Agendas, reports and minutes

The Highland Council

Minutes of Meeting of the Health, Social Care and Wellbeing held REMOTELY on Wednesday, 26 August 2020 at 10.30am.

Present:
 
Mrs J Barclay
Mr B Boyd
Mrs I Campbell
Mrs M Cockburn
Mrs M Davidson
Mr A Henderson (sub for Mr J Finlayson)
Mr A Jarvie
Mr D Louden
Mrs D Mackay Mr W Mackay
Mrs I Mackenzie
Mrs L Munro
Mrs M Paterson
Mr D Rixson
Mr K Rosie
Ms E Roddick
Mr A Sinclair (sub for Mr C Smith)
Miss N Sinclair

Non Members also present:

Mr A Christie
Mr R Gale
Mr A Graham
Mr J Gray
Mr A Jarvie
Mr B Lobban
Mr J McGillivray 
Mr A Mackinnon
Mrs A MacLean
Mr D MacPherson
Mr C Munro
Ms P Munro
Mrs T Robertson

 
Officials in attendance:
Mrs D Manson, Chief Executive
Mrs F Malcolm, Interim Head of Integration Adult Social Care
Ms K Ralston, Head of Children’s Services and Chief Social Work Officer
Ms J Jennett, Head of Children’s Services (Operations)
Ms J Park, Interim Head of Health
Mr I Kyle, Head of Improvement and Performance
Mr B Porter, Head of Support Services
Mr M Mitchell, Service Finance Manager
Ms D Munro, Child Protection Training Officer
Mrs L Dunn, Principal Administrator, Chief Executive’s Office
Ms F MacBain, Committee Administrator, Chief Executive’s Office
Ms M Zavarella, Administrative Assistant, Chief Executive’s Office

An asterisk in the margin denotes a recommendation to the Council.
All decisions with no marking in the margin are delegated to Committee.

Linda Munro in the Chair
Preliminaries

The Vice Chair, Nicola Sinclair, expressed thanks on behalf of the Committee to all health and social care staff for dealing with the challenges experienced during the Covid emergency.  Gratitude was also expressed to Highland Council Social Work staff and High Life Highland archive staff who worked on the Scottish Child Abuse Inquiry, on the agenda at Item 5.
  
1. Apologies for Absence
 Leisgeulan 
  
Apologies for absence were intimated on behalf of Mr M Finlayson and Mr C Smith.

2. Declarations of Interest
 Foillseachaidhean Com-pàirt

Item 5 – Mr A Jarvie (non-financial)
Item 6 – Ms L Munro (non-financial)

Mr D Louden declared a general non-financial interest in terms of being a Trustee of Home-Start East Highland but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that his interest did not preclude his involvement in the discussion.
  
3.  Good News
 Deagh Naidheachdan

The Committee NOTED the verbal update on the following good news items and AGREED a copy of the Good News be circulated to the Committee:-

• thanks were extended to all staff who had continued to deliver the “day job” whilst also reacting to and dealing with the impact of Covid, and also to the members of the Escalation Support Team set up by NHS Highland;
• details were provided of the activities that had taken place at the Family Centre Merkinch Summer Hub 2020;
• Fostering & Adoption Service – examples were provided of many positive outcomes that had been experienced during lockdown.  “Fostering Focus” had been sent to all foster carers and prospective adopters across Highland in July, and thanks were extended to a couple who were retiring from fostering aged 75 and 80, and who had looked after 22 children;
• Placement Services Change Programme - 36 young people had returned to Highland since the start of the Placement Programme in June 2018 and work was actively being undertaken to return a further 15 young people this financial year; and
• the Echo Project (Highland Hospice) had collaborated with the Council to host a series of virtual sessions to Health & Social Care staff on ‘Wellbeing and Resilience through Covid-19’.
 
4.  Future Thinking of Care in the Highlands - Opening up a conversation with our Communities, staff and partners
Smaoineachadh mu Chùram san Àm ri Teachd sa Ghàidhealtachd – A’ fosgladh còmhradh le ar coimhearsnachdan, luchd-obrach is com-pàirtichean

The Chief Executive introduced the item, emphasising that everyone matters equally and paying tribute to the leadership shown by Members as part of the Covid recovery process. She welcomed the inclusion of the care message in the Council’s mission statement and as the new COSLA email slogan.

A presentation included the national picture and Highland data for children in care. The national promise for the future included an Independent Care Review to move towards early intervention and prevention and phase out acute and crisis care. Reference was made to the thoughts of Dr Katherine Trebeck, social care support and the reform of adult social care, care home data, and challenges and opportunities for the future.

