Links to Integrated Joint Board Papers
Created on 01 August 2016
The following links to Integrated Joint Board papers have all be imported from Chrome and were working prior. If any of the links do not work please email us for correction. These are all in alphabetical order. There are more than 31 as some councils store current papers separately from older Board papers.
More Information on Health and Social Care Integration
Created on 1 August 2016
Integrated Joint Boards were all fully established by the end of March 2016. A number had been meeting over the previous years while some ran their Shadow Boards right up to the deadline.
It is early days in the operation of Integrated Joint Boards. So much so that there is not even harmony in what to call them. Some just invert the letters and call them Joint Integrated Boards, one or two still call them Health and Social Care Partnership Boards.
However these have been 3 years in the making and none of them can claim to be surprised that they are suddenly running the health and social care together. Early directions really matter. They set the path for future development. Those who say it is too early to judge are making a mistake. Once structures and priorities are established it is hard to shift huge bureaucracies that are rely on hundreds and thousands of people to make decisions and carry out their policies.
That is why we wanted to understand what was happening with Learning Disability services in the new Integrated Joint Boards and how would the needs of this group of vulnerable adults have their needs addressed.
We decided to examine the agendas and reports for 2 meetings for each of the Integrated Joint Boards currently operating in Scotland. We wanted to cover wherever possible meetings since April 1st 2016 since that was the date that Boards were given full legal responsibility.
We ignored agenda items which cover the minutes of sub committees and looked at the general headings of each agenda item. Where it was unclear what an agenda item was about we looked at the reports in more detail. You can see the dates of the meetings and the agenda items covered by linking here.
The agendas ranged in size from looking at 3 to over 20 agenda items. Even the minutes of the meetings gives no idea of how long the meetings take and the amount of time devoted to each item. It is possible that those looking at 3 items touched on them in more detail than those with large agendas. But the disparity is in itself interesting given that the “democratic control” exercised by councils over all social care matters has now been transferred to half appointed, half elected Boards. Who is it that now has authority for supervising decision making on matters of local autonomy, if items are not discussed at the Integrated Joint Boards.
In the 62 Board Meetings that we looking at, no Board directly addressed this matter. Of course, IJBs are busy organisations and don’t cover every part of their remit at each meeting. Prioritisation is an important part of efficiency.
Digging a little bit deeper in the papers managed to find one reference to a Learning Disability service review as part of an overall plan in Glasgow to transform Health and Social Care generally. This plan was to use the Integrated Joint Board’s resources to lever other public resources into joint working on a much bigger scale.
4 Boards directly addressed the matter of mental health (Angus, Dumfries, Glasgow and Moray). 3 of these boards looked at the coordination between in patient and community services. The other discussed a strategy board that set up coordination meetings. It would seem that the linking of resources from the health and the social care sections was the driver for this attention.
1 board (West Lothian) looked at issues connected to people with physical disabilities. This was to establish a 3 year commissioning cycle of support services for people with physical disabilities.
However Delayed Discharge and plans for changing care home for older people were discussed on 55 agenda items. These ranged from progress updates on the numbers of people who were experiencing delayed discharge of greater that 14 days to the plans for developing more “intermediate care”.
Intermediate Care is defined by the Joint Improvement Team as “intermediate care as a continuum of integrated community services for assessment, treatment, rehabilitation and support for older people and adults with long term conditions at times of transition in their health and support needs”. However many of the reports seemed to describe this as a “building based” service which would help people leave hospital and move (temporarily) to a setting that would then enable them to get ready to move home again.
Our concern is that the focus of Integrated Joint Board will be on those very areas in which there is a strong shared interest in approach from the health and social care sector. Some of the very success in Learning Disability support has been about establishing the predominance of social care and the social model of disability.
Even though there are strong residual Learning Disabilities within the health service, the social model dominates. Integrated Joint Boards might choose to spend much more time and resources on “priority” issues such as delayed discharges and the pathways for older people to return to the community.
….. More to Follow…..
So what do they talk about on Health and Social Care Joint Integration Boards
Created on 1 August 2016
All across Scotland, the 31 Integration Joint Boards have been meeting to begin their official work in running social care in Scotland. This is a major shift in policy that has been given an easy ride so far. The NHS is one of our national treasures and bring social care together with health can surely only be a good thing. But as our article on Page 2 suggests, the NHS may not always guarantee good care.
The minutes of all Joint Boards are available online for anyone to have a look at. We analysed the agendas and papers for 62 meetings of 31 Integrated Joint Boards to see what they talked about.
There is no mention of Learning Disability Services in these meetings between March and June of 2016. Often the poor relation of social
work, we worry about a lack of priority for people with learning disabilities. We did spot one reference inside the papers of the Glasgow Board which promised a further review of Learning Disability Services for the year 2017-18 as part of another “efficiency drive.”
