Minutes of the Special Joint Meeting of the Highland Council and the Highland NHS Board held in the Council Chamber, Council Headquarters, Glenurquhart Road, Inverness on Thursday, 12 May 2011 at 10.00am.
Present: Highland Council
Mr G Farlow, Ms L Munro, Mr R Rowantree, Mr D Mackay, Mr J Rosie, Mr B Fernie, Ms G Ross, Mr G Smith, Mr D Bremner, Mr R Coghill, Mr D Flear, Mr W MacKay, Mrs D Mackay, Mr J McGillivray, Mr I Ross, Mrs I Campbell, Mr R Greene, Dr A Sinclair, Mrs J Urquhart, Mr M Finlayson, Mr M Rattray, Ms M Smith, Mrs C Wilson, Mr R Durham, Mr A Rhind, Mr P Cairns, Mrs A MacLean, Mrs M Paterson, Dr D Alston, Mr B Barclay, Mr C Fraser, Mrs I McCallum, Mr H Fraser, Mr J Laing, Mr D Millar, Mr I Renwick, Mr B Clark, Mr A Henderson, Mr E Hunter, Mrs H Carmichael, Mrs M Davidson, Mr D Hendry, Mr H Wood, Mr A Graham, Mr A Christie, Mrs P Munro, Miss J Campbell, Mrs B McAllister, Mr P Corbett, Mr D Kerr, Mr N Donald, Mr J Finnie, Mr F Parr, Mr I Brown, Mr J Gray, Mr K MacLeod, Mr R Wynd, Mr J Ford, Mr L Fraser, Mrs L MacDonald, Mr G Marsden, Mr A S Park, Mr J Holden, Mr R Pedersen, Mr T Prag, Mr S Black, Ms J Douglas, Mr D Fallows, Mr G Rimell, Mr D Cameron, Dr M Foxley, Mr B Gormley, Mr B Murphy
Present: Highland NHS Board
Mr G Coutts, Mrs G McCreath, Mr C Punler, Ms S Wedgwood, Mr I Gibson, Dr I Bashford, Mr M Iredale, Ms H May, Dr V Shelley (videoconference), Ms E Mead, Mr M Evans, Mr O McLennan, Ms E Robertson, Dr M Somerville, Mr B Brackenridge (videoconference), Mr R Creelman
Depute Chief Executive
Assistant Chief Executive
Director of Education, Culture and Sport
Director of Housing and Property
Director of Planning and Development
Director of TEC Services
Director of Social Work
Mr A S Park and Mr G Coutts jointly chaired the meeting
1. Apologies for Absence
Apologies for absence were intimated on behalf of Lady M Thurso, Mr D Chisholm, Mr D Henderson, Mr R Balfour, Mrs G Sinclair, Mr J Crawford, Mr Q Cox, Mr R Stewart, Ms A Gent and Ms P Courcha.
2. Declarations of Interest
Mr G Coutts (Highland NHS Board) declared a non financial interest in Item 3 on the grounds of being Chair of the Scottish Social Services Council and Director of the University of the Highlands and Islands.
Mr I Brown (Highland Council) declared a non financial interest in Item 3 on the grounds of being employed as an electrician by NHS Highland but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that his interest could not reasonably be taken to fall within the objective test and remained in the room.
3. Planning for Integration – Development of a Lead Agency Model in Highland for Care Services
There had been circulated Joint Report No. HC-NHS-1-11 dated 12 May 2011 by the Chief Executive, Highland Council, and Chief Executive, NHS Highland, which confirmed that the Highland Council and the NHS Highland Board were progressing a proposal to implement a Lead Agency Model for Adult and Children’s Services across Highland. A programme of work was being followed to evidence the proposed change, demonstrate the relevance of the Lead Agency Model, engage users, staff and the wider public and prepare proposals for the governance, management and local accountability of Adult and Children’s Services. A decision was now sought with regard to progression and implementation based on the work to date.
