IJB”) on 28 June 2016

To: Councillor Len Ironside CBE (Chairperson); Jonathan Passmore (Vice-

Chairperson); and Councillors Cameron, Donnelly and Young; and Rhona Atkinson, Dr Nick Fluck and Professor Mike Greaves (NHS Grampian Board Members; and Mike Adams (NHS Grampian Partnership Representative), Jenny Gibb (Professional Nursing Adviser, NHS Grampian), Jim Currie (Trade Union Representative, Aberdeen City Council(ACC)), Bernadette Oxley (Chief Social Work Officer, ACC), Kenneth Simpson (Third Sector Representative), Howard Gemmell (Patient and Service User Representative), Gill Moffat (Carer Representative), Faith-Jason Robertson-Foy (Carer Representative), Dr Stephen Lynch (Clinical Lead, NHS Grampian), Dr Satchi Swami (Secondary Care Adviser, NHS Grampian) and Judith Proctor (Chief Officer, Aberdeen City Health and Social Care Partnership (ACH&SCP)).

Town House,

ABERDEEN, 21 June 2016

INTEGRATION JOINT BOARD

The Members of the INTEGRATION JOINT BOARD are requested to meet in Meeting Room 5, Aberdeen Health and Social Care Village on TUESDAY, 28 JUNE 2016 at 10.00 am.

FRASER BELL

HEAD OF LEGAL AND DEMOCRATIC SERVICES

AGENDA

DETERMINATION OF EXEMPT BUSINESS

1 Members are requested to determine that any exempt business be considered with the press and public excluded

ITEMS OF BUSINESS

2 Draft Minute of Previous Meeting - 26 April 2016 (Pages 3 - 12)

Public Document Pack

3 IJB Scheme of Delegation (Pages 13 - 22)

4 Corporate Risk Register (Pages 23 - 46)

5 Delayed Discharge Update (Pages 47 - 56)

6 Winter and Contingency Planning (Pages 57 - 68)

7 GGI Report (Pages 69 - 92)

8 Proposed Revision to IJB Meeting Date (Pages 93 - 94)

ITEMS THE BOARD MAY WISH TO CONSIDER IN PRIVATE

9 Social Work Complaint Review Committee Outcome (Pages 95 - 104)

10 Joint Inspection of Services for Older People (verbal update)

11 Draft Minute of Clinical and Care Governance Committee - 24 May 2016 (Pages 105 - 110)

12 Draft Minute of Audit and Performance Systems Committee - 31 May 2016 (Pages 111 - 118)

Website Address: http://www.aberdeencityhscp.scot/ Should you require any further information about this agenda, please contact Iain Robertson, 01224 522869 or [email protected]

http://www.aberdeencityhscp.scot/


Minute of Meeting

26 April 2016

Community Health and Care Village, Aberdeen

Present: Councillor Ironside CBE (Chairperson); Jonathan Passmore (Vice Chairperson); and Councillors Donnelly (for items 1-9) and Samarai; and Rhona Atkinson (as substitute for Sharon Duncan), Dr Nick Fluck and Professor Mike Greaves (NHS Grampian Board members); and Jenny Gibb (Professional Nursing Adviser, NHS Grampian), Mike Adams (Partnership Representative, NHS Grampian), Jim Currie (trade union representative - Aberdeen City Council (ACC)), Bernadette Oxley (Chief Social Work Officer, ACC), Kenneth Simpson (Third Sector Representative), Gill Moffat and Faith-Jason Robertson-Foy (Carer Representatives), Howard Gemmell (Patient/Service User Representative), Dr Satchi Swami (Secondary Care Adviser, NHS Grampian), Dr Stephen Lynch (Clinical Lead, NHS Grampian) and Judith Proctor (Chief Officer, Aberdeen City Health and Social Care Partnership (ACH&SCP)).

Also in attendance: Alan Gray (interim Chief Finance Officer, ACH&SCP), Tom

Cowan (Head of Operations, ACH&SCP), Kevin Toshney (Planning and Development Manager, ACH&SCP), Roderick MacBeath (Senior Democratic Services Manager, ACC) (for item 3), Jess Anderson (Legal Manager, ACC) (for item 6) Gail Woodcock (Localities Programme Manager, ACH&SCP) (for item 8) and Iain Robertson (Democratic Services, ACC).

Apologies: Sharon Duncan. The agenda and reports associated with this minute can be located at the following link:- http://committees.aberdeencity.gov.uk/ieListMeetings.aspx?CommitteeId=516 Please note that if any changes are made to this minute at the point of approval, these will be outlined in the subsequent minute and this document will not be retrospectively altered.

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Agenda Item 2

http://committees.aberdeencity.gov.uk/ieListMeetings.aspx?CommitteeId=516

OPENING REMARKS 1. The Chair opened the meeting and introduced Dr Satchi Swami (Secondary Care Adviser, NHS Grampian) and welcomed him to his first meeting of the Board. The Chair also advised that this would be Councillor Gill Samarai’s final meeting as a member of the IJB and he thanked her on behalf of the Board for her contribution during the integration of health and social care in Aberdeen City. The Board resolved:- (i) to welcome Dr Satchi Swami as the Board’s Secondary Care Adviser; and (ii) to thank Councillor Gill Samarai for her contribution during the integration of

health and social care in Aberdeen City. DETERMINATION OF EXEMPT BUSINESS 2. The Chair proposed that item 9 (Senior Leadership Team: Structure Outline) of

today’s agenda (item 10 of this minute) be considered with the press and public excluded.

The Board resolved:- in terms of Section 50(A)(4) of the Local Government (Scotland) Act 1973, to exclude the press and public from the meeting during consideration of the aforementioned item of business so as to avoid disclosure of exempt information of the classes described in paragraph 1 of Schedule 7(A) of the Act. MINUTE OF PREVIOUS MEETING 3. The Board had before it the minute of the previous shadow Board meeting of 29 March 2016. With reference to item 8 (IJB Standing Orders) Roderick MacBeath (Senior Democratic Services Manager, ACC) explained that the Law Society of Scotland had advised that they had no legal objections to his nomination as the IJB’s Standards Officer. At this point the Chair nominated Mr MacBeath as the IJB’s Standards Officer and the Board agreed to this nomination; With reference to item 8 (IJB Standing Orders) Mr MacBeath highlighted that he had drawn up a register of members interests and he explained that the Clerk would distribute these to members after the business meeting; and With reference to item 11 (Scheme of Delegation) Mr MacBeath informed the Board that the scheme had been significantly amended since being presented to the Board on 29 March 2016 and advised that the revised scheme would be submitted to the Board at its next meeting on 28 June 2016. The Board resolved:- (i) to nominate Mr Roderick MacBeath as the IJB’s Standards Officer, subject to

final approval from the Standards Commission;

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(ii) to note that a report on the revised Scheme of Delegation would be presented to the Board at its next meeting on 28 June 2016;

(iii) to note the information provided; and (iv) otherwise approve the minute as a correct record. BUSINESS STATEMENT 4. The Board had before it a statement of pending business for information. The Board resolved:- (i) to request that the Strategic Plan be removed from the Business Statement; (ii) to request an update on the Strategic Plan’s Indicative Timetable at the

Board’s meeting on 25 October 2016; (iii) otherwise to note the statement. IJB DIRECTIONS TO ABERDEEN CITY COUNCIL AND NHS GRAMPIAN 5. The Board had before it a report by Kevin Toshney (Planning and Development Manager, ACH&SCP) which set out the functions that had been delegated to the IJB by Aberdeen City Council and NHS Grampian, its Directions to these partner organisations on how these functions would be delivered. The report recommended:- that the Board – (a) to endorse its directions to ACC in relation to those delegated functions that

ACC delivers on behalf of the IJB; (b) to endorse its directions to NHS Grampian in relation to those delegated

functions that ACC delivers on behalf of the IJB; (c) to agree that these, and all future Directions that may be agreed by the Board,

be issued on the Board’s behalf by the Chief Officer to the Chief Executives of ACC and NHS Grampian as appropriate;

(d) to agree that future papers on the transformation of integrated health and social care services consider what impact they would have on either (or both) set(s) of Directions;

(e) to agree that both sets of Directions be reviewed by the Audit and Performance Systems Committee as and when updates were required, and at a minimum on an annual basis in respect of the following financial year.

Kevin Toshney (Planning and Development Manager, ACH&SCP) spoke to the report and explained that legislation required the IJB to set out a mechanism for implementing the Strategic Plan and this would take the form of Directions from the IJB to Aberdeen City Council and NHS Grampian. Mr Toshney highlighted that the funding associated with these Directions had been drawn from the IJB’s revenue budget 2016-17 and that the Directions made it explicit that delegated functions and services would be provided delivered in terms of current operational arrangements and in the wider context of the Strategic Plan.. He added that the Directions, if approved would remain in effect until such time as they were varied, revoked or superseded by the Board.

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Thereafter there were questions on Directions for hosted services and discussion on the development of a Service Level Agreement or Memorandum of Understanding with the other Grampian IJBs for the provision and delivery of hosted services. The Board resolved:- (i) to endorse its directions to ACC in relation to those delegated functions that

ACC delivers on behalf of the IJB; (ii) to endorse its directions to NHS Grampian in relation to those delegated

functions that ACC delivers on behalf of the IJB; (iii) to agree that these, and all future Directions that may be agreed by the Board,

be issued on the Board’s behalf by the Chief Officer to the Chief Executives of ACC and NHS Grampian as appropriate;

(iv) to agree that future papers on the transformation of integrated health and social care services consider what impact they would have on either (or both) set(s) of Directions;

(v) to agree that both sets of Directions be reviewed by the Audit and Performance Systems Committee as and when updates were required, and at a minimum on an annual basis in respect of the following financial year; and

(vi) to request a report on future IJB Directions for hosted services.

RISKS COVERED BY THE CLINICAL NEGLIGENCE AND OTHER RISKS INDEMNITY SCHEME (CNORIS) 6. The Board had before it a report by Alan Thomson (Solicitor, ACC) which outlined to the Board the potential risks of not signing up to CNORIS. The report recommended:- that the Board – (a) Note the contents of the report; (b) Note the contents of the report at Appendix 1; (c) Direct the Chief Officer to apply to Scottish Ministers to join CNORIS for

Directors and Officers cover; and (d) Agree the expenditure to purchase membership of CNORIS at the amount set

out at 2.3.1 of Appendix 1. Jess Anderson (Legal Manager, ACC) spoke to the report and advised that the Scottish Government’s Statutory Guidance had recommended that IJBs should have risk pooling and claims management arrangements in place and highlighted that 23 other IJBs including Aberdeenshire and Moray had signed up to CNORIS. Ms Anderson explained that the risk associated with IJB membership of CNORIS was considered low and therefore the annual contribution had been set at £3,000. Thereafter there were questions on the extent of CNORIS’ coverage in the event of a substantial claim for compensation from individuals impacted by a decision of the IJB and whether claims covered areas such as criminal justice. There were also questions on the process for determining the validity of claims against the IJB and under what circumstances the IJB would need to seek legal advice independent of Aberdeen City Council and NHS Grampian. The Board resolved:- (i) to note the contents of the report;

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(ii) to note the contents of the report at Appendix 1; (iii) to direct the Chief Officer to apply to Scottish Ministers to join CNORIS for

Directors and Officers cover; (iv) to agree the expenditure to purchase membership of CNORIS at the amount

set out at 2.3.1 of Appendix 1; (v) to request legal clarification on how claims would be validated and determined; (vi) to request that membership of CNORIS be monitored and reviewed on a

regular basis; and (vii) to request that the Chief Officer raise risk pooling and claims management

arrangements at the next IJB Chief Officers meeting. STRATEGIC COMMISSIONING INVESTMENTS (TRANSFORMATION FUNDS) 7. The Board had before it a report by Judith Proctor (Chief Officer, ACH&SCP) which set out a Strategic Commissioning and Transformation Programme for the IJB and outlined the process undertaken to develop these priorities. The report recommended:- that the Board - (a) Endorse the principle of strategic commissioning as set out in the paper in

Appendix 1; (b) Agree these as the priority strategic commissions for development over a

rolling three year programme; (c) Agree the high level investment proposals set out in the paper; (d) Agree that oversight of delivery of the programme would continue under the

Transformation Programme Board which would, in turn, report to the Audit and Performance Systems Committee;

(e) Request an annual report on progress and milestones, or as required by exception to the IJB;

(f) Agree that funding not committed to these strategic commissions would be directed by the Transformation Programme Board, within an agreed allocation process aligned to the IJB’s Strategic Plan; and

(g) Agree the establishment of new posts related to the delivery of this programme.

The Board received a presentation from Judith Proctor in which she advised that the Transformational and Strategic Commissioning Plan would provide the mechanism for delivering the Strategic Plan. Mrs Proctor summarised the context of health and social care integration and the consultative process undergone during the development of the Strategic Plan. She explained that the Transformational and Strategic Commissioning Plan would encompass three main areas of focus: 1. Enablers: This area would concentrate on the development of mobile

working, shared networks, platforms to support integrated teams and cultural and organisational change;

2. Commissioning Approach: This area would look at supporting locally

focussed commissioning, improving integrated working with third and independent sector providers and increasing capacity and sustainability through joined up working and better relationships; and

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3. Development of New Models: This area would focus on the development of Acute Care@home, building community capacity and modernising primary care.

Mrs Proctor also highlighted the resourcing and governance arrangements of the IJB and the importance of being prudent in relation to risk and the necessity of having robust structures in place. She also added that the Partnership would be realistic in its planning and not overpromise on its capacity to deliver services. Thereafter there were questions on the bidding process for Transformational Funding; the proposed level of funding to be allocated to independent and third sector providers; and the viability of ring-fencing funding for projects and services to be delivered at locality level. Members also highlighted the importance of information analysis and the development of an evaluation framework to avoid a retrofit analysis after year two; and the Partnership’s use of the Programme Management Office to deliver sustainable change and avoid the expansion of existing capacity. The Board resolved:- (i) to endorse the principle of strategic commissioning as set out in the paper in

Appendix 1; (ii) to agree these as the priority strategic commissions for development over a

rolling three year programme; (iii) to agree the high level investment proposals set out in the paper; (iv) to agree that oversight of delivery of the programme would continue under the

Transformation Programme Board which would, in turn, report to the Audit and Performance Systems Committee;

(v) to request an annual report on progress and milestones, or as required by exception to the IJB;

(vi) to agree that funding not committed to these strategic commissions would be directed by the Transformation Programme Board, within an agreed allocation process aligned to the IJB’s Strategic Plan;

(vii) to agree the establishment of new posts related to the delivery of this programme;

(viii) to request that a report on the principle of ring-fencing transformational funding be presented to the Audit and Performance Systems Committee; and

(ix) to thank the Chief Officer for the informative presentation. COMMUNITY EMPOWERMENT ACT CONSULTATION 8. The Board had before it a report by Gail Woodcock (Localities Programme Manager, ACH&SCP) which brought to the Board’s attention the ongoing consultation relating to the Community Empowerment (Scotland) Act and sought agreement that a formal response to the consultation be submitted on behalf of the ACH&SCP. The report also suggested a process for supporting responses to future consultations on behalf of the ACH&SCP. The report recommended:- that the Board – (a) Note the consultation on the draft guidance in respect of the Community

Empowerment Act and the timescales involved, which mean that it was not

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possible to bring a full draft consultation response to the IJB for approval prior to the consultation response deadline;

(b) Instruct the Chief Officer to develop and provide an appropriate response on behalf of the ACH&SCP to the current consultation relating to the Community Empowerment Act, in consultation with the Chair and Vice Chair of the IJB;

(c) Delegate to the Chief Officer the responsibility for responding to future relevant consultations on behalf of the ACH&SCP, in consultation with the Chair and Vice Chair of the IJB, bringing draft consultation responses to the IJB or appropriate committee if appropriate and when time permits.

