HC/NHSH Leadership and Performance Group Minute

Agenda

Minutes of the Meeting of the Highland Council/NHS Highland Leadership and Performance Group held in Committee Room 2, Council Headquarters, Glenurquhart Road, Inverness on Tuesday 16 February 2009 at 3.00 p.m.

Present:-

NHS HIGHLAND

Mr G Coutts (in the Chair)
Mr I Gibson
Dr R Gibbins

HIGHLAND COUNCIL

Dr M E M Foxley (co Chair)

Mr A S Park

Mr J Finnie

Mrs M Davidson,

Mr A B Dodds

Present/For Action

Mrs H Dempster, Director of Social Work, Highland Council (HD)
Mrs J Baird, Director of Community Care, NHS Highland (JB)
Mr J King, Head of Community Care, Highland Council (JK)
Ms E Mead, Chief Operating Officer, NHS Highland - Item 7(ii)
Mr J Allison, Principal Administrator, Highland Council (JA)

Mr G Coutts in the Chair

1. Apologies for Absence

Apologies for absence were intimated on behalf of Mr J Gray, Highland Council.

2. Minutes of Previous Meeting

There had been circulated for approval Minutes of Meeting of the Leadership and Performance Group held on 16 December 2008, the terms of which were AGREED subject to the following amendment:

Item 9 Delete: the words “NHS (Highland)” from the second paragraph and insert “the Joint Partnership”.

3. Matters Arising

There were no matters arising from the previous meeting.

4. Social Work Inspection Report

There had been circulated Joint Report No lp-01-09 by the Director of Social Work enclosing the final report from the Social Work Inspection Authority following their recent follow-up inspection visit.

There was a wide ranging discussion during which the progress made with the recommendations was noted. It was recognised that a greater openness and honesty was important if real progress on joint working was to be made. It was agreed that this would enable more effective tackling of issues. However, it was acknowledged that there needed to be a greater understanding of the issues restricting joint working and cultural and behavioural issues also needed to be addressed.

Following a detailed discussion, the report was NOTED and it was AGREED that the following actions be undertaken:

(i) The comments made on partnership working be taken on board and an
     exercise of self assessment be undertaken next year to assess what
     improvements had been made;
(ii) The three Highland areas produce a joint report to highlight good joint
      working and at the same time point out the controls on these
      arrangements due to organisational blockages;
(iii) Badenoch and Strathspey/South East Area be invited to explain their
      methods and structures that seemed to work well, to determine what
      elements could be beneficially applied in other areas;
(iv) Budget implementation should be studied to see how the collaborative
      approach was working;
(v) The need for a protocol to ensure communication at appropriate levels
      was effective should be examined; and
(vi) That the CES would arrange a meeting with Directors and report back.

5. Single Shared Assessments Remit and Way Forward

There had been circulated Report No lp-02-09 by the Director of Social Work recommending the formation of a small working group, proposing a remit for such a group to lead on the redesign and mapping of the business process of electronic assessment and suggesting how the work might be progressed.

During discussion the following points were NOTED:

The current system asked about information that would be rarely needed or was not relevant to many cases;
Skills training was needed to assist staff to understand what information to collect in particular cases;
There were different solutions available but simple, understandable user friendly ones that gather relevant information were likely to be more acceptable;
While the technological aspect was important, for information sharing, GIRFEC had operated without the technological solution being implemented in the initial stages;
Work be done to streamline processes and eliminate duplication which, to be successful, would require radical redesign pulling the systems/processes into one.

And it was AGREED that:

(i) A report about the arrangements in North Lanark to make assessments
     simpler on how to obtain data for assessments to make it user focussed in
     order to get the system accepted by practitioners, be brought to the
     next meeting; and
(ii) Thereafter the group consider if the process met national standards.

6. Code 51X Patients: Delayed Hospital Discharge: Complex Cases

There was tabled lp-03-09 by the Head of Operations Community Care on the issues surrounding adults with brain injuries and their delayed discharge.

The following points were noted:

The Partnership should impose a time limit because a significant number of bed days were involved;
The assessments were often complex to complete in the 30 days guideline;
There was perhaps a need for a more detailed report on anticipatory care and demonstrating how this process could dovetail with single shared assessment; and
More detailed emphasis was needed on prevention and rehabilitation in relation to reducing delayed discharge.

The Group NOTED the report and AGREED that these points be considered in the review of the protocol and that Highland Community Care Forum be consulted.

7. Community Care Performance Report

i. Balance Scorecard

There had been circulated a copy of the Community Care Performance Balanced Scorecard 2008/09 which was NOTED and AGREED that it be recirculated once the blank pages had been completed.

ii. Exception Reports

a) Reduce Emergency Bed Days for Older People: (Reference; 1(iv))

There had been circulated Report by the Chief Operating Officer on the reduction of the rate per 1000 population of emergency occupied beds in acute specialities for older people (aged 65+) . The figures showed a small but steadily increasing figure and outlined the actions proposed to address the issue. The report was NOTED and AGREED that the position be monitored and a further report be submitted in 6 months time.

b) No Delayed Discharge Patients Waiting Over 6 weeks (reference :4(iii))

There had been circulated Report outlining the number of delayed discharge patients breeching the 6 week target. The reasons and possible solutions were discussed in full including the adoption of procedure used by other authorities.

The use of intensive home care in the most complex cases should be emphasised to staff. However, it was possible there were insufficient home carers to meet requirements.

The report was NOTED and AGREED that reports be prepared on the exceptional cases with consideration as to whether a letter should be issued by the Chief Executives to emphasise to breechers or their families the need for the release of the bed spaces.

iii. Balance Scorecard Definitions

The balanced scorecard definitions as at December 2008 were APPROVED.

8. Joint Community Care Plan

There had been circulated Report No lp-05-09 by the Director of Social Work setting out the scope of the Joint Community Care Plan and examined how it would be developed.

The Group AGREED:-

(i)   The subject should be a standing item on the Agenda for this group;
(ii) The Director of Social Work take back the feelings of the Group on the
      importance of the issues involved;
(iii) A briefing meeting be set up to inform all those involved; and
(iv) A report be submitted on the Joint Community Care Plan to the meeting
      of the Housing and Social Work on 27 May 2009 along with a
      presentation.

9. National Review of Care for Older People

There had been circulated Report No lp-06-09 by the Director of Social Work updating Members on the work of COSLA and the Scottish Government to pursue reviewing and reforming older people’s care in light of the imminent demographic changes and the existing and anticipated service pressures. The revised remit of the Ministerial Strategy Group for Health and Social Care embraced a more strategic and forward thinking agenda which would include substantial Service redesign but costs would need to be tested and COSLA were examining this.

The Group NOTED the report and AGREED that the issue was of sufficient importance that it might be a suitable topic for a paper to be submitted to the the Housing and Social Work Committee and it would be appropriate for NHS Highland to attend for discussion of the item.

10. Future Meeting Dates

Members APPROVED the following meeting dates for 2009:-