JOINT REPORT BY ARGYLL AND BUTE COUNCIL & NHS HIGHLAND (SUBMITTED TO ARGYLL AND BUTE COUNCIL ON 20 MARCH 2014

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1 Highland NHS Board 1 April 2014 Item 5.2 JOINT REPORT BY ARGYLL AND BUTE COUNCIL & NHS HIGHLAND (SUBMITTED TO ARGYLL AND BUTE COUNCIL ON 20 MARCH 2014 HEALTH AND SOCIAL CARE INTEGRATION Report by Sally Loudon, Chief Executive, Argyll and Bute Council and Elaine Mead, Chief Executive, NHS Highland 1. SUMMARY 1.1 Argyll and Bute Council and NHS Highland are actively planning for the implementation of new arrangements to meet statutory duties and responsibilities that will shape the future delivery of health and social care in Argyll and Bute. 1.2 This report sets out a number of key recommendations to ensure the partnership meets the statutory requirements and timeframe for the implementation of the Public Bodies (Joint Working) (Scotland) Bill by 1st April This legislation places a duty on local authorities and NHS Boards to develop defined arrangements for the integration of health and social care services in their area. 2. RECOMMENDATIONS 2.1 It is recommended that Argyll and Bute Council and NHS Highland Board: a) Note the summary update in relation to Health and Social Care integration and current legislative proposals by the Scottish Government outlined in the Public Bodies (Joint Working) (Scotland) Bill. b) Endorse the body corporate model outlined within the Bill as the partnership s preferred model. c) Establish a shadow Integration Board populated by appropriate membership as outlined in the legislation. d) Agree to delegate the responsibility for the recruitment of a Chief Officer for Health and Social Care to both Chief Executives following agreement by each partner to the scope of services to be included within the integrated partnership. e) Agree to the establishment of a joint project board to take forward the preparatory work required to deliver the preferred model which includes a comprehensive engagement and integration plan. f) Agree to the establishment of a consultation group under Section 26 of the legislation. g) Note that work will be undertaken to prepare a recommendation for a future meeting for both partners to jointly agree the scope of services to be delegated to the new Integrated Partnership. h) Agree a delegation to the Argyll & Bute Council Leader in consultation with the relevant Policy Leads to identify the elected members representatives to sit on the Shadow Integration Board and a delegation to the Chair and Chief Executive of NHS Highland to identify the Board members to sit on the Shadow Integration Board.

2 3. LEGISLATIVE CONTEXT 3.1 The Depute First Minister announced in December 2011, the Scottish Government s policy intention to legislate to integrate Health and Social Care Services across Scotland. The indications were that the legislation would be permissive and allow significant flexibility on what services could be included and on the model of integration to be adopted by local partnerships. The Scottish Government published a consultation on the proposals to integrate adult health and social care services in Scotland in May 2012 with responses to be submitted by September Argyll and Bute Council agreed its response to the consultation at its meeting of 23 August 2012, NHS Highland agreed its response in June 2012 and further submissions were noted from CoSLA, SOLACE and relevant professional bodies such as ADSW as well as a range of practitioners. The Council submitted its response to the consultation in September The Consultation paper set out the Scottish Government s vision of a successfully integrated system of adult health and social care for Scotland which will exhibit the following characteristics: Consistency of outcomes across Scotland, so that people have a similar experience of services, and carers have a similar experience of support, whichever Health Board or Local Authority area they live within, while allowing for appropriate local approaches to delivery; A statutory underpinning to assure public confidence; An integrated budget to deliver community health and social care services and also appropriate aspects of acute health activity; Clear accountability for delivering agreed national outcomes; Professional leadership by clinicians and social workers; and It will simplify rather than complicate existing bodies and structures. 3.3 The Scottish Government published its response to the feedback received through the consultation in February The response addressed the following areas: The case for change whom to legislate for? Outline of proposed reforms what to legislate for? National outcomes for adult health and social care; Governance and accountability; Integrated budgets and resourcing; Jointly Accountable Officer; and Professionally led locality planning and commissioning of services. 3.4 On the 31 st May 2013 the Scottish Government presented the Public Bodies (Joint Working) (Scotland) Bill as the legislative vehicle to take forward the integration of health and social care. The Bill reached stage 2 by November 2013 and implementation of the Act is expected to be in April