Gail Woodcock spoke to the report and advised that the Community Empowerment (Scotland) Act imposed duties on Community Planning Partnerships (CPP) and partners around the delivery of improved local outcomes and the involvement of community bodies at all stages of the community planning process and this was of particular interest to the IJB as locality planning was a key element of the Public Bodies (Joint Working) (Scotland) Act. Ms Woodcock explained that differences in terminology between the two acts may prove to be problematic as the Community Empowerment Act defined localities as natural communities, whereas the Public Bodies Act deemed localities to be artificial boundaries. She further advised that the ACH&SCP had been engaging with CPP colleagues on how services would be planned and delivered at locality, city and regional levels and that work was ongoing to develop a Participation and Engagement Strategy to ensure that communities had a voice during the process as this would provide added value to decision making. She also noted that Part 5 of the Community Empowerment Act set out the framework for the asset transfer process and this would be of interest to the IJB as physical assets were a key enabler to deliver many of the services that the ACH&SCP was responsible for. Thereafter members requested that all future consultation responses be published on the Partnership’s website for public inspection; and Judith Proctor advised that IJBs were statutory partners of CPPs and she confirmed that the Chair would represent the IJB, with support from the Chief Officer on the Aberdeen City Community Planning Partnership. The Board resolved:- (i) to note the consultation on the draft guidance in respect of the Community

Empowerment Act and the timescales involved, which mean that it was not possible to bring a full draft consultation response to the IJB for approval prior to the consultation response deadline;

(ii) to instruct the Chief Officer to develop and provide an appropriate response on behalf of the ACH&SCP to the current consultation relating to the Community Empowerment Act, in consultation with the Chair and Vice Chair of the IJB;

(iii) to delegate to the Chief Officer the responsibility for responding to future relevant consultations on behalf of the ACH&SCP, in consultation with the Chair and Vice Chair of the IJB, bringing draft consultation responses to the IJB or appropriate committee if appropriate and when time permits; and

(iv) to request that all consultation responses made on behalf of the IJB be published on the ACH&SCP website.

IJB 2017-18 MEETING DATES

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9. The Board had before it a report by the Clerk which proposed a meeting schedule for the IJB for 2017-18. The report recommended:- that the Board – (a) Agree the 2017-18 meeting dates as outlined in the report; and (b) Approve the publication of the meeting dates on the ACH&SCP website. The Clerk spoke to the report and advised that the report proposed similar arrangements to the existing meeting schedule whereby the IJB would meet on a bi-monthly basis with meetings commencing at 10am on Tuesdays, alternating between the Town House and the Community Health and Care Village. He added that after consultation no meetings had been found that conflicted with Aberdeen City Council or NHS Grampian Board meetings and approval of these dates would enable IJB meeting dates to be included in Aberdeen City Council’s Calendar of Meetings for 2017 which would be considered at Full Council on 11 May 2016. The Board resolved:- (i) to agree the 2017-18 meeting dates as outlined in the report; and (ii) to approve the publication of the meeting dates on the ACH&SCP website. In accordance with the decision recorded under article 2 of this minute, the following item was considered with the press and public excluded. SENIOR LEADERSHIP TEAM: STRUCTURE OUTLINE 10. The Board had before it a report by Tom Cowan (Head of Operations, ACH&SCP) which informed the Board of the proposed approach to establishing a Senior Leadership Organisational Structure for the ACH&SCP. The report recommended:- that the Board – (a) Agree the organisational design outlined within the report; and (b) Instruct the Chief Officer to deliver the structure within the existing resources

of the present management structures, along with the additional Transformational Funding outlined in the accompanying Strategic Commissioning Investments report.

The Board resolved:- (i) to agree the organisational design outlined within the report; and (ii) to instruct the Chief Officer to deliver the structure within the existing resources

of the present management structures, along with the additional Transformational Funding outlined in the accompanying Strategic Commissioning Investments report.

WORKSHOP SESSION STRATEGIC RISK REGISTER

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11. The Board then broke out into a workshop session presented by Hilary Merett and Donal Sutton (Good Governance Institute) which focussed on the development of the Board’s Strategic Risk Register. COUNCILLOR LEN IRONSIDE CBE, Chairperson.

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1


Report Title Scheme of Delegation

Lead Officer Judith Proctor

Report Author Jessica Anderson / Alan Thomson

Date of Report 10th June 2016

Date of Meeting 28th June 2016

1: Purpose of the Report

To outline the delegations reserved to the Integration Joint Board, to set out the

Operational Protocol to the Chief Officer and Chief Finance Officer and to clarify

the accountability considerations.

2: Summary of Key Information

Under the terms of the Aberdeen City Integration Scheme, Aberdeen City Council

and NHS Grampian delegated a range of statutory functions in respect of health

and social care to the Aberdeen City Integration Joint Board (IJB)1. Delegated

services are in line with the Public Bodies (Joint Working) (Scotland) Act 2014

(hereinafter referred to as “the Act”) and guidance and also take account of a

number of ‘hosted’ services i.e. services managed by one of the three Grampian

Integration Joint Boards on behalf of all. This delegation came into effect on 6th of

February 2016 when the Integration Scheme was approved by Scottish Ministers.

The budgets previously held by Aberdeen City Council and NHS Grampian in

respect of these functions were delegated to the IJB on the 1st of April 2016 when

the Strategic Plan was published, signalling the Partnership’s formal

commencement.

Legislation requires that the IJB shall Direct Aberdeen City Council and NHS

Grampian to deliver the services (set out in Annex 1, Part 1 and 3, and Annex 2,

Part 2 of the Integration Scheme). The IJB, through the Chief Officer, has

responsibility for the planning, resourcing and operational delivery of all integrated

services within the Strategic Plan. The Chief Officer has a direct line of

1 Public Bodies (Joint Working) (Scotland) Act 2014

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Agenda Item 3

2


accountability to the Chief Executives of the Health Board and the Council for the

delivery of integrated services. The Chief Officer is responsible for ensuring

delivery of the National Health and Wellbeing outcomes, any locally delegated

responsibilities for health and wellbeing and for measuring, monitoring and

reporting on the underpinning measures and indicators that demonstrate progress.

To assist in the discharge of its functions, the IJB shall appoint a number of

committees and will define the powers of those Committees. These Committees

have been agreed by the IJB and are the Audit and Performance Systems

Committee and the Clinical and Care Governance Committee. Terms of

Reference for both of these have similarly been agreed.

Aberdeen City Council and NHS Grampian noted that the functions set out in the

Integration Scheme were being delegated to the IJB. It is important to highlight

that these functions have been delegated, and not transferred, to the IJB. This

means that the legal responsibility for the functions still remains with the Council

and NHS Grampian. An annual report will be published by the IJB setting out

performance against the National Outcomes.

The Chief Officer has a dual role. She/he is accountable to the IJB for the

responsibilities placed on the IJB under the Act and the Integration Scheme, and

they are accountable to the NHS Board and Council for any operational

responsibility for integrated services, as set out in the Integration Scheme.

In her/his capacity as a Chief Official in the Council and in the NHS, the Chief

Officer of the IJB has powers delegated to her/him by virtue of her/his position.

The Aberdeen City Council Delegated Powers approved 8 October 2014 and last

updated 22 October 2015 applies to the Chief Officer of the IJB, with general

delegations at page 3, and more specific delegations at page 52.

Set out in Appendix 1 of this report is a draft Scheme of Delegation which sets out

the delegations to the IJB and clarifies the remit and responsibilities of the Chief

Officer and the Chief Financial Officer in respect of the operational management

and deliverability of the integrated services as set out in the Integration Scheme.

The IJB will retain all powers which are specifically reserved to the IJB, its

committee, or sub-committees. The matters reserved to the IJB or committees are

mainly the strategic policy, financial or regulatory issues requiring to be decided by

the IJB, whilst the operation delivery and implementation of integrated services

shall be conducted in accordance with the approved Schemes of Delegation of the

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3


Partners.

The approach as set out in the Scheme of Delegation appears to be akin to

neighbouring IJBs.

The Chief Executive of Aberdeen City Council intends to review the Council’s

Scheme of Delegation as part of Aberdeen City Council’s Governance Review,

and present the revised version as it relates to the IJB, to a future meeting of the

IJB.

3: Equalities, Financial, Workforce and Other Implications

There are no equality, financial or workforce implications.

The agreed Scheme of Delegation will clearly set out lines of accountability, and

enable to the Chief Officer and Chief Financial Officer to discharge their duties to

deliver the integrated services as detailed in the Strategic Plan, in accordance with

relevant policies and procedures of the Partner Organisations.

Without an appropriate Scheme of Delegation in place, there is a real risk that the

Chief Officer and the Chief Financial Officer will not be able to discharge their

responsibilities under the Integration Scheme, or that delivery of key services is

significantly delayed. This Scheme of Delegation and Operational Protocol shall be

read with the Scheme and each Partner’s approved Scheme of Delegation.

It is vital that the Scheme of Delegation is regularly reviewed along with other

governance documents to ensure that it is still fit for purpose.

4: Recommendations

The Integration Joint Board is asked to:

1) Approve the attached Scheme of Delegation

2) Agree that the Scheme of Delegation be reviewed annually, or as and when

required by officers.

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4


3) Note that the Chief Executive of Aberdeen City Council shall review the

Council’s Scheme of Delegation and agree that she bring a further report to the

IJB setting out the outcome of the review as it relates to the IJB.

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Appendix 1- Scheme of Delegation 1 INTRODUCTION AND INTERPRETATION 1.1 This Scheme of Delegation (hereinafter referred to as the “Scheme”) was

approved by Aberdeen City Integration Joint Board (hereinafter referred to as the ”IJB”) on 28 June 2016. The Scheme sets out the powers delegated to the IJB and clarifies the remit and responsibilities of the Chief Officer and the Chief Financial Officer in respect of the operational management and deliverability of the integrated services as set out in the Scheme.

1.2 The Interpretation Act 1978 shall apply to the interpretation of this Scheme as it

applies to the interpretation of an Act of Parliament.

2 CORE PRINCIPLES

2.1 Aberdeen City Council and NHS Grampian (hereinafter referred to as “the Partners”) delegated various functions to the IJB on 1st April 2016. The Partners retain overall statutory responsibility for their respective functions delegated to the IJB.

2.2 The matters reserved to the IJB or committees are mainly the strategic policy,

directions, financial or regulatory issues requiring to be decided by the IJB, while the day to day operational matters are assigned to officers. The remit of officers of the IJB detailed at Section 4 is not exhaustive.

2.3 The Chief Officer will have delegated responsibility from the Partners for all

matters in respect of the operation, development and implementation of policy unless specifically reserved to the IJB or other Committees, together with such statutory duties as may have been specifically and personally assigned to the Chief Officer. Such delegations are at all times to be exercised in accordance with the relevant law, and any Partner Financial Regulations, approved Schemes of Delegation and Standing Orders.

2.4 The Partners will be required to delegate to officers from both organisations

specific delegated powers under Partners approved Schemes of delegation, duties or responsibilities to enable them to discharge the operational elements of health and social care to deliver the IJB’s Strategic Plan. Any officer using delegated powers will be fully accountable to the Chief Officer for their own actions and or decisions, who in turn shall be accountable to the Chief Executives of the Health Board and Council respectively.

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3 Specific powers reserved for the Integration Joint Board 3.1 The powers which are reserved to the IJB or its committees are comprised of

those which must, in terms of statute, be reserved, and those which the IJB has, itself, chosen to reserve. Powers which are not reserved are delegated, in accordance with the provisions of the Integration Scheme and this Scheme.

3.2 The following is a comprehensive list of what is reserved to the IJB or any of its

committees:

a) Any other functions or remit which is, in terms of statute or legal requirement bound to be undertaken by the IJB itself;

b) To establish such committees, sub-committees and joint committees as may

be considered appropriate to conduct business and to appoint and remove Conveners, Depute Conveners and members of committees and outside bodies;

c) The approval of the annual Budget;

d) The approval of the Financial Strategy;

e) The approval or amendment of the Standing Orders regulating meetings

proceedings and business of the IJB and Committees and contracts in so far as it relates to the engagement of consultants, or external advisors for specialist advice;

f) The approval or amendment of the Scheme of Delegation detailing those

functions delegated by the IJB to its officers;

g) The decision to co-operate or combine with other Integration Joint Boards in the provision of services other than by way of collaborative agreement;

h) The approval or amendment of the Strategic Plan including the Financial

Plan;

i) To deal with matters reserved to the IJB by Standing Orders, Financial Regulations and other schemes approved by the IJB; and

j) To issue Directions to the Partners under sections 26 and 27 of the 2014 Act.

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4 OPERATIONAL PROTOCOL - SPECIFIC PROVISIONS OF DIRECTIONS TO OFFICERS IN ACCORDANCE WITH THE PARTNERS’ APPROVED SCHEMES OF DELEGATION

4.1 Chief Officer The Chief Officer will act as the principal policy adviser to the IJB on matters of general policy and to assist Members to formulate clear objectives and affordable programmes having regard to changing priorities, directions to partners, statutory and financial requirements and community needs and expectations. The Chief Officer will be held responsible and accountable for the strategic and operational management of all delegated functions, including performance of all Services that form part of the AH&SCP delegated by the Partners through the Integration Scheme and their respective approved Schemes of Delegation, with the exception of Acute Services. The Chief Officer is the Leader of the IJB’s Executive Management Team and has overall responsibility for the following:-

a) the delivery of health and social care services as set out in the Integration Scheme and

b) implementing any Direction issued by the IJB

c) Strategic management of services and resources d) Strategy and Policy Development

e) Leading Improvement

The Chief Officer shall discharge her/his duties in accordance with the powers as delegated to them by the Partners under their respective approved Schemes of Delegation. In discharging her/his duties and in making any recommendation to the IJB, the Chief Officer will demonstrate to the IJB that she/he have followed relevant Partner procedures and sought approval, where this is required. 4.1.1 The Chief Officer shall discharge their duties by:

a) ensuring that a corporate approach to the management and execution of the IJB’s affairs is maintained and that advice to the IJB is given on a co-ordinated basis.