During discussion the following issues were considered:

• Adult Social Care training, with a focus on mental health, would take place for Members on 28 August 2020 at 11am;
• the presentation slides should be emailed to Members;
• the increasing amount of care that was required by society was of concern;
• care homes were not only for elderly people;
• the need to remodel the delivery of care and improve the quality of life for people within communities was challenging as front-line services had to continue being delivered while being redesigned.  Partnership working was key;
• the references to early intervention were welcomed and ‘prevention’ should also be included;
• it was important to distinguish between those who wanted care and those who needed care;
• it had been noted that some voluntary services during the Covid crisis had replaced the need for more official care services and discussion on how to build on this was required;
• it could be more challenging to provide care-related support for younger people, and it was vital the finances were arranged to ensure the best use was made of them, noting that finances had been distorted for many years due to high expenditure on out of authority care placements. Efforts to tackle this were summarised and reference was made to early intervention and prevention though the provision of respite youth activities, advice, and safe places for young people to gather.  Sport, or even exercise such as walking, was of significant benefit to young people. It was felt that better use could be made of self-directed care and more required to be done to tackle mental health and substance abuse in families;
• Pauline Munro gave an example of an older person with self-care needs and an officer would discuss this with her outwith the meeting;
• there was to be a virtual ACEs (Adverse Childhood Experiences) conference on 6 November 2020 at 10.30am.  It was not yet known if it would be possible, from a technical perspective, to have open access to it;
• the efforts of the Lochalsh Community Partnership during the Covid crisis were praised and a summary was provided of their activities. It was disappointing the community minibus was no longer in operation due to social distancing requirements and this would be discussed with the Transport Manager;
• continued smarter working with the third sector would be helpful;
• attention was drawn to the problem of children arriving at school hungry, dirty, or tired and practical school-based solutions for these issues were proposed;
• the efforts of volunteers in communities were appreciated but possible volunteer-burnout was of concern, and long-term reliance on volunteers could be problematic;
• the focus on communities was welcomed and examples were provided of excellent community work undertaken in secondary schools with youth workers;
• it was important for people to be in care homes as close as possible to their own homes and families, and reference was made to the ‘Let Us Stay Up’ initiative which had highlighted the importance of allowing people receiving care, especially young people, to be treated as individuals and live as normal a life as possible, for example not being put to bed early due to an inflexible care regime;
• reference was made to the high number of children who were providing care for their parents in Sutherland and the importance of providing them with emotional, practical and financial support;
• an audit of all areas of good practice would be helpful to allow others to duplicate projects;
• it was suggested that health and social care should be provided by one organisation rather than being seen as being delivered by two separate organisations, and should be based on a life cycle approach, from prenatal to palliative care.  A revised framework for management information was suggested;
• the Chair suggested it had been useful to start this conversation with the Committee and that it would be continued at future meetings;
• consideration should be given to reviewing the Council estate to establish if schools or other buildings could be used for young people as part of care/youth activities. It was thought the current Council policy on the need for janitorial attendance at out of hours events was a barrier and Members should consider lobbying for this to be changed;
• it was hoped Aviemore Green Health could present to the Committee in future on their work;
• reference was made to some children finding school a respite from a difficult home-life and the importance of investing in support for such children when they were young was emphasised; and
• the Chief Executive referred to the community asset transfer policy, emphasised the importance as acting as one Council and pointed out that service plans were being developed and would be presented soon.  New structures for working with partners were being developed and lessons from Members on community working would be taken on board.  The Leader of the Council endorsed the importance of the service plans and would consider changes required to the Council’s programme.

The Committee NOTED the presentation and AGREED:

i. the presentation be emailed to Members of the Committee; and
ii. to consider reviewing the Council estate to establish if schools or other buildings could be used for young people as part of care/youth activities.
  
5. Scottish Child Abuse Inquiry and Implications for Local Authorities and presentation on Historic Abuse Inquiry and Section 21
 Rannsachadh Droch Dhìol Chloinne agus Seaghan airson Ùghdarrasan Ionadail agus Taisbeanadh air Rannsachadh Mì-ghnàthachadh Eachdraidheil agus Earrann 21

Mr A Jarvie declared a non-financial interest in this item in terms of being a Director of High Life Highland but, in terms of the dispensation granted by the Standards Commission, remained to participate in the discussion.

There had been circulated Report No HCW/09/20 dated 17 August 2020 by the Executive Chief Officer Health and Social Care. 