The importance of tackling the “Delayed Discharges” of older people. Is clear. Some explain that the Scottish Government has provided a strong financial incentive if targets are reached to reduce delays of more than 2 weeks. Most IJBs discuss delayed discharges at every meeting. Some had 4 agenda items dealing with this.
Delayed Discharges are about people who no longer need hospital care but can’t leave hospital for various reasons. This is an expensive cost to health boards. A former Cabinet Secretary for Health said “The average cost of keeping someone for a week in an acute hospital across Scotland is £4600 a week. While on average, to keep and treat someone in a home setting is £300 a week.”
Actions by the IJbs to tackle Delayed Discharges are varied – Clacks and Stirling are proposing the building of a new Intermediate Care complex for 116 people as part of a “Care Village”. East Renfrewshire is proposing to sell off their only “In house” residential care home and buy (cheaper?) care from the independent sector. Edinburgh is increasing its uptake of Care At Home while reducing its Complex Care Respite Services at the Astley Ainslie. Renfrewshire will use Technology Enabled Care and Staff Tracking systems to get more out of the “In House” Care At Home Team.
The East Dunbartonshire Board approved a Delayed Discharge care package for a patient with Guillain-Barre syndrome. Since some Boards had not discussed clinical or professional care at all, it was unusual to see one Board resolve an individual case. KS had been stuck in hospital for less than 6 months and while he continued to need special help with breathing, he no longer required hospital care. Because KS has the capacity to explain what he wants, he was allowed to reject a nursing home option and opt for a support service in his own home. The package has been agreed at a cost of £6,655 per week (annual cost of £346,107).
Its great to see really innovative community care packages being developed. But from this brief survey of Integrated Joint Boards, we are worried that the “delayed discharges” of older people and their medical needs are going to be the priority and that once again Learning Disability service are being left behind.
This Is A Disgrace—NHS Care Could And Must Do Better!
Created on 01 August 2016
Waterloo Close NHS care facility in Kirkintilloch, East Dunbartonshire near Glasgow cares for 6 people with profound learning disabilities and should provide safe and secure care.
Over a 2 year period following his admission, Michael Howard, 53, who has Down’s Syndrome suffered black eyes and broken ribs at the care centre and was struck so hard that he had to be rushed to hospital. Michael’s ordeal came to a head when he was taken to hospital on July 7, 2014, after being found covered in blood with a serious wound to his genitals.
The doctor treating him at Glasgow Royal Infirmary insisted on contacting social services. Managers at the Waterloo Close NHS care facility had failed to call the police after any of the previous incidents, meaning the chance to gather crucial forensic evidence was lost.
His brother Neil said: “Michael had no track record of being to accident and emergency before he moved there in 2012 but suddenly he was suffering all manner of injuries that could not be explained.
“He got a sore face which was absolutely shocking – he needed six stitches. One person said he’d tripped over his duvet but the manager was saying that he put his shoes on the wrong feet and fell over the laces.
“They had no idea how he got three broken ribs and we only found out when he was taken to Stobhill Hospital with a chest infection and it came on an X-ray. We had strong suspicions something untoward was happening. Michael suddenly wouldn’t go into the big communal sitting area with all the patients and staff.”
The Health and Social Care Partnership would only say, “A member of staff who had his employment terminated has been reinstated after a dismissal appeal.”
The Daily Record reports that George Mayne, 45, was sacked following the final attack on Michael and then reinstated on appeal. It has now emerged in the same paper that Mayne was convicted in 2011 for hurling sectarian abuse and threatening behaviour at an Old Firm match. He was fined £300 and handed a football banning order for the incident at Ibrox on December 28, 2011.
Mayne is now working at a care unit for vulnerable adults with dementia, Birdston Nursing Home, also in Kirkintilloch.
A warning about Health and Social Care Integration from England
Created on 20 May 2016
An early study by the Policy Innovation Research Unit into the development of Health And Social Care Integration in England has found it struggling. Just as in Scotland, H&SCI started with ambitious visions to transform care for people with multiple long-term conditions and frail older people by shifting services out of hospitals, reducing costs and improving people’s experiences of care
There had been plans to use a wide range of initiatives to meet these objectives including multi-disciplinary teams, improved access to services, rapid response teams to reduce avoidable admissions, telecare and telehealth, increasing the use of community resilience and personal health budgets.
However such ambitions became more limited and focused on “short term, financially driven goals”, mainly around containing hospital admission and discharge costs. The range of initiatives used had narrowed to setting up multi-disciplinary teams, improving care planning, creating a single point of access for services and using care navigators to provide people with information and advice on accessing care.
Things that helped integration work were:
- Where there were simple organisational structures, such as a single council and NHS trust sharing similar boundaries.
- When staff were involved in integration initiatives to the extent that they felt ownership over them.
