Performance And Audit Committee (integration Joint Board) - 24/11/2021

At a MEETING of the PERFORMANCE AND AUDIT COMMITTEE OF THE DUNDEE CITY HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD held remotely on 24th November, 2021.

Present:-

Non-members in attendance at the request of the Chief Finance Officer:-

Trudy MCLEAY, Chairperson, in the Chair.

I APOLOGIES FOR ABSENCE

There were no apologies for absence submitted.

II DECLARATION OF INTEREST

There were no declarations of interest.

III MINUTE OF PREVIOUS MEETING AND ACTION TRACKER

(a) MINUTE

The minute of meeting of the Committee held on 29th September, 2021 was submitted and approved.

(b) ACTION TRACKER

There was submitted the Action Tracker PAC33-2021 for meetings of the Performance and Audit Committee.

The Committe noted and updated accordingly.

Following questions and answers the Committee further agreed:-

(i) to note that following enquiry from Bailie Wright that Jenny Hill would provide an update on re-admissions to the next meeting of the Committee; and

(ii) to note as advised by Kathryn Sharp that analytical work on readmissions in the North East area was recommencing and that works in relation to Falls would also be undertaken.

IV PERFORMANCE AND AUDIT COMMITTEE MEMBERSHIP AND CHAIRPERSON

Reference was made to Article V of the minute of meeting of the Integration Joint Board held on 25th October, 2021, wherein reappointments to the Performance and Audit Committee were agreed and appointment was made to the position of Chairperson of the Committee.

The Committee agreed to note that Trudy McLeay, Donald McPherson, Dr James Cotton, Raymond Marshall and Martyn Sloan had been reappointed as members of the Performance and Audit Committee and that Trudy McLeay had also been appointed to the position of Chairperson of the Committee.

V AUDIT SCOTLAND ANNUAL REPORT AND INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2020/2021

There was submitted Report No PAC30-2021 by the Chief Finance Officer presenting the Integration Joint Boards (IJB) Draft Audited Annual Statement of Accounts for the year to 31st March, 2021 for approval, to note the draft external auditors report in relation to these accounts and approve the response to this report.

The Committee agreed:-

(i) to note the contents of the Audit Scotland cover letter attached as Appendix 1 of the report and the draft external auditors report attached as Appendix 2 of the report including the completed action plan outlined on pages 23 to 27 of the report, and in particular that Audit Scotland had indicated they would issue an unqualified audit opinion on the Integration Joint Boards 2020/2021 Annual Accounts;

(ii) to endorse the report as the Integration Joint Boards formal response to the external auditors report;

(iii) to instruct the Chief Finance Officer to provide an update on progress of the action plan noted in Appendix 1 of the external auditors report by February 2022;

(iv) to approve the Audited Annual Accounts attached as Appendix 3 of the report for signature and instruct the Chief Finance Officer to return these to the external auditor; and

(v) to instruct the Chief Finance Officer to arrange for the Annual Accounts to be published on the Dundee Health and Social Care Partnership website by no later than 30th November, 2021.

Following questions and answers the Committee further agreed:-

(vi) to note as requested by Trudy McLeay that Dave Berry would look to provide information on Accounts in Inductions for Members;

(vii) to note as advised by Donald McPherson the availability of induction information on a national level and a local level and that Dave Berry may wish to look at the content of the Induction Manual provided by the Perth Partnership for future inductions;

(viii) to note following enquiry from Donald Macpherson that information on Transformation would be covered in forthcoming Budget Development Sessions;

(ix) to note following enquiry from Donald McPherson that Tony Gaskin had made a presentation to the Angus Partnership on the topic of Risk Appetite and that he would share this with the Committee;

(x) to note as advised by Tony Gaskin that the South Lanarkshire area had also done some work in relation to their Strategic Commissioning Plan and the identification of Risks and he would look to get permission from them to share that document with the Committee; and

(xi) to note the advice of Dave Berry that a further Development Session on Risk Management would be arranged for members in the new year;

VI INTERNAL AUDIT REPORT - PERFORMANCE MANAGEMENT

There was submitted Report No PAC31-2021 by the Chief Finance Officer presenting findings of the Internal Audit Review of Performance Management to the Committee.

The Committee agreed:-

(i) to note the content and findings of the Internal Audit Review of Performance Management attached as Appendix 1 to the report;

(ii) to note and agree the action plan associated with the report as the management response to the findings, as detailed on pages 7 to 9 of Appendix 1 of the report; and

(iii) to instruct the Chief Finance Officer to report progress in delivering the actions set out in the action plan through the Governance Action Plan presented to each Performance and Audit Committee Meeting.