The Chair introduced the presentation, commenting on the sombre and important nature of the item and the thousands of hours of work which had gone into the Inquiry.
The Leader of the Council praised the staff and others who had worked on the issue since 2004 and welcomed that the Bill was now being progressed and due recompense would be provided, with early payments having been made to people with terminal illnesses.
 
A presentation included the history of the decision in 2004 to conduct an Inquiry into past institutional child abuse, the financial redress advanced payment scheme, Section 21 Notices (Children in Foster Care), redress for survivors, and next steps and recommendations.

During discussion, the following issues were considered:

• information was sought and provided on how someone who had experienced abuse could get in contact, which was through the Council, through a third party or by contacting the Inquiry directly;
• the report was harrowing and lessons must be learnt by having robust systems in place with early intervention measures;
• child protection was everyone’s business;
• it was vital the Council prepared adequately for when the Bill came into effect in April 2021 for five years. A briefing would be circulated on the work being done on the outcomes from the Inquiry via the Council’s Corporate Risk Register, with timelines;
• in relation to the need to provide therapeutic support, conversations about this in addition to the finances required, were ongoing with the Scottish Government, Social Work Scotland, Chief Social Work Officers, and COSLA.  The Committee would be updated as clarity developed; and
• it was decided, following discussion, the recommendation which stated ‘acknowledge the future reputational risks to the Council as a consequence of the Inquiry’ should be removed.

The Committee NOTED the presentation and:

i. NOTED the presentation and recognised the work undertaken by Council staff and colleagues at the HLH Archive Centre;
ii. NOTED the publication of the Redress for Survivors (Historical Child Abuse in Care) (Scotland) Bill on 13 August 2020; and
iii. NOTED the potential unfunded costs to the Council arising from this new legislation and the completion of this and on-going Inquiries;
iv. AGREED a briefing be circulated on the work being done on the outcomes from the Inquiry via the Council’s Corporate Risk Register, with timelines; and
v. AGREED the Committee continue to be updated in due course as the Bill progressed. 

 
6.  Commissioned Health Service Assurance Report
 Aithisg Barantachaidh Seirbheis Slàinte Barantaichte

Ms L Munro declared a non-financial interest in this item in terms of being a Director of the Family Nurse Partnership but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct concluded that her interest did not preclude her involvement in the discussion.

There had been circulated Report No HCW/10/20 dated 17 August 2020 by the Executive Chief Officer, Health and Social Care.

During discussion, the following issues were considered:

• in response to a question about the roll-out of the Family Nurse Partnership across the Highlands, this would be discussed with the Scottish Government at their next meeting in eight weeks and any issues and timescales would be reported back;
• concern was expressed at the failure to achieve the targets for statutory health assessments and immunisations for Looked After children, and the reasons behind the statistic were summarised, including the need for meaningful health assessments with the engagement of the child, who might often be in a stressful situation, that children often moved location. Immunisation rates had dipped during Covid lockdown.  Recruitment was underway for two specialist nurses who would be tasked with focusing on early intervention including assessments and immunisations;
• the inclusion of vacancy data in revenue monitoring reports would be considered for future;
• it was pointed out that much of the data on domestic violence was anecdotal and a report was sought once a robust method had been established for the collection of local data from all relevant agencies on domestic violence.  A future presentation to the Committee on the work of the Highland Violence Against Women Partnership Group was proposed;
• the importance of officer succession planning was emphasised and efforts in this regard were summarised;
• information was sought and provided on preparations for the winter flu vaccination programme, noting that it had been widened for 2020-21;
• the important role of school nurses was highlighted and reference was made to the recent ‘transforming nursing in the community’ programme, with a refocus on addressing health inequalities and child poverty. A wide variety of health professionals would be involved with schools and communities in the future and people could also seek advice at pharmacies on a range of issues;
• information was sought and provided on the ‘Just Ask’ helpline which had been operational for around two years and facilitated families getting in touch with Allied Health Professionals;
• the redeployment of health staff from the Council to the NHS during the Covid emergency was summarised, although there had been less demand for their services than had been anticipated;
• the working relationship between the Council and NHS Highland had improved during the Covid emergency, with more clarity on roles and responsibilities;
• information was sought and provided on the development of locally-required skills with UHI;

• following a request for red / amber / green ragging of issues in reports, it was explained the performance framework was being reviewed to produce a set of measures to ensure effective governance and ragging would then form part of future assurance reports; and
• the value of mother and toddler groups was highlighted, and it was hoped those which had paused due to Covid would resume in due course.