3 4. LEGISLATION 4.1 The Public Bodies (Joint Working) (Scotland) Bill includes the following provisions and coverage: 4.2 Principles of Integration The Bill is based on the following principles of integration: 1. is integrated from the point of view of recipients 2. takes account of the particular needs of different recipients 3. takes account of the particular needs of recipients in different parts of the area in which the service is being provided 4. is planned and led locally in a way which is engaged with the community and local professionals 5. best anticipates needs and prevents them arising 6. makes the best use of the available facilities, people and other resources 4.3 Models of Integration The Bill highlights four permitted models for integration. These are defined below: a) Delegation of functions by the local authority and the Health Board to a body corporate (an "integration joint board") this was referred to in the consultation as the "body corporate" model b) Delegation of functions by the local authority to the Health Board (also referred to as the "Lead Agency Model with the Health Board as Lead"). c) Delegation of functions by the Health Board to the local authority (also referred to as the "Lead Agency Model with the local authority as Lead"). d) Delegation of certain functions by the local authority to the Health Board and the delegation of other functions by the Health Board to the local authority (also referred to as the "Highland Lead Agency Model" reflecting the current arrangements between NHS Highland and the Highland Council) 5. PREFERRED MODEL Body Corporate 5.1 Both Argyll and Bute Council and the NHS Highland Board will need to take a joint decision in building a sustainable model for integration going forward. Building on the well-developed approach to partnership working, the proposal is for the establishment of a Body Corporate vehicle to be agreed as the way forward. This takes cognisance of the strong partnership performance in areas of health and social care with particular emphasis on the progressive work in relation to older person. s services and shifting the balance of care in compliance with national policy. 5.2 Under the proposed legislation in relation to the Body Corporate model there is a requirement to establish an Integration Board. The new Integration Board would be an executive committee of both organisations with delegated decision making power. The extent of this delegation will need to be defined but it is expected that this will follow the requirements of the Bill in relation to, 3

4 strategic planning, budget allocation and monitoring, contracting and commissioning arrangements, performance scrutiny, etc. The key elements of the legislation will need to be met in relation to issues of governance, resource integration, performance framework and described within an integration plan and will need to be agreed with Scottish Government. An integral feature of this model is the appointment of a chief officer responsible for strategic and operational management of the new service who will be accountable to the Integration Board. The legislation does not require the partnership to set up a standalone new organisation. The Scottish Government has described the body corporate model as an empty vessel with a legal persona. 5.3 The membership of the Integration Board would need to reflect the status of the committee safeguarding a balanced membership between both partners ensuring a focus on Argyll and Bute issues. Although the Bill does not at this time make specific reference to the composition of the Integration Board, the Bill Advisory Group has previously recommended that 10% of elected members be considered (equivalent of 4 for Argyll and Bute Council) with an equivalent number of Health Board members. It is proposed that the shadow Integration Board should be established by the end of April 2014to provide joint support and direction to the establishment of the integrated arrangements by April The established practice in Argyll & Bute over the previous 10 years is one of redesigning in partnership, reducing delayed discharge, pooling resource release and revenue and investing in services in the context of a joint performance framework for older people. In general this has seen the development of constructive working relationship between the Council and the local Community Health Partnership (CHP) and is evidenced by the creation of a number of community services across health and social care and significantly improved performance in a number of key areas including nationally recognised performance on delayed discharge. This is accompanied by other areas of service integration around learning disability, O T and addictions services. 5.5 On this model the Argyll and Bute Health and Social Care Partnership would have the following key features/ benefits: The model would be recognisably an Argyll and Bute partnership reflecting local circumstance and locality planning arrangements will be formed around recognised locality areas. The appointment of a Chief Officer (employed by one of the two partner agencies) but responsible to both agencies and reporting to the two Chief Executives (as envisaged by the "community of governance" concept in the consultation document). Establishing an integrated management structure which builds on the existing staff capacity and capability will be essential. It is envisaged at this stage that there will be limited change in the status of staff roles and responsibilities. However over time it is recognised that some changes may be required to reflect the relative maturity of the new corporate vehicle and the potential for integrated management. Integration of resources into a single operational budget. 4

5 The model would be less disruptive to front line services and quicker to implement. There would be no requirement for movement of staff from one agency to another and this will lesson any risks associated with this aspect of future integration. The proposal would enable all integrated services to avoid structural barriers with linked services such as housing or education. The Chief Officer would sit on the Council and Health Board management teams and also be accountable to the NHS Board/Council Chief Executives. In the context of NHS Highland day to day operational reporting will be through the Chief Operating Officer. The model would allow for the partnership s performance to be monitored against an agreed national outcomes framework. Issues around the statutory role of the Chief Social Work Officer or Mental Health Officers or concerns around integration with criminal justice services, ethical standards or other health related role issues would be easier resolved. 5.6 A key consideration for each partner would be an agreement in relation to the scope of services to be delegated to the Integrated Partnership within a Body Corporate model. These are set out below All adult health and social care services only (de minimus) All Adult and Children s Health and Social Work Services All NHS Services in Argyll and Bute (planning, delivery, and commissioned services) as well as Adults and Children s Social Work Services of Argyll and Bute Council. 5.7 An options appraisal has been completed by the Argyll and Bute Council project team which was presented to a member. s seminar. A similar options appraisal will be conducted by NHS Highland regarding the scope of services to be delegated..the Council and NHS Highland will be required to formally agree the scope of service / functional inclusion into the body corporate model and a joint proposal will be presented to both partners at a future date. 6. JOINT PREPARATION FOR INTEGRATION 6.1 There is significant work to be taken forward to meet the legislative timeline for integration and this will be progressed within a joint project board reporting to the shadow Integration Board. The project team will include senior officers and representatives from key partners. The membership of this group will be defined by the Chief Executives of both organisations. It is expected that both Chief Executives will jointly chair the project board. 6.2 The shadow Integration Board is required to prepare an Integration Plan and submit this plan to Scottish Government for their approval. The content of the plan will include; the model and scope of services to be included governance and management arrangements, locality planning arrangements financial arrangements;; delegated powers to the Integration Board; performance framework. Agreed outcome framework 5

