Agendas, reports and minutes

The Highland Council

Minutes of Meeting of the Health, Social Care and Wellbeing held REMOTELY on Wednesday, 8 July 2020 at 12.30pm.

Present:
Mrs J Barclay
Mr B Boyd
Mrs I Campbell
Mrs M Cockburn
Mrs M Davidson
Mr J Finlayson
Mr A Jarvie
Mr D Louden
Mrs D Mackay
Mr W Mackay
Mrs I Mackenzie
Mrs L Munro
Mrs M Paterson
Mr M Reiss (substitute)
Mr D Rixson
Mr K Rosie
Ms E Roddick
Mr C Smith

Non Members also present:

Mr A Baxter
Miss J Campbell
Mr A Christie
Mr J Gordon
Mr A Jarvie
Mr B Lobban
Mrs B McAllister
Mr A Mackinnon
Mrs A MacLean
Mr D MacPherson
Mrs T Robertson

Officials in attendance:
Mrs D Manson, Chief Executive
Mrs F Malcolm, Interim Head of Health
Ms K Ralston, Head of Children’s Services and Chief Social Work Officer
Mrs L Dunn, Principal Administrator, Chief Executive’s Office
Ms F MacBain, Committee Administrator, Chief Executive’s Office
Ms M Zavarella, Clerical Assistant, Chief Executive’s Office

Also in attendance:
Mr D Park, Chief Officer, NHS Highland
Ms D Sutherland, YPeople
Ms R Connelly, Connecting Carers

An asterisk in the margin denotes a recommendation to the Council. 
All decisions with no marking in the margin are delegated to Committee.

Ms Linda Munro in the Chair

Preliminaries

• The Chair welcomed representatives from new partners, YPeople and Connecting Carers, who would be attending all future meetings.
• Mrs M Cockburn spoke of the impact of Covid-19 on the Highlands, her sadness at the loss of lives, and thanked staff at NHS Highland, the Council, and third sector organisations, as well as volunteers in communities, for their hard work during challenging times.

1. Apologies for Absence
   Leisgeulan

An apology for absence was intimated on behalf of Miss N Sinclair.

2. Declarations of Interest
Foillseachaidhean Com-pàirt

The Committee NOTED the following declarations of interest:-

Item 3 – Mr W Mackay (non-financial)
Item 3 – Mrs I MacKenzie (non-financial)
Items 3, 4, 5 – Mr A Christie (financial)
Items 3, 4, 5 – Mr M Reiss (non-financial)
Items 3, 4, 5  – Mr K Rosie (non-financial)

Declaration of Interests for Items 3, 4 and 5:

• Mr A Christie declared a financial interest in the remaining items in terms of being a non-Executive Director of NHS Highland but, having applied the objective test did not feel that his interest precluded his participation in the discussion.
• Mr M Reiss declared a non-financial interest in the remaining items in terms of being a Director of Caithness Mental Health Support Group but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that his interest did not preclude his involvement in the discussion
• Mr K Rosie declared a non-financial interest in the remaining items in terms of being Chair of the Caithness Drug and Alcohol Forum but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that his interest did not preclude his involvement in the discussion.

3. Adult Social Care Assurance
Barantas Obair Shòisealta Inbheach

Declarations of Interest – Mr W Mackay declared a non-financial interest in this item in terms of being a voluntary member of Caithness Enable, and Mrs I MacKenzie declared a non-financial interest in this item in terms of having relatives resident in Care Homes but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that their interest did not preclude their involvement in the discussion.

There had been circulated Report No HCW/07/20 dated 12 June 2020 by the Interim Head of Health.

The Interim Head of Health introduced her report, highlighting key assurance issues, and the Chief Officer for NHS Highland gave a presentation, which included an update on Covid-19, recovery plans, Scottish Government guidance, testing, and care home issues, including an update on Home Farm future options.