The Committee:

i. NOTED the measures put in place across the Covid-19 pandemic to support the commissioned child health service in Section 6 of the report;
ii. NOTED the service delivery arrangements and commented on plans for service improvement and clinical and professional governance set out in Section 9 of the report;
iii. AGREED to discuss the roll out of the Family Nurse Partnership across the Highlands with the Scottish Government at their next meeting in eight weeks and report back on issues and timescales;
iv. AGREED to report back to the Committee once a robust method had been established for the collection of data on domestic violence; and
v. AGREED to bring a future presentation to the Committee on the work of the Highland Violence Against Women Partnership Group. 
  
7. Overview of Data Reporting to Scottish Government  
 Tar-sealladh mu Aithris Dàta do Riaghaltas na h-Alba

There had been circulated Report No HCW/11/20 dated 17 August 2020 by the Executive Chief Officer, Health and Social Care.

During discussion, the following issues were considered:

• data headlines could be alarming and where there were significant variances, some reference or explanation in the report would be helpful;
• references to early awareness and signposting were welcomed;
• it was important to benchmark Highland performance against other areas and share best practice. It was explained that networking was undertaken with other Local Authorities and Child Protection Committees to monitor national trends;
• the significant increase in children placed on the Child Protection Register during Covid was of concern, especially since the children were more difficult to reach due to lockdown, and attention was drawn to the audit being undertaken of the Child Protection Register, which would be presented to a future Committee meeting;
• concern was expressed not only for the immediate impact of lockdown but the longer-term economic impact and its effect on services;
• it was vital to learn lessons from the pandemic and to be prepared for a second lockdown or other similar pandemic. Learning points included communication methods, and the impact on parental mental health, noting that almost half of children on the Child Protection Register had parents with substance abuse issues;
• the vulnerability of foster care provision had increased during the pandemic, with some foster parents having to shield, and it would be checked whether this had been included in the Council’s Covid recovery plans; and
• the need to provide support after transition from children’s to adult services was emphasised, especially for less mature young people.

The Committee:

i. NOTED the findings contained in the report;
ii. NOTED the creative ways in which services and partners had ensured contact with vulnerable children, young people and their families during the Covid-19 pandemic;
iii. AGREED to check the Council’s Covid recovery plans included tackling the vulnerability of the foster care provision experienced during the pandemic; and
iv. AGREED to bring back the audit, including process and findings, of the Child Protection Register to a future Committee meeting. 
  
8. Transformation and Governance Arrangements with NHS Highland
 Ullachaidhean Cruth-atharrachaidh agus Riaghlachais le NHS na Gàidhealtachd

There had been circulated Report No HCW/12/20 dated 21 August 2020 by the Executive Chief Officer, Health and Social Care.

During a summary of the report, attention was drawn to two key amendments to the terms of reference, that membership of the Project Management Board would consist of four councillors and four NHS HIGHLAND Board members, and that paragraphs 7.2 and 7.3 of the reports, workstreams, now included mental health. The Chair clarified that of the four Councillors to sit on the Project Management Board, one would be from the SNP opposition group, one from the Conservative group and two from the Administration.

During discussion, the following issues were considered:

• it was felt there had been insufficient scrutiny of the partnership arrangements in the past and this would be taken into consideration as part of governance arrangements of the reviewed agreement;
• it was queried whether the Project Management Board was a step towards an Integration Joint Board (IJB) instead of a Lead Agency arrangement, noting that Highland was the only area in Scotland without an IJB.  It was explained that while there were advantages and disadvantages of each model, there were no plans to move towards an IJB, however the Project Management Board was a significant step towards an Integrated Strategic Plan, which was needed. The Joint Monitoring Committee provided governance;
• the improved working relationship between the Council and NHS HIGHLAND during the Covid crisis was welcomed, with mutual trust being key;
• the Chief Executive provided a correction in regard to paragraph 7.2 of the report which was read out to the meeting and was detailed below;
• the themes detailed in paragraph 7.3 of the report would be subject to review across all services, from communities to acute services. Assessments for children and adults would be looked at further, following three months of workshops at the end of 2019. Key work would be undertaken with the Community Planning Partnerships and other local organisations. It was important to aim for best value on income maximisation and issues around transitions had been identified as a key piece of work, as had workforce planning;
• it was clarified that the intended review of the Partnership Agreement in April 2020 had been postponed due to Covid and work remained ongoing on this;
• the importance of working at pace on all issues discussed was emphasised;
• it was clarified that the Community Planning Partnership was not the only type of group working well at local level, with Aviemore Green Health being given as an example of good practice;
• it would be ideal if NHS HIGHLAND and the Council’s Health and Social Care delivery  could be merged into one service partnership model and be presented as such to the public, rather than viewing it as a project-based initiative. Reference was made to the need to look after people as a continuous process from pre-birth to death; and
• it was important to create and promote proper careers in care, with reasonable salaries, training and commitment, and the Interim Head of Integration for Adult Social Care would discuss this further with Councillor Bill Boyd outwith the meeting.