6 6.3 Both the Argyll and Bute Council and NHS Highland Board are required to establish a consultation and engagement group under Section 26 of the Bill to ensure there is robust engagement with partners and localities relating to the formulation of a three year strategic integration plan. The Bill states this group should include a range of members with an interest in the integration of health and social care. 6.4 The shadow Integration Board will have no formal delegated powers other than the oversight and development of the new corporate vehicle and the development of the Integration Plan, until legally established in April Existing governance arrangements will continue until this time. 7. APPOINTMENT OF CHIEF OFFICER 7.1 There is a statutory requirement under the Bill within the Body Corporate model to appoint a Chief Officer. The Chief Officer will be a senior appointment, at senior executive level or equivalent, and will be accountable to the Chief Executives of the Health Board and Local Authority. The post-holder will have the authority to make resource decisions within the context of the standing financial instructions of both organisations and with respect to existing corporate governance arrangements..the recruitment and appointment of this post will be undertaken jointly by Argyll and Bute Council and NHS Highland and it is anticipated that council members and nonexecutive Directors who are members of the shadow integration Board will be invited to participate in the interview process. This post is critical to the success of the new partnership arrangements and is required under the new legislation. 7.2 A draft job description for the Chief Officer post will be developed subject to agreement by both the Argyll and Bute Council and the NHS Highland Board as to the scope of services delegated to the Body Corporate vehicle. It is proposed that, subject to the decisions made by both partners in relation to the model of integration and other arrangements outlined in this paper, the responsibility for the recruitment of a Chief Officer for Health and Social Care is delegated to both Chief Executives to take forward. 8. COMMUNICATION AND ENGAGEMENT 8.1 At the earliest possible opportunity the shadow Integration Board will need to consider and endorse a comprehensive communication and engagement strategy which meets the robust requirements of the legislation in terms of involvement and engagement with service users and carers and representatives from other community groups and the private and third sector representatives. It is vital that proper and meaningful participation is secured from the wide range of stakeholders who are involved in health and social care integration. This will include community reps, Public Partnership Forums (PPF), Community Care Forums, community councils, Reshaping Care for Older People (RCOP) Locality Groups etc. All future communication with partners and stakeholders should be jointly agreed and this will be achieved by linking in both communication teams within the current CHP and the Council. 6

7 9. CONCLUSION 9.1 Argyll and Bute Council and NHS Highland are now actively moving forward to progress the Integration of health and social care services in Argyll and Bute. There are a number of key recommendations noted in this report that will ensure compliance with new statutory duties and responsibilities contained in the Public Bodies (Joint Working) (Scotland) Bill. 10. IMPLICATIONS Policy: Financial: Personnel: This is a significant area of policy development for both the Council and NHS Highland however it is expected to be a legislative requirement that both partners will need to comply with fully. It is likely that the greater part of the budgets of the existing social work services will form part of an integrated budget for the Partnership to manage. The exact details related to the scope of services will be defined in due course. Financial implications for the setting up of the overall management and governance of the Body Corporate are as yet undefined. The vast majority of staff contracts will be unaffected by the adoption of the body corporate model. There is no requirement to transfer staff between agencies. However there will be substantial changes to the operational and strategic management arrangements for all staff involved. Equal Opportunities: None Legal: Risk: Customer Services: The Partnership will be underpinned with a formal Integration Plan. In particular the governance and accountability arrangements will impact on the current arrangements and standing orders of both partners. The process of integration introduces a large number of risks for the partners. These risks will be closely monitored by the project board and Integration Shadow Board. The intention of the integration agenda is to improve the customer experience and the efficiency and effectiveness of the services they receive. Sally Loudon Chief Executive Argyll and Bute Council Elaine Mead Chief Executive NHS Highland 21 March

8 For further information contact: Cleland Sneddon Executive Director of Community Services Tel: Deborah Jones Chief Operating Officer NHS Highland Tel:

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