Following questions and answers the Committee further agreed:-

(iv) to note following enquiry from Trudy McLeay the advice of Vicky Irons that work was ongoing in relation to recruitment and career development for staff and that this would feature in future reports incuding work in relation to the establishment of a hybrid SVQ which would enable staff to transfer more easily across care areas such as adult and child care more easily;

(v) to note following enquiry from Trudy McLeay that Dave Berry would keep the Committee appraised of progress in relation to the Finance Group;

(vi) to note following enquiry from Councillor Short the advice of Tony Gaskin that he welcomed feedback from the Committee on the possible direction of future audits and that he would arrange for the current annual audit plan to be reissued to Councillor Short for her reference and that he would also liaise with Dave Berry on engagement process with the Committee in relation to the next plan including the possibility of development sessions; and

(vii) to note following enquiry from Donald McPherson the advice of Dave Berry that Directions could only be issued to partner bodies against the resources the Parterhsip had in its delegated budget and that the Partnership were currently examining additional funding streams which would require support functions.

VII DUNDEE HEALTH AND SOCIAL CARE PARTNERSHIP PERFORMANCE REPORT 2021/2022 QUARTER 1

There was submitted Report No PAC26-2021 by the Chief Finance Officer updating the Performance and Audit Committee on 2021/2022 Quarter 1 performance against the National Health and Wellbeing Indicators and Measuring Performance Under Integration interim targets.

The report also proposed a revised approach and format for quarterly performance reports based on feedback received from Integration Joint Board Members and internal audit colleagues.

The Committee agreed:-

(i) to note the changes that had been made to the format and content of the quarterly performance report based on learning to date and feedback received (section 4.3 and 4.4 of the report);

(ii) to approve the proposed future approach to quarterly performance reports, analytical reports and improvement reports (section 5 of the report);

(iii) to note the performance of Dundee Health and Social Care Partnership, at Local Community Planning Partnership (LCPP), Dundee, Tayside and Scotland levels (where available), against the National Health and Wellbeing Indicators and Measuring Performance Under Integration indicators (summarised in section 6 and Appendix 1 of the report);

(iv) to instruct the Chief Finance Officer to submit a further in-depth analysis of readmissions data, which should include analysis of the data for the specialty with the highest readmission rate (excluding where reasons for poor performance were due to coding) no later than 31st March, 2022 (sections 5.4 and 6 of the report);

(v) to instruct the Chief Finance Officer to submit a further analysis of the reasons for the deterioration of performance against National Indicator 17 (care inspectorate gradings) no later than 31st March, 2022 (sections 5.4 and 6 of the report); and

(vi) to instruct the Chief Finance Officer to submit an update report on improvement activity that had been undertaken to address the increased rate in hospital admissions due to a fall no later than 31st March, 2022 (sections 5.5 and 6 of the report).

Following questions and answers the Committee further agreed:-

(vii) to note following enquiry from Trudy McLeay in relation to figures on readmission rates showing as being 40% poorer since 2016 the advice of Kathryn Sharp that this didnt reflect a training need in relation to recording of information but that this reflected current national guidance being followed by NHS Tayside and that the Scottish Government had been approached on this basis with a view to possible review on impact of this on how this appeared against content of reports;

(viii) to note the advice of Jenny Hill that there were areas of higher levels of readmission and that this wasnt about being discharged from hospital early but more likely reflecting a large population with respiratory problems and that these areas were being examined;

(ix) to note the observation of Donald McPherson that in future reports charts represented could benefit from indicators on upper and lower ranges driven by national targets to get a sense of the position of the Partnership in this regard;

(x) to following enquiry from Donald McPherson in relation to data on falls and further work in this regard for the over 65s as to whether this was due to environment such as lighting, gritting and pavement conditions the advice of Lynsey Webster that currently the Partnership received data to say there had been a fall in a street but not the nature or possible cause;

(xi) to note the advice of Jenny Hill that Dr Matthew Kendall had been undertaking a lot of work in relation to Falls and that this may be of benefit for presentation to future meeting of the Committee; and

(xii) to note that Diane McCulloch would look at points raised in relation to falls, increased frailty of older people due to Covid and other areas such as deaths arising from use of drugs in terms of risks for representation in future reports.