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b) monitoring the performance of members of the Executive Management Team and their direct reports.

c) giving direction on the applicability of this Scheme and where appropriate that

any officer shall not exercise a delegated function.

d) appoint or make recommendations as to the engagement of consultants, external advisors or specialists pursuant to any decision taken by the IJB.

e) consider and deal with any urgent issues arising, following the procedure set

out at 6.2,

f) maintenance of good internal and external public relations.

g) the identification, planning and mitigation of risks affecting the IJB.

h) the provision of business continuity including identification of issues, business continuity planning, liaison with external bodies and putting in place arrangements to deal with business continuity issues.

i) compliance with duties under the Health and Safety at Work Act 1974 and

other legislation relating to health and safety.

j) to be the primary point of contact with the Health and Safety Executive in matters relating to the health and safety of premises or services.

k) all powers ancillary to or reasonably necessary for the proper performance of

the Chief Officer’s general duties and responsibilities.

4.2 Chief Finance Officer

The Chief Finance Officer has overall responsibility for Finance including Audit;

Financial Management; and any Procurement by the Health and Social Care

Partnership

The financial limits as set by the terms of this Scheme shall be reviewed by the Chief

Finance Officer in April each year and any proposed amendment reported to the IJB.

The Chief Financial Officer shall discharge her/his duties in accordance with the powers as delegated to them by the Partners under their respective approved Schemes of Delegation. In discharging her/his duties and in making any recommendation to the IJB, the Chief Financial Officer will demonstrate to the IJB that she/he have followed relevant Partner procedures and sought approval, where this is required.

Page 20

4.2.1 The Chief Finance Officer is responsible for the leadership and co-ordination,

planning and policy and the strategic and management of the following services:-

a) Act as the Proper Officer responsible for the administration of the financial

affairs of the IJB in terms of section 95 of the Local Government (Scotland )

Act 1973

b) To adhere to IJB and Partner Financial Regulations and relevant Codes of

Practice of the Board for the control of all expenditure and income.

c) The monitoring of the IJB’s capital and revenue budgets during the course of

each financial year and reporting thereon to the IJB.

d) Determine all accounting procedures and financial record keeping of the IJB.

e) Subject to the approval of the Chief Officer and in conformity with any

Financial Regulations and any approved policy, authorise the transfer of

approved estimates from one head of expenditure to another, within a

Service estimate, unless it is considered to materially affect the approved

budget, in which case authorisation of the IJB will be sought.

f) To arrange the necessary insurances through CNORIS to protect the

interests of the IJB (Directors and Officers cover) and make arrangements

with CNORIS concerning claims handling and settlement of claims.

g) To have financial oversight of any procurement for the engagement of

consultants, external advisors for specialist advice entered into directly by the

Health and Social Care Partnership or the Chief Officer (but not procurement

carried out on behalf of the Partnership or Chief Officer by a Council or

Health Board).

h) To be the primary point of contact with both internal and external audit and

provide information as appropriate.

Page 21


1

INTEGRATION JOINT BOARD.

Report Title The Corporate Risk Register


Report Author Kevin Toshney

Date of Report 17th May 2016

Date of Meeting 28TH June 2016


This paper brings to the attention of the IJB, the partnership’s corporate risk

register comprising of the current strategic and operational risk registers.


Development, Contents and Ownership of the Corporate Risk Register.

The Integration Scheme stresses the importance of a robust risk management

reporting and assurance framework to good governance and the shadow

Integration Joint Board recognised this by approving such a framework at its

meeting in March 2016.

This Risk Management Framework is one of a suite of frameworks that have been

factored into the Integration Joint Board’s Assurance Framework showing how

and where the IJB and its committees gets the necessary assurance about the

governance, operation and performance of the partnership.

The approved Risk Management Framework incorporates a risk management

policy, risk appetite statement and corporate risk register which itself contains two

elements, the strategic and the corporate operational risk registers.

The strategic risk register (appendix one) sets out the high level risks which may

threaten achievement of the IJB’s strategic priorities, in order for the board to

monitor its progress, demonstrate its attention to key accountability issues, ensure

that it debates the right issue, and that it takes remedial actions to reduce risk to

integration. Most importantly, it identifies the assurances and assurance routes

Page 23

Agenda Item 4

2


against each risk and the associated mitigating actions.

The first version of the strategic risk register was developed by the IJB at a

workshop facilitated by the Good Governance Institute after the first public meeting

of the IJB in April 2016.

The Good Governance Institute recommended the format used by the strategic

risk register as not only did it show on one page, the identified risk, an assessment

of the likelihood and impact of harm, the mitigating measures and the assurance

controls but it also crucially shows any variation in that risk assessment, identifies

known assurance gaps and outlines current performance.

The Chief Officer and the Executive Group will agree what issues should be

included in or removed from the Strategic Risk Register based on their own

discussions and submit to the Audit and Performance Systems committee and

then the IJB for formal review and approval.

The Audit and Performance Systems Committee reviews the Strategic Risk

Register for the effectiveness of its management of risk and the wider assurance

mechanisms.

The Corporate Operational Risk Register (appendix two) comprises high scoring

operational risks or those which cannot be managed at a sector or service level. It

has a different format from the strategic risk register as it reflects the Datix

recording system previously agreed as forming the basis of our risk management

processes.

It is understood that there may be some degree of commonality between the

corporate operational risk register and the strategic risk register given the desire to

evidence a strong strategic coherence and an alignment with the partnership’s

statement of intent and risk appetite statement. The connectivity between risk

registers is preferable to disconnected isolation.

The Director of Operations will own the corporate operational risk register and it

will be a standing item for discussion at the senior operational management team

meetings. The Director of Operations will report changes to the risk register to the

Chief Officer through the Executive Group.

Page 24

3


Audit & Performance Systems Committee – 31st May

The Corporate Risk Register was taken to the meeting of the Audit & Performance

Systems Committee on the 31st of May. After useful discussion, the Committee

agreed to the following recommendations:

1. Endorse the current strategic risk register contained within the corporate

risk register.

2. Endorse the current corporate operational risk register contained within the

corporate risk register.

3. Remit the reviewed corporate risk register to the next meeting of the

Integration Joint Board with the committee’s expressed opinion of how

appropriate, comprehensive and effective it is deemed to be.

4. Request that the corporate risk register is updated by the appropriate risk

owners and tabled as a standing item at future Committee meetings.

Additionally, the Committee agreed to:

1. Review the format of the registers every 6 months.

2. Changes would be tracked on the registers to record revisions.

The Role of the Integration Joint Board.

In line with the Board Assurance Framework (adopted by the sIJB at its meeting

on 26th March), it is proposed that the Corporate Risk Register will be reported to

the Board bi-monthly, demonstrating the changes in the risk profile of the IJB. The

IJB has a role in moderating all escalated risks that are brought to its attention to

ensure an appropriate and consistent response to the challenges that they

present.


There are no obvious, immediate implications for the Equalities duties of the

Integration Joint Board however robust, well managed risk registers should

ensure that the potential for detriment to the many different citizens and their

families who use and depend on our services is minimised.

Page 25

4


It is anticipated that any potential financial implications are minimised due to

both the strategic and corporate operational risk registers identifying the risk of

financial loss/harm and seeking to mitigate this possibility accordingly.

It is anticipated that the partnership’s workforce will be reassured by the

scrutiny that the IJB and the Audit and Performance Systems committee

applies to the corporate risk register and its constituent elements to ensure that

all risks are appropriately identified and mitigated.

4: Recommendations


1. Note the recommendations agreed by the Audit and Performance Systems

committee with respect to the Corporate Risk Register.

2. Endorse the Corporate Risk Register.

3. Agree that following appropriate scrutiny by the Audit and Performance

Systems committee of the Corporate Risk Register, the strategic risk

register will be presented to the IJB for further discussion and approval.

Page 26

www.good-governance.org.uk 1

APPENDIX 1

Aberdeen City Health and Social Care Partnership Strategic Risk Register 2016/17

May 2016

- DRAFT -

Page 27


The following were the risks highlighted at the most recent IJB workshop on the Strategic Risks. Those that are underlined were new risks identified from the initial drafted set and had been agreed in that meeting for inclusion in the final draft Strategic Risk Register for presentation to the Audit and Performance Systems Committee prior to final approval by the IJB.

1. There is a risk of significant market failure in Aberdeen City

2. There is a risk of financial failure , that demand outstrips budget and IJB cannot deliver on priorities, statutory work, and project an overspend

3. Failure of the IJB to function, make decisions in a timely manner etc

4. There is a risk that the outcomes expected from hosted services are not delivered and that the IJB does not identify non-performance in

through its systems. This risk relates to services that Aberdeen IJB hosts on behalf of Moray and Aberdeenshire, and those hosted by those

IJBs and delivered on behalf of Aberdeen City.

5. There is a risk that the governance arrangements between the IJB and its partner organisations (ACC and NHSG) are not robust enough to

provide necessary assurance within the current assessment framework – leading to duplication of effort and poor relationships

6. There is a risk that services provided by ACC and NHS corporate services on behalf of the IJB do not have the capacity, are not able to work at

the pace of the IJB’s ambitions, or do not perform their function as required by the IJB to enable it to fulfil its functions

7. There is a risk that the IJB and the services that it directs and has operational oversight of fail to meet performance standards or outcomes as

set by regulatory bodies

8. There is a risk of reputational damage to the IJB and its partner organisations resulting from complexity of function, delegation and delivery

of services across health and social care.

9. Failure to deliver transformation at a pace or scale required by the demographic and financial pressures in the system

10. There is a risk that the IJB does not maximise the opportunities offered by locality working

Page 28


- 1 -

Strategic Priority Outcomes, safety and transformation

Lead Director CO until Director of Strategic Commissioning appointed

Description of Risk There is a risk of significant market failure in Aberdeen City

Risk Rating High

Movement Rationale for Risk Rating

Previous experience of provider failure in City and wider across Scotland

Discussion with current providers and understanding of market conditions across the UK

Impact of Living Wage on profitability depending on some provider models

Rationale for Risk Appetite

3rd and independent sectors key strategic partners in delivering transformation and improved care experience and we have a low tolerance of risk of market failure

Controls Robust market and relationship management with the 3rd and independent sector and their representative groups, creation of a Director of Strategic Commissioning role as part of the wider strategic transformation programme, market facilitation programme and robust review of all

Mitigating Actions

Creation of capacity and capability to manage and facilitate the market

Development of provider forum to support relationship and market management

Page 29


contracts and our commissioning model. Risk fund set aside with transformation funding

Additional SG funding toward the Living Wage and Fair Working Practices

Assurances Market management and facilitation Audit and Performance Systems Committee overview

Gaps in assurance Market or provider failure can happen quickly despite good assurances being in place

Current performance No current issues to report

Comments Market remains subject to change

- 2 -

Strategic Priority Outcomes and transformation

Lead Director Director of Finance and Business (CFO)

Description of Risk There is a risk of IJB financial failure with demand outstripping available budget. There is a risk that the IJB cannot deliver on priorities and statutory work, and that it projects an overspend.

Risk Rating Medium


Analysis of demographic change and growth in demand year on year

Analysis of current budget pressures known and expected in the Public Sector in Scotland and the UK

Understanding of financial pressures on both partner organisations (ACC and NHS Grampian)


Page 30


The IJB has a low risk appetite to financial failure and understands its requirement to achieve a balanced budget. However the IJB also recognises the significant range of statutory services it is required to meet within that finite budget and has a lower appetite for risk of harm to people.

Controls Chief Finance Officer has been appointed and this role is important in ensuring sound financial information and supporting sound financial decision making, Budget reporting and escalation. There is an Integration Scheme in place with provision for the management of finances in partners with ACC and NHS Grampian and a Strategic plan and Transformational Commissioning plan agreed by the IJB in April 2016. Transformational plans include investment to save over a three year period.

Mitigating Actions NHS and ACC will ‘underwrite’ the IJB’s budget in year 1 of its formal operation – however this needs to be seen in the context of the pressures on those partners’ budgets. Whilst the IJB has agreed a forward Transformational plan, there is a risk that we are unable to deliver transformation and efficiencies at the pace required.

Assurances

Audit and Performance Systems Committee oversight and scrutiny of budget under the CFO

Board Assurance Framework.

Gaps in assurance

None known

Current performance Balanced budget but elements underpinning this need addressed – e.g. staffing underspend through failure to recruit cannot be sustainable position

Comments

Regular and ongoing budget reporting and tight management control in place

- 3 -


Lead Director Chief Officer

Page 31


Description of Risk There is a risk that the IJB fails to function properly within its Integration Scheme, Strategic Plan and Schemes of delegation in particular reference to being able to make appropriate decisions in a timely manner and meet its required functions.

Risk Rating Medium

Movement Rationale for Risk Rating Failure of the IJB to function is a fundamental risk which would impact on all strategic priorities. Capacity of Executive Group while recruitment to full complement in structure, a potential risk Rationale for Risk Appetite Zero appetite.

Controls

Experience of operating in shadow form

Agreed etiquette of the board and risk appetite statement allowing for balance of timely decision taking with effective challenge and scrutiny

Performance reporting mechanisms

Mitigating Actions

Recruiting to further senior posts in the structure

Operation of Executive team focussing on priorities

Assurances

Board Assurance Framework

Audit & Performance Systems Committee

Gaps in assurance

None known

Current performance

Meeting requirements

Comments

Page 32


Increasing workload experienced following ‘go live’ and in relation to need to support IJB’s committees – being mitigated by further recruitment to senior posts

- 4 -

Strategic Priority Outcomes and transformation


Description of Risk There is a risk that the outcomes expected to be delivered by hosted services are not realised and that the IJB fails to identify non-performance through its own systems. This risk relates to services that Aberdeen IJB hosts on behalf of Moray and Aberdeenshire, and those hosted by those IJBs and delivered on behalf of Aberdeen City.

