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SRG 7 - Integration Joint Boards and Primary and Community Care

The seventh Stakeholder Reference Group (SRG) for the Moving Forward Together (MFT) Programme took place on Tuesday 27th of February. The Group of 13 patient, service user and carer representatives (details at the end) heard a presentation and engaged in discussion about the Integration Joint Boards, the services they direct and their role in transformation.

Liz Porterfield, the Co-Chair of the group welcomed everyone and introduced Susanne Millar, Chief Officer (Strategy and Operations) & Chief Social Work Officer, Glasgow City Health and Social Care Partnership who presented on the direction of travel for the community and primary care services within Health and Social Care Partnerships. She provided background to the formation of the Integration Joint Boards (IJBs) in 2014 that was described by the Health Minister as the biggest change in healthcare since 1948 (formation of NHS).

Susanne said they fundamentally changed the way that health and social care services are planned and delivered across Scotland. Each IJB produces a single Strategic Plan for Health & Social care for their locality area and commissions the Local Authority Council and Health Board to deliver services to meet this. The key principles underpinning their locality plan include meeting the 9 nationally agreed health and wellbeing outcomes using integrated budgets with joint and equal accountability across health and local authority.

She outlined the functions delegated to the IJB and how they provide direction to Councils and Health Boards to employ staff and deliver services. The Health Board is responsible for the overall planning for acute services across the Board area. The IJBs are responsible for strategic planning for health and social care services and for the strategic commissioning of unscheduled care services in their locality area. The Health Board is required to ‘set aside’ a portion of acute budget for those functions delegated to IJBs which are carried out in hospitals.

Susanne explained that, similar to the approach taken for acute services, services were being planned using a tiered approach that focused on self management and care being delivered at or close to people’s homes. Each of the 6 IJBs across Greater Glasgow and Clyde had identified 8 common priority areas (below) and how these were central to this process and reflected national policy.

She then spent time discussing in more detail some of these and for example described how supporting more older people to live at home with enhanced care packages, anticipatory care plans and intermediate care models had contributed to reducing bed days (how much time someone spends) in hospitals.

To facilitate this she spoke about and highlighted the need to allow risk explaining that for older people health isn’t in a fixed downward direction and it can improve; however for this to happen then reducing the time spent in hospital was crucial. This is often contrary to what family, carers and sometimes service providers think, but if people want to live independently at home as long as possible then sometimes some calculated risk is required to enable this. She also spoke about how inequality, early years and improving life chances were a key area as they had a huge impact on adult health and wellbeing and how they use services in later life.

Susanne finished by saying that there needs to be better public awareness of IJBs as the future will bring ever closer integration with more joint working and teams that span health and social care – something that has been highlighted as critical to the MFT Programme. However, there also needs to be wider and ongoing conversation with the public about the political and economic factors and the financial situation within public services that will have implications on how we pragmatically plan, design and deliver services.

Liz Porterfield thanked Susanne for her presentation before the Group asked questions and led discussion on a number of topics. Martin opened by saying that more needed done to raise awareness of the existence and function of the IJBs with the wider public who in his opinion were unaware of them. Several members agreed and Thomas, who sits on some local committees, said that he had never heard of them. Janice said that she like to talk to people about her involvement and the work that goes on behind the scenes; however IJBs were are mystery to he and Margaret sad that the Government had missed the opportunity to promote them when they launched.

As Anne Marie, Martin and Margaret were also non-voting members of their local IJB they explained how they functioned, their networks for informing people and touched upon accountability. Anne Marie explained that the IJB all have public websites where people can access information about their work and that the Board meetings are open to the public – she encouraged members of the Group to attend their local meeting. Gordon said that people don’t engage with healthcare planning in that way; however as everyone can become ill it’s important to invest in it so that services can reflect local opinion.

Aileen and Helen both asked for clarity on how they are funded and how are the public and special interest groups involved in how money is spent. There was discussion that it comes from both health and local authority budgets and then decide how that should be spent to best serve the health and social care needs of the local population. Margaret said that the public need to know more about funding as they could have more of a say what services are delivered. This led to a wider conversation about funding and it how it was allocated with the public awareness that health and social care is facing considerable financial constraints. Gordon highlighted that third sector organisations, many who supported people across health and social care, had borne the brunt of cuts to funding.

There was recognition that the Programme was looking at how to use resources better, but that many people would feel threatened by changes to hospital services as they would question whether new models would work.  Gordon spoke about the culture change within mental health services and that this was different across generations and that key to this work is the promotion of the preventative aspects and that the aim is to keep people out of hospital. Betty spoke about the need for better coordination and liaison of services in the community; and that the focus and resource allocated should be driven by what is best for the person.

Alison asked about older adult rehabilitation and the setting people are assessed in outwith hospital such as intermediate step-down care. She spoke about consistency across Glasgow and Clyde and that in some areas there wasn’t the same services e.g. if people are discharged straight home without this then what happens? Thomas recognised the need to provide more care in or close to people’s homes but said the many community services are like cogs and someone needs to manage them all to ensure they function as a whole.

Morag said she understood the Programme is about improving things for everyone; however as she heard on the radio this day there is dissatisfaction in some areas across staff people using services e.g. people being discharged too soon without adequate support, or always wanting to see a doctor. She said more needs to be done to educate people at a local level about the rationale for change and to improve their knowledge of the systems so they know how to use them better. Karen said that the work in Inverclyde had been successful in doing this using social media and stories to generate knowledge with targeted work with specific groups to change culture around how people used primary care.

Karen also said she agreed that risks need to be taken in some areas and resources should focus on reablement as patients in a hospital setting can quickly lose the ability to live independently; however with resources being  scarce better more seamless ways of working together are needed. Margaret said that people need to understand that this is planning for the future.  She said  we have to communicate that even without financial pressures there simply isn’t the staff  in some areas to keep going the way we are; therefore the system needs to change and some people will be uncomfortable with this, but it needs done.

 

In Attendance

Liz Porterfield (Co-Chair)

NHSGGC - MFT Core Team

John Barber (Facilitator)

NHSGGC - MFT Core Team

   

Presenting

Susanne Millar  

Chief Officer (Strategy and Operations) & Chief Social Work Officer, Glasgow City Health and Social Care Partnership

 

Patient, Service User and Carer Representatives

Aileen Hills

 

Alison Stewart

 

Anne Marie Kennedy

 

Betty Graham

 

Gordon McInnes

 

Helen Morgans-Wenhold

 

Ian Good

 

Janice Woodburn

 

Karen Haldane

 

Margaret Telfer

 

Martin Brickley

 

Morag McIntosh

 

Stacey Highfield

 

Thomas Cassidy