Held on 24th October 2018

Welcome to the briefing from the Angus Integration Joint Board (IJB).  It is hoped this short summary will help to provide some details about the work taking place in Angus to support health and social integration.  We are always interested in any feedback and if you want to leave comments, details of how these can be provided are given overleaf.

The latest Integration Joint Board meeting took place on 24 October 2018 and what follows is a summary of the topics that were discussed in open session. If you would like to see the full reports these are published online at: https://www.angus.gov.uk/healthsocialcareintegration/integration_joint_board_agendas_reports_and_minutes.

Agenda Item 4 – Appointment to the Board (Report IJB 74/18)

The purpose of this report was to note the appointment of a voting member to the Board. The IJB noted the appointment by Angus Council of Councillor Bob Myles as a voting member of the Board to replace Councillor Derek Wann.

Agenda Item 5 – Timetable for Meetings

The IJB approved the timetable of meetings from January 2019 to December 2019.

Agenda Item 6 – Finance Report (Report IJB 75/18)

This report provided an update to the Angus IJB regarding the financial position of Angus IJB, including financial projections, updates regarding savings progress, and financial risk.  The IJB noted the overall projected financial position for 2018/19, including noting status of Enhanced Community Support implementation, the need to conclude its roll out and requested an update re the status of the roll out at the next IJB meeting. It was also noted that the IJB had still to finalise the impact of demographic growth within Older People’s Services in 2018/19 and that this will be taken forward by the Service Manager (Older People’s Services).  They noted progress with 2018/19 savings delivery; the update regarding IJB reserves; and the risks documented in the Financial Risk Assessment. The main financial reporting issues in this report were set out in sections 3, 4 and 5. The overall projected financial position for 2018/19, based on very early information with many ongoing risks, was of an underspend. This reflected in year underspends for Adult Services and Local Hospital and Community Health Services being offset by overspends on hosted services and, in particular, Prescribing.  The overall financial position of the IJB does have a material impact on the way Angus IJB provides services in future. By making ongoing progress with delivery of efficiencies and cost reduction programmes alongside service redesign and modernisation, the IJB would be most able to deliver the services it requires to deliver to the local population on a sustainable basis.

Agenda Item 7 – Budget Settlements with Angus Council and NHS Tayside (Report IJB 76/18)

This report was an update to the IJB regarding the proposed budget settlements between Angus IJB and both Angus Council and NHS Tayside for 2018/19. The IJB formally approved the proposed budget settlement with Angus Council for 2018/19 and agreed to note its concerns to Angus Council that a larger share of the £1.5645m was not passed on. They supported the IJB Chief Officer and Chief Financial Officer with any further reasonable representation to national forums about increased budget settlement guidance. The IJB also formally approved a 1.5% uplift in budget settlements with NHS Tayside for core and Prescribing budgets for 2018/19 and the additional c£400k uplift in budget settlements with NHS Tayside to support pay agreements for 2018/19. The IJB noted the additional c£200k uplift in budget settlements with NHS Tayside to support Prescribing for 2018/19 and supported the IJB Chief Officer, Chief Finance Officer, Clinical Director and Pharmacy Leads to continue to develop dialogue with NHS Tayside regarding incremental annual adjustments to the IJB’s prescribing allocation to deliver a realistic and fair long term prescribing allocation settlement.  They supported the IJB Chief Officer and Chief Finance Officer to reach agreement with NHS Tayside to devolve a budget commensurate with current commitments re Complex Care to Angus IJB.  The IJB noted concern about the lack of progress regarding the Large Hospital Set Aside issue to NHS Tayside.  They supported the IJB Chief Officer to develop discussions with NHS Tayside to take this issue forward, and requested an update from the Chief Officer at the February 2019 Board meeting. In conclusion, the IJB agreed with the view of the Chief Officer and Chief Finance Officer that the proposed budget settlement with Angus Council should be accepted.  They also agreed with their view that the budget settlement with NHS Tayside should be accepted, with a series of caveats as reflected in the recommendations to this paper.