The Committee:-

i. NOTED and APPROVED the proposed approach as set out in the Terms of Reference; and
ii. AGREED Section 7.2 of the report be corrected to read: The project will require to focus on the following key areas in terms of the future delivery of family and community care for children and adults with a focus on residential care, care at home and in the community, learning disability and mental health and well-being. 

9. Revenue Budget Monitoring 1st Quarter 2020/21
 Sgrùdadh Buidseit Teachd-a-steach Ràith 1 2020/21

There had been circulated Report No HCW/13/20 dated 17 August 2020 by the Executive Chief Officer Health and Social Care.

During discussion, the following issues were considered;

• in response to concerns about the overspend on Looked After Children, it was suggested the Chair, Leader of the Council and relevant Social Work officers discuss this in more detail outwith the meeting;
• an underspend on family and children social work had been reported for several years and required investigation. It was welcomed that recent recruitment for social workers had attracted a good number of applications, and information on vacancies would be welcomed in future reports. A summary was provided of ongoing recruitment and work that was being undertaken with Human Resources on recruitment;
• information was sought and provided on the numbers of children accommodated outwith the area during Covid, noting that some had complex issues. Efforts were being made to bring these children and young people back to Highland;
• concern was expressed about budget variances as follows: a £600k overspend on residential care in the first quarter of the year, a £200k spend on temporary agency staff in the first quarter of the year (for which there was no budget set), foster care fee expenditure and whether this was for out of area placements, and an overspend on ‘supporting people’ of £154k in the first quarter. It was considered important that Members were informed of such variances and where the pressures in the system were. More information was also sought on underspends as follows: vacancy management, notably the budget for nurses being only 73% spent, direct payments for self-directed care being underspent by £190k (with £111k having been spent), and half of the £185k budget for overnight care for vulnerable adults being unspent in the first quarter. Responses were provided for some of the issues raised, including the use of agency staff to cover vacancies, the efforts to reduce the number of out of area placements, the need to keep siblings together whenever possible, and the effect of Covid on overnight care for vulnerable adults and on the availability of self-directed care.  The Head of Support Services suggested further discussions be held with Councillor Derek Louden outwith the meeting to address the detail of the issues raised, including variances and the amalgamation of cost centres. It was suggested that financial training be offered to Members who required it, possibly to be combined with Service issues. The importance of effective financial scrutiny was highlighted;
• attention as drawn to the need for a strategic view of the long-term consequences of the pandemic;
• given the challenges in recruiting professional staff to rural areas, the importance of local training was emphasised; and
• it was suggested the figures on the report were six months out of date but it was pointed out they represented the position at 30 June 2020.

The Committee NOTED the report and AGREED:-

i. the Chair, Council Leader and relevant Social Work officers discuss the overspend on Looked After Children in more detail outwith the meeting;
ii. consideration be given to including information on recruitment outcomes within future revenue reports; and
iii. training on financial scrutiny be offered to Members, possibly combined with related Service issues. 
  
10. School Years Immunisation Report
 Aithisg Ion-dhìon Bhliadhnaichean Sgoile

There had been circulated Report No HCW/14/20 dated 10 August 2020 by the Executive Chief Officer, Health and Social Care.

It was hoped that more support for this service would be obtained via the Committee, given the amount of nursing time vaccination took up, the widening of the threshold for flu vaccinations, and GP services being at capacity.  A summary was provided of ongoing discussions with NHS Highland about the use of part-time nursing staff in commissioned health services to take on additional hours to help to deliver the GP practice adult vaccination programme. Discussion were also underway about the possible use of school buildings during school holidays.  Members welcomed the return of the nurses and other health staff to schools.

The Committee NOTED the report and the partnership working and future planning.
  
11. Minutes
 Geàrr-chunntas

The following Minutes had been circulated and were NOTED:

i. Highland Child Protection Committee – 19 November 2019, 5 March and 4 June 2020;
ii. Highland Violence Against Women Partnership Group – 20 February, 16 March and 20 April 2020;
iii. Highland Community Justice Partnership – 19 December 2019 and 11 March 2020; and
iv. Highland Council/NHS Highland Joint Monitoring Committee – 22 January 2020. 
  
The meeting ended at 4.10pm.