Risk Rating Medium


Considered medium risk due to the reporting arrangements being relatively new and needing testing in the first full year of operation


The IJB has some tolerance of risk in relation to testing change

Controls

Integration scheme agreement on cross-reporting

NE Strategic Partnership Group

Operational risk register

Mitigating Actions

This is discussed regularly by the three North East Chief Officers

Regular discussion regarding budget with relevant finance colleagues

Assurances Audit & Performance Systems Committee

Gaps in assurance None currently known

Page 33


Current performance No issues to report

Comments

- 5 -



Description of Risk There is a risk that the governance arrangements between the IJB and its partner organisations (ACC and NHSG) are not robust enough to provide necessary assurance within current assurance framework – leading to duplication of effort and poor relationships

Risk Rating Medium

Movement Rationale for Risk Rating Considered medium as arrangements are complex and mitigations untested in the ‘go live’ environments Rationale for Risk Appetite The IJB has zero appetite for failure to meet its statutory requirements.

Controls

Scheme of delegation

Integration Scheme

Current governance committees within IJB and NHS

North East Strategic Partnership Group

Mitigating Actions

Consultation and engagement between bodies

Consideration being given by Chief Officers regarding development of Service Level Agreements or other mechanism

Page 34


Assurances

Agreement on regular reporting on hosting at each IJB

Regular Chief Officer meetings across Grampian area

Chief Officer a member of both NHS Grampian Senior Leadership Team and Aberdeen City Council’s Corporate Management Team

Gaps in assurance

Potential gaps around standard interpretation of schemes

Current performance

No current issues to report

Comments

- 6 -

Strategic Priority Outcomes and service transformation


Description of Risk There is a risk that the services provided by ACC and NHS Corporate Services on behalf of the IJB do not have the capacity or are unable to work at the pace of the IJB’s ambitions. There is a further risk that they are unable to perform their function as required by the IJB to enable it to fulfil its functions.

Risk Rating High


Given the wide range and variety of services that support the IJB from NHS Grampian and ACC there is a possibility of under or non-performance

Depending on which area this is in (e.g. corporate finance, legal services) the consequences are considered significant

Page 35


Rationale for Risk Appetite There is a zero tolerance in relation to not meeting legal and statutory requirements.

Controls

IJB Strategic Plan

IJB Integration Scheme

Agreed risk appetite statement

Role and remit of the North East Strategic Partnership Group in relation to shared services

Mitigating Actions

Regular reporting at both Executive Management Team and Senior Operational Management team

Regular and ongoing Chief Officer membership of ACC Corporate Management Team and NHS Grampian Senior Leadership Team

Consideration in relation to Service Level Agreements being undertaken by the 3 North East Chief Officer.

Assurances

Executive Group reviews performance of corporate services’ support regularly

Chief Finance officer role ensure liaison in relation to financial services

Chief Officer regularly discusses these service provisions with Corporate Directors

Gaps in assurance

None currently significant though note consideration relating to possible future Service Level Agreements

Current performance

No issues to highlight

Comments

- 7 -

Strategic Priority Outcomes, safety, transformation of services

Lead Director Director of Finance and Business

Page 36


Description of Risk There is a risk that the IJB and the services that it directs and has operational oversight of fail to meet performance standards or outcomes as set by regulatory bodies and that, as a result, harm or risk of harm to people occurs.

Risk Rating Possible/Moderate = Medium

Movement

Rationale for Risk Rating Risk felt to be moderate, given controls with potential risks in need of mitigation due to go-live implications Rationale for Risk Appetite The IJB has zero tolerance of harm happening to people as a result of its actions or inaction.

Controls

Clinical and Care Governance Committee and Group Audit and Performance Systems Committee

Risk-assessed performance plans and actions

Development of KPIs reported

Mitigating Actions System re-design and transformation

Assurances

Executive Group reviews processes and performance regularly

Joint meeting of IJB Chief Officer with two Partner Body Chief Executives

Audit & Performance Systems Committee

Clinical and Care Governance Committee

Gaps in assurance

Formal performance systems not yet developed.

Audit & Performance Systems Committee not yet met

Intelligent Board performance model

Page 37


Current performance Council and NHS performance systems remain in place with single reporting in development

Comments

- 8 -

Strategic Priority All


Description of Risk There is a risk of reputational damage to the IJB and its partner organisations resulting from complexity of function, delegation and delivery of services across health and social care

Risk Rating High

Movement Rationale for Risk Rating Newness of the organisation and agenda for system transformation pose risk of reputational damage Rationale for Risk Appetite Willing to risk certain reputational damage if rationale for decision is sound.

Controls

Executive Management Team

IJB and its Committees

Operational management processes and reporting

Board escalation process

Mitigating Actions

Clarity of roles

Staff and customer engagement

Effective performance and risk management

Page 38


Assurances

Role of the Chief Officer and Executive Team

Role of the Chief Finance Officer

Performance relationship with NHS and ACC Chief Executives

Communications plan / communications officer

Gaps in assurance None known at this time

Current performance

Chief Finance Officer appointed on interim and permanent post being recruited to

Communications officer in place to lead reputation management

Comments

- 9 -



Description of Risk Failure to deliver transformation at a pace or scale required by the demographic and financial pressures in the system

Risk Rating Medium

Movement Rationale for Risk Rating This is the overall risk – each of our transformation programme workstreams will also be risk assessed with some programmes being a higher risk than others Rationale for Risk Appetite The IJB has some appetite for risk relating to testing change and being innovative. The IJB has zero appetite for harm happening to people.

Page 39


Controls

Strategic Transformation and Commissioning programme management and governance

Audit and Performance Systems Committee

Transformation programme board in place

Recruitment to key senior posts agreed

Mitigating Actions

Programme approach being taken in terms of the transformation programme

Recruitment taking place into senior and key project and programme management posts

Regular reporting to Executive Management Group

Regular reporting to Audit and Performance Systems Committee

Assurances

Executive Management and Committee Reporting

Programme Management approach

IJB oversight

Board escalation process

Gaps in assurance

Executive Management team developing financial model for transformation programme to track delivery of change and efficiencies – this is in developing and as such, a gap.

Current performance No issues to report.

Comments

- 10 -



Description of Risk There is a risk that the IJB does not maximise the opportunities offered by locality working

Page 40


Risk Rating Medium

Movement Rationale for Risk Rating Considered medium in relation to ability to work at the pace required until all senior and locality posts recruited to in the new structure Rationale for Risk Appetite The IJB has some appetite to risk in relation to testing innovation and change. There is zero risk of financial failure or working out with statutory requirements of a public body.

Controls

Transformation programme and programme board


Mitigating Actions

There is a localities development programme manager in place supporting this work

Agreed operational structure that reflects the importance of localities and roles which support transformational potential of working at this level

Assurances

Regular Transformational Programme Board reports to Executive Management Team and to Audit and Performance Systems Committee

Programme Management approach

Agreement to recruit to Director of Strategic Commissioning role which will lead on the transformation at Executive level

Gaps in assurance

None currently known

Current performance

Programme agreed at April’s IJB and current milestones being met

Comments

Page 41


Page 42

Last Updated 03.05.16Aberdeen City Health and Social Care Partnership - Operational Risk Register

Strategic Priority Description of Risk Context Impact Date Last

AssessedControls Gaps in Control

Lik

eli

ho

od

Co

ns

eq

ue

nc

e

s

Ris

k

As

se

ss

me

nt

Assurances Risk Owner/

HandlerComments

Workforce

The is a risk that the

Partnership will not have

the supply and quality of

workforce to meet

operational requirements

A combination of demographic, labour

market and transformational change is

currently putting operational delivery of

strain. These factors vary by discipline,

sector and hierarchical level.

Unable to deliver core services -

including statutory responsibilities

and national local targets. Risk of

harm/ adverse conditional for

those using Partnership services,

alongside reputational damage.

Lack of capacity could have an

adverse effect on strategic

priorities.

Established workforce plans.

Mechanisms for staff

communications and feedback.

Recruitment and Retention

initiatives. Support Mechanisms

for employee health and wellbeing.

Established escalations processes

for workforce related risks.

Established support for training

and development of staff

Lack of consistency in strategic

workforce planning which is linked to the

transformation agenda for the

partnership. Ongoing difficulties around

harmonising workforce development

recruitment and retention across two

distinct organisations Po

ssib

le

External Provision

There is a risk that the

partnership will be unable

to commission the range

of external provision

required to provide safe

and effective services.

A combination of demographic, labour

market and economic factors mean

that the social care market is currently

unable to supply the level of care

required. The downturn in the oil

industry is yet to affect this market.

The current market is already fragile

with providers leaving the market.

Unable to deliver the range and

level of care services required in

the city. The fragile market puts

new providers off coming into the

city.This impacts negatively on

Delayed Discharge figures and

national and local targets and

increases adverse public

protection and other risks.

1. Care Academy

2. Working with providers to

look at different models of care

delivery.

3. Community Capacity Building

(ABCD)

4. Living Wage

5. Hospital at Home

We lack control over the local economy

that would make Aberdeen a more

attractive place to be a paid carer.

Ongoing difficulties in selling caring as a

career option.

Po

ssib

le

Mo

de

rate

Me

diu

m

External Provision

There is a risk of a GP

practice/s ceasing the

provision of General

Medical Services

(example of Brimmond

MG in 2015)

A number of factors conspire to

challenge the sustainability of General

Practice, including GP retirals,

workforce availability, increasing

demand, small business model,

evergreen mortgages.

The statutory duty to provide

General Medical Services may

be compromised. If another

independent entity cannot be

secured to deliver services,

technically NHS Grampian,

through the Partnership, would

be expected to take over the

service directly – ie. provide a

salaried service. The challenges

facing the Partnership in securing

workforce would be the same as

those facing a GP practice.

Connected into system wide

recruitment initiatives. Strong

Primary Care Development Team,

working in tandem with GP Clinical

Leads. Good working

relationships and links with local

practices – issues brought to light

through team. Commitment by

Partnership to ongoing

modernisation and transformation

in primary care which is ongoing.

Independent contractor status – we do

not have direct control; we do not have

access to practice accounts / business

situation. (looming crisis not always

apparent).

Po

ssib

le

Mo

de

rate

Me

diu

m

Infrastructure


infrastructure to support

operational requirements

fails or is inadequate

Infrastructure required to support

operational services delivery includes:

IT systems and supporting processes

including information sharing and

premises.

The infrastructure is largely that which

is provided by ACC and NHSG.

The inherited IT infrastructure has

significant gaps to support service

functions and to enable robust data

collection and reporting against local

and national outcomes/targets

A robust IT platform is essential to

support integrated working and

information sharing.

We have two separate business

support systems which need to

interface either through realignment or

the establishment of new integrated

business processes

Premises; some of which are no longer

fit for purpose; some do not have the

potential to support

multidisciplinaryworking environments

in support of our locaility model

Disruption to delivery of core

operational services - including

statutory responsibilities and

national/ local targets.

Risk of harm if information

necessary to support decision

making is not available

Risk of being unable to report

against local or national

outcomes/ targets

Impact on transformational

agenda and decision making if

there is a lack of robust data to

support this

Premises limitations adversely

impacting on service capacity

and waiting times and ability to

redesign services/workforce to

support integrated working in our

locality model

AHSCP Infrastructure workstream

being established ; IT,

Capital/Premises and Business

processes

ATOS commissioned to carry out

scoping work to inform future IT

strategy

Community health premises group

Primary Care Capital Development

programme board

Carefirst development including

Multi-Agency View (MAV) to

support information sharing

Pan-grampian workstreams

supporting IT development

/information including Joint Data

Sharing Group

Roll-out plan for Trak-care for

AHPs

Planning for community nursing

Vision system development

underway

Absence of a pan-Grampian overview

around IT to support IJB developments

Revised Memorandum of Understanding

(MOU) re Information sharing and

Service Level Agreement (SLA) with

Information services Division (ISD)

awaiting sign-off

AHSCP Infrastructure workstream at

early stages and yet to have an impact

on desired developments

Lack of capacity within ehealth and

support services to drive infrastructure

improvements at pace

Lack of a city-wide partnership premises

strategy

Po

ssib

le

Mo

de

rate

Me

diu

m

Standing Item on monthly SOMT

agenda

Changes in Risk register reported by

Head of Operations (HOO) to Chief

Officer (CO) through Executive Group


HOO to Audit and Performance

committee

Audit and Performance committee

report to IJB

Any clinical and care risks that arise as

a result of infrastructure would also be

reported to the Clinical and Care

Governance committee

Clinical and Care Governance

Committee reports clinical and care

governance risks (including those

arising from infrastructure) to the IJB

Outwith meeting structures CO will

appraise Chair/Vice Chair of IJB of any

significant changes to the risk register

Head of Joint

Operations

The partnerships

infrastructure is

largely that which has

been inherited from

ACC and NHSG.

Ongoing collaboration

required with partners

to support our

transformational

change.

Future opportunities

for collaboration

across all sectors i.e.

3rd, Independent,

Housing as

appropriate with

respect to premises

and data sharing.

Page 43

Governance

There is a risk that our

governance systems fail

or are inadequate which

would lead to operational

and/or strategic failures

Effective governance systems are

required to ensure we operate safely,

effectively and within an agreed

framework. There are different

governance processes in partner

organisations. Framework for new

governance structures and systems

within the partnership have been

agreed by the IJB, but these are not

yet fully established during this

transition period

Services may be unsafe,

ineffective, lack control.Could

result in reputational damage.If

there is an external view that

governance arrangements are

inadequate, the partnership may

become subject to additional

external scrutiny, and intervention

11/04/2016 Existing robust policies and

procedures within the partnership

organisations which we continue

to work to. As new governance

arrangements are embedded, all

staff will be updated on any

changes. Partnership controls

include service level risk

registers/management plans.

Partnership assurance processes

including IJB, Audit & Performance

Systems Committee, Clinical and

Care Governance Framework,

Financial management systems,

HR systems, Schemes of

delegation, Professional and

Management governance

structures.(Some of these controls

sit with the IJB, some with our

partnership bodies.)

Committees still in very early stages and

roles and remits yet to be finalised. In

transition period, application of existing

policies and procedures could be

perceived as inequitable for staff in the

same team working to different policies

Po

ssib

le

mo

de

rate

me

diu

m

Ensure this is a standing Item on

monthly SOMT agenda.


Head of Operations (HOO) to Chief

Officer (CO) through Executive Group


HOO to Audit and Performance

committee

Audit and Performance committee

report to IJB. Any clinical and care

risks that arise as a result of

governance would also be reported to

the Clinical and Care Governance

committee. Chief finance officer role

around financial assurance. Chief

Social Worker over-arching

governance role in relation to SW

practice.

Clinical and Care Governance

Committee reports clinical and care

governance risks to the IJB.

Outwith meeting structures CO will

appraise Chair/Vice Chair of IJB of any

significant changes to the risk register.

