don’t use technology so have to get over that hurdle first.
Also trying to engage with some teenagers to help support use of technology with older people (digital
engagement) – it is a hidden talent. Lorna is in touch with a group in Moray called Living Golf – using golf as
motivation, inspiration and supporting health and well-being. Hope to spread these networks / tools out to
other areas ie smoking cessation – could get others to inspire. Funding for Living it Up runs out May 2015.
Cllr Creswell asked Lorna how she recruited the champions. Lorna advised Jimmy heard about LiU and got
in touch to see if he could get involved. Generally put feelers out and chat to people to see if they wish to
get involved. Range of champions involved including an octogenarian who uses a lot of technology. Fabio
expressed his interest in intergenerational work.
The Chair asked if there has been a report detailing positive outcomes achieved against original plan. Lorna
advised the national perspective is in hand – Glasgow Caledonian University are auditing it. Locally focusing
on tracking of benefits which is not always that easy. From today’s meeting Lorna advised she will take
away the support element outcomes.
Judith added that people taking own responsibility of care, Jimmy going out to support others – it’s very
powerful. Peoples’ experiences / stories – important to capture that. Champions group – links made with
North East Sensory Services – continue to make connections / network. Human interest stories key – they
inspire people. Val echoed Judith’s statement, adding it is very inspiring, like the idea of getting in touch with
elderly people about technology – would help across the board in a number of areas.
The Chair concluded it is very important to personalise the work we are doing the rewards are colossal and
is advised he is very interested in Jimmy’s blog, regret that he cannot meet him today. Lorna advised she is
happy to come back to a future meeting to update, hopefully jimmy can attend.
The Chair noted the report and congratulated Lorna on the work to date.
8. Draft Market Position Statement
First iteration of draft Market Position Statement is attached with papers as Appendix 1. This is a transparent
process, with open dialogue with the wider community stakeholders by providing them with the current
picture of social care delivery including demand and finance. Judith stated that this was a very useful
document that brings together what we know about the challenges and sets out transition towards SDS and
how we facilitate that transition using models available. Clearly sets out transition and intent and it is open to
ideas. Roddy informed the Committee that feedback is welcomed.
Fabio advised one idea is reducing use of block contracts; gives purchasing power to stimulate economy.
That is great; however, releasing use of block contracts can create challenges – to transition onto different
model etc, he asked how that will be managed. Roddy replied it will be assessed and only progressed if
appropriate – very open at this stage. If not appropriate to move out of block contracts will consider that and
engage with public. He expressed it will be a very thoughtful process. Pauline Knox, SDS Commissioning
Lead, put this report together. It is evolving, considered approach, engaging nationally as well. George
made references to SDS in report, he advised this approach is new to us in health; legislation doesn’t allow
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us to do that, will be a challenge. Judith added the
root of it is outcomes of what people want to achieve
– not always about money and commissioning services, it can be about engaging with groups ie LiU project.
Roddy advised further iterations will be circulated when available. The Committee noted the report.
9. Introduction to the 10 Year Plan
Tracey reported the 10 year plan is a visionary document of where we (Moray) would like to be in 10 years
time, it is an approach taken by community planning partnership.
Obesity – would like to reduce prevalence in over 16s and young people, smoking cessation, reduce %age
of admissions to hospital relating to alcohol, mental health and wellbeing (will include suicide), early years
early preventions, breast feeding rates, community care service delivery – clients and service users feel
safe, reduce fuel poverty, there are a range of targets. It is quite challenging and a priority for community
planning partnership.
Judith added it is a developmental document and one that will be flexible. Tracy agreed saying it is an
opportunity to engage with community planning board to enable and support them to make informed
decisions. Cllr Creswell added it is a real shift in whole partnership moving forward, lots of players, lots of
opportunities, lots of resources. The Chair asked how plan will mesh with integration. Judith replied there is
no real clarity, integrated joint board recognises there will be a relationship between health and social care
partnership and community planning board but accountable to respective boards. Would like to see good
partnership working – dialogue to be had to see how the two organisations will work together. Cllr Creswell
stated health and social care is part of everyone’s agenda within Community Planning Partnership 10 Year
Plan. The Chair noted the information given and would welcome a presentation at the next CHSCP
Committee to look at in more detail.
10. AOCB
Dementia Awareness Week – Cllr Creswell referred to Dementia Awareness Week which was last week.
Lorna attended Dementia Adventure where a couple told a story about dementia and how it affected them
and their family from diagnosis to treatment; despair to a great outcome. Great human interest story.
8 Pillar Model – Cllr Creswell noted the reminiscent box in libraries – simple resource, all can get involved to
help.
Person Centred Approach – George attended a patient safety workshop in Glasgow where Sally Magnusson
did a presentation on dementia including the benefits of music. Pledge to provide music to those in
community hospitals with dementia. George reported Moray will try and put in place in the near future –
huge benefits.
11. Date of Next Meeting
The next meeting of the Moray CHSCP Committee will take place on Thursday 11 September, 10:00am,
Meeting Room, Spynie Dental Centre, Elgin.
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