SUBJECT: SHADOW GOVERNANCE ARRANGEMENTS FOR THE DEVELOPMENT OF A HEALTH AND SOCIAL CARE INTEGRATION SCHEME FOR MORAY

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1 PAGE: 1 REPORT TO: THE MORAY COUNCIL ON 2 JULY 2014 SUBJECT: SHADOW GOVERNANCE ARRANGEMENTS FOR THE DEVELOPMENT OF A HEALTH AND SOCIAL CARE INTEGRATION SCHEME FOR MORAY BY: CORPORATE DIRECTOR (EDUCATION AND SOCIAL CARE) 1. REASON FOR REPORT 1.1 This report describes the approach in developing an Integration Scheme for Moray. The report also seeks approval for a Memorandum of Understanding (MoU) which outlines the process of securing the agreement of both The Moray Council and NHS Grampian in relation to the high level strategic decisions that require to be made by both parent bodies in determining the contents of the Integration Scheme for Moray before April This report is submitted in terms of Section II (1) of the Council's Administrative Scheme relating to any new policy matter which does not fall within the terms of reference of any Committee. 2. RECOMMENDATION 2.1 It is recommended that The Moray Council:- i) Notes that The Public Bodies (Joint Working) (Scotland) Bill has now completed the legislative process and has received Royal Assent; ii) Notes the approach to the development of an Integration Scheme (Plan) for the joint delivery of adult and older people s health and social care services in Moray; iii) Agrees a Memorandum of Understanding (MoU) with NHS Grampian as the basis of Shadow Integration Joint Board to support the transitional decision making process for the creation of an Integration Scheme for Moray (Appendix 3); and iv) Agrees the amendment of the Scheme of Delegation relative to the powers of the Corporate Director (Education and Social Care) to make specific provision for management of the integration process as set out in Appendix4. 3. BACKGROUND

2 PAGE: The Public Bodies (Joint Working) (Scotland) Bill has now completed the legislative process and has received Royal Assent. Following this approval, the Scottish Government has also now submitted for consultation the draft Regulations and Orders which will accompany this Act. The draft Regulations include the proposed scope of functions that, for those using the body corporate model, will require to be transferred across to the new Integrated Joint Boards from each Local Authority and NHS Board. 3.2 Council will note that the Scottish Government has invited responses as part of the consultation exercise on the draft Regulations and this is a separate agenda item for this meeting. This report will therefore focus on outlining the progress in developing an Integration Scheme for Moray following the approval of the Act. 3.3 A key element of the Act is that all NHS Health Boards and their respective local authorities, who have chosen to adopt the body corporate model, will require to have an Integration Joint Board established and arrangements for the delivery of a new integrated service detailed in a Joint Integration Scheme (previously called a Joint Integration Plan) by April As for all Scottish Partnerships, the implication for Moray is that by April 2015 a new governance arrangement will be defined between the NHS Grampian Board, The Moray Council and the newly formed Integration Joint Board. 3.5 The new governance arrangement will mean that the Integration Joint Board will, through the Act, have responsibility for determining how the agreed budget will be spent and for all decisions in relation to the delegated functions pertaining to health and social care services for adults and older people in Moray. The longstop for completion of the integration process is April This means that the date by which and rate at which services transfer to the Integration Joint Board prior to April 2016 is a matter for agreement in the Integration Scheme. 3.6 Decision making responsibility within the areas of the Integration Joint Board will therefore shift from the NHS Grampian Board and from the Council s Health & Social Care Services Committee to the newly formed Integration Joint Board. This is illustrated as APPENDIX 1. It should be noted that although the same staff will continue to deliver a service on the ground, they will do so in accordance with directions issued by the Integration Joint Board. The parent bodies will monitor performance through annual reports submitted by the Integration Joint Board, and also through the 3 elected members who sit on the Board. 3.7 The purpose of this report is to consider the implications for this Authority and the future Integration Joint Board following the passing of the Bill. The first section of this report will however consider the progress made to date in developing the Integration Scheme for Moray and the interim governance arrangements that have already been established. The second part of the report will seek approval of a MoU to support the interim decision making of a

