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The Highland Council Agenda
Item
12 March 2015 Report
No
HC/1/
Integration Scheme – Public Bodies (Joint Working) (Scotland) Act 2014
Report by Chief Executive
Summary
This report introduces the Integration Scheme that is required to meet the new statutory
duties, in accordance with the Public Bodies (Joint Working) (Scotland) Act 2014.
1. Background
1.1 NHS Highland and Highland Council agreed new integrated arrangements for the
delivery of health and social care for adults and children, with effect from April
1.2 The legal basis for this arrangement was the Partnership Agreement between the
Highland Council and the NHS Highland Board. While the Partnership Agreement
remains the basis for the lead agency arrangements that are now in place, it was
based on legislation that is now superseded by the Public Bodies (Joint Working)
(Scotland) Act 2014. This new legislation requires that the organisations agree an
Integration Scheme by 1 April 2015.
1.3 Accordingly, the draft Integration Scheme that is attached at Appendix One, has
been developed by senior officers and members of both organisations, on the basis
of the Partnership Agreement and any subsequent changes agreed by the
organisations.
1.4 This process has involved some fine-tuning of existing governance arrangements,
for example the Strategic Commissioning Group becomes a Joint Monitoring
Committee, as described at Appendix Two.
1.5 It may be necessary to make final amendments to the Integration Scheme, for
example taking account of legal advice or the advice of Scottish Ministers. Should
this be necessary, final approval should be delegated to the Chief Executives of the
two organisations.
1.6 It is intended that a full review of the current arrangements is now undertaken,
involving consultation with elected members and stakeholders, and that a further
report is brought to the Highland Council and the NHS Highland Board.
1.7 This review should involve members from across the Council, with terms of
reference that are agreed with NHS Highland. It should lead to new arrangements
that are cost neutral or better.
2. Implications
2 .1 The Integration Scheme fulfils the requirements of the Public Bodies (Joint
Working) (Scotland) Act 2014.
2.2 There are no new resource; equalities; climate change/carbon clever; risk, Gaelic
or rural implications arising from this report.
Recommendation
Members are asked to agree:
(i) the draft Integration Scheme, subsequent to any necessary final
changes which are delegated to the Chief Executives of Highland
Council and NHS Highland;
(ii) to a review of governance arrangements, involving members from
across the Council;
(iii) to work with NHS Highland to determine a timescale and process.
Designation: Chief Executive
Date:
Author:
Background Papers:
Aims and Outcomes of the Integration Scheme
"The Highland Partnership is committed to achieving the best possible outcomes for our population and service users. We believe that services should be person-centred and enabling, should anticipate and prevent need as well as react to it, should be evidence based and acknowledge risk. We will improve the quality and reduce the cost of services through the creation of new, simpler organisational arrangements that are designed to maximise outcomes and through the streamlining of service delivery to ensure it is faster, more efficient and more effective."
The Highland Council and NHS Highland launched this statement of intent in December 2010 and this heralded the development of integrated services for children, young people and adults across the Highland Council area. Integration progressed in April 2012 and this Integration Scheme reiterates the vision and the associated detail of how services are integrated in line with the Lead Agency model set out in the Public Bodies( Joint Working) (Scotland)Act 2014 ('the Act') and associated regulations.
Further detail of the development of integrated services for children and adults is contained within the Partnership Agreement between the parties of 2012. The Partnership Agreement is considered guidance for the partnership, supplementing this Integration Scheme.
The Highland Partnership through the Lead Agency arrangements commits to achieving the National Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Act.
Schedules 1-3 set out the descriptions of the integrated services for Children, Young People and Adults as well as for those transitioning between services.