Risk Owner: Head

of Joint Operations

Risk Handler: Sally

Wilkins/Lynn

Morrison

Protection of People


partnership will be unable

to effectively meet its

obligations to protect and

support the community -

including those most at

risk within society

The partnership has very specific

duties in relation to supporting and

protecting the people of Aberdeen.

There are wide ranging, but includee

duties relating to the protection of

children, adults at risk, and the general

public via both mental health and

criminal justice services.

Significant risk of multiple types

of harm occyuring to those most

vulnerable in society and the

general public. A secondary, but

related impact, would be the

serious reputational harm to the

partnership if such a failure were

to occur.

Multiagency procedure and

protocols are in place that address

the specific duties and

responsibilities for public

protection across the partnership.

Public Engagement strategies are

in place to promote wider public

awareness of protection of people

and early intervention.

"Ownership" and awareness of the

protection of people agenda is not yet

consistent across all sectors and

disciplines within the partnership -

resulting in operational gaps.

Public awareness of the protection of

people agenda is also not consistent

across the population of Aberdeen.

As yet, the Partnership does not monitor

specifically how other risks (such as

workforce concerns) directly impact on

the protection of people agenda.

Capacity in the systems for earlier

intervention at lower thresholds remains

limited.

Po

ssib

le

Ma

jor

Hig

h

Health and Safety


Partnership will be unable

to meet its statutory

responsibilities to protect

the health and safety of

staff and citizens.

The scale of the workforce and variety

of services (particularly community

based settings) that is out with their

immediate control means that the

Partnership is required to effectively

manage multiple and variable risks to

both employees and patients/clients.

A breach in health and safety

may result in physical or

psychological harm resulting in

death, sickness absence or claim

against the organisation. This

could result in financial and

reputational damage for the

organisation and potentially lead

to a disruption of service and loss

of capacity. A breach in health &

safety may result in both

physical/psychological harm to

individuals and environmental

harm to physical assets. Beyond

the immediate impact to

indiviudals and property there is

also the real possibility of

financial and reputational

damage to the organisation and

possible disruption of service and

loss of capacity.

ACC and NHSG already have well

established policies/procedures in

place that will be reviewed to

ensure that they meet the needs of

the organisation. Absence

management systems are in

place. Healthy Working Lives

programme in place. Datix is in

place to capture risk (NHSG only

at present) and risk registers are

regularly monitored and reviewed.

Established support for training

and development of staff

Need to review/harmonise policies

within organisation and to recommend

the establishment of an Aberdeen

Health and Social Care Partnership

Health and Safety Committee.

Recommend review of need for

additional separate Community Health

and Social Care Health & Safety

Groups. Risk reporting and capturing is

not currently consistent across

organisations. There is a need to

harmonise risk reporting via Datix.

Un

like

ly

Mo

de

rate

Me

diu

m

Standing item for review/discussion at

SOMT.

Page 44

Environmental Factors

Catastrophic

environmental issues,

failure of external support

systems and/or pandemic

episodes resulting in

inability to deliver services

and/or keep staff and

citizens safe from harm.

The organisation may suffer the effects

of severe weather, fire, power failure,

fuel shortage, terrorism or the threat of

pandemic illness that may impact on

its ability to deliver key/life and limb

services and keep staff and citizens

safe from harm.

Disruption to services, an inability

to deliver core services, the

short/long term loss of buildings,

key infrastructure, such as ICT

systems failure and/or the

inability to deploy staff within the

organisation, including contracted

providers responsible for service

delivery.

14/04/2016 Local Resilience Partnership; Up-

to-date Winter Weather Policies,

Major Infections Disease Plan,

Business Continuinty Plans &

Business Impact Assessments in

place for all Service Delivery Units;

Staff & Management training,

competence & confidence in

application through learning &

feedback opportunities. Formal

Senior Managers & Executive

Level on-call rotas covering all

aspects of the Partnership. ACC's

Emergency Planning Policy &

Procedure (link on intranet site),;

UK Government Planning of

Emergencies (www.scot.gov.uk);

Scottish Government Guidance on

Resilience (www.gov.scot).

Some BCPs and staff competence

require refresh; Training for new staff;

No formal SW Management on-call rota

in place; Transitional state - need to

ensure staff remain clear of

arrangements during this time of

change. Control Rooms -

identifiction/information connecting both

organisations' Control Rooms; Media

Communication Strategy; Overarching

Governance Structure; Sharing of Plans

IM&T/Facilities & Estates. Un

like

ly

Mo

de

rate

Me

diu

m

Outcome of recent flooding incident

debrief exercise awaited; Planning and

training refresh planning in hand; IJB

Partners building relationships &

learning about each others

arrangements/systems;

Implementation of IJB Management

Structure arrangements under way.

Plans are regularly reviewed and

updated. In the absence of formal SW

Management on-call rota, SW Seniors'

contact details have been made

available.

IJB Business

Manager

Business Processes There is a risk that the

business processes could

become over complicated,

inefficient and not cost

effective by trying to

integrate two sets of

systems.

There is a risk that the IT

systems will be unable to

support the business

processes to integrate

successfully

There is a risk that there

will be inadequate

resources to provide the

business support to

localities.

The Business processes of the partner

organisations (NHSG & ACC) are

designed to serve the needs of each

organisation. Neither of the systems

in its entirety is fit for purpose

IT capability is crucial to efficient,

effective business processes that are

fit for purpose. Currently IT provision

and support is provided by either

NHSG or ACC. The support to the

business processes is good but the

respective IT departments may be

limited in their ability to provide support

for any changes.

There is a definitive amount of funding

available to support the work of the

Partnership including business

processes

Complicated business processes

that staff have to follow could

result in a disruption to services

Changes that are required to

provide first class business

processes to the H&SCP could

be delayed/not happen.

Inefficient business processes

could lead to increased costs.

Reputational harm could result

due to inefficient systems

If workable IT solutions are not

achieved in a reasonable

15/03/2016 Systems and infrastructure

workstream has been established.

Work has started on the possibility

of using NHSG DATIX system to

record complaints & incidents and

to manage risk.

Production and review of this risk

register

ATOS have been appointed to

look at our IT requirements and

how the existing systems can be

enhanced to achieve the desired

aim.

Finance Workstream has been

established and is fully functional

Workstream hasn’t established a

programme of work yet.

ATOS recommend changes that are not

acceptable to the parent organisations.

We do not know how much it will cost to

run a locality and this may differ in each

locality.

Standing Item on SOMT agenda.

Existing systems can be utilised until

H&SCP systems have been devised

and tested.

There are regular meetings with ATOS

to ensure the work is progressing in

line with the project brief.

There are regular meetings of the joint

finance teams

Head of Operations

(HOO)

Page 45

Financial

There is a risk that the IJB

will overspend on its

budget

2016/17 budget savings

not achieved

Failure to deliver on

Scottish Government’s

expectations around

Living Wage and

additional capacity and

transformation

The council & NHSG have delegated

budgets to the IJB and expect them to

achieve a balanced budget.

Demographic pressures, pressures in

the care provider market and local

labour market may all impact on the

ability to be able to achieve a balanced

budget.

In setting the budgets for 2016/17 a

significant level of savings targets

have been approved. There are also

prior years savings which are only

being achieved due to staff turnover

savings and lack of available care

provision.

Significant sums of additional money

have been allocated by the SG to allow

for increases in capacity and

transformation and a specific

requirement to implement Living wage

across social care providers

Services may need to be reduced

in order to make savings to

achieve balanced budget.

Reputational risk if the IJB

overspends.

Impact on future years funding

levels.

Potential impact on overall

financial position which could

then lead to reduction in services

which would impact on service

users.

Reputational damage.

The Scottish Government

anticipates that this can be

achieved by 1 October 2016, but

this will not be without a range of

challenges to overcome. Given

that achievement of this policy

was made one of the conditions

of the agreement on the 2016/17

local government funding

settlement there is a risk that

sanctions may be taken if this

cannot be achieved.

15/03/2016

Regular monitoring of budgets and

forecasting will assist in controlling

expenditure levels within funds

available, give assurance as to the

likelihood of any overspend and

enable timely advice to be given to

the Board to take relevant

decisions.

Regularly monitor and track

achievement of savings targets,

financial monitoring and controls

Legal framework that will empower

the IJB to be able to achieve the

Living wage targets.

Financial monitoring of the

appropriate use of the additional

funds

Lack of certainty in the legal and

procurement framework that will allow

the IJB to enforce payment of the Living

Wage within contractual arrangements

Inaccuracies and inconsistent updating

of financial packages in Carefirst system

leads to difficulties in being able to

provide accurate forecasts in a volatile

area of the business.

As a newly established model of

working there may be gaps that have

not yet been exposed.

Lack of certainty in the legal and

procurement framework that will allow

the IJB to enforce payment of the Living

Wage within contractual arrangements.

Page 46

1


Report Title Delayed Discharge Performance and Improvement Programmes - Update


Report Author Kenneth O’Brien

Date of Report 30-05-2016

Date of Meeting 28-06-2016


This report is presented to the Integrated Joint Board (IJB) for the purposes of provision of information, supporting scrutiny of the Partnership’s performance, and to facilitate further discussion. This paper follows on from the previous update provided to the then shadow Integration Joint Board at its meeting of 25th August 2015. Two key areas are discussed:

Current delayed discharge performance information in regards to the Aberdeen City Partnership;

AND

The current status of the Aberdeen City Delayed Discharge Action Plan – with information on indicative costs.


Current Performance Information For the purposes of clarity, the IJB should be aware that the Delayed Discharge figures classify patients/clients into THREE types of delay:

“Standard” Delays – which are individuals who are medically fit for discharge and yet remain in a hospital bed.

“Code 9” Complex Delays – which are individuals who have particularly

Page 47

Agenda Item 5

2


complex needs (such as requiring legal intervention in the courts) that would indicate a longer timescale for a safe and appropriate discharge.

“Code 100” Commissioning/Reprovisioning Delays – which are individuals who have exceptional complex needs relating to previously being long-term hospital inpatients or other such prolonged circumstances. It is recognised by the Government that the normal timescales for discharge would be unable to be adhered to for such patients/clients.

“Code 100” delays are reported to the Government however are not included in published data - therefore “Code 100” delays are not presented in this report. The IJB should be aware that such “Code 100” patients/clients are, however, discussed locally to ensure that progress is made in appropriately discharging them. For information only, the number of “Code 100” patients within Aberdeen City in May 2016 was 5.

[FIGURE 1]

Figure 1 shows the overall count of those patients/clients classified as a ‘delayed discharge’ as at the monthly census point, (reflecting the fact that the Government captures Delayed Discharge performance on a monthly basis). This includes both “standard” delays and “code 9 delays”. As can be seen, there has been a general trend downwards in the eight month period since progress was reported to the IJB.

Page 48

3


[FIGURE 2]

Figure 2 shows the number of bed days occupied by patients/clients classified as

a delayed discharge, also presented at monthly intervals. This also shows a

general trend downwards in the eight month period since progress was last

reported to the IJB, (although the rate of decrease is steeper for bed days than

overall delay numbers).

[FIGURE 3]

Page 49

4


Figure 3 shows Aberdeen City’s number of delayed discharges in the context of

other partnership areas. The most current cross-partnership data comes from the

census information gathered for April 2016. When progress was last reported to

the shadow IJB, Aberdeen City had the second highest number of standard

delayed discharges across Scotland (behind the city of Edinburgh). The position

as of the most current data available is that Aberdeen City ranks fifth in regards to

volume of delayed discharges.

[FIGURE 4]

Figure 4 provides information on the length of delay for delayed discharge

patients/clients at monthly census points. The longer delay periods (100-200 and

200+) tend to only be complex cases.

Page 50

5


[FIGURE 5]

Figure 5 breaks down where within hospital specialisms delays are occurring.

This is the latest information available based on the May 2016 census information.

Geriatric Assessment remains, by far, the largest speciality for delayed discharge

patients, followed by Rehabilitation Medicine.

[FIGURE 6]

Page 51

6


[FIGURE 7]

Figures 6 and 7 shows the reasons why patients/clients are a delayed discharge.

The vast majority of standard delays are accounted for due to lack of an

appropriate resource – primarily care home placements or care at home provision.

The majority of current “Code 9” complex delays are due to the need to seek legal

orders for patients/clients under the auspices of the Adults with Incapacity

(Scotland) Act 2000, along with a need for specialised care resources for the

under 65’s.

Aberdeen City Delayed Discharge Action Plan

As had been previously reported to the shadow IJB, an Aberdeen City Delayed

Discharge Group has been operating since 2015, bringing together primary care,

secondary care and social work/social care staff to monitor performance and

implement improvements in delayed discharge performance.

To that end, the Aberdeen City Delayed Discharge Group has a regularly updated

action plan which documents current initiatives and future plans. This plan also

tracks the anticipated and indicative costs related to the action plan that are paid

for from the, now recurring, Delayed Discharge funding stream. This action plan

Page 52

7


is provided in its entirety in Appendix 1 for the IJB’s review.

Key aspects of the action plan that the IJB may wish to note:

The successful recruitment and subsequent introduction of additional

social work capacity that is now embedded in both the ARI and Woodend

hospital sites. Initial data indicates an already notable reduction in delays

pertaining to social work/care assessment. This project will be evaluated

more fully later in 2016.

The ‘building up’ of interim bed capacity to support the early discharge of

patients/clients whilst they await a more permanent care setting of their

choice. The group is presently evaluating the ‘first tranche’ of interim bed

provision and intends to expand this resource further based on early

evidence.

The ‘social care campus’ project has now had its feasibility study

concluded and proposals approved. A full business case is now being

constructed to move the project to its next phase.

The Aberdeen City Delayed Discharge Group is planning a workshop in June/July

2016 which will aim to look at the ‘next steps’ to build on the existing action plan

and entrench/quicken improvements in delayed discharge performance.


The issue of Delayed Discharge disproportionately impacts upon older adults and adults with chronic illness and/or long term disabilities. Whilst ‘age’ and ‘disability’ are protected equality characteristics, it is not anticipated that there will be anything other than a positive impact for both groups via an improvement in the timeliness of discharges. As noted above, the implementation of the ‘action plan’ (see Appendix One), involves expenditure from the dedicated delayed discharge funding stream. The overall use of this fund was included as part of the Chief Officer’s paper on ‘Strategic Commissioning and Transformation’, presented at the IJB meeting of 26th April 2016. There are no new financial implications not already addressed within the financial ‘envelope’ set out in that earlier paper.

Page 53

8


There are no direct workforce implications relating to this report.

4: Recommendations


1. Note the Partnership’s current performance in relation to delayed

discharges;

2. Note the current status and progress in relation to the Aberdeen City

delayed discharge action plan;

3. Request further regular updates on delayed discharge performance and

actions taken to further improve performance.