During a summary of the report, it was confirmed that the Highland Council and NHS Highland Board had considered proposals for this new partnership model to deliver health and social care in a report to the Special Joint Meeting which had been held on 16 December 2010. The report had outlined the shared values and principles underpinning a joint approach to service delivery for Adult Community Care and Children’s Services, summarised the reasons why the leadership of the Highland Partnership believed a new model for service planning and delivery was needed, considered a variety of possible models, highlighted the preferred model and proposed further work to continue the momentum towards significantly improved arrangements to deliver better outcomes, increased effectiveness and the achievement of further efficiencies.
From the outset, the Leadership Group had been committed to evidencing the case for change in both Adult and Children’s Services and this had led to the exploration of local, national and international reports which highlighted the benefits of integrated working. In this regard, it was imperative to demonstrate improvements in outcomes for the Highland population and some base line information was being progressed to support this evaluation at a later stage. Much work had also been completed on the benefits of integration and the Scottish Government had produced its own summary in 2010 referencing the Arbuthnott Clyde Valley Review and development of Care Trusts in North East Lincolnshire and Torbay as well as reflecting progress made through Joint Future.
In regard to Children’s Services, it was confirmed that the experience and associated learning and evaluation captured by changes to date across the Highland Partnership supported the assumptions that a Lead Agency Model would deliver changes in service and positive outcomes. The service model and functions within Children’s Services would best be delivered in an integrated model and would need careful consideration to ensure the good progress made in integration to date was not lost and effective services could be sustained. Some staff groups remained concerned about the perceived benefits of this model for users and services however and these concerns would need to be logged and addressed.
In relation to Adult Services, it was advised that staff, users and carers could see the added value that an integrated approach would bring but there was a need to continue working with all stakeholders as models were defined in order to ensure that the revised services worked better for all who used them with the impact being assessed by those measures which were known to indicate failings, such as delayed hospital discharge, extended length of hospital stay and emergency admissions to hospital.
In terms of Engagement, the Highland Partnership had committed to wide engagement of all stakeholders and it had been stated that a change of this order would require a formal consultation process. A formal communications plan had therefore been drafted and this included consultation work across Highland focusing on engagement with local and national media, working with NHS Highland and the Highland Council communications teams, engagement with professional organisations, service users and carers and engagement with and demonstrating evidence of support from local and national champions for change. As part of this, there had been a number of events and workshops, presentations to strategic groups and ongoing engagement through the development of the Staff Partnership Forum. Information gathered from these events had informed the issues log which would be managed through the Programme Board. In addition, members of the Programme Board had committed to attending Ward Forum meetings across the Highlands in order to ensure that the proposed changes were explained and local views collected. In this regard, specific information was provided within the report for both Children’s and Adult Services across Highland.
In relation to Proposed Models, it was confirmed that the Lead Agency service models for children and adults were being scoped with involvement from the Programme Board and the Staff Partnership Forum and would be presented to the next joint meeting in June. In order to scope these models, those involved had focused on the services around the child and family and the adult and carer and as such had kept a person centred approach as a matter of principle. The emphasis had then been on the functions or tasks involved which would be more effective if developed in an integrated way and this had led to a list of functions being compiled and which had been detailed in the report. In this regard, it was advised that there were a number of areas of both children’s and adult’s provision yet to be agreed and a final and complete list of functions would therefore be presented at the next meeting.
In regard to Governance, considerable work was progressing across the organisations to ensure that accountabilities were clear and robust and in this regard the Programme Board had focused considerable effort on reviewing current governance arrangements. In terms of strategic governance, there was a requirement for a commissioning strategy supported by a number of working groups involving providers, users, carers and voluntary groups etc to look at aspects of service development with a subsequent report to a joint high level commissioning group which would consider and determine the outcomes to be achieved and the performance standards and measures for services with recommendations being made to both the Council and the Highland NHS board thereafter. It had been acknowledged that these were complex and complicated issues and a proposed Governance Model would therefore be presented to the next joint meeting in June for consideration.