The parties:
THE HIGHLAND COUNCIL, established under the Local Government etc (Scotland) Act 1994 and having its principal offices at Glenurquhart Road, Inverness IV3 5NX ("HC");
And
HIGHLAND HEALTH BOARD, established under section 2(1) of the National Health Service (Scotland) Act 1978 (operating as "NHS Highland") and having its principal offices at Assynt House, Beechwood Park, Inverness IV2 3BW ("NHSH")
IT IS AGREED as follows:-
Definitions And Interpretation
1.1. In this Scheme the following expressions shall (unless the context requires otherwise) have the following meanings:-
"Adults" means individuals aged 16 or over;
"Adult Services Delegated Functions" means those functions (on the basis that the scope of their application is taken to be limited to the Operating Area) specified in Column A of Annex 2 Part 1 to the extent that they relate to the services (again,
limited in scope to the Operating Area) specified in Column 8 of Annex 2 Part 1 insofar as delivered for the benefit of Adults;
"Adult Services DF Accommodation" means the Transferring Accommodation related to Adult Services Delegated Functions;
"Adult Services DF Contracts" means those contracts in force from time to time to which NHSH is party, to the extent that such contracts relate to the Adult Services Delegated Functions;
"Adult Services DF Creditors" means those amounts owing by NHSH from time to time in connection with the exercise of the Adult Services Delegated Functions;
"Adult Services DF Databases" means those databases, the rights to which are owned by NHSH, to the extent that such databases are used in connection with the exercise of the Adult Services Delegated Functions;
"Adult Services DF Debtors" means the debts owed to NHSH from time to time in connection with the exercise by NHSH of the Adult Services Delegated Functions;
"Adult Services DF Employees" means the employees wholly or mainly assigned from time to time to the exercise of the Adult Services Delegated Functions;
"Adult Services DF Equipment & Furniture" means the equipment, furniture and other items held from time to time by NHSH, to the extent that they are used in the exercise of the Adult Services Delegated Functions;
"Adult Services DF Supplies" means all stocks and other supplies held by NHSH from time to time (including, without limitation, items which - although subject to reservation of title conditions in favour of the supplier - are under the control of NHSH) in connection with the exercise of the Adult Services Delegated Functions;
"Adult Services Support Arrangements" means the arrangements, relating to the provision of ongoing support by HC to NHSH in the exercise of Adult Services Delegated Functions, specified in Part 2A of the Schedule;
"Business Day" means a day on which the headquarters of both of the Partners are open for business;
"CNORIS" means the Clinical Negligence and Other Risks Indemnity Scheme for the national health service in Scotland;
"Children and Young People" individuals from birth until they attain the age of 16;
"Children's Services Delegated Functions" means those functions (on the basis that the scope of their application is taken to be limited to the Operating Area) specified in Column A of Annex 1 Part 1 to the extent that they relate to the services (again, limited in scope to the Operating Area) specified in Column 8 of Annex 1 Part 1 insofar as delivered for the benefit of Children and Young People;
"Children's Services DF Accommodation" means the Transferring Accommodation related to Children's Services Delegated Functions;
(a) in relation to Integrated Adult Services, the balances held by NHSH from time to time to the extent that they represent Financial Contributions by HC to support the delivery of those services;
(b) in relation to Integrated Children's Services, the balances held by HC from time to time to the extent that they represent Financial Contributions by NHSH to support the delivery of those services;
"Effective Time" means 00.01 a.m. on the Commencement Date;
"FOISA" means the Freedom of Information Act (Scotland) Act 2002;
"Financial Contributions" means, in respect of a given Financial Year, HC's Financial Contribution in respect of that Financial Year and NHSH's Financial Contribution in respect of that Financial Year;
"Financial Year" means each period from 1 April in one year to 31 March in the immediately succeeding calendar year during the Term, and on the basis that the first Financial Year shall run from the Commencement Date until 31 51 March 2016 "Financial Years" shall be interpreted accordingly;
"HC Share of the VAT" means the element of the VAT incurred by NHSH on expenditure relating to the Integrated Adult Services which are deemed to relate to the Adult Services Delegated Functions, and on the basis that the methodology for calculating the element of the VAT which relates to Adult Services Delegated Functions will be agreed between NHSH, HC and HMRC;
"HC's Financial Contribution" means, in respect of a given Financial Year, the contribution made or to be made by HC in respect of that Financial Year in pursuance of section 6
"ICT Infrastructure" means computer hardware and software, and including laptops and other portable devices, servers, workstations, printers, scanners, projectors, mobile phones and smartphones;