Page 54

Key Milestones / Actions Lead Officer(s) Started End Date RAG Latest Update £ 16/17 £ 17/18 £ 18/19

Performance Data Recording

Develop performance dashboard of key data relating to Delayed

Discharge

Liane Cardno & Kenny

O'BrienMay-15 G

Dashboard up and running with EDISON data populating current and past trend fields. KOB + LC now working

alongside Care Management to populate capacity and vacancy data for care homes into the dashboard. Dashboard will

soon move to "Tableau" platform to allow for greater flexibility in editing/presentation. Small amount of funding provided

to Care Management administration to pay admin worker additional hours to valdiate all care home data with each home

provider.

150

Choice Policy to be Redrafted and RefreshedKenny O'Brien & Louise

BrodieMay-16 R

KOB joining discharge collaborative. To primarily be progressed through that forum, but with reports back to

Partnership DD group and support from group as needed. [Status will change from 'Red' when Discharge Collaborative

confirm formally they are happy to progress this work].

Acute Care at Home Kevin Toshney Apr-16 GBeing project managed seperately from DD Group - directly reporting to Integration and Transformation Programme

Board. Remaining on DD dashboard for finance tracking purposes.400,000 110,000

Enhanced Hospital Social Work CapacityKenny O'Brien & Lindsey

FlockhartNov-15 Nov-17 G

Additional social work capacity now in place and being utilised. Focus now switching to evaluation of effectiveness of

intervention + any plan to mainstream/maintain funding past original two year DD commitment.140,000 94,000

Discharge Coordinator PostKenny O'Brien & Jason

NicolNov-15 A

Currently reviewing if post still required given additional social work capacity in discharge hub + KOB's seconded role.

Job description has been drafted + agreed that post should be properly graded so DD group is aware of exact costs

should they choose to progress with creating post.

60,000 15,000

Neuroflow Coordinator Jason Nicol Nov-15 A JN currently exploring recruitment options via potential tender to third sector. 40,000 10,000

DD Health Intelligence Post ShortfallLiane Cardno & Jillian

EvansJan-15 G

Recurring payment made from DD funds to cover shortfall in health intelligence budget for dedicated DD analyst.

[Review with Health Intelligence to determine if required on an ongoing basis] 12,000 12,000 12,000

Bed Base Review - Older Adult Beds [Hospital/Care

Home/Respite/Interim/Intermediate]

Kenny O'Brien & Jason

NicolJun-16 Jun-17 A

KOB currently reviewing scope of project. Project brief will be finalised and sent to Partnership's SOMT for sign off and

approval to proceed (anticipated to be completed by 01-06-2016). KOB and JN also working with Health Intelligence to

support detailed/accurate modelling of current and future need (as part of Grampian wide bed base work).

60,000

Identify and Commission Interim Beds to Support DischargeKenny O'Brien & Lindsey

FlockhartNov-15 G

Interim beds in Bon Accord Care care resources now established and operational. 6 beds in a private nursing home

also established and operational as an initial test. KOB, LF and ACC contract manager now having initial discussions

with care home providers about possible expansion of nursing home interim beds.

Identify and Commission Interim Housing ProvisionDorothy Askew & Kenny

O'BrienDec-15 G

Report has now gone forward to next ACC Communities Housing & Infrastructure Committee to seek permission for

properties to be used for 'step down/interim' delayed discharge function. Once approval granted, KOB and DA to meet

with ACC housing colleagues to plan capital spend on adapting properties + exact operational details on how interim

properties will operate.

70,000

New Model of Care at Home ProvisionMartin Kasprowicz &

Lindsey FlockhartNov-15 A

LF updated group on progress to date. Noted that the model being proposed for Aberdeen City has similarities to model

implemented in Inverness. Inverness model has resulted in no clients/patients waiting more than 14 days for a care

package from hospital. Inverness have been invited down to meet with Care at Home forum/providers and ACC

Service Managers. MK to still present full paper on formal plans for future care provision in the city.

100,000

Agreed that full appraisal of options required, with evaluation and decision to follow. Independent programme manager

has now been identified to commence work on project.150,000

Contribution towards salary costs related to Joint Equipment Store work - anticipated to be spending for 2016/17 only. 12,400

Anticipatory Care Planning - Review to Improve Impact + Minimise

Admissions, Re-Admissions and Failed Discharges Lynn Morrison May-16 A

LM participating in Short Life Working Group. Group is currently evaluating what existing work already done in this area

can be refreshed and publicised vs. what new work is required. Next meeting in June should provide mkore detail on

next steps.

Third Sector Engagement to Support DischargeKenny O'Brien & Louise

BrodieNov-15 A

Stalled until recently. KOB now joining discharge collaborative to support exploring this option via this more operational

group which has third sector representation on it. [NOTE: Monies reserved are indicative for financial planning

purposes - may vary based on option apprasial]

75,000

Telehealthcare Use in Supporting DischargeKenny O'Brien & Dorothy

AskewAug-15 R

Initial proposals/costings for a 'blanket' use of telecare for discharge support resulted in very high cost estimates -

significantly beyond scope of delayed discharge budget. Need to review this item from 'base zero' again. KOB has

discussed with Julie Somers and Kevin Toshney - JS now looking at technology options for acute care at home which

DD group may 'piggyback' on if the propsals also support wider discharge. [NOTE: Monies reserved are indicative

for financial planning purposes - may vary based on option appraisal and proposal received]

100,000

Social Care Campus - Social Care Recruitment & Retention Project Dorothy Askew Jan-15 GFeasibility study now concluded and proposal approved. Full business case now being developed by DA to progress

project further.290,000

Shared Homes Project Dorothy Askew May-15 ADiscussions initially taken place with Aberdeenshire and their 'Shared Lives' project - r.e. possible joint work, however

this has stalled. DA now looking at potential brief for tender out to third sector - still very early stages.

Interim and Intermediate Bed Base Provision

Discharge Pathway [Process of Discharge & Resources to Support Discharge]

Delayed Discharge Action Plan - Updated 25-05-2016

Capital Projects Supporting Discharge

SPEND FROM DD BUDGET

Services & Other Resources to Support Discharge

Establish a Joint Equipment Store for Aberdeen Cirt Julie Kennedy Jun-15 A

Page 55

CURRENT TOTAL ALLOCATED SPEND 1,509,550 241,000 12,000

REMAINING UNCOMMITTED DELAYED DISCHARGE BUDGET 534,550 884,000 1,113,000

Page 56

1


Report Title Winter (Surge) Planning over Winter 2016-17


Report Author Christina Cameron

Date of Report 31st May 2016



The purpose of this paper is to report on the shared process that was followed for

winter (surge) planning for health and social care services in the Grampian area

for winter 2015-16. It sets out the steps taken to prepare for winter across

community and acute settings and how those efforts are co-ordinated.

This paper also outlines a draft, high-level process for the co-ordination of joint

preparations in 2016-17, highlighting those steps that form part of the direction and

guidance from Scottish Government.

The paper seeks formal noting from the Aberdeen City Integration Joint Board and

comment on the draft process for the coming winter.


Winter 2014-15 was a very challenging winter across the UK and in Scotland for

health and social care services; demand for service was very high and the ability

and capacity of teams and resources to respond was sorely tested. In an effort to

avoid a similar experience for Scotland in 2015-16, the Scottish Government

directed Health Boards to undertake winter planning that was even more robust

than in previous years to ensure that improved planning was shared and

coordinated with partners in Health and Social Care Partnerships. Key areas for

focus in the July 2015 guidance were the length of time people had to wait for

service in Emergency Departments (4hr target) and how many people were

delayed in hospital beds awaiting discharge back to their home or homely setting

(delayed discharges).

Page 57

Agenda Item 6

2


Chief Officers and key colleagues from Aberdeen City Health and Social Care

Partnership met with stakeholders from other parts of health and social care

across Grampian at several key meetings, beginning in May 2015 for a formal

debrief exercise covering experience of the previous winter. From that point Chief

Officers and colleagues worked jointly across the partnerships and with the acute

and corporate teams in NHS Grampian to develop local plans, share knowledge

and provide support and feedback on planning for winter challenges and surge

conditions. A Winter Plan for Aberdeen Health and Social Care Partnership was

complete by October 2015. A joint Board of Chief Officers and the Chief Executive

of NHS Grampian approved the Draft Winter Plan for Grampian in August 2015

and the final approved version was submitted as a joint document to Scottish

Government in October 2015.

An event offering the opportunity for structured testing was held in September,

where representatives from all Partnerships and the acute sector had the chance

to work together at a ‘tabletop’ session, facilitated by the Head of Civil

Contingencies from NHS Grampian. This proved successful and a valuable

chance to test and refine partnership plans before final draft.

Feedback on the Grampian Winter Plan was very positive from Scottish

Government with commendation on the thoroughness of approach and its

readability.

Performance measures which are used as indicators of resilience across the

whole system were very good across the whole of the winter period for Grampian.

The two key areas highlighted by Scottish Government performed positively:

the 4 hr target performance for Aberdeen Royal Infirmary was the highest in

four years and improved by nearly 7 percentage points

the number of delayed discharges decreased markedly across Grampian

and reduced in the City from 104 in July 2015 to 73 in November 2015.

It should be further noted that this performance was during a period of

unprecedented levels of local flooding; teams responded admirably and

demonstrated high levels of resilience.

Page 58

3


The winter planning process for 2016-17 has already begun with a cross-system

event taking place in May in Inverurie and a cross-system Winter Planning Event

scheduled for 29 July. The health and social care system is in a very strong

position to build on the success of last year and further consolidate our planning

approach to winter and surge situations.


Resilience and the ability to flex resources in response to surge or winter

pressures can often be dependent on the level or availability of resource in the

system. Some of the success seen in winter 2015-16 could be attributed to

additional beds or care packages being made available in community settings.

Some of the preparatory work undertaken in Aberdeen City identified potential

actions that would improve winter resilience .e.g. funding additional cover for

staff sickness absence or pump priming a hospital at home model. If

considered in 2016, these actions have an associated financial implication and

would be managed within the Partnership.

There are however other factors that impact on resilience that are not wholly

financial; namely the availability of an appropriately skilled workforce to afford

‘flexing’ the system. In many teams, the established workforce is limited and

already operating at full capacity – offering managers very little ability to

increase rotas as a response to a surge in demand. Workforce planning

therefore is a significant issue that requires early discussion in the winter

planning process.

Joint and shared events such as the Winter Planning Event on 29 June 2016

are arranged to offer a valuable opportunity to discuss a shared agenda with

peers from across the whole of the system, as are the tabletop exercises. They

are usually two or three hours in duration so consideration should be given to

diaries for those who should attend.

There is an established planning process within Aberdeen City Health and

Social Care Partnership for planning winter and surge responses; additional

support is on offer from NHS Grampian via the Unscheduled Care Programme.

Page 59

4


4: Recommendations


1. Direct the Chief Officer to engage fully with the winter planning process as

outlined in this report.

2. Agree that as part of the winter planning process, IJB approval of the 2016-

17 Grampian Winter Plan should be sought.

3. Agree to remit the approval process for the 2016-17 Grampian Winter Plan

(pending expected guidelines from Scottish Government) to the IJB Chair,

Vice Chair and the Chief Officer for further consideration and agreement.

4. Direct the Chief Officer to present a report to the IJB as soon as is

practicable on the recommendations within the approved 2016-17

Grampian Winter Plan.

Page 60

5


Draft Process & Timescales for Development and Review of the

Grampian Winter Plan

Grampian Unscheduled Care Action Plan

June

Draft Grampian Winter Plan prepared

for review by Senior Leadership Team

August

Also informed by:

Partner Winter Plans

and SGHD Guidance

Local Business Continuity &

Winter Plans tested and reports

produced

September

Implementation & Review

from October Ongoing review

via Delivery

Team and

System HuddlesWeekly Data Returns to SGHD

Winter Debrief and lessons

learned from previous

year’s Winter Plan

May

Winter Plan Event

to identify Winter Initiatives

June

Draft Grampian Winter Plan

forwarded to Scottish Government

August

Draft Acute and IJB Winter Plans

July

Approved Grampian Winter Plan

(forwarded to Scottish Government)

October

Final Draft of Grampian Winter Plan submitted

to Senior Leadership Team

September

Page 61

6


Page 62

1


Report Title Civil Contingencies


Report Author Lorraine McKenna, Business Manager

Date of Report 24/05/2016

Date of Meeting 28/06/2016


To inform and assure the IJB that Aberdeen City Health & Social Care Partnership has an appropriate Civil Contingencies response to an emergency situation.


The Civil Contingencies Act (2004) and accompanying non-legislative measures,

delivers a single framework for civil protection in the UK. Part 1 of the Act along

with other regulations and statutory guidance set out clear roles and

responsibilities for those involved in emergency preparation and response at the

local level. NHS Grampian and Aberdeen City Council are considered Category 1

responders and are subject to a set of civil protection duties which include

assessing risk of an emergency, producing contingency and business continuity

plans, sharing information with other organisations and co-operating with other

local responders to enhance co-ordination and efficiency in an emergency

situation.

The Integration Joint Board (IJB) is responsible for the planning and delivery of

delegated functions which not only includes the ambitions for the future, but the

contingency aspect as well. Although Aberdeen City Health & Social Care

Partnership (ACHSCP) is not listed in the legislation as a Category 1 responder,

the partnership has a responsibility to be able to react to an emergency situation

that involves patients, clients, or staff and to assure the partner organisations,

NHS Grampian and Aberdeen City Council, that the Partnership is in a position to

support them in such a situation. Having a planned and exercised response to

emergency situations is in line with the risk appetite statement in the strategic plan

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which states that the IJB will accept “no or minimal risk of harm to service users or

staff.”

To do this, business continuity plans have been produced that outline the actions

to be taken in a situation where business could not be carried out in the normal

way due to an unforeseen event. It is more critical that some of the services the

Partnership is responsible for continue uninterrupted than others e.g. general

practice or social care as opposed to physiotherapy or podiatry. This is not to say

that the latter services are unimportant, but in an emergency situation a decision

would have to be made about how scarce resources would be used in the most

effective way ensuring that patients or clients are not without the critical aspects of

the care they require.

The existing individual business continuity plans for health and social care are

currently being used. This is a holding position until it is possible to produce an

integrated plan. Alongside these plans, a three year Civil Contingencies plan is in

draft form and covers aspects such as planning (including exercising the plans),

training and the out of hours response. The three year plan includes

recommendations made by the joint short-life working group set up at the request

of the Chief Officers of the three Health & Social Care Partnerships. The group

looked at the development of a common approach to an integrated major incident

response as part of an NHS and/or Local Authority major incident response.