During discussion, the following issues were considered:

• the value of the NearMe project during lockdown was highlighted and gratitude was expressed for officers involved, noting the transformational impact of digital technology in the delivery of health services during the pandemic and for the future;
• second waves of the virus would most likely be localised and protocols had been developed;
• the vast majority of test results in Highland were negative, and most were received within 24 hours, against a target of 48 hours. In relation to antibody testing, this was a national issue and guidance would be adopted once issued;
• information was sought and provided on the measures in place for the provision of PPE to Care Homes;
• information was sought and provided on measures put in place to restrict Care Home staff moving between multiple Care Homes;
• in relation to the communication of test results, this remained the responsibility of the Scottish Government and NHS Scotland. Attention was drawn to issues of patient confidentiality, especially in small rural areas with few cases;
• all Care Homes had defined cleaning regimes in place following protocols that had been developed with the Council, NHS Highland, independent providers and the third sector;
• the supplementary report was from 24 April 2020 to demonstrate the plans that had been in place from an early stage. It was intended as supplementary to the main assurance report;
• communication measures were summarised and had included daily meetings, weekly briefings with Members, and officer representation at various NHS Highland groups. Ongoing high levels of communication were vital;
• information was sought and provided on lessons learnt about communication following the outbreak at Home Farm, on the Isle of Skye in terms of adequacy, timeliness and clarity. Issues of confidentiality and misinformation on social media were highlighted, and the matter was currently being dealt with by HC One, the Care Home operator, and the Care Inspectorate;
• it was welcomed that all staff in Care Homes had tested negative for the virus in Scotland. Residents were not routinely tested, but were tested when being discharged from hospital into a Care Home;
• given that ultimate responsibility for Adult Social Care (ASC) remained with the Council, a high level of scrutiny was required for the partnership agreement, in addition to regular assurance reports, to consider more than national indicators. It was suggested that this committee rather than a sub-committee should undertake this;
• the Chair reminded Members that training in ASC would be provided from August 2020;
• assurance was sought that dementia patients were not having their freedom of movement inappropriately restricted, noting that locking doors should be a last resort, restricted and time limited. The Chief Social Work Officer summarised policy and practice in this regard;
• concern was expressed about the impact the pandemic had on adults with learning disabilities and in response some of the challenges and solutions were summarised;
• in relation to infection prevention and control, it was helpful that ASC was being delivered by NHS Highland on behalf of the Council given that Public Health was part of the NHS;
• concern and sadness were expressed in relation to recent mental health incidents in Caithness, and a lack of emergency out of hour care for this type of incident, which had resulted in the establishment of the group, No More Lost Souls. The Chair explained that a seminar would be held on the key issues for Members and CPP members in October 2020, with speakers anticipated from across Scotland to promote discussion and action;
• although confidentiality concerns were acknowledged and understood, it was important to provide as much information and data to the public as possible, to foster trusting relationships and encourage meaningful public participation. In particular, it was felt by some there had been insufficient communication on the Home Farm outbreak, although the Council response was praised, with local Members having worked together in a positive manner. Attention was drawn to the nuanced data available on the Scottish Government website;
• concern was expressed about the lack of publicity and information around mobile military-run testing in Caithness in recent weeks, which might have led to a lower uptake of the service;
• concern about support for vulnerable homelessness clients would be taken up with the homelessness team;
• the Chief Social Work Officer summarised the support that was being provided during the crisis for mental health and addiction issues, as well as longer term preventative measures;
• regular updates for Members on ASC issues were sought in future;
• concern was expressed about the lack of broadband/WIFI in some Care Homes, which made it more difficult for residents to keep in touch with their families;
• attention was drawn to the numbers of people who had been shielding, or too nervous to leave their homes, and the support they would require to regain their confidence;
• information was sought and provided on preparations for a possible second wave of the virus in winter;
• concern was expressed that some people were being discharged from hospital to their homes without care packages; and
• information was sought and provided on Care Home staffing resilience, with attention drawn to Care Home contingency plans, early mobilisation, the use of bank staff and the NHS escalation support team. Care Home and agency staff were tested every seven days. To increase staff availability in the longer term, a Care Academy was being developed.

The Committee NOTED the report and AGREED that assurance be provided to Cllr B McAlister that vulnerable homelessness clients were being fully supported.

4. Governance and Transformation
Riaghlachas agus Cruth-atharrachadh

There had been circulated Report No HCW/08/20 dated 28 June 2020 by the Interim Head of Health.

In relation to transformation, attention was drawn to the improved working relationships, trust, knowledge and understanding between NHS Highland and the Council, in part brought about through the regular meetings that had taken place to tackle the pandemic. The report also detailed the planned programme management approach to governance, with proposed workstreams to better understand communities and work differently.