"in Agreed Form" means in the terms agreed by or on behalf of both Partners prior to the Commencement Date;
"Information Sharing Protocol" means the protocol (relating to the sharing of information between the Partners) set out in section 8 of the Scheme;
"Integrated Adult Services" means (subject to the detailed approach to individual strands of services, as set out in the Position Statements) those services delivered or commissioned by NHSH in the exercise of the functions specified in Column A of Annex 1 Part 2 and Annex 2 Part 1 to the extent that they relate to the services specified in Column B of Annex 1 Part 2 and Annex 2 Part 1 insofar as delivered in respect of the Operating Area for the benefit of Adults;
Integrated Children's Services" means (subject to the detailed approach to individual strands of services, as set out in the Position Statements) those services delivered or commissioned by HC in the exercise of the functions specified in Column A of Annex 1 Part 1 and Annex 2 Part 2 , to the extent that they relate to the services
specified in Column B of Annex 1 Part 1 and Annex 2 part 2 insofar as delivered in respect of the Operating Area for the benefit of Children and Young People;
"The Integration Scheme Regulations" means the Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014
"Law" means any applicable statute or any delegated or subordinate legislation, any enforceable community right within the meaning of section 2(1) of the European Communities Act 1972, any applicable guidance, direction or determination with which either Partner is bound to comply, and any applicable judgment of a relevant court of law which is a binding precedent in Scotland, in each case as in force in Scotland from time to time;
"Lead Agency" means:-
(a) in relation to Integrated Adult Services, NHSH;
(b) in relation to Integrated Children's Services, HC;
"NHSH's Financial Contribution" means, in respect of a given Financial Year, the contribution made by NHSH in respect of that Financial Year in pursuance of clause 6•'
"Outcomes" means the Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Act
"Partners" means HC and NHSH; "Partner" shall be interpreted accordingly;
"Patient Information" means all personal health information, which shall be taken to refer to any information relating to the health and well-being of an identifiable individual;
"Quarter" means a period of three consecutive calendar months commencing on the first day of each Financial Year, and every subsequent period of three consecutive calendar months thereafter during the Term;
"Receiving Authority" means:
(a) in respect of the Adult Services Delegated Functions, NHSH;
(b) in respect of the Children's Services Delegated Functions, HC;
"Scheme" means this Integration Scheme; "Service User Information" means any data (including, without limitation personal data and sensitive personal data within the meaning given to those expressions by the Data Protection Act 1998) held by HC relating to a service user from which the identity of that service user can be established or inferred;
"Special Equipment" means:
(a) in the context of provisions relating to the Adult Services Delegated Functions, those items of equipment used in connection with the exercise of Adult
forecasts, and records relating to future developments, planning, litigation and/or legal advice); and
(v) records relating to services supplied in the course of exercise of Adult Services Delegated Functions;
but excluding the Retained Databases;
(b) in the context of provisions relating to the Children's Services Delegated Functions, all records held by or to the order of NHSH (whether or not falling within the definition of Confidential Information, and in whatever form) relating exclusively to the exercise of Children's Services Delegated Functions, including (without limitation)
(i) all accounts, books, vouchers, service user and supplier records, contracts, invoices received and copies of invoices issued, orders and quotations made/received;
(ii) all contracts of employment, employment policies, documents, files, records or information relating to the Transferring Employees or their terms and conditions of employment;
(iii) any formulae, designs, specifications, drawings, data, manuals or instructions, research materials, catalogues and correspondence files;
(iv) records concerning the operations, management and administration of the Children's Services Delegated Functions (including business plans and forecasts, and records relating to future developments, planning, litigation and/or legal advice); and
(v) records relating to services supplied in the course of exercise of Children's Services Delegated Functions;
but excluding the Retained Databases;
"VATA" means the Value Added Tax Act 1984;
"VAT Guidance" means the guidance prepared by the Department of Health and HM Custom and Excise entitled VAT arrangements for Joint NHS/Local Authority Initiatives including Disability Equipment Stores and Welfare- Section 31 Health Act 1999 dated 12 June 2002 (updated 7 March 2003 );
Reference to a statute or a statutory provision includes a reference to it as from time to time amended, extended or re-enacted.