3 PAGE: 3 Shadow Partnership Board prior to the establishment of an Integration Joint Board. 4. THE APPROACH TO DEVELOPING AN INTEGRATION SCHEME FOR MORAY 4.1 The Council will note that work is underway in progressing the development of an Integration Scheme for Moray. 4.2 The approach taken to the development of the Integration Scheme has been detailed in the Project Initiation Document (PID) (APPENDIX 2). 4.3 The PID document outlines the remit of the 5 work stream sub groups tasked with addressing the key elements of the Act. The 5 work stream sub-groups are; Joint Outcomes, Developing Joint Systems, Workforce, Joint Resources & Financial Planning and Governance and Accountability. 4.4 To ensure that the work of each of these groups is co-ordinated, the Co- Chairs of these groups also meet once a month as part of the Integration Management Group. 4.5 At a strategic level, overseeing the development of the plan and the work of the Integration Management Group and the 5 sub groups is the Transitional Leadership Group (TLG). 4.6 The TLG is co-chaired by the Chair of the Health & Social Care Services Committee and a NHS Grampian (Non Executive) Board Member. As noted in APPENDIX 3, membership of this group is high level and reflects the key stakeholders responsible for shaping health and social care in Moray. This includes a further 2 NHS Grampian Board members and Councillors sitting on the Health & Social Care Services Committee, GP Representative, the CHSCP General Manager, the Third Sector Interface Manager Workforce Representatives, Public Participation Forum Representation, the Head of Community Care and The Director of Education and Social Care in Moray. 4.7 While the work of each work stream sub group is ongoing, the TLG considers that satisfactory progress against the projection plan has been made to date. 5. ISSUES RELATING TO THE INTEGRATION JOINT BOARD (SHADOW) 5.1 Nevertheless, both the TLG and the Integration Management Group consider that if good progress is to continue to be made in developing the draft Integration Scheme then ongoing decisions will require to be made in the period between now and October 2014 regarding issues that will form the contents of the plan. 5.2 These decisions relate primarily to the articulation of a vision for a future integrated partnership, agreeing what locality planning will mean in Moray, the rationale for the joint budget, performance management and the scope

4 PAGE: 4 and functions to be delegated in accordance to the body corporate model and the rationale for the joint budget. 5.3 Council will note that decisions pertaining to these issues are complex in that they involve the input and endorsement of not only the TLG but also The Moray Council and NHS Grampian. 5.4 Furthermore, Council will also note that there is a significant risk that a failure to address these issues at an early stage will result in an inability to have secured approval of the Integration Scheme by April In considering the most appropriate means of addressing this situation and ensuring that timely decisions are made, Officers propose that a Memorandum of Understanding (MOU) is approved by both The Moray Council and the NHS Grampian Board. 5.6 While the MoU articulates the respective roles of the Transitional Leadership Group, the Local Authority, The NHS Grampian Board as well as dispute resolution, the key point made by the document is; as the need for decisions arise in relation to the development of the integration scheme, recommendations on key strategic issues are made to the respective parent bodies by the Transitional Leadership Group. It is proposed that Full Council is the committee within the Moray Council to which progress will be reported and from which relevant approvals will be sought. This will allow the Group s decision making process to develop and mature to ensure that the group is ready to assume control of relevant integrated services by April 2015 or the date otherwise agreed in the Integration Scheme. very urgent issues, in respect of the Council s interests could be determined by the Chief Executive in discussion with the Council s Co Chair of the Transitional Leadership Group and Group Leaders for later homologation at Committee. although decisions at operational level would be informed by the strategic guidance given by the parent bodies, they would continue to be taken by relevant Chief Officers based on existing delegations, supplemented by the new addition proposed in Appendix 4, in discussion and in agreement with the Transitional Leadership Group/Shadow Integration Joint Board, these decisions being summarised in periodic formal reports to the parent bodies. 5.7 The proposed Memorandum of Understanding is attached (See Appendix 3). 5.8 As one of the parent bodies, the Council is asked to agree to adopt the MoU to support the transitional decision making process in respect to the creation of an Integration Scheme for Moray.