During discussion, the following issues were considered:

• the tone of the report was welcomed, as were the plans for improved scrutiny, although concern was expressed about the role of Members on the project management board. Attention was drawn to the recommendation for two Members to be on the Project Board, one from the Administration and another to be discussed by the Chair and Vice Chair with the Group Leaders. Further detail would be included in the August report, following discussion with NHS Highland;
• in view of recent tragic incidents in Caithness, it was suggested mental health be added as a workstream to the report at section 7.2, especially given the inadequacy of out of hours care for mental health emergencies. A review of workstreams was required to take account of possible changes in priority as a result of Covid;
• Cllr Cockburn sought information on the role of school nurses in relation to infection prevention and control;
• across Highland, Community Planning Partnerships (CPPs) were not running in an equitable manner, with some functioning better than others. Sutherland was highlighted as an exemplar CPP and had the formal commitment of a full-time member of staff from Police Scotland to assist with administration. The ECO Customer & Communities would be asked to meet with Cllr Deirdre Mackay and other interested Members to discuss continued community resilience and the role of the CPPs, and to consider reporting back to the next meeting of the Committee on 26 August 2020;
• re-enablement and succession planning required further attention, and the planned Care Academy was highlighted as part of this;
• timeframes were required for the Project Board;
• communities and volunteers were praised for their response to the pandemic and concern was expressed about the long term economic and health implications;
• it was suggested that in section 3 of the report there were potential resource, legal and risk implications, rather than none as stated. The Chief Executive clarified that this paper was primarily about the establishment of the Project Board but that the feedback would be passed onto the ECO Performance & Governance for future reports;
• it was important the workstream ‘Review of the assessment model’ was not diminished even if it was to be delivered differently in future. A summary was provided of the workshops with NHS Highland that had developed the model, more of which were anticipated before August 2020, at which point more information could be provided;
• reference was made to the Easter Ross CPP which had been awaiting fire service representation to replace the previous chair;
• attention was drawn to the importance of income maximisation and Member involvement on this was urged;
• communities and third sector partners had assisted with workforce planning during the Covid crisis but it was important to maintain a professional service and not to become reliant on volunteers and emergency solutions;
• the important role of development and community trusts, and community councils was highlighted, in addition to the CPPs. It was pointed out that the CPPs were a statutory function and that work was ongoing to properly capture all the functions that were being undertaken at local level including the resilience partnerships; and
• information was sought on the cost of Covid to the Council and this was being worked on via the Corporate Resources Committee and full Council. Attention was also drawn to the benefits that had been realised, with the example of staff learning.

The Committee NOTED the current position and the proposed approach and AGREED:-

i. Group leaders meet with the Chair and Vice Chair of the Committee to discuss and agree recommendations for cross-party membership of the Project Board and to report back to the next meeting of the Committee on 26 August 2020 following discussion of the proposals with NHS Highland;
ii. mental health be added to the list of the key areas of focus for the future delivery of adult social care (item 7.2 in the report), and the key workstreams be reviewed, having been agreed pre-Covid;
iii. Cllr Muriel Cockburn be emailed with details about school nurse involvement in infection prevention and control; and
iv. the ECO Customer & Communities meet with Cllr Deirdre Mackay and other interested Members to discuss continued community resilience and the role of the CPPs, and to consider reporting back to the next meeting of the Committee on 26 August 2020.

5. Partnership Arrangements with NHS Highland – Update
Ullachaidhean Com-pàirteachais le NHS na Gàidhealtachd – Cunntas às Ùr

There had been circulated Report No HCW/09/20 dated 28 June 2020 by the Interim Head of Health.

In summary of the report, it was explained that although the Highland Integration Scheme had been due to expire in June 2020, a six-month extension had been granted as a result of the Covid crisis.

During discussion, the following issues were considered:

• the Interim Head of Health was thanked for her work and contribution to improving working relations between the Council and NHS Highland;
• outcomes from the Covid crisis had demonstrated the value of the Highland’s Lead Agency model and it was noted that only a review was required, with many aspects of the current agreement still being acceptable;
• attention was drawn to the significant issues included in the Integration Scheme and it was hoped that suitable timely solutions would be found for all challenging areas;
• the detail in the Implications section of the report was welcomed; and
• the approach going forward was to review key areas and have a reviewed scheme in place within six months. It was proposed a further update be brought to the Committee in August 2020 detailing areas that required further scrutiny, and the additional risks posed by Covid going forward, for example local lockdowns, virus spikes and the effect of the virus on communities and individuals.

The Committee:

i. NOTED and APPROVED the current position and the proposed approach; and
ii. AGREED to consider a further update to the next meeting on 26 August 2020, taking into consideration the points made during discussion including areas of best practice and new areas of risk as a result of the pandemic.

The meeting ended at 3.45pm.