Words denoting the singular number only include the plural, and vice versa.
Unless the context otherwise requires, any reference to a clause or paragraph is to a clause or paragraph of the Scheme.
The headings in the Scheme are included for convenience only and shall not affect its interpretation.
In implementation of their obligations under the Act, the Parties hereby agree as follows:
In accordance with section 1(2) of the Act, the Parties have agreed that the integration model set out in sections 1(4 )(d) of the Act will be put in place for [the Highland Partnership], namely the delegation of functions by the Parties to a Lead Agency that is to be established by Order under section 9 of the Act. This agreement comes into force on April 151 2015 subject to Ministerial approval.
2.9 Administration: Business support for the Joint Monitoring Committee will be provided by Highland Council. This will include preparation and arrangement of all meetings and reports, taking and circulation of minutes.
2.10 The diagram below illustrates the relationship between the Joint Monitoring Committee and the Lead Agencies.
HIGHLAND COUNCIL NHS HIGHLAND
EDUCATION, CHILDREN
AND ADULT SERVICES
COMMITTEE
JOINT MONITORING
COMMITTEE
STRATEGIC PLANNING
GROUP
HEALTH AND SOCIAL
CARE COMMITTEE
2.11 The Education, Children and Adult Committee has a range of responsibilities, and as with all other strategic committees of HC, this involves 22 elected members. Nine of the members act as lead members from the District Partnerships. This ensures that issues relevant to the local implementation of policy and strategy can inform the work of the committee, and vice versa.
2.12 Three members of the NHSH Board are members of the Committee, participating fully in decision-making and scrutiny processes, albeit they may normally only attend for those issues that are concerned with the management and delivery of the integrated service.
2.13 The Highland Health and Social Care Committee within NHSH ensures that primary, secondary and social care sit as equal partners around a formal sub-committee of the NHSH Board - this committee includes in its membership 3 elected members from Highland Council.
3. DELEGATION OF FUNCTIONS
3.1 The functions that are delegated by NHSH the Lead Agency- HC, to exercise, in conjunction with the functions specified in Column A to Part 2 of Annex 2, are set out in Column A to Part 1 of Annex 1.
3.2 The functions that are delegated by HC to the Lead Agency - NHSH, to exercise in conjunction with the functions specified in Column A of Part 2 to Annex 1 are set out in Column A of Part 1 of Annex 1.
Highland Council will report to NHS Highland on performance on a quarterly basis.
NHS Highland will collate the full range of performance information, as required for local and national reporting purposes, for both lead agencies.
4.5 Clinical and Care Governance
4.5.1 There are a range of policies and procedures in place which will support staff in the application of NHS Highland's clinical governance & risk management requirements:-
Quality & Patient Safety Framework Complaints Management Policy and Procedures Incident Management Policy & Procedures Being Open Policy Risk Management Policy Health & Safety Policy General Work Place Risk Assessment Procedures Dealing with Employee Concerns Policy Management of Employee Capability Policy Written Information for Patients Policy Policy for Consent to Treatment, Surgery and Invasive Procedures Health Records Management Policy
4.5.2 As part of the Governance requirements of both organisations in the Highland Integration model, the following section outlines the commitment to Professional Leadership which has been established by the Lead Agencies to ensure sustainability of safe and high quality services.
4.5.3 Social Care: The CSWO will be in the first or second tier of management within the integrated children's service in Highland Council.
4.5.3.1 S/he has direct access to the Chief Executive of both lead agencies, and to the senior leadership and members of the Council and NHS Highland Board. The CSWO is enabled to influence corporate issues, such as managing risk, and budget priorities in both organisations. It is suggested that this should include involvement in the main strategic committees of the two lead agencies.
4.5.3.2 The CSWO is the Director or Head of Service (where the Director does not fulfil the criteria) within the integrated service for children, and will effect the role within the management structures of the service, and through the other means and forums identified below.
4.5.3.31t is envisaged that there will be a senior manager at Directorate level within NHS Highland, with responsibility for the professional leadership of social work and social care staff, who will be accountable for this to
the CSWO. This provides a lead officer in each agency with a leadership structure across the Operational Units.