These recommendations are summarised below:-

1. Single Duty Senior Manager for the Health & Social Care Partnership i.e.

Senior Manager On Call (SMOC)

2. HSCP joint emergency/major incident management team

3. Single control room/function to support Health & Social Care Partnership

incident management

4. Common standard of information resource and tools to support major

incident response

5. Clarify Chief Officer role in an emergency/major incident response

6. SMOC initial half-day awareness raising and training session.

7. Health & Social Care Partnership to undertake training needs analysis to

understand their training requirements.

8. Business Continuity – no change, status quo to be maintained in the interim

9. Resilience Governance arrangements to be developed to ensure

appropriate assurance reporting and resilience risk management

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10. Joint Resilience Group for the Health & Social Care Partnership

The business continuity plan for health is being updated at the moment. This

involves individual health services e.g. Physiotherapy, Podiatry, community

services etc., updating their business impact analyses. The business impact

analyses outline what the impact would be on the individual services if there was

an interruption to business as usual and how the services would respond. The

business impact analyses feed in to the overarching business continuity plan for

health which highlights the critical services as general practice, community

services and in-patient services at Woodend hospital. The update will include

social care as the fourth critical service and will reference the adult and support

services business continuity plans.

To ensure the continuation of a robust response to an emergency situation, the

historical Civil Contingencies group for health still functions and is chaired by the

business manager. This group continues to deal with planning, training and has its

own risk register and work plan. The risk register feeds in to the existing health

operational and strategic risk registers. A mechanism needs to be devised to feed

in to the Health & Social Care Partnership’s new risk registers.

The business manager represents the Health & Social Care Partnership on the

NHS Grampian Civil Contingencies committee with a sector report being submitted

to the quarterly meetings. The short life working group noted that there are no

equivalent governance or response arrangements for social care. The expansion

of recommendation No. 10 above suggests that the membership and agenda of

the existing group be extended to include social care representatives and relevant

agenda items.

It is assuring to note that the short life working group stated “health resilience

governance and incident response arrangements are well developed and long

established, e.g. duty senior manager rotas (SMOC), incident control room

arrangements, trained loggists and incident support staff *. Local Authorities have

arrangements in place to deliver their areas of emergency response responsibility,

including social care support; however NHS Grampian and the Local Authorities

have taken different approaches in their planning, with activation of different

response structures during incidents”. The Joint Resilience group

(recommendation No. 10 above) will be the vehicle for progressing to a joint

approach to emergency planning and response.

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*By way of explanation, the duty senior manager rotas are rotas of senior

managers who respond to situations that may arise within core and out of hours on

a 365 day, 24/7 basis. The incident control room is located at Summerfield House

and is equipped with telecommunications, IT and the relevant documentation to

record the decision making process during the incident. Trained loggists record

the decisions made by the emergency/major incident management team and what

other options were considered before arriving at the decision. The incident

support staff are staff drafted in to support the management team with

administration requirements other than the loggist.


Equalities; no direct impact on the IJB’s equalities duties as such but the ongoing

health and wellbeing of the protected groups underpins our wish to have

comprehensive effective plans in place

Identified contingencies have some financial implications, some of which are

already accounted for in service budgets etc., however there may be a

requirement for funding to implement the recommendations of the short life

working group for example, video conferencing in the control room, training

A Fundamental element of contingency planning is to ensure the wellbeing and

preparedness of the workforce to respond in a required manner. Planning

transparency enhances the confidence of the workforce in the Health & Social

Care Partnership and its partner organisations.

4: Recommendations

The IJB is asked to:

1. Note the current response capabilities of the Health & Social Care

Partnership to emergency situations

2. Endorse the ongoing development of an integrated response system.

3. Request that officers bring the completed Civil Contingencies Plan and

present it to a future meeting for endorsement.

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Report Title Good Governance Institute – Delivery of Action Plan


Report Author Judith Proctor


Date of Meeting 28th May 2016


This paper provides in Appendix 1 the final report from the Good Governance institute in respect of the work they were commissioned to undertake on behalf of the then Shadow Integration Joint Board in Aberdeen.


Committee members will recall that the then Shadow Aberdeen City Integration

Joint Board for Aberdeen (sIJB) commissioned support from the Good

Governance Institute in order to support the sIJB develop its capacity and

capability as a developing organisation with significant responsibilities and

resources. This commission also recognised the complex legal and accountability

framework that the IJB would operate in, and the different expectations and

responsibilities on IJB voting members as distinct from those in their ‘parent’

organisations.

The report provides background to the initial work and an update in relation to the

recommendations that had been set out in the mid-year report in November 2015.

It demonstrates the range of improvement and progress that the IJB has made

over this year in key areas:

Governance processes and structures;

Developing Board maturity as evidenced on benchmarking against the

maturity matrix;

Board dynamics and team working toward formal integration

Board Assurance Frameworks and escalation processes agreed and in

place; and

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Agenda Item 7

2


Significant progress toward developing its strategy for delivery.

The report sets out the IJB’s progress against the planned activity and makes a

number of recommendations in relation to future progress and development.

Recommendations are set out throughout the report and these are set out below

for ease of reference:

1. GGI recommends that the IJB reassess themselves against the good

governance matrix a 6-month intervals to support the Board’s ability to test

out its effectiveness and maturity, moving to an annual assessment in line

with its agreed cycle of business;

2. GGI recommends that ACHSCP closely links the achievement of its

strategic priorities with the practical application of its agreed risk appetite

statement, revisiting the discussion on appetite for risk as needed;

3. GGI recommends that ACHSCP should continue to engage and

communicate with staff, localities and partners about its values, strategy

and implementation plans;

4. GGI recommends that the ACHSCP Executive Group review the current

status of the IJB’s risk escalation and risk assessment processes, and cycle

of business to ensure these are appropriately utilised and understood by

IJB members and embedded within committee operations, in line with the

processes set out in the Assurance and Escalation Framework;

5. GGI recommends that the development of the Clinical and Care

Governance Framework and of the broader clinical and care governance of

ACHSCP is a key aspect of focus for the organisation in the coming

months;

6. GGI recommends that ACHSCP undertake a SIPOC (see report page 16)

mapping exercise of its committees in order to support clarity of roles and

responsibilities from the outset, as well as supporting the shared

understanding of assurance

7. GGI recommends that the progress made in strengthening the Board

dynamics is applied to the committees, and in particular that attention is

paid to encouraging even contribution from members and the appropriate

content and delivery of agenda items;

8. The IJB has discussed principles of engagement and guidelines for Board

etiquette. GGI recommends that ACHSCP agree a board etiquette

approach that facilitates both trust and challenge;

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9. The GGI recommends that the IJB consider undertaking a distinct Board

development programme to assist with the achievement of 7 and 8 above,

as well as strengthening both individual members’ capability and

competency and also effective team interaction;

10. GGI recommends that ACHSCP continue its commitment to shared system-

wide learning with partners, and, supported by the knowledge management

resources produced to date, considers utilising forums such as the North

East Strategic Partnership Group, IJB Chief Officers’ Group, and board-to-

board meetings with other IJBs to drive forward constructive benchmarking

and the sharing of best practice; and

11. GGI recommends that ACHSCP adopt an Integrated Reporting approach to

the production of its annual Performance Report.


The work undertaken with the GGI supports the IJB in establishing robust processes and procedures for ensuring sound financial and workforce planning alongside appropriate risk management and escalation processes to ensure issues are dealt with at the right level in the organisation. This report has no impact on equalities however the IJB is required to have sound governance around its equalities duties and this is supported by it being a robust and capable public sector organisation.

4: Recommendations


1. Discuss the first draft GGI report in regard to the development of the IJB

and its Committees up to, and over the go live period;

2. Consider and agree the recommendations for action as set out in the report;

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- DRAFT -

Aberdeen City Health and Social Care Partnership

Governance development programme 2015-16

Draft report from the Good Governance Institute (GGI)

May 2016

The Good Governance Institute

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The Good Governance Institute

The Good Governance Institute exists to help create a fairer, better world. Our part in this is to support those who run the organisations that will effect how humanity uses resources, cares for the sick, educates future generations, develops our professionals, creates wealth, nurtures sporting excellence, inspires through the arts, communicates the news, ensures all have decent homes, transports people and goods, administers justice and the law, designs and introduces new technologies, produces and sells the food we eat - in short, all aspects of being human.

We work to make sure that organisations are run by the most talented, skilled and ethical leaders possible and work to build fair systems that consider all, use evidence, are guided by ethics and thereby take the best decisions.

Good governance of all organisations, from the smallest charity to the greatest public institution, benefits society as a

whole. It enables organisations to play their part in building a sustainable, better future for all.

Client: Aberdeen City Health and Social Care Partnership

Project name: Governance development programme

Document name: Final report – draft version

Reference: GGI_ACHSCP_GDP_Report_0516_draft

Version: Draft version 1 – draft for 31st May Audit and Performance Systems Committee

Date: May 2016

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Authors: Hilary Merrett, Senior Associate, GGI and Donal Sutton, Team leader – Service Development, GGI

Reviewed by: David Cockayne, Managing Director, GGI

Designed by: Emiliano Rattin, Senior Communications Officer, GGI

This document has been prepared by GGI Limited. This report was commissioned by Aberdeen City Health and Social Care Partnership. The matters raised in this report are limited to those that came to our attention during this assignment and are not necessarily a comprehensive statement of all the opportunities or weaknesses that may exist, nor of all the improvements that may be required. GGI Limited has taken every care to ensure that the information provided in this report is as accurate as possible, based on the information provided and documentation reviewed. However, no complete guarantee or warranty can be given with regard to the advice and information contained herein. This work does not provide absolute assurance that material errors, loss or fraud do not exist.

This report is prepared solely for the use by the board of Aberdeen City Health and Social Care Partnership. Details may be made available to specified external agencies, including regulators and external auditors, but otherwise the report should not be quoted or referred to in whole or in part without prior consent. No responsibility to any third party is accepted as the report has not been prepared and is not intended for any other purpose.

© 2016 GGI Limited

GGI Limited, Old Horsmans, Sedlescombe, near Battle, East Sussex TN33 0RL is the trading entity of the Good Governance Institute

[email protected]

www.good-governance.org.uk

Contents

Executive summary Progress, activities and outputs

1 Assessment of governance arrangements and Board effectiveness 2 Assessing board maturity 3 Risk Appetite and the Partnership’s approach to risk

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4 ACHSCP Board Assurance and Escalation Framework 5 Committee structure 6 Board dynamics 7 Knowledge Management and system leadership

Appendix

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Executive Summary

Aberdeen City Health and Social Care Partnership (ACHSCP) has been established through the Public Bodies (Joint Working) (Scotland) Act 2014. The newly established entity is tasked with integrating health and social care services in Aberdeen city, working with the partner bodies of Aberdeen City Council and NHS Grampian to deliver fundamental changes to how acute and community health care services, as well as social care services, are planned, funded and delivered. Commencing in June 2015, ACHSCP has been working with the Good Governance Institute (GGI) on a governance development programme with the shadow Integration Joint Board (IJB) in preparation for an April 2016 go-live date. GGI has described its work with ACHSP as having three phases:

This report describes GGI’s initial diagnostic work which identified the key requirements for the IJB in delivering on its governance requirements in 2015/16. The initial phase of the programme has enabled the development of a number of key governance structures and processes, designed to build a platform for decision-making to support delivery of an integrated health and social care system. There has also been significant growth in Board dynamics, behaviours and team working ahead of the Board successfully assuming statutory authority on April 1st 2016. The report outlines ACHSCP’s progress on this development journey to date, and identifies recommended actions for further strengthening the competence, structures, and systems required to deliver the Partnership’s ambitions. The key outputs of the initial phase of the programme have been:

The negotiation and development of the IJB Risk Appetite statement

The agreement of the methodology for assessing board effectiveness and establishment of a baseline using the maturity matrix

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The production of the ACHSCP Board Assurance and Escalation Framework (AEF)

A demonstrable improvement and definition of ACHSCP’s Board organisation, behaviours, dynamics and sense of strategic purpose

ACHSCP has committed itself to this governance development programme as part of the organisation’s duty to integrate health and social care services. Operating in shadow form, the Board has made significant progress in developing its strategy and the necessary supporting processes to move towards formal operations. GGI has been impressed with the high level of enthusiasm and commitment of those involved, both Board members and the wider ACHSCP team.

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Progress, activities and outputs

1 Assessment of governance arrangements and Board effectiveness

During the second half of 2015, the GGI team undertook this assessment, with significant input from IJB members and stakeholders. Findings were aligned to key governance principles as follows:

The ensuing report, published in November 2015 set out a road map of priorities for supporting the delivery of a world-class governance system. A set of recommendations were included in this report and the following table summarises progress to date. Revise vision and values document to include strategic objectives and desired outcomes.

-

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Identify and debate drivers and threats to desired outcomes. Identify the IHB’s key information needs, including horizon-scanning and market intelligence, as a result.

Within the agreed IJB agenda going forward.

Include detailed description of board members’ roles and responsibilities, as individuals and collectively, in an induction manual.

To be delivered by GGI.

Develop and run scenarios with sIJB members exploring accountability issues for different service arrangements (e.g. hosted; planning only etc), including the professional governance implications of service failure, potential for conflict of interest and the requirements of openness and transparency.

This has been partially addressed within the risk appetite workshop series, and in facilitated discussions around handling challenging events. This is a core element of the IJB’s developing accountability arrangements hosted services.

Map out decision-making process within and between organisations for identifying and allocating funding.

Within the agreed IJB agenda going forward. The IJB has appointed its Director of Finance and Business.

Secure independent legal advice as a priority.

Within the agreed IJB agenda going forward. The IJB have appointed Mr Roderick MacBeath (Senior Democratic Services Manager, ACC) as Standards Officer to the IJB.

Develop an Engagement Strategy which sets out objectives, goals and measures of success and assurance mechanisms.


Engage with workforce on identifying the potential gains from integrated working for staff.


The IJB should debate and set its risk appetite against each of its strategic objectives or

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outcomes.

The IJB has agreed its risk appetite statement, and has had several mature discussions on risk appetite. This has included applying the risk approach to the draft strategic risk register, and will continue to be taken forward and applied as ACHSCP further develops its organisational objectives.

Work should be progressed on the committee structure, setting out:

Sub-committee providing assurance on governance and risk systems

Sub-committee providing assurance on the quality and safety of services (professional governance)

Management groups receiving, reporting and escalating information on operations

As described within this report, the IJB are progressing well with this, and have successfully implemented requirements ahead of formal go-live

Work on the risk management system should now be organised around strategic objectives and focus on risks to service planning and delivery and the achievement of integration goals.

The ACHSCP Board Assurance and Escalation Framework (AEF) was adopted by the Board at its March 29th meeting. The IJB has are progressing well with operationalising the risk management system, including populating their Strategic Risk Register accordingly.