VIII DUNDEE INTEGRATION JOINT BOARD INTERNAL AUDIT PLAN PROGRESS REPORT

There was submitted Report No PAC27-2021 by the Chief Finance Officer providing the Performance and Audit Committee with a progress update in relation to the current Internal Audit Plan as well as work ongoing relating to the 202/2022 plan.

The Committee agreed to note the continuing delivery of the audit plan and related reviews as outlined in the report.

Following questions and answers the Committee further agreed:-

(i) to note following enquiry from Donald McPherson on a previous action that the status of ongoing audits be inserted in reports the advice of Tony Gaskin that he would arrange for this to be done for the next meeting.

IX GOVERNANCE ACTION PLAN PROGRESS REPORT

There was submitted Report No PAC28-2021 by the Chief Finance Officer providing the Performance and Audit Committee with an update on the progress of the actions set out in the Governance Action Plan.

The Committee agreed to note the progress made in relation to the actions set out in the Governance Action Plan as outlined in Appendix 1 of the report.

X PSYCHOLOGICAL THERAPIES WAITING TIMES

There was submitted Report No PAC29-2021 by the Chief Finance Officer updating the Performance and Audit Committee on those specialities within the hosted Psychological Therapies Service that continued not to achieve Health Improvement, Efficiency, Access & Treatment (HEAT) targets, highlighting contributory factors and the actions being taken to address the same. This was based on the previous report Psychological Therapies Waiting Times PAC33-2018 and was inclusive of all Psychological Therapies Services that contributed to the adult 18 week referral to treatment target and excluded those that did not. For that reason, Psychotherapy Services had been added to the report.

The Committee agreed:-

(i) to note the current position and reasons for certain specialities currently failing to meet HEAT targets as outlined in sections 4.3, 4.4, 4.5 and 4.7 of the report;

(ii) to note the actions undertaken within the Psychological Therapies Service (PTS) to address the current waiting time challenges as outlined in sections 4.6 and Appendices 1 and 2 of the report; and

(iii) to note the intention to develop a Strategic Plan including the introduction of a pan-Tayside Strategic Commissioning Group as noted in section 4.7 of the report.

Following questions and answers the Committee further agreed:-

(iv) to note the advice of Dr Michelle Ramage that in light of national trauma training programme as to what services were to be provided that this would be examined in terms of the Strategic Commissioning Plan;

(v) to note following enquiry from Bailie Wright the advice of Arlene Mitchell that the Partnership were looking to develop a micro site to encourage recruitment within the mental health service;

(vi) to note following enquiry from Bailie Wright in relation to increase of workload in particular for older people due to Covid the advice of Arlene Mitchell that this reflected a decrease in referrals initially and then an increase as people may have paused therapy to await face to face consultations rather than technological based consultations.

XI CLINICAL, CARE AND PROFESSIONAL GOVERNANCE

There was submitted Report No PAC32-2021 by the Clinical Director providing an update to the Performance and Audit Committee on the business of the Dundee Health and Social Care Partnership Clinical, Care and Professional Governance Group. The report was presented as an SBAR (Situation, Background, Assessment and Recommendations).

The Committee agreed:-

(i) to note the exception report for the Dundee Health and Social Care Partnership Clinical Care and Professional Governance;

(ii) to the proposal to amend the reporting format to reflect that adopted by NHS Tayside Care Governance Committee as detailed in 4.1 of the report; and

(iii) to note that the authors were recommending that the report provided moderate assurance.

Following questions and answers the Committee further agreed:-

(iv) to note following observations of Trudy McLeay in relation to the fabric of the building at Constitution Street the advice of Diane McCulloch that this was currently under examination by NHS Tayside in relation to upgrading works and possibilities of the service being co-located within another building shared with the Third Sector.

XII ATTENDANCE LIST

There was submitted Agenda Note PAC34-2021 providing a copy of the attendance return for meetings of the Performance and Audit Committee held to date over 2021.

The Committee agreed to note the position as outlined.

XIIl PROGRAMME OF MEETINGS PERFORMANCE AND AUDIT COMMITTEE - 2022

The Committee agreed to note that the programme of meetings for the Committee over 2022 would be as follows:-

Wednesday, 2nd February, 2022 - 10.00 am

Wednesday, 23rd March, 2022 - 10.00 am

Wednesday, 20th July, 2022 - 10.00 am

Wednesday, 28th September, 2022 - 10.00 am

Wednesday, 23rd November, 2022 - 10.00 am

XIV DATE OF NEXT MEETING

The Committee agreed to note that the next meeting of the Committee would be held on Wednesday, 2nd February, 2022 at 10.00 am.

Trudy MCLEAY, Chairperson.