4.5.3.4 The CSWO will determine formal deputising arrangements to cover any period of her/his absence.
4.5.3.5 Other Means and Forums to ensure Effective Professional Social Work Leadership
The CSWO is responsible for ensuring further means and forums for ensuring effective social work leadership within both agencies, to fulfil the professional responsibilities set out in the Practice Governance Framework, and to enable social workers to also fulfil their responsibilities.
The CSWO will continue to have responsibility for authorising the registration of all social work and social care staff with the Scottish Social Services Council
4.5.4 Nursing, Midwifery and Allied Health Professionals (NMAHP): Accountability and Reporting Arrangements
The NMAHP Leadership Framework draws on:
- the Joint Declaration on NMAHP Leadership from Scotland's Chief Nursing Officer,
- Chief Health Professions Officer and NMAHP Leaders (201 0) Codes,
- standards and guidance of the Nursing and Midwifery Regularity Council ("NMC"))
- AHP Regulatory Body (Health Professions Council ("HPC")
- A framework for reform: devolved decision-making. - Moving towards single-system working (NHS HDL (2003)11)
- guidance on Appointment of Nurse Directors (2002)
- the NHSH's Executive Nurse Director's current Job Description.
4.5.5 The principles, Professional Leadership framework and structure are embedded in the governance and management structures that are developed for both integrated services in Highland (NHSH and the Highland Council). This ensures that NHSH, the Highland Council, managers, NMAHP leaders, NMAHP staff and those they delegate care to ensure safe, effective and person centred care. It is also relevant to the commissioning of 3rd sector services by both partners.
4.5.6 There is an Executive Nurse Director but s/he requires to ensure that both the Highland Council and NHS Highland fulfil their responsibilities, to enable NMAHPs to also fulfil their professional accountabilities and service responsibilities.
4.5.7 The Executive Nurse Director ensures that a Lead Nurse and a Lead AHP are in the first or second tier of management and professional leadership is embedded throughout the operational structure, within the integrated children's service in the Highland Council who will support the Executive Nurse Director to deploy their role.
NHS HIGHLAND GOVERNANCE STRUCTURE
Governance Committees:
Staff Governance Committee
Audit Committee
Clinical Committee
Pharmacy Committee
Governance
Practices
Improvement Committee
Endowment Funds Committee
Highland Health & Social Care Governance Committee
Argyll & Bute Health & Social Care Partnership
Health & Safety Committee
Asset Mana ement Grou
Sub Committees:
Remuneration Committee
Sub-
Adviso Committees:
Highland Partnership Forum
Adult Social Care Practice Forum
Control of Infection ' I LC-=-=-o:...:..m:.:.:m:.:.:i.:..::tte-=-e-=--________j-- Area Clinical Forum
Area Drugs & Therapeutics Committee
Spiritual Care Committee
Finance & Performance Sub Committee Executive
Area Allied Health Professions Committee
Area Optometric Committee
Area Committee
Area Committee
I GP Sub-Committee
Strategic Planning Group
Area Pharmaceutical Committee
Joint Monitoring Committee
[HIGHLAND COUNCIL GOVERNANCE STRUCTURE I
Director of
Care and
Learning
NHS
Executive \
Director
NHSH Non
Executive
Adult Services
Development &
Scrutiny Sub-
Committee (Max
9 Members)
...... (^) ...... ......
NHSH & THC Joint Monitoring Committee Strategic Planning Group
...... ..... +I
.. ........^
......... .........
...^ ...
Board
Chief Executives ,._^ ____^ _.^ : Health and Social Care In
: Committee :
k ...^ ......^ ......^
Education, Children and
Adult Services Committee
22 Council Members
(Political Balance)
& 3 NHS Board members
........
~
L--------------------
District Partnerships
(9 Council Members)
District Partnership
members
(NHS, THC & 3rd
\ I
I Culture & Leisure I \
District Partnerships (9)
Development &
Scrutiny Sub
Committee (Max 9
Members)
Criminal Justice
Sub Committee
(Max 9 Members)