A plan to support the Chief Officer and colleagues in the short and mid terms should be developed, to protect the IJB from staff turnover or shortages and reduce the dependence on key individuals.

There has been valuable IJB discussion around the capacity of the Executive Group. The IJB agreed the organisational structure of the Senior Leadership Team at its 26 April 2016 meeting.

A programme of board development based on key competences and identifying measures of success should be developed.

GGI have witnessed a growing maturity in Board dynamics over the course of this programme, and commend the IJB on this progress and encourage members to continue in this regard.

The induction manual should include a code of conduct, setting out expected behaviours of board members. This might be supported by the sIJB working through scenarios.

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To be delivered by GGI. This has been partially addressed within the risk appetite workshop series, and in facilitated discussions around handling challenging events The IJB has discussed principles of engagement and guidelines for Board etiquette (Appendix 1).

The discipline for agenda planning and structure, board papers and presentations should be agreed and monitored. The basis for this discipline should be the achievement of IJB outcomes and focussed on enabling decision-making.

The IJB continues to progress well with this.

Methods for assuring that decisions and actions are recorded, assigned and monitored should be established, and reflect the timing requirements of the cycle of business.

The IJB continues to progress well with this, as set out within the Board Assurance and Escalation Framework (AEF).

Processes for dealing with conflict of interest and for assuring high levels of probity and openness should be developed in line with the IJB’s stated principles and values.

This is supported by the agreed AEF. The IJB have appointed Mr Roderick MacBeath (Senior Democratic Services Manager, ACC) as Standards Officer to the IJB. Further implementation is within the agreed IJB agenda going forward.

2 Assessing board maturity

As part of this programme, and building on the findings of the assessment described above, ACHSCP undertook an assessment of its governance maturity using the GGI Maturity Matrix (Appendix 2) and has outlined and agreed a target development pathway over the next 12 months to April 2017 (Appendix 3). The matrix is used to assess the effectiveness of a board against the key governance requirements. It provides a useful framework to enable the IJB to plan its development in line with good governance principles. It is now appropriate for ACHSCP to move from what has primarily been a developmental focus, and to place more emphasis on testing the fitness for purpose of its systems and structures as it seeks to deliver health and social care transformation in Aberdeen. The Board must now demonstrate leadership by ensuring that the organisation is accountable for the delivery of its strategy and by shaping a healthy culture for the board and the organisation. As described below, there is a range of

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governance resources now in place, which can be used as the supporting framework for further maturity.

GGI recommends that the IJB reassess themselves against the good governance matrix at 6-month intervals to support the Board’s ability to test out its effectiveness and maturity, moving to an annual assessment in line with its agreed cycle of business.

3 Risk Appetite and the Partnership’s approach to risk

As part of strengthening an embedding the IJB’s approach to risk, GGI facilitated three workshops with board members. These focused on the development of the IJB’s understanding and approach to risk appetite, and the governance functions surrounding this.

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The three workshop topics are outlined below:

These workshops were designed to strengthen governance pre go-live, and specifically to test risk appetite in practice. The IJB has successfully built a practical understanding of risk management, and has developed tools and resources which allow its risk approach to be applied throughout the organisation’s operations.

The Board has agreed its risk appetite statement (Appendix 4), and work is underway to further embed the risk management system, particularly around the development of the Board’s Strategic Risk Register. The IJB has committed to ensuring that templates for Board and Committee papers make reference to risks on the Strategic Risk Register as a means of aiding effective discussion and decision-making.

January 2016 – Strategic Commissioning Outcomes and Locality Planning

Key deliverables which will define ACHSCP in year 1

Assessing specific options and opportunities to leverage real change in years 2 & 3

Locality planning and managing autonomy

February 2016 – Innovation and Learning & Future Focus

Learning from local innovations in the last 5 years

What has driven change in the past & what will in future?

Stimulating and supporting innovation and change to achieve our strategic outcomes

March 2016 – Handling Challenging Events

Scenario testing to assess strategic approach, governance systems, and accountabilities around:

Financial Breaches

Provider Failure

Harm to People

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GGI recommends that ACHSCP closely links the achievement of its strategic priorities with the practical application of its agreed risk appetite statement, revisiting the discussion on appetite for risk as needed.

It will also be necessary for the ACHSCP to ensure that its approach to risk is embedded in decision-making beyond the Board itself. In order to gain maximum benefit from the progress the Board has made in relation to its approach to risk, this approach must be understood and applied by staff across ACHSCP.

Successfully communicating with staff and partners about the ACHSCP’s risk tolerances and the dynamics of balancing different types of risks and opportunities will aid effective decision-making across the Partnership’s activities. This is especially important in the context of locality working, where the governance process should support local autonomy with accountability, in line with the Partnership’s agreed approach to risk.

GGI recommends that ACHSCP should continue to engage and communicate with staff, localities and partners about its values, strategy and implementation plans.

4 ACHSCP Board Assurance and Escalation Framework

The ACHSCP Board Assurance and Escalation Framework (AEF) was adopted by the Board at its March 29th meeting and describes the basis of the Partnership’s approach to good governance. The purpose of the framework is to provide assurance to the IJB and key stakeholders that the IJB has in place a robust system for the management of risk and the delivery of integration goals. The framework is designed to support appropriate and transparent management and decision-making processes which are underpinned by the principles of good governance. It will enable the board to be assured of the quality of its services, the probity of its operations, and of the effectiveness with which the board is alerted to risks to the achievement of its strategic priorities. The AEF describes the regulatory framework within which the IJB operates, and the

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vision, values and principles that the assurance processes set out are designed to support. Fundamental to the framework are the IJB’s strategic priorities and the appetite for risk that the board has across these priorities.

It presents and populates a model where individuals, groups and committees, plans, reports and reporting processes are mapped at different organisational levels, against two broad assurance requirements: compliance and transformation. A key element of the assurance framework is the risk management system, whose outputs (i.e. strategic and corporate risk registers, and other reports) contribute significantly to board assurance on key risks to objectives. Now operating as a statutory entity, the IJB needs to drive forward the implementation of the framework and to ensure it is mainstreamed within Board operations.

The formally agreed delegation to committees will also require assurances on controls facilitated by the AEF, with the committee programmes of work clearly linked to the content of the Strategic Risk Register and broader framework.

Subsequent to the development of the AEF, GGI has facilitated a further workshop with the IJB, populating its Strategic Risk Register in line with the members’ understanding of risk appetite and in the context of competing priorities.

GGI recommends that the ACHSCP Executive Group review the current status of the IJB’s risk escalation and risk assessment processes, and cycle of business to ensure these are appropriately utilised and understood by IJB members and embedded within committee operations, in line with the processes set out in the AEF.

5 Committee structure

ACHSCP have established two sub-committees to the Board:




Where expected outcomes are not being achieved it is important for boards to understand why. The Audit and Performance Systems Committee (APSC) has been established to support this purpose. APSC will have an ongoing assurance role to the board that all relevant governance systems are working and delivering added value. This will include ongoing scrutiny of the Assurance and Escalation Framework as the key

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means by which the board navigates the organisation towards the agreed strategic objectives.

The operation of the APSC will be fundamental to oversight of the system to identify, understand, monitor, and address current and future risks to the Partnership’s strategic objectives.

Specifically, the APSC will support assurance through assessment of:

Fitness for purpose of the Board Assurance and Escalation Framework

Effectiveness of the process around the Strategic Risk Register

How complete and embedded the risk management system is

Integration of governance arrangements

Appropriateness of self-assessment against regulation standards

In parallel with its distinct governance and assurance functions, the APSC will form an important element in supporting the capacity of the IJB. The activities of the APSC should contribute to ensuring that the level of discussion and assurance occurring at Board level is appropriate and effective.


The role of the Clinical and Care Governance Committee (CCGC) is to oversee and ensure provision of a coordinated approach to clinical and care governance issues within the ACHSCP.

The CCGC has a key role in assessing high value clinical and care risks, considering the adequacy of mitigation, the assurance provided for that mitigation and referring residual high risks to the Board. It has a key role in assuring the board that learning from governance systems across services, including learning arising from incidents, complaints and identified risks, is shared and embedded as widely as possible. As such, the CCGC will play an important role in ensuring that ACHSCP is a learning organisation and that the Board is properly sighted on the impact of clinical and care risks to achieving its objectives.

The need for the IJB to be assured of robust clinical and care governance is particularly significant, given the transformational context of ACHSCP and its ambitions of delivering innovative models of health and social care.

GGI recommends that the development of this committee and of the broader clinical and care governance of ACHSCP is a key aspect of focus for the organisation in the coming months.

The IJB has operated in shadow form ahead of its formal operation in April 2016. In this

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time, Board members have developed the dynamics of their partnership working as well as the information servicing needs and expectations of Board discussions. The committees of the Board are newly established, and have not operated in shadow form. In order to mature the operations of these committees as rapidly as possible, ACHSCP will need to ensure that the purpose and Terms of Reference (ToR) are fully understood by all. In particular, it will be necessary to instill a common and shared understanding of the roles and responsibilities of the chairs and members of committees, and the assurance expectations of the Board itself.

In assessing committee operation and effectiveness, the SIPOC process management framework offers a useful guideline:

Suppliers Inputs Processes Outputs Customers

In relation to ACHSCP Committees, the ‘customers’ could be understood as the Board, and internal and external auditors, while the ‘outputs’ would include committee reports and papers. In this way, the SIPOC framework can be used to understand and test Board assurances and how these are produced.

GGI recommends that ACHSCP undertake a SIPOC mapping exercise of its committees in order to support clarity of roles and responsibilities from the outset, as well as supporting the shared understanding of assurance.

6 Board dynamics

Effective Board operations require continued investment in strengthening governing body dynamics and a balancing a unified corporate approach with robust challenge and assurance.

GGI have witnessed a growing maturity in Board dynamics over the course of this programme, and commend the IJB on this progress and encourage members to continue in this regard. In particular, effective team dynamics and the quality of interaction at the Board have been aided by the shadow operations of the IJB, and facilitated discussions within workshop settings around topics such as the Board’s assurance needs in relation to handling challenging events.

With established committees in operation, the IJB should be better supported in its strategic focus, with the level of discussion reflecting this. Committees should provide a supplementary venue to the Board for the management of the interface between strategic and operational issues, ensuring that Board meetings are not dominated or distracted by process-heavy discussion.

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GGI recommends that the progress made in strengthening Board dynamics is applied to the committees, and in particular that attention is paid to encouraging even contribution from members and the appropriate content and delivery of agenda items.

The IJB has discussed principles of engagement and guidelines for Board etiquette (Appendix 1). GGI recommends that ACHSCP agree a board etiquette approach that facilitates both trust and challenge.

GGI recommends that the IJB consider undertaking a distinct Board development programme to assist with the achievement of the two recommendations above as well as strengthening both individual members’ capability and competency and also effective team interaction.

7 Knowledge management and system leadership

Throughout this programme, ACHSCP has demonstrated a desire to combine internal organisational governance development with broader system-wide learning and benchmarking as part of its commitment to successful health and social care integration.

Listed below are the key governance knowledge management resources which have been co-constructed with ACHSCP to date as part of developing best practice guidance and resources for the Board and partners to take forward:

ACHSCP Risk Appetite Statement (Appendix 4)

ACHSCP Board Assurance and Escalation Framework

GGI & ACHSCP Risk Appetite Board Assurance Prompt, including a maturity matrix to support better use of risk in partnership decision taking (Appendix 5)

GGI self assessment governance maturity matrix for integrated partnerships in Scotland (Appendix 2)

Developmental assessment of ACHSCP against the good governance maturity matrix; outlining progress and targets from IJB start; December 2015; April 2016; April 2017 (Appendix 3)

ACHSCP quality and care governance maturity matrix (Appendix 6)

GGI recommends that ACHSCP continue its commitment to shared system-wide learning with partners, and, supported by the knowledge management resources

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produced to date, considers utilising forums such as the North East Partnership, IJB Chief Officer group, and board-to-board meetings with other IJBs to drive forward constructive benchmarking and the sharing of best practice.

The 2014 Act obliges all partnerships to publish a Performance Report covering performance over the reporting year. As well as reporting on their strategic commissioning plan and financial statement as outlined in guidance from Scottish Government, ACHSCP may wish to consider adopting an Integrated Reporting (IR) approach.

IR has at its heart the concept of agreeing with stakeholders what they value and what capitals they wish to see improved. The system requires organisations to agree value creation with stakeholders in these capitals and then set about improving and reporting on progress and learning. For instance, as well as the traditional areas of finance, staff numbers, and estates, ACHSCP values the skill base of its staff, the community experience, efficiency, research, contribution to local public health, employment and well being, its impact on the environment and leadership in local and national debates. At the moment the system has the advantage of not being a statutory requirement so avoids the failure regime of targets or the stultification of pro forma annual reports. Moreover, the concept lends itself well to the communication and engagement efforts of ACHSCP to date, which mirror the International Integrated Reporting Council’s (IIRC) goal to make corporate reporting clear, concise, and relevant.

GGI recommends that ACHSCP adopt an Integrated Reporting approach to the production of its annual Performance Report. Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5

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Appendix 6

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Report Title Proposed Changed to IJB Meeting Date


Report Author Judith Proctor




To propose a revision to the schedule of meetings of the IJB.


A schedule of meetings had been agreed at the sIJBs meeting on 26.01.2016. Previously the Board had raised concerns that there was a long time-period between the meeting in October and the next meeting in January. These concerns were particularly pressing as this occurred over the winter period. To reduce the time between meetings, it is suggested to postpone the meeting on the 25th of October to the 15th of November. Therefore, the proposed dates are:

30th August

15th November

31st January

28th March


Accepting the proposed change will reduce the time-lapse between meetings of

the IJB over the winter period. Additionally, it will allow for up-to-date financial

information to be reported to the IJB.

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Agenda Item 8

2


4: Recommendations


1. Endorse the suggested amendment to the IJBs schedule of meetings, as outlined above.

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Document is Restricted

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Agenda Item 9Exempt information as described in paragraph(s) 3 of Schedule 7Aof the Local Government (Scotland) Act 1973.



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Exempt information as described in paragraph(s) 3 of Schedule 7Aof the Local Government (Scotland) Act 1973.



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Exempt information as described in paragraph(s) 3 of Schedule 7Aof the Local Government (Scotland) Act 1973.



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Agenda Item 11Exempt information as described in paragraph(s) 1, 3 of Schedule 7Aof the Local Government (Scotland) Act 1973.



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Agenda Item 12Exempt information as described in paragraph(s) 8 of Schedule 7Aof the Local Government (Scotland) Act 1973.


Documents

IJB”) on 28 June 2016