Agenda Item 8 – Angus IJB Financial Plan (Report IJB 77/18)

The purpose of this report was to update the IJB regarding the developing Angus IJB Financial Plan for period 2019/20 to 2021/22.  The IJB noted this update regarding the IJB’s multi-year financial plan and requested an update to a future meeting.  Regarding interventions set out in 2018/19, the IJB requested an update regarding progress with MIIU plans and the final stages of the originally approved Angus Care Model (In Patients workstream) at its next Board meeting, including a restatement of financial planning impacts.  The IJB will receive an update regarding proposed changes in charging for 2019/20 at its next meeting regarding funding streams, and requested that Board members, specifically voting members, are kept more fully informed of discussions with Partners as they develop in the period in advance of formal budget approval. In relation to cost pressures, the IJB will receive a report at its next meeting that contains further detail about the likely impact of demographic pressures going forward and that provide updated assessments of the financial impact of the Carers Act and Free Personal Care (under 65s).  Regarding Planned Interventions, the IJB will receive updates at its next Board meeting in relation to:-

  • extending the Angus Care Model Review of In Patient Services including setting out refined financial plans.
  • Psychiatry of Old Age plans including setting out refined financial plans.
  • the progress with the Angus Care Model Care Home Review including a restatement of financial plans for In House Care provision and Nursing Services.
  • the progress with the Angus Care Model – Care Home Support Services workstream (noting this will now include a broader review of Support Services).
  • the progress with the Learning Disability Review / Improvement Plan including a re-statement of financial plans.
  • the potential benefit of both Collaboration and Working with Partners (Angus Council and NHS Tayside) (February 2019 IJB meeting).

Agenda Item 9 – Workforce Plan (Report IJB 78/18)

This report provided the first fully integrated Angus Health and Social Care Partnership (HSCP) Workforce Plan. This plan was developed and approved by the Angus HSCP Staff Partnership Forum.  The IJB noted and commented on the content of this report.  They also noted that an effective workforce plan ensures that Angus HSCP has a workforce of the right size and with the right skills, within a budget that it can afford, which is able to deliver on the commitments contained within its strategic plan.

Agenda Item 10 – Winter Plan 2018/19 (Report IJB 79/18)

The purpose of this report was to present to Angus IJB the Winter Planning arrangements for NHS Tayside and Health & Social Care Partnerships for 2018/19. This is an integrated plan and work has been ongoing to ensure the Health & Social Care Partnerships and Acute Services are developing cohesive plans for winter. The IJB approved and endorsed the Winter Plan (NHS Tayside and Partner Organisations 2018/19) for submission to the Scottish Government and also noted the Angus Hospital Admission & Discharge Management Plan that underpins the Winter Plan.

Agenda Item 11 – Prescribing Management Update (Report IJB 80/18)

This report provided an update to the IJB on the prescribing management plans in Angus.  The IJB noted the content of the paper and the ongoing progress being made locally and regionally to address the prescribing overspends, and requested a further update to be provided to the IJB in February 2019. While there are numerous factors at play, there is cautious optimism that the intensive efforts ongoing in Angus are starting to deliver the outcomes required, recognising that it is likely to take a number of years to bring Angus’ prescribing spend closer to the national average.  Clinical engagement and leadership at all levels with regards prescribing within Angus continues to be high.  All Angus practices have committed to undertaking additional clinically led prescribing initiatives within their practice by January 2019, to support the delivery of additional efficiencies, based on the information provided to them within their practice specific prescribing report.  Ongoing monthly local meetings of the Prescribing Management Group, and Prescribing Management Group + clinical colleagues, enables ongoing local review and revision of local plans to both respond t new challenges and share best practice.  All work continues to be collated in the Angus Prescribing Work Plan.

Agenda Item 12 – Angus Community Justice Partnership Annual Report 2017-18 (Report IJB 81/18)

This report advised the IJB that the Community Justice (Scotland) Act 2016 places a duty on partners to work together to achieve outcomes to reduce re-offending. As part of the reporting process, an annual report is required to be submitted to Community Justice Scotland, and was presented to them for their information. The IJB noted the content of the report.

Feedback and Comments

We hope you found this brief summary useful, but any comments or feedback are considered very useful.  Please contact us at our email address: hsciangus.tayside@nhs.net.