In terms of Local Accountability, Members of the Highland NHS Board and the Council had emphasised the need to ensure that the model for integrated services included the means for exercising local community engagement and democratic accountability. Members had a responsibility and role to act on behalf of constituent and community interests with regard to both children’s and adult services and in addition Highland NHS Board were required to engage with patients, the public and communities in relation to the delivery of services for which it had responsibility. It was therefore proposed to establish the means to exercise these responsibilities through Local Partnerships which would bring together the various local stakeholders and frontline staff representatives with managers in children’s and adult services. Consultation on the arrangements for the Local Partnerships would take place at Ward Forums and Community Care Stakeholder events which had been planned for May and June and the outcomes would be reported to the next joint meeting.
In regard to Implications, ongoing work in relation to Finance, Human Resources, Property, Legal, Information and Communication Technology and Strategic Commissioning was highlighted and it was confirmed that, whilst service planning discussions were at a relatively early stage, there were no issues which presented insurmountable financial or legal barriers to integration.
In relation to Implementation, it was confirmed that it was imperative that the key outcomes were clear and progress could be evidenced to contribute to improving these outcomes. In this regard, the Programme had to deliver a key number of workstreams, namely Project Management, Lead Agency Model, Service Specifications, Commissioning Documentation, Change Management Programme and Evaluation, and this would involve a considerable commitment from a number of staff, leaders across the organisations, the Programme Board and the Project Team.
Finally, in terms of the Proposed Next Steps, it was confirmed that a further report would be presented to the next joint meeting which would detail the services being proposed to be transferred to a Lead Agency and the Governance Arrangements to ensure that each agency was able to discharge its new responsibilities whilst retaining accountability. It was noted that Elected and Board Members, in retaining this accountability, would have to be assured of a process and structure which enabled scrutiny, performance management and support in line with the expectations set out in the Commissioning Agreement. In this regard, a high level implementation plan was being prepared in readiness for decisions to be taken in June and this would highlight the steps to be taken between then and April 2012.
In addition, a number of events had been scheduled to continue the engagement with people across the Highlands, including stakeholder events in Inverness and Fort William to build on engagement processes adopted in developing the Community Care Plan, further briefings for Elected and Board Members, workshops for staff to build on the work completed to date in engaging staff groups which were likely to be affected by the proposals and Ward Forums at which members of the Programme Board would provide an update on the proposals and capture local views.
During discussion, Members commended the Officers involved for the work undertaken to date and the considerable commitment which had been given, particularly by the Project Board, the Transitions Director and the Trade Union representatives.
In terms of the integration of community care, it was confirmed that the reasons for progressing this were clear and the current proposals represented an opportunity to take this forward for the significant benefit of communities across the Highlands. In this regard, it was suggested that in future one of the key issues would be that performance management would be properly outcome measured as it would be across the whole provision of services and this would be a significant improvement.
In relation to children’s services, the case for change had been clearly made within the report and again represented the correct way forward. Reference was also made to the work which had already been undertaken with the Scottish Government in terms of ‘Getting It Right For Every Child’ (GIRFEC) which had resulted in a great deal of benefit for the Highlands but there was still further work to be progressed.
Highland Council and the Highland NHS Board AGREED:-
(i) that the case for change had been evidenced;
(ii) that the Lead Agency Model was the preferred model;
(iii) that work should continue on defining the scope of the services to be
integrated and that this should be presented to the Joint Highland
Council/Highland NHS Board meeting in June;
(iv) that a model of Governance should be presented to the Joint Highland
Council/Highland NHS Board meeting in June;
(v) that at present, and recognising that there was further work to be done,
there were no identified impediments to developing this model in terms of
legal, financial or HR issues and that work on the details should be
(vi)that the outcome agreements and commissioning documentation should
be the subject of further reports to the Board and Council;
(vii) to continue to support the Programme of Implementation; and
(viii)to acknowledge that there might be changes ahead that they were
currently unaware of but which might influence progress and
The meeting ended at 10.55am.