Things that were barriers to integration were:
- Professional boundaries and cultural differences between health and social care staff
- Failure of staff from different professions to trust one another
- Staff too busy “firefighting” to maintain existing services to be motivated to engage in integration initiatives.
- cuts to services such as befriending services, lunch clubs and peer support which undermined initiatives to develop communities’ resilience
- A lack of dedicated funding, hampering the ability to initiate changes to services.
In Scotland, we are at a very early stage. In a number of areas, Shadow Joint Boards have been meeting over the last year while in other areas the Integrated Joint Board are only now meeting for the first time.
However the government are already taking action. They will review what should be the right number of Integrated Boards. This could lead to mergers, more shared boundaries for health and social care services and perhaps as few as 3 – 8 new Boards to cover all of Scotland.
And the Scottish Government are promising a further £1.3 billion in the integrated partnerships to build up social care capacity. This would work to undercut the some of the difficult financial choices and could see more being spent on mental health, GPs and social care.
Nonetheless it would be rash to ignore the lessons emerging from England given the hopes and expectations being placed on this policy.
A QUESTION OF DEMOCRACY
At the Highland Health and Social Care Partnership meeting of 3rd of March which cut the weekly income of social care clients by £22 (see newsletter article on care charges), only one elected Councillor was present. The rest were all NHS Board members or non voting employees.
Exactly when did such decisions start being left in the hand of unelected technocrats?
A warning for Scotland on Health and Social Care Integration
17 May 2017
Health And Social Care Integration is struggling in England. Increasing financial constraints on councils and NHS bodies are making it harder to achieve integrated health and social care, government-funded research has warned. The study also found that engaging frontline staff in initiatives to integrate care was proving challenging in a climate where they were “firefighting” to keep existing services running.
Health and social care were beset by an “integration paradox” in which the financial environment made it ever more important to integrate care but, at the same time, made it more difficult to make progress in doing so.
The findings came from an early evaluation of the integrated care and support pioneers programme, a Department of Health initiative set up in late 2013 to test new ways of integrating care for people who needed the support of multiple care services. The study, by the Policy Innovation Research Unit, assessed the initial 14 pilots from January 2014 to July 2015 and was largely based on interviews with 140 council, clinical commissioning group (CCG), NHS trust and voluntary sector staff involved in pioneers.
The pioneers started with ambitious visions to transform care in their areas for people with multiple long-conditions and frail older people by shifting services out of hospitals, reduce costs and improve people’s experiences of care. They had plans to use a wide range of initiatives to meet these objectives including multi-disciplinary teams, improved access to services, rapid response teams to reduce avoidable admissions, telecare and telehealth, increasing the use of community resilience and personal health budgets.
But the researchers found that over time their ambitions appeared to have become more limited and focused on “short-term, financially driven goals”, mainly around containing hospital admission and discharge costs. Also, the range of initiatives used had narrowed to setting up multi-disciplinary teams, improving care planning, creating a single point of access for services and using care navigators to provide people with information and advice on accessing care.
Interviewees identified a number of barriers to and enablers of integration. Most of the enablers were local factors. These included the relative simplicity of organisational structures, with the best arrangement perceived to be when a pioneer involved just one council, CCG and NHS trust with similar boundaries. The most important of the enablers was perceived to be staff involvement in integration initiatives and the extent to which they felt ownership over them.
However, the report found that professional boundaries and cultural differences between health and social care staff were also barriers to integration. Interviewees identified difficulties in encouraging staff from different professions to trust one another or to motivate staff to become engaged in integration initiatives when they were “firefighting” to maintain existing services.
Interviewees felt the cuts to local government and financial constraints on the NHS were limiting their ability to reshape services. For example, initiatives to develop communities’ resilience were undermined by cuts to services such as befriending services, lunch clubs and peer support. Also, the pioneers were not given dedicated funding, hampering their ability to initiate changes to services. Over the course of the fieldwork, researchers found that the balance between barriers and enablers were, if anything, shifting towards the former as the financial situation deteriorated.
“This was resulting in an ‘integration paradox’,” said the report. “Growing need and declining budgets provided an even stronger imperative for more effective integration. However, at the same time, this context made it more difficult to make progress.” The context increased the incentives for organisations to “defend existing roles and resources for fear of something worse” The research team has been commissioned by the Department of Health to do another evaluation of the pioneers programme running up to 2020.
Understanding What Health And Social Care Integration Might Mean
Created on 17 September 2015
The Learning Disability Alliance Scotland has produced a new guide to what Health and Social Care Integration might mean for people with learning disabilities. It uses a combination of Easy Read information and photo stories including the “Carry On” films to help explain what the benefits of working together are. This will still take some time to work through but it is a fun way of exploring a challenging subject.
However this is not a study of what is actually happening on the ground with local authority and health board plans. Further research on this will be available at a later date.