5 PAGE: Approval of the MoU will also be sought by NHS Grampian and the Council will be informed of the outcome of this decision If approved, Officers consider that the adoption of the MoU would support the continued development of the TLG and enable the Group to progress towards adopting full decision making powers by April 2015 or within an agreed timescale thereafter as detailed within the Integration Scheme While the adoption of the MoU may require additional reporting to both parent bodies, this course of action would be consistent with what has been described as a Shadow Integrated Joint Board Arrangement. This would allow the TLG to undergo the following stages of development to reach full maturity and become an Integrated Joint Board while being offered the support of both the NHS Grampian Board and The Moray Council. These stages could be considered as a:- a. Learning phase b. Decision making (practice phase)-on reduced scope c. Decision making-full scope If the MoU is approved by the Council and the NHS Grampian Board it is recommended that the Transitional Leadership will henceforth be named and described as the Shadow Integrated Joint Board Finally, the Council will note that provisional approval of the draft Integration Scheme will be sought from the Full Council and NHS Grampian Board prior to entering the consultation phase. The draft Integration Scheme is scheduled for submission to the respective parent bodies for November Following the consultation exercise, the revised Integration Scheme will be brought back to each parent body for approval at the beginning of 2015 prior to being submitted to the Scottish Government for final approval. 6. SUMMARY OF IMPLICATIONS (a) (b) Moray 2023 A Plan for the Future/ Service Plan The integration of health and social care services is underpinned by 9 high level national health and wellbeing outcomes and a suite of underpinning performance indicators. A number of these outcomes and indicators, such as feeling safe and the proportion of people in permanent care, are also part of the measures which are used to monitor progress against the Moray 2023 A Plan for the Future priority area; adults living healthier, sustainable independent lives safeguarded from harm. Policy and Legal The legal Partnership Agreement for the Integration Joint Board will be progressed by the Governance and Accountability sub-group.

6 PAGE: 6 (c) Financial Implications Although there are no financial implications directly arising from this report, the formation of the new partnership will see transference of funds from both NHS Grampian and Moray Council Adult Community Care Services to a pooled budget. Financial controls and governance arrangements will be subject to the work of the Joint Resources & Financial Planning and the Governance and Accountability sub groups. In terms of the development of the Integration Scheme, The TLG identified that there were capacity issues in terms of senior officer s time, within both the Council and the NHS, to progress this plan. The TLG was however notified in May 2014 that it has been awarded 129,000 by the Scottish Government to address these issues. Progress is now under way to appoint 3 temporary positions to support the work of the Workforce, Governance & Accountability and Joint Resources and Financial Planning work streams. This Committee will be informed of the appointment of these officers in due course. (d) (e) (f) (g) Risk Implications Risk management arrangements have been developed to ensure that the TLG can address risk and issues as they materialise through the work of the sub groups. The Council will note that the immediate risk is that a failure to address governance issues could result in an inability to meet the 1 April 2015 deadline for the approval of the Integration Scheme. Agreeing the scope of integration in Moray in terms of the draft Regulations is also a key risk as the work of a number of sub groups cannot progress until this is done. Staffing Implications The preferred body corporate model will leave both health and social care staff on their existing terms and conditions for now (The Scottish Government appears to envisage a full transfer of staff at a later stage and the legislation specifically caters for this) and it is the intention that integration will, through integrated working, improve job satisfaction for both health and social care staff. Staffing issues are being addressed by the Joint Workforce sub group. Property Through the work of the Joint Resources and Financial Planning Sub- Group, opportunities may arise to rationalise the existing asset base of health and social care services. Any proposal will nevertheless be reported at a later date. Equalities The draft Integration Scheme will be subjected to an extensive consultation exercise and a comprehensive Equality Impact Assessment before being submitted for final approval.

7 PAGE: 7 (h) Consultations The following have been consulted and are in agreement with the sections of this report relating to their areas of responsibility: Head of Community Care, Corporate Director (Education and Social Care), Judith Proctor (General Manager (Moray) NHS Grampian), Head of Legal & Democratic Services-Council, Margaret Forrest (Legal Services Manager), Head of Financial Services, Head of HR & ICT. 7. CONCLUSION 7.1 As work in developing the Integration Scheme for the Integration Joint Board progresses, the Transitional Leadership Group has been presented with a challenge in terms of the group s authority to make decisions in terms of the contents of the draft scheme. This is specifically in relation to the scope of the future integrated partnership and the rationale for budget setting. 7.2 This report therefore seeks approval for the adoption of a Memorandum of Understanding to further assist with the strategic decision making process pertaining to the development of this plan as well as a minor change to the Council s Scheme of Delegation. 7.3 The report also recommends the amendment of the Scheme of Delegation relative to the powers of the Corporate Director (Education and Social Care) to make specific provision for management of the integration process as set out in APPENDIX 4. Author of Report: Robin Paterson, Integration Project Officer Background Papers: with author Ref: