Integration Joint Board Agenda Document Pack - 22 August 2024
North Ayrshire Council · 22 August 2024
Back to Integration Joint Board — 22 August 2024 and its agenda
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Integration Joint Board Meeting Thursday, 22 August 2024 at 10:00 Council Chambers, Cunninghame House, Irvine / Hybrid via Microsoft Teams Meeting Arrangements This meeting will be held on a predominantly physical basis but with provision, by prior notification, for remote attendance by Elected Members in accordance with the provisions of the Local Government (Scotland) Act 2003. Where possible, the meeting will be live-streamed and available to view at https://north-ayrshire.public-i.tv/core/portal/home. 1 Apologies 2 Declarations of Interest Members are requested to give notice of any declarations of interest in respect of items of business on the Agenda. 3 Minute/Action Note The accuracy of the Minutes of the meeting held on 13 June 2024 will be confirmed and the Minutes signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local Government (Scotland) Act 1973 (copy enclosed). 4 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP) on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 5 Annual Performance Report 2023-24 Submit report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the Annual Performance 2023-24 (copy enclosed). 6 2024-25 – Month 3 Financial Performance Submit report by Paul Doak, Head of Service (HSCP Finance and Transformation) to provide an overview of the Integration Joint Board’s financial performance as at month 3 (June) (copy enclosed). 7 Accounts commission - IJB Finance & Performance Submit report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the recently published Accounts Commission report and the findings from their national analysis of IJBs (copy enclosed). 1
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8 Delayed Discharge Improvement Plan Submit report by Kerry Logan, Head of Service (Health and Community Care) to consider the above (copy to follow). 9 Chief Social Work Officer’s Annual Report 2023-24 Submit report by Scott Hunter, Chief Social Work Officer (NAHSCP) to present the annual Chief Social Work Officer report which is required by Scottish Government (copy enclosed). 10 North Ayrshire – Being Trauma Informed and Responsive Submit report by Scott Hunter, Chief Social Work Officer (NAHSCP) to provide an update on the ongoing work to develop our approach and response to trauma (copy enclosed). 11 Whistleblowing Annual Report – 2023-24 Submit report for information in relation to whistleblowing concerns raised in 2023/24 (copy enclosed). 12 Whistleblowing Report – Quarter 1, April – 30 June 2024 Submit report for information in relation to whistleblowing concerns raised in Quarter 4 (April – 30 June 2024) (copy enclosed). 13 Urgent Items Any other items which the Chair considers to be urgent. Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home, where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public seating areas will not be filmed. However, by entering the Council Chambers, using the press or public seating area or (by invitation) participating remotely in this meeting, you are consenting to being filmed and consenting to the use and storage of those images and sound recordings and any information pertaining to you contained in them for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. If you do not wish to participate in a recording, you should leave the meeting. This will constitute your revocation of consent. If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk. 2
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IJB Sederunt Voting Members Joyce White (Chair) Margaret Johnson (Vice-Chair) Cllr Anthea Dickson Cllr Nairn McDonald Jean Ford Tom Hopkins Marc Mazzucco Vacancy NHS Ayrshire & Arran North Ayrshire Council North Ayrshire Council North Ayrshire Council NHS Ayrshire & Arran NHS Ayrshire & Arran NHS Ayrshire & Arran Professional Advisors Caroline Cameron Director Paul Doak Head of Service/Section 95 Officer Aileen Craig IJB Monitoring Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Thelma Bowers Mental Health Adviser Darren Fullarton Associate Nurse Director/ Lead Nurse Vacany Acute Services Representative Dr Louise Wilson GP Representative Sharon Hackney Lead Allied Health Professional Elaine Young Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Terri Collins Staff Rep - NHS Ayrshire and Arran Vacancy Staff Rep Vacancy Carers Representative Clive Shephard Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third Sector Rep/Chair Arran Locality Forum 3
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 13 June 2024 at 10.00 a.m. involving participation by remote electronic means and physical attendance within the Council Chambers, Irvine. Present (Physical Participation) Voting Members Councillor Margaret Johnson, North Ayrshire Council (Chair) Joyce White, NHS Ayrshire and Arran (Vice-Chair) Councillor Anthea Dickson, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran Professional Advisers Caroline Cameron, Director of Health and Social Care Partnership Paul Doak, Head of Service (HSCP Finance and Transformation)/Section 95 Officer Scott Hunter, Chief Social Work Officer Thelma Bowers, Mental Health Adviser Sharon Hackney, Lead Allied Health Professional Stakeholder Representatives Linda McFarlane, Staff Representative Present (Remote Participation) Voting Members Councillor Timothy Billings, North Ayrshire Council Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Iain Jamieson, Clinical Director Elaine Young, Public Health Representative In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families and Justice) Kerry Logan, Head of Service (Health and Community Care) Roseanne Burns, Senior Manager (Children & Families) Eleanor Currie, Principal Manager, (Finance) Michael McLennan, Lead Officer (Alcohol & Drugs Partnership) Michelle Sutherland, Partnership Facilitator, HSCP Linda Taylor, Team Manager, Litigation (Legal Services) Karen Andrews, Team Manager (Governance) Lindsay Kirkwood, Psychologist (NHS Ayrshire and Arran) Shannon Wilson, Committee Services Officer 4
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Hayley Clancy, Senior Committee Services Officer Apologies Councillor Nairn McDonald Jean Ford Darren Fullarton Vicki Yuill 1. Apologies for Absence Apologies for Absence were noted. 2. Declarations of Interest In terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members of Devolved Public Bodies, Joyce White advised she was appointed as a Board Member of Phoenix Scotland in a voluntary capacity. 3. Minutes The accuracy of the Minutes of the meeting held on 9 May 2024 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 3.1 Matters Arising from the Action Note Updates in terms of the Action Note were detailed as follows: • Audit Scotland report - Scheduled for later in the year. • Chief Social Work Officer Annual Report: Justice Services Update – on the agenda. 4. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on the developments within the North Ayrshire Health and Social Care Partnership. The report provided an update on the following areas: • SSSC Codes of Practice update for all HSCP staff; • Prevent, a strand of the UK Government’s Counter-Terrorist Strategy that aims to reduce the threat to the UK; • the third annual report, Local Government and The Promise published by COSLA and the Improvement Service; • the review of Social Work Governance and Assurance across Scotland; • the updated Self Directed Support Framework of Standards; • Alzheimer’s Scotland’s recently published report on the Future of Long Term Care In Scotland; • mentoring training for newly qualified newly qualified social workers; • pan-Ayrshire showcase event, sharing examples of innovation in health and social care from across Scotland and beyond held on Tuesday 11 June; • learning disability health check plans update; 5
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• new transitions support group; • North Ayrshire Council recognised as a Fostering Friendly Employer; • Anam Cara re-opening event; • bronze digital telecare implementation award; • Ayrshire achieves award; and • school welfare rights officer. Noted. 5. Armed Forces Covenant Submitted report by Caroline Cameron, Director (NAHSCP) on the new Armed Forces Covenant Duty 2021 with Statutory Guidance published in November 2022, set out at Appendix 1 to the report. Noted. 6. Justice Services Submitted report by Caroline Cameron, Director (NAHSCP) on the work of North Ayrshire and pan Ayrshire Justice Services. Members asked questions and were provided with further information in relation to: • vacancy levels with Justice social workers in comparison with Children and Families; • Scottish Government’s ring-fenced Criminal Justice grant; • unpaid work team operating on Arran; • future funding; and • employability mentors located within the Unpaid Work Service. Noted. 7. North Ayrshire ADP Annual Reporting Survey 2023/2024 Submitted report by Michael McLennan, Alcohol and Drug Partnership on the Annual Reporting Survey for submission to the Scottish Government, with the Survey set out at Appendix 1 to the report. Members asked questions and were provided with further information in relation to: • stigma reduction; • feedback from Scottish Government on the survey response; and • the positive work on the islands provision. Noted. 8. Children's Services Plan Performance Update 2023-24 Submitted report by Caroline Cameron, Director (NAHSCP) on the achievements contained in the North Ayrshire Children’s Services Plan Performance Update 2023- 24. The Children’s Services Plan Performance Update was set out at Appendix 1, 6
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Children’s Services Action Report set out at Appendix 2 and Children's Services Performance Indicators Report set out at Appendix 3 to the report. Members asked questions and were provided with further information in relation to: • local measures of specific priorities in our area; and • the number of care experienced children using the app. Noted. 9. 2023-24: Month 12 Financial Performance Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation), on the IJB’s financial performance as at month 10 (January). Appendix A to the report detailed the financial overview of the Partnership position, while Appendix B provided an overview of those service changed which did not have financial savings attached. Appendix C highlighted the movement in the budget position following the initial approved budget. Members asked questions and were provided with further information in relation to: • the potential risk of not meeting the target for 2024/25; • the significant deterioration from the previously projected position; and • Care at home overspend. The Board agreed to (a) note the overall integrated financial performance for the financial year 2023-24 and the overall year-end overspend of £4.483m, adjusted to £7.464m after earmarking of funds received for a specific purpose, also noting the significant deterioration from the previously projected position; (b) note the progress with delivery of agreed savings; (c) approve the budget reductions detailed at paragraph 2.10; (d) approve the proposed earmarking as detailed in the report, leaving a balance of £0.357m in free general fund reserves; (e) establish a Finance Working Group, chaired by the IJB Vice-Chair, to support increased oversight of the financial position. 15. Whistleblowing Report Quarter 4, January – 31 March 2024 Submitted report by Karen Callaghan, Corporate Governance Co-ordinator, in relation to whistleblowing concerns raised in Quarter 4 (January – 31 March 2024). Noted. The meeting ended at 12:00pm 7
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Integration Joint Board 22nd August 2024 Subject : Director’s Report Purpose : This report is for awareness to advise members of North Ayrshire Integration Joint Board (IJB) of developments within North Ayrshire Health and Social Care Partnership (NAHSCP) Recommendation : IJB members are asked to note progress made to date. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran IJB Integration Joint Board HSCP Health and Social Care Partnership UNCRC United Nations Convention on the Rights of the Child CSWO Chief Social Work Officer 1. EXECUTIVE SUMMARY 1.1 This report informs members of the Integration Joint Board (IJB) of the work undertaken within North Ayrshire Health and Social Care Partnership (NAHSCP), nationally, locally and Ayrshire wide. 2. BACKGROUND 2.1 This report provides IJB with up to date information on recent activity across the HSCP since the last IJB. 3. CURRENT POSITION National Developments 3.1 UNCRC Update 8
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The United Nations Convention on the Rights of the Child (UNCRC) became part of Scots law on Tuesday 16 July, further supporting young people to be at the heart of public services. Everyone has a special responsibility to protect and advocate for the rights of our children to ensure they are free to learn, play and develop, and this is a now a legal responsibility for public bodies. The UNCRC includes the following general principles: • for rights to be applied without discrimination (Article 2); • for the best interests of the child to be a primary consideration (Article 3); • the right to life, survival and development (Article 6); and • the right for the child to express a view in matters that affect them and to have that view taken into account in accordance with the child’s age and maturity (Article 12) Under the Act, public authorities have a range of duties placed on them including consideration of the implications for children and young people in developing policy and delivering public services in Scotland. The Scottish Government has developed a range of resources to support public authorities to take a children’s human rights approach and plans to publish statutory guidance to support the implementation and operation of their duties of the UNCRC Act. Consultations/Call for Views There has been increased activity over the past few months in relation to the number of consultations and Call for Views received from various sources including the Scottish Parliament and Scottish Government. These have been varied, cutting across a range of services, consultations and calls for views of note for the IJB are :- 3.2 Call for Views - National Care Service The Health, Social Care and Sport committee have launched a call for views on the National Care Service (Scotland) Bill – draft Stage 2 amendments. This provides an opportunity to feedback on the proposed amendments and propose further amendments. The Committee also intends to take oral evidence as part of Stage 2 scrutiny during September and October. During the course of its Stage 1 scrutiny of the Bill, the Health, Social Care and Sport Committee received notification of the Scottish Government’s intention to propose amendments to the Bill at Stage 2. The amendments were to reflect a consensus agreement it had reached with COSLA on a model of shared legal accountability for governance of the proposed National Care Service. 9
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In the Committee’s Stage 1 report, a majority of Committee Members requested the Scottish Government publish the draft text of its Stage 2 amendments and share these in advance of formal Stage 2 proceedings. This was to enable the Committee to take further evidence on the amendments prior to undertaking formal proceedings. In her covering letter to the Committee, the Minister states: Through our proposed Stage 2 amendments, the main changes to the Bill will be as follows: • The creation of a National Care Service Board. The National Care Service Board (NCSB) is intended to provide national oversight and improvement of social work services, social care support and community health services which fall within the scope of the National Care Service. It would prioritise the actions that will make the most difference to outcomes for people: clear and consistent national standards, performance against those and accountability for delivery. • Greater consistency of local planning and delivery of reformed integration authorities rather than Care Boards. This will support implementation of NCS priorities by building on existing structures and good practice. Similar to our North Ayrshire earlier responses regarding the NCS, officers from North Ayrshire Council and the Integration Joint Board will collaboratively develop a joint response, which will be shared with IJB members in due course. The deadline for responses has been extended from 30th August to Friday, 20th September 2024. 3.3 Consultation - Adults with Incapacity (AWI) Scottish Government have published a consultation on updates to the Adults with Incapacity (Scotland) Act 2000. The consultation includes updates on the principles of the AWI Act, powers of attorney, guardianships, medical treatment certificates for adults lacking capacity, research and deprivation of liberty. It also asks questions around moving incapacitated adults from acute hospital wards to other accommodation in circumstances where their discharge is delayed. Scott Hunter, CSWO will lead on the HSCP response to the consultation ensuring a range of professionals and practice experts will have the opportunity to feed into this extensive consultation. The closing date for responses is 17th October 2024. 3.4 Call for Views – Pre Budget Scrutiny 2025-2026 The Scottish Parliament’s Health, Social Care and Sport Committee has launched a Call for Views as part of its pre-budget scrutiny 2025-26. In recent years, in line with the recommendations of the Budget Process Review Group (BPRG) report, Scottish Parliament subject committees have undertaken pre- budget scrutiny in advance of the publication of the Scottish budget. The intention is 10
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that Committees will use pre-budget reports to influence the formulation of spending proposals while they are still in development. The Committee has agreed to focus this year’s pre-budget scrutiny on the financial position of Integration Joint Boards (IJBs). The deadline for views is 20th August 2024. Key areas of focus are likely to include the context and challenges for IJBs, performance against national health and wellbeing outcomes, and the financial outlook for IJBs currently and in the future. The HSCP will respond to this call for views and ensure the position for North Ayrshire IJB is appropriately presented and shared. North Ayrshire Developments 3.5 NAHSCP Partnership Awards – Promoting Wellbeing Together Nominations are now open for the North Ayrshire Partnership Awards 2024, with the event this year focusing on the theme of wellbeing. The awards will celebrate the staff teams and individuals who work within health and social care in North Ayrshire, as well as the volunteers, charities and community groups who provide support to residents. This year’s awards have a total of nine individual and team categories to choose from - and you can make as many nominations as you like. You can find further information about this year’s award categories and a link to nominate online on the NAHSCP website. Nominations close on Friday 30 August and winners will be announced at the ‘North Ayrshire Partnership Awards – Promoting Wellbeing Together’ event at Redburn Community Centre in Irvine on Friday 25 October. 3.6 Review of Social Work Governance and Assurance Following the update at the last meeting, North Ayrshire HSCP have now received formal notification from the Care Inspectorate of the intention to undertake a review of social work governance and assurance across all 32 local authorities which will commence on 15th July 2024 and conclude on 20th December 2024. 11
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The approach to the review will include :- • A national staff survey, focussing on community based front line social work staff and their first line managers. We will provide each local authority with a copy of the staff survey results from their area to support any local improvement activity, • The review of some core documents that can demonstrate governance and assurance approaches in local authority areas, • A structured interview with a few core staff from each local authority area, including Chief Social Work Officers, • Three themed focus groups, where each local authority will be invited to send two middle or senior managers to each session. The lead co-ordinator for North Ayrshire will be Scott Hunter, CSWO. The Care Inspectorate will hold briefing sessions for co-ordinators to answer questions and provide further context for the review. Scott Hunter will keep IJB updated throughout the progress of the review. 3.7 Welfare Rights – GP Practices Update Money Matters in partnership with the Improvement Service / Scottish Government are participating in an intitial 2- year project to deliver Welfare Rights services in GP Practices. Nine GP practices were selected by the Improvement Service and in 2023-24 additional funding was provided to extend the project to cover Island and Rural practices with Arran and Millport going live in July 23. The first practices went live in June 22 and currently there are 3 Income Advisers (IA) who now cover the 11 practices between them. The project has now secured a further year’s funding from Improvement Service / Scottish Government to continue the project into year 24/25. 646 referrals were received in 2023-24 (429 in year 1) and £2.9m of financial gains have been achieved for patients and residents of North Ayrshire in the second year of the project, with a cumulative total of £3.8m since the project began. This project has demonstrated the real value of financial advice for residents being placed co-located with front line teams and practiioners, supporting services to refer residents for onward support and addressing stigma and challenges in accessing financial inclusion services. 12
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3.8 Community Wealth Building Update NAHSCP continue to support the Council’s Community Wealth Building Strategy through a variety of different areas. Through a detailed assessment, the HSCP reflected on the 5 CWB Pillars and agreed the HSCP would be able to directly impact on the Procurement and Fair Employment Pillars. A range of short and longer term goals was agreed and progress against these pillars is noted below. Procurement • 25 (or 81%) of contracts were awarded to local providers, resulting in £17.6m (or 94% of the total value) being invested in local services. In addition to supporting the CWB objectives, this also positively contributes towards objectives outlined in our Strategic Plan. • An exercise was carried out to analyse spend and consider where the HSCP may be able to influence spending patterns and encourage local spend. The outcomes from this exercise illustrated that the HSCP currently performs very well in this area. • There is no available data which illustrates the spending patterns of our local care and support providers, therefore it is difficult to gauge areas for improvement at this time. However, work will be carried out to assess possible linkages between providers and local supply chains. The HSCP will work alongside the Council’s Business Team to use their knowledge of local business in North Ayrshire and to facilitate introductions with local suppliers and potentially devise a local directory which details local suppliers for the Providers’ key areas of spend. Fair Employment • The vast majority of care and support providers based in North Ayrshire are subject to formal contract management which focusses on ensuring fair work practices, including fair pay and support for staff to reach their full potential. Many of the staff live within North Ayrshire. • HSCP worked alongside the Programme Manager, Fair Work Ayrshire and a range of other advisory services to develop and deliver a Fair Work Practice Academy for providers delivering care and support in North Ayrshire. There were 6 sessions in total each focussing on one of the strands of fair work and an industry professional with expertise in each strand was invited to share knowledge and experience with delegates. Colleagues from Scottish Government and Scotland Excel have taken a keen interest in the academy and met with facilitators with the intention of sharing this example of best practice. • Recent analysis indicates that fair work practices are more developed for those providers who attended this academy, and discussions are currently underway about next steps in this area. • Challenges in relation to recruitment, retention and the general perception of social care as a career of choice are well documented. A consultation exercise has recently taken place to establish current recruitment efforts across the adult social care market. Outcomes from the consultation will be shared with 13
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providers and there is an intention to consider supports on offer to providers in this area as well as opportunities for joint recruitment events. Moving forward the HSCP will continue to influence to spend local wherever possible and establish a list of suppliers that care providers regularly purchase from and devise a directory of local suppliers. 3.9 RISE – North Ayrshire’s Recovery Festival North Ayrshire Alcohol and Drug Partnership is thrilled to announce RISE - North Ayrshire’s first ever recovery festival! Organised in partnership with Turning Point Scotland, Minds of Recovery and Freed Up, the event will be held at Irvine Moor on Saturday 14 September as a celebration of recovery, inspiration, support and empowerment The day will kick off with a memorial walk and flowers ceremony from 11am, before the main event gets under way at noon (running until 4pm). As well as live entertainment, there will be a funfair and food vans, and info and support will also be available. The event is completely free to attend and no booking is required. Keep an eye out on NAADP’s X page and the North Ayrshire Protecting People Together Facebook page for further details. 3.10 Survey for Unpaid Carers North Ayrshire Carers Gateway is looking to revamp the offering of therapies to unpaid carers within North Ayrshire localities and is looking for views from carers on what they would like to see and how they would like it to be delivered. A short online survey has been produced, which should only take a couple of minutes to complete. COVID Update 3.11 NHS Inform Advice – Update As of the 13th June 2024, the NHS Inform advice on Covid-19 has been updated. This was informed by a review from Public Health Scotland and Scottish Government clinicians. Based on this review, it was recommended that the advice to self-isolate for five days following a positive Covid-19 test should be removed from guidance. This change to public health advice now brings Scotland in line with guidance in Wales and Northern Ireland. 14
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This change to NHS Inform guidance also follows the recent removal of asymptomatic COVID-19 testing before discharge from Scottish hospitals to care homes and hospices. Since 30 August 2023, health and social care staff with symptoms of a respiratory infection have been asked to follow the Covid-19 advice on NHS Inform. We ask health and social care staff to continue to follow this NHS Inform advice going forward. If there are any further changes to this advice, Scottish Government will engage with, and inform, health and social care employers accordingly. The DL from August 2023 as been updated as per the changes outlined in this email. To access this updated DL please use the following link: Notice of changes to Scottish Government’s COVID-19 testing guidance. Any staff who are returning to work after recovering from symptoms of a respiratory infection, should do so in discussion with their line manager. This will allow for an appropriate risk assessment to take place prior to their return to the workplace. This is of particular importance for staff who work in areas of high clinical risk (please see PHS guidance on return to work). 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 4.7 Key Priorities None 5. CONSULTATION No specific consultation was required for this report. User and public involvement is key for the partnership and all significant proposals will be subject to an appropriate level of Consultation. Caroline Cameron, Director [Carolinecameron@north-ayrshire.gov.uk/01294 317723] 15
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Appendices Nil 16
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Integration Joint Board 22nd August 2024 Subject : Annual Performance Report 2023-24 Purpose : For Discussion Recommendation : That the Integration Joint Board (IJB) should note the key achievements during 2023-24 and the publication of the Partnership’s Annual Performance Report. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required x 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms ABI Alcohol Brief Intervention ADP Alcohol and Drug Partnership AILN Ayrshire Independent Living Network CAMHS Child and Adolescent Mental Health Service CASST Children and Adolescent Specialist Support Team CPO Community Payback Order HSCP Health and Social Care Partnership IJB Integrated Joint Board MAASH Multi Agency Assessment and Screening Hub NADARS North Ayrshire Drug and Alcohol Recovery Service SLIC Scottish Library & Information Council 1. EXECUTIVE SUMMARY 1.1 Each year the Partnership is required to publish an Annual Performance Report, both to comply with legislative requirements and to demonstrate the progress made in working towards strategic priorities and national outcomes. 1.2 The draft report was provided to the Performance and Audit Committee and the Senior Management Team in July 2024 and has been published on the Partnership’s website. 1.3 This covering report highlights some of the key achievements during 2023-24 which are contained within the Annual Performance Report. 17
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2. BACKGROUND 2.1 Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires Partnerships to publish an annual performance report setting out an assessment of performance in planning and carrying out the integration functions for which they are responsible. 2.2 Guidance for Health and Social Care Integration Partnership Performance Reports (published by the Scottish Government, March 2016) was followed to ensure the content of our performance report met the requirements. 2.3 Following the provision of the report to the Performance and Audit Committee and the Senior Management Team all provided feedback on the report content has been reflected in the preparation of the final document. Performance Highlights 2.4 The Annual Performance Report demonstrates the ongoing progress made by the Partnership in delivering against its vision and strategic priorities, as well as the Scottish Government national health and wellbeing outcomes, children’s and justice service outcomes and a range of local measures 2.5 The report uses case studies throughout to demonstrate some of the performance highlights. Key highlights against each of the Strategic Priorities are outlined below: Provide Early and Effective Support • The North Ayrshire Primary Care Development Manager has implemented the ‘Providing Welfare Rights in GP Practices’ within 11 North Ayrshire GP practises. 2023-24 saw a 208% increase in financial support to patients/ residents with a value of £2,907,341 being generated compared with £945,273 the previous year. • Community Link Workers provided over 2,000 clinics with over 6,000 patient contacts • Our Drug and Alcohol Service continues to surpass targets for Alcohol Brief Intervention: ABI Delivery Priority Settings: Target – 3,420; Actual – 6,389 ABI Delivery Wider Settings: Target – 856; 1,210 • The efforts of the Ward 2 team at Ayrshire Central Hospital have been so successful their work has secured a ‘Greatix Award’; an award that recognises excellence. • The Dementia Support Service received an unannounced inspection. This inspection was to test a new way of confirming better performance and low risk services continue to perform at a required standard. The inspection confirmed the previous good evaluation. 18
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Tackle Inequalities • Our Money Matters Team once again supported the most vulnerable people in our communities, accessing entitled benefits to the incredible sum of £20,081,590.91, an increase of over £1.5million from 2022 to 2023. In total 5,739 referrals were received by the service. • The new ‘Building Caring Communities’ unpaid carer strategy for 2023 to 2025 was launched. This will further support the estimated 14,000 unpaid carers in North Ayrshire. • The inspection of our Adult Support and Protection work was undertaken with an outcome described as ‘commendable’ in the final report. Enable Communities • Two events in August were hosted by the Refugee Support Team to support families from Syria and Ukraine become more familiar with their community and to support their Health and Wellbeing. 20 Ukrainian and 16 Syrian families attended. • During the past year 68 compliments were received and 111 complaints. 15 complaints were upheld. • Ayrshire Independent Living Network (AILN) continues to support the Partnership providing Self- Directed Support advice. During the 2023 calendar year 457 people were supported (30% resident in North Ayrshire) with 180 new referrals received across Ayrshire. • Two new initiatives were launched - Baristamoss and The Glam Hideaway – in support of those using the Day Opportunities service for adults with a learning disability at Trindlemoss. Develop and Support our Workforce • We held our celebration of care event, otherwise known as the Partnership Awards, on the 20 June at the Volunteer Rooms in Irvine. • The Partnership has experienced significant workforce challenges across the Health and Social Care sector, including and probably the most challenging of these being on the island of Arran. Including a number of other initiatives the new health and social care accommodation, Glenartney, opened its doors in 2023 and has already been a huge benefit in being able to provide high quality accommodation for staff who commute to work on the island. • Several managers within the Health and Social Care Partnership successfully completed our Systems Leadership course during 2023 to 2024. The course has been designed to introduce social work and social care professionals to system leadership considering a whole systems approach to complex human systems. • A new Nurse Practitioner role was developed along with a training and competency framework to support the demand at the Arran War Memorial Hospital • Over the last 3 years our Staff Wellbeing Programme has delivered several successful wellbeing initiatives/activities to support the wellbeing of staff. This work was initially funded by the Scottish Government in 2021/22 and has 19
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been funded solely by North Ayrshire’s Integrated Joint Board (IJB) for the last 2 financial years. • As part of the NAHSCP Learning and Development Strategy 2023-28 we stated that we are committed to making sure that staff are supported to Be The Best They Can Be. As part of this commitment, we are delighted to say we have been working in Partnership with The Skills Network to develop new and Free learning opportunities for our staff Improving Mental and Physical Health and Wellbeing • In early April, we opened applications for our bespoke Mental Health & Well Being fund. This fund allows applications for support for up to £500 per child, young person or carer/parent. This may be for a specific one off spend or a more regular payment of support over a longer period of time. The fund is designed to specifically target issues of mental and emotional distress and wellbeing rather than mental illness. • As of November the number of beds available within Ward 7A was permanently reduced from 10, to 7. As a result of this change, the ward has seen a variety of benefits, including reduced levels of behaviours perceived as challenging, and space to explore new developments, with a view to improving the care environment and client experience. • In October 2023, we received the written findings of a recent Care Inspectorate unannounced inspection of one of our residential Children’s Houses, Abbeycroft. The service received a scoring of 5 (in evaluating quality, a six-point scale is used where 1 is unsatisfactory and 6 is excellent) • 1,710 Naloxone kits were handed out in Ayrshire during the year (846 of which were in North Ayrshire), with 51 lives reported to have been saved in that time (31 in North Ayrshire). However, the true number of lives saved is thought to be higher, with many instances of Naloxone use going unreported. • North Ayrshire Libraries won the Scottish Library & Information Council (SLIC) Project Excellence Award for their pioneering work in supporting those recovering from problematic alcohol and/or other drug use. The partnership between North Ayrshire Libraries and North Ayrshire Drug and Alcohol Recovery Service saw the creation of a safe, supported, non-clinical environment in Kilwinning Library on a weekly basis for NADARS staff, service users and their families to attend Children’s and Justice Outcomes • Progress on The Promise continued this year focusing on: o A new North Ayrshire Will Keep The Promise Instagram Channel o Forming a Care Experienced Youth Group within all Secondary Schools within North Ayrshire to give care experienced young people a platform to use their voice to initiate real change as well as having a safe space to communicate with staff and one another o Awareness raising and training • The ‘Signs of Safety’ assessment and planning model started its implementation. This model places parents, children and everyone naturally 20
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connected to the child at the centre of the assessment, decision-making and planning and is a significant paradigm shift for children’s services. • Our Children and Adolescent Specialist Support team (CASST) were able to create a modern apprentice opportunity. It was agreed that the team would benefit hugely from recruiting someone with lived experience of substance use • Our Rosemount Project received referrals to work with 127 families across North Ayrshire • We continued to utilise investment from the Whole Family Wellbeing Fund into the Family Centred Wellbeing Service; Therapeutic Counselling; Support in Early Years; Dad’s Support Worker; Neurodevelopmental activities, to highlight a few areas. • A group of six clients of North Ayrshire’s Unpaid Work team have received recognition certificates from the Koestler Awards for their original artworks. The Koestler Awards for arts in criminal justice started in 1962. Each year, over 3,500 people in custody and in the community share their creative work by taking part. • As a result of having an established Prevent Multi Agency Panel Process, North Ayrshire are one of only three HSCPs in Scotland to be selected to participate in the Prevent Multi Agency Panel Hydra training sessions that the Home Office and College of Policing run. • We continue to surpass Community Payback Orders Unpaid Work completed on time targets. Level 1: Target – 57%; Actual - 97.3% Level 2: Target – 67%; Actual - 96.1% • Following a slight ‘dip’ in Drug Treatment and Testing Order (DTTO) Assessments in 2022-23, the number of assessments increased to 66 from 43 in 2023-24 with 24 orders imposed. • 2023-24 saw a decrease in Diversion from Prosecution; 130 from 173. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. Mental Health Lead Partnership • Montrose House Care Home received an unannounced inspection on 14 September 2023 which was a follow up to the initial inspection which took place in June 2023. The service is continuing to implement a robust improvement plan and is working alongside wider Health and Social Care Partnership colleagues to build on the improvements made since the last inspection. • With the launch of the national Mental Health and Wellbeing Strategy – a pan Ayrshire implementation group has been formed to consider the impact of delivery and workforce planning both locally and on a Pan Ayrshire basis, this will be called the Strategic Leadership Group. • The Learning Disability service continues to experience workforce pressures across a number of its elements, in particular Trindlemoss House. 21
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• The Social Work Team has seen significant improvements with regard to staffing levels, which has enhanced its capacity to respond to issues such as overdue reviews. None-the-less, the service is very conscious of the continuing pressure on the team and service fragility linked to workforce. • Trindlemoss Day Opportunities has been a contributor to the successful delivery of the How We See Ourselves poetry/art animation project, within a project led by Neighbourhood Networks • A Drug and Alcohol Services report from North Ayrshire Drug and Alcohol Recovery Service (NADARS) and North Ayrshire Alcohol and Drug Partnership (ADP) highlighted some of the positive work being undertaken to prevent drug and alcohol related deaths locally. The report details some of the work carried out over the past year, including the ongoing implementation of the Scottish Government’s Medication Assisted Treatment (MAT) Standards, providing additional support to individuals following a non-fatal overdose, increasing access to residential rehabilitation programmes, and the continued roll-out of the life-saving medication Naloxone across North Ayrshire, which reverses the effects of an opioid overdose. • North Ayrshire had been set a target of increasing the number of individuals receiving medial assisted treatment from 882 in 2020 to 959 by March 2024, with 2023-24 figures (1,011) already exceeding the 2024 target. • The Scottish Government’s Communities Mental Health and Wellbeing Fund for Adults has distributed around £36 million to community initiatives supporting mental health and wellbeing across Scotland. The Green Health Partnership included provision of a contribution amounting to £46,125 in Year 2, for projects specifically focussed on ‘green health’ related activity. This resulted in a total of £516,107 being distributed to 55 projects across North Ayrshire. Early monitoring demonstrates that so far, an additional 5,000 North Ayrshire residents have already benefitted from the Year 2 projects. There will be a continued emphasis in Year 3 on responding to the cost-of-living crisis and on those facing socio-economic disadvantage. 2.6 The report concludes with information on the important role played by Locality Planning Forums as a key conduit between local communities and the Partnership, the transformation programme and financial performance. Publication 2.7 This annual performance report is part of a suite of partnership public-facing documents. These documents are available from the NAHSCP web site 3. PROPOSALS 3.1 It is proposed that IJB notes the key achievements during 2023-24 and the publication of the Annual Performance Report on the Partnership’s website. 22
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3.2 Anticipated Outcomes Informing the people of North Ayrshire and wider stakeholders on the progress of health and social care integration, specifically relating to: • Outcomes for local people. • Locality health and social care needs. • Service provision (including lead partnership responsibilities and commissioned services); • Transformational Change. • Budget and financial information. 3.3 Measuring Impact With the publication of the Annual Performance Report 2023-24 the Partnership has met its obligations under the Public Bodies (Joint Working) (Scotland) Act 2014. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 4.7 Key Priorities This would ensure we fulfil our obligations in the Integration Scheme 5. CONSULTATION Consultation has taken place with staff, partnership stakeholders, the Partnership Senior Management Team (PSMT) and the IJB Performance and Audit Committee (PAC). Caroline Cameron, Director Neil McLaughlin, Manager Performance and Information Systems on 01294 317744 or email nmclaughlin@north-ayrshire.gov.uk Appendices North Ayrshire Health and Social Care Partnership Annual Performance Report 2023-24 23
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North Ayrshire Health and Social Care Partnership Annual Performance Report 2023 to 2024 24
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Reflections from the Director Welcome to our Annual Performance Report for 2023 to 2024. This report focusses on the performance of services during one of the most challenging years our health and social care services have faced, as we emerged from the pandemic. Our services have faced extreme pressures over the period, with increasing demand and individuals requiring a different type of support. Despite these challenges there have been many significant achievements, and these are outlined in this report. We expect our services to face on-going challenges, including supporting those who were not able to access a health and social care professional due to demands and restrictions, and addressing the rise in poor mental wellbeing in our communities. We have learned much from our pandemic experience, such as recognising the strength and resilience within our communities, discovering how truly determined and hard-working our workforce is, and finding greater ways to work in collaboration with our partners. The year 2023 to 2024 is the second year of our Strategic Plan 2022 to 2030, ‘Caring Together’. Through delivery of this plan, we hope to help create a North Ayrshire where everyone can live a safe, healthy, and active life. Working together, we can develop a vibrant and proactive health and social care service, that is adaptable to the changing needs and demands of North Ayrshire and will continue to provide our communities with the right service at the right time. We are ambitious in how we want to change and modernise our services and will focus on the integration of services to deliver real change to the way services are being provided. We will direct our resources to improve service performance and outcomes for our communities. Our transformation programme will focus on service redesign to align future service models to strategic priorities and our reducing resources. In conclusion, I want to acknowledge the tremendous efforts of staff across the Health and Social Care Partnership who have been under immense pressure for a sustained period, whilst continuing to deliver services with professionalism and dedication. I look forward to the next twelve months with optimism and know that we will continue to work with our partners to meet the needs of our communities. Caroline Cameron Director, North Ayrshire Health and Social Care Partnership 25
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3 Contents Reflections from the Director............................................................................................................. 2 Visions, Values and Priorities ............................................................................................................ 4 Local Priorities .................................................................................................................................. 5 Structure of this report ...................................................................................................................... 6 Provide Early and Effective Support ................................................................................................. 7 Tackle Inequalities .......................................................................................................................... 16 Enable Communities ....................................................................................................................... 22 Develop and Support Our Workforce .............................................................................................. 31 Improve Mental and Physical Health and Wellbeing ....................................................................... 38 National Health and Wellbeing Indicators ....................................................................................... 47 Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes ... 51 Children’s Outcomes ................................................................................................................... 52 Justice Outcomes ........................................................................................................................ 58 Reporting on localities ..................................................................................................................... 63 Transformation Programme ............................................................................................................ 66 Reporting on lead partnership responsibility ................................................................................... 73 Mental Health Services ................................................................................................................ 74 Child Health Services .................................................................................................................. 80 Inspection of service ....................................................................................................................... 84 Financial performance and best value ............................................................................................ 91 Appendix ......................................................................................................................................... 98 26
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4 Visions, Values and Priorities North Ayrshire Health and Social Care Partnership (NAHSCP/the Partnership) is working towards a vision where: “All people who live in North Ayrshire are able to have a safe, healthy and active life.” Our Partnership includes health and social care services within Health and Community Care Services (H&CC), Mental Health and Learning Disability Services and Children, Families and Justice Services. In this annual performance report, we look back on the progress we have made, share some of our successes and reflect on some areas that have proved challenging. This report aligns with our “Caring Together” Strategic Commissioning Plan 2022 to 2030. This is the first time the Health and Social Care Partnership has set out such a long-term plan for how we intend to improve services and the health and wellbeing of the local community. The plan set out our pandemic recovery intentions, as well as offering a longer-term vision for local health and social care services. Over the period of this strategic plan, the Health and Social Care Partnership will seek to: We see these priorities as interlinked, and we expect that where we see success against one priority, it’s effect will positively impact against others. People who use our services and North Ayrshire residents will experience our Partnership values in the way our staff and volunteers engage with you and how we behave. We will treat you with: 27
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5 Local Priorities The themes of the strategic plan are how the HSCP will plan services and seek positive outcomes across the whole of North Ayrshire, but each community within North Ayrshire will have unique challenges and different inequalities. As such, the HSCP is required to develop planning in a smaller geographic area for different localities, which in North Ayrshire are: • Arran • Garnock Valley • Irvine • Kilwinning • North Coast and Cumbrae, and • Three Towns A new method for carrying out local planning in these areas has been developed over the last year and is currently being implemented in order to develop priorities and actions in the form of published Locality Plans, to be developed by 2025. This method will analyse local data, engagement, and service information, and ensure continued community feedback and leadership to develop robust, informed plans. 28
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6 Structure of this report We have measured and evaluated our performance in relation to: • Partnership Strategic Objectives • Scottish Government National Health and Well-being Outcomes • Children’s and Justice Services Outcomes • Local measures The North Ayrshire Health and Social Care Partnership continues to have lead partnership responsibilities across Ayrshire and Arran for Mental Health and Learning Disability Services as well as Child Health Services (including immunisation and infant feeding). We have reflected on some of the highlights and challenges of leading these services across Ayrshire. We will show that all our services (those provided by our Partnership staff and those provided by other organisations on our behalf) are providing high quality care and support to the people of North Ayrshire. Finally, the partnership continues to face financial challenges in delivering and improving services from within the available budget, during the year we have made significant progress towards achieving financial balance and overall service sustainability. We have detailed our financial position and reflected on how we continue to provide assurance that we are delivering Best Value in North Ayrshire for Health and Social Care services. 29
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7 Provide Early and Effective Support National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3 Health and social care services contribute to reducing health inequalities. 30
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8 1.1 Preventing Suicide in North Ayrshire: ‘Creating Hope Together: Scotland’s Suicide Prevention Strategy 2022 to 2032’ Staff from across North Ayrshire HSCP were joined by colleagues from NHS A&A, East and South HSCPs and Third Sector partners for a suicide prevention event at Saltcoats Town Hall in October. The theme of the event was ‘Creating Hope Together’, recognising that suicide prevention is everybody’s business and that we can all take action - no matter how big or small - to prevent suicide. The aims of the day were to encourage discussion and generate ideas for taking action to prevent suicide in North Ayrshire, share our knowledge so far about suicide prevention and highlight areas of good practice, inspire a call to action across all sectors to work and learn together to drive change in North Ayrshire and consider what more can be done to prevent suicide and identify the support needed to ensure everyone can play their part. As well as staff from NAHSCP/NAC/NHS A&A, representatives of Arran CVS, Dalry Men’s Shed and dsm-firmenich also delivered thought-provoking presentations on the day, with attendees taking part in two workshop sessions that will help to shape our next steps. 1.2 The North Ayrshire Primary Care Development Manager worked successfully with 11 North Ayrshire GP practises, selected by the Scottish Government Improvement Service and HSCP Money Matters team, to implement the ‘Providing Welfare Rights in GP Practices’. The initiative saw Income Advisors based in these practices, who worked with patients and residents to carry out complete benefits checks, help them make claims and support them if they were disputing claims. Arran and Millport went live in Quarter 3 of 2023 to 2024. Year two of the pilot resulted in: • 646 referrals to the service (compared to 429 in the first year, 50.5% increase) • there have been 44 referrals made to other agencies to support patients with fuel, debts and other supports from HSCP • £2,907,341.52 has been generated for patients and residents of North Ayrshire in the second year of the project with a total £3,852,615.06 since the project commenced in 2022 to 2023 Community Link Workers followed by GP’s and then Mental Health Practitioner’s being the highest referrers into project. 1.3 Community Link Workers continue to support people aged 16 and over on a wide range of issues affecting health and wellbeing, such as money worries, unemployment, social isolation, bereavement, alcohol, and drug use, managing stress, low mood and anxiety and living a healthier lifestyle. Over 2,000 clinics were provided in North Ayrshire GP Surgeries with over 6,000 patient contacts made. Community Link Workers have increased their reach by being involved in the roll out of North Ayrshire Council’s No Wrong Door policy, this policy builds on existing efforts to ensure that residents can access the funding or support that they need during the cost of living crisis. 31
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9 Residents can now access advice and support from a number of key services including, financial inclusion, employability, homelessness, digital access/skills and community link workers, by completing a simple online form. As part of for this initiative the team worked closely with the NAHSCP communications officer to create an online A-Z list of services that can assist with a wide range of wellbeing, emotional and practical support services. This addition to the NAHSCP has been well received and is now one of the most viewed pages. 1.4 The Scottish Government’s 2021 to 2022 Programme for Government committed to invest £500million of Whole Family Wellbeing Funding (WFWF) across Scotland, over the lifetime of the Parliament to help family support services to make transformational changes to reduce the need for crisis intervention and to shift investment towards prevention and early intervention. We are now in year two of the four year programme. In September, further proposals linked to this funding were agreed or previously agreed initiatives began operating. Some of the approved initiatives include: • A Dads’ Support Worker. The recruitment of a Dads’ Support Worker within the integrated Universal Early Years’ team will allow an expansion of the offer of early help for children under the age of 5 and their families, which has been recognised by the Scottish Government as an example of good practice. The post will be responsible for developing and delivering specific programmes for Dads, including practical parenting workshops; working in partnership with Dads Rock and learning from the established programmes and approaches they have developed. The post will aim to test how, from an early years’ perspective, we can better engage with dads and other male caregivers to encourage a more active parenting role. • A Community Charge Nurse for Care Experienced Young People, based in our Throughcare/Aftercare Team. This post will allow for care experienced young people to be seen by a specialist mental health nurse without delay and on an early intervention basis. The WFWF can also be used to scale up existing services which fit within the ethos of the funding criteria and following consideration, agreement was reached to: • Expand our Family Centred Wellbeing Service which currently offers early and effective support to families aged five to 12 years of age, on a broad range of topics surrounding parenting, budgeting, school-based issues etc, to a multi-disciplinary service which will build on existing services offered to include providing pre and post assessment family support to children, young people, (aged five to 18 years of age) and their families where there are Neurodevelopmental disorders. The team which will consist of Support Workers, Speech and Language resource and Occupational Therapy resource, will work closely with the Neurodevelopmental Empowerment and Strategy Team (NEST), and will align to existing models of requests for assistance within children’s services. They team will also work closely with colleagues from other services such as Education, Employability and other services within the HSCP. • Expand our Early Years service with an additional three Social Workers, which will allow our Early Years Team to expand and allow us to focus on both early intervention and improve mental and physical health and wellbeing. 32
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10 1.5 The North Ayrshire Drug and Alcohol Service (NADARS) has continued to demonstrate high levels of performance by meeting national and local standards and targets, such as access to treatment waiting times, provision of alcohol brief interventions (ABIs), the roll-out of Naloxone supplies and increasing patient choice regarding Opiate Substitution Therapy (OST) medications. The team continues to identify new ways of working to provide a more agile and streamlined service and further improve performance. This work has been evidenced by the delivery of early intervention services in the delivery of Alcohol Brief Interventions (ABI) in both priority (Primary Care, A&E and Antenatal) and wider settings. Indicator 2021 to 2022 2022 to 2023 2023 to 2024 Target set by Scottish Government – Priority Settings 3,420 3,420 3,420 Total ABI delivery in Priority Settings (Ayrshire & Arran) 5,776 4,933 6,398 33
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11 1.6 The North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) utilises multidisciplinary holistic interventions to focus on providing high-quality care and support, through proactive early intervention and preventative action. They aim to assist patients presenting with falls, frailty, low grade infections and general functional decline to avoid hospital admission where possible and facilitating early discharge home from hospitals. The North Ayrshire Enhanced Intermediate Care Team brings together the expertise of dedicated Physiotherapists, Occupational Therapists, Technical Instructors, Dieticians, Community Psychiatric Nurses, Pharmacists, Admin workers, Rehabilitation Nurses, Advanced Nurse Practitioners, and Intermediate Care GP with special interest into one single multidisciplinary and interdisciplinary team; focused on problem-solving for patients in their own homes across all of mainland North Ayrshire. The seven-day rehabilitation service facilitates early discharge from hospital and provides a rapid alternative to acute hospital admissions. The Enhanced part of the team addresses medical and clinical issues that limit a patient’s ability to engage in rehabilitation via a shared care model with the patients registered GP. Indicator 2021 to 2022 2022 to 2023 2023 to 2024 Target set by Scottish Government in Wider Settings 856 856 856 Total ABI delivery in Wider Settings (Ayrshire & Arran) 1,027 1,207 1,210 34
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12 1.7 The Scottish Patient Safety Programme (SPSP) is a national quality improvement programme that aims to improve the safety and reliability of care and reduce harm. Launched in 2008, SPSP has played a central role in improving the quality and safety of care over the last 15 years. Adult acute inpatient wards continue to implement SPSP work streams improving patient experience and reducing risk. Currently focusing on group work, early feedback from patient group has been positive. 1.8 The Partnership’s Care at Home Team continue to offer exceptional support to the people of North Ayrshire. The Care at Home service has registrations split over two areas on a locality basis. In November 2023, The Irvine, Kilwinning, Garnock Valley and Community Alarm localities were inspected by the Care Inspectorate, receiving very positive feedback that staff demonstrated “passion and commitment to providing the best care possible” noting service users and their families spoke “warmly and gratefully for the services they received and the difference it made to their lives”. The inspector also recognised the good partnership working between the team and District Nurses, GP's, the Hospice, and many others – all with the goal of supporting and meeting the needs of our service users. The inspection found that staff spoke of their pride in being part of the service, of job satisfaction and of making a difference to service users’ daily lives, recognising the guidance, training, and development they received to help them do so. 1.9 The Community Wards continue to embark on a number of initiatives to improve the experience of their patients. The efforts of the Ward 2 team at Ayrshire Central Hospital has been so successful their work has secured a ‘Greatix Award’ – a network which celebrates excellence. The award recognises that having identified that the number of acquired pressure ulcers was well above the normal, interventions were put in place, which over a period of only six months not only reversed the trend, but reduced incidents to below previous levels. The team has now also appointed ‘Pressure Ulcer Champions’ to continue this excellent work. 1.10 Care Opinion is an independent website where service users can anonymously share their personal experiences of registered adult health and social care services. Stories are submitted by members of the public, which are then moderated and posted online by Care Opinion. Both positive and negative stories can be shared through the platform. 35
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13 Our partnership with Care Opinion gives us the opportunity to respond to feedback online, learn what’s working well (and what isn’t working so well) and make any changes required to enhance people’s experience of our services. It also gives us the chance to hear about some of the fantastic work being carried out by our teams across North Ayrshire. Your opinion matters and can help shape our services. 1.11 A pilot inspection to test a new way of confirming that better performing, low risk services are continuing to provide good quality care and support took place during an unannounced inspection of the Partnership’s Dementia Support Service on 21 and 22 November 2023. This inspection did not include an updated grading however did confirm the previous good evaluation has been maintained with recognition given to ongoing developments within the service. Key messages from the inspection included: • People who used the service were safe and protected from harm. • The service had good governance and quality assurance processes in place. • The service was well led and managed. • The impact that the service has on families was clear and comments included: o “I think it's brilliant, he looks forward to his visits.” o “The staff are all lovely, he was wary at first but now he looks forward to it.” o “Very happy with the service, the staff member is lovely, very patient and tries to engage him.” o “The support gives me time out as I trust the staff, they've built a good relationship with him.” o “It's a brilliant, brilliant service, it's like having friends to the house.” 1.12 Case Study: Arran War Memorial Hospital Arran Emergency department sees and treats approximately 2,500 patients per annum. During the busy Spring and Summer season the population of Arran increases from the 5,000 resident population to over 25,000. This seasonal variation impacts significantly on attendances at the Emergency Department (ED). In Spring 2019 a refurbishment at Arran War Memorial Hospital to create a two bedded Emergency department from Ward 1 was carried out. Before the refurbishment there was one small room covering minor injuries to Full Resuscitation in a building over 100 years old. No flexibility in the space and a difficult area to work in safely. Nursing staff also not only working within ED but were also covering in patient areas and out-patients. As the activity in ED increased as well as the complexity and frailty of patients presenting at the hospital, the space was not fit for purpose and staffing all areas was challenging. The level of nursing skill required was increasing out of hours and the historical GP on call / hospital nursing model needed reviewed. 36
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14 Re-categorising Ward 1 to a new ED area has given us the maximum space to increase our work area by more than double. This has allowed two bays, a circulating area, staff base and accessible toilet and shower area. In addition to the new Emergency Department a new Nurse Practitioner role was developed, and specific training and a new competency framework has been developed to support people attending the Emergency department. Our vision for these new ED roles is for a more advanced level with the ability to see, treat and discharge within their scope of competency. With no academic course sitting alongside their learning, there were a number of challenges in achieving upskilling and completing competency documentation. After approaching a couple of universities, the Glasgow Caledonian University faculty staff were very supportive in arranging for the ED nurse practitioners to undertake a post Grad Certificate in advanced practice moulded around remote and rural island practice in the subjects and competencies they needed to cover. They are currently on this course and have the support of their GP and Advanced Nurse Practitioner colleagues locally and on the mainland through this. The Arran Emergency department covers a wide range of presentations, from acutely unwell who need immediate transfer to the mainland via helimed helicopter, around 175 transfers per year, to less acute who can transfer on the ferry, to those who can require admission to the inpatient facility within Arran war memorial. There are also a significant number who require to be seen and treated on the day. This transformation of our emergency and unscheduled care service on Arran has been very successful and means we can deliver high quality care on the island for both residents and visitors in a modern and more patient centred space with highly trained nursing staff. We are hopeful that by 2024 we will have completed our recruitment and appointed an Advanced Nurse Practitioner to complete the team. National Indicators Indicator NAHSCP Scotland Adults able to look after their health very well or quite well 89% 91% Adults supported at home who agreed that they are supported to live as independently as possible 67% 72% Adults supported at home who agreed that they had a say in how their help, care or support was provided 51% 60% 37
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15 Indicator NAHSCP Scotland Rate of Emergency Hospital Admissions for adults (Per 100,000 population) 14,009 11,707 Rate of emergency bed days for adults 142,222 112,883 Falls rate per 1,000 population aged 65+ 22 23 38
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16 Tackle Inequalities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5 Health and social care services contribute to reducing health inequalities. 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 39
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17 2.1 The HSCP has recognised the value of employees with lived experience in areas such as drug and alcohol recovery. In November 2023, we held our first peer mentor meeting for our recovery development workers within the organisation. The partnership recognises the impact that individuals with lived experiences bring to our workforce when we are trying to make a difference and reach individuals who are impacted by addiction. Whilst our recovery development workers have had a positive impact on those who require support with alcohol and drug use, we also recognise that we have created a sense of hope, direction and achievement for individuals who previously were very much removed from the labour market due to their history with addiction. We have recovery development workers within our Justice Services and Service Access teams. The following is an extract from a recovery development worker currently employed within Justice Services. “Just a wee email to say thank you for your patience with me, my jobs amazing and the privileged nature of the roles not lost on me. It has been a life changing thing for me. I’m grateful for the people around me and the good guidance. In all fairness I do absolutely love my job and my role, it has been a total game changer for me. Having a really supportive team around me and good management is the biggest thing I think that has seen me settle and slot into the team as well as I have. It’s a real privilege to work in the place that helped me so much to change my life, I hope to do the same for the people who I come into contact within the role. The fact I’ve got an amazing management who trust me, encourage me, and value my input makes it all the better.” 2.2 Our new North Ayrshire Financial Inclusion Strategy was launched in April, setting out our vision for “a financially healthy North Ayrshire where people have the knowledge, skills, resources and confidence to manage their money effectively and live fulfilling and healthy lives,” as well as our intentions for working towards that ambition. ‘Financial inclusion’ refers to the ability of individuals to access appropriate financial services or products to manage their money effectively. The strategy reflects on the impact of the current economic situation and cost of living crisis and how these are affecting both North Ayrshire residents and local financial advice and support services, which are experiencing increasing levels of demand for services. Financial inclusion services are intended to provide access to the best financial advice and products to support people to build their financial resilience and confidence to manage their money and deal with financial difficulties. Poor financial wellbeing impacts on all aspects of life and can leave lasting damage on future life chances. 2.3 Our Money Matters Team once again supported the most vulnerable people in our communities, accessing entitled benefits to the incredible sum of £20,081,590.91, an increase of over £1.5million pounds from 2022 to 2023. In total 5,739 referrals were received in 2023 to 2024. 40
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18 2.4 North Ayrshire Health and Social Care Partnership is funding a new debt advice service, which will be delivered by CHAP for the next two years through their base at The Michael Lynch Centre for Enterprise in Ardrossan. CHAP provides free, independent debt advice and practical solutions for all - no matter how big or small your debt problem. With a team of specialist staff, one of CHAP’s expert debt advisers can talk through your options and help decide the best way forward for you, before setting up a chosen debt solution and allowing you to take back control of your life. Services on offer include: • Negotiating repayments with creditors, including payday loan lenders • Advice on bankruptcy • Assistance with court proceedings • Accredited Debt Arrangement Scheme (DAS) advisors • Assistance with council tax arrears Email enquiries@chap.org.uk or use the online contact form. In addition to the new debt advice service, a Financial Inclusion Partnership for North Ayrshire has recently been established by NAHSCP. This new partnership was one of the key objectives detailed in the North Ayrshire Financial Inclusion Strategy 2023 to 2028, which sets out North Ayrshire Council’s response to the current cost of living crisis in relation to the provision of welfare rights and debt advice, as well as wider financial inclusion services. The partnership aims to foster collaboration and enable a joint approach, making the best use of all available resources to provide the greatest benefits to individuals, families and communities in relation to entitlements, managing money, debt, financial literacy, digital inclusion, affordable lending, fuel poverty, health and wellbeing and more. 2.5 Support for dads in the Three Towns received a boost thanks to an exciting new venture between NAHSCP and Scottish charity Dads Rock. 41
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19 This first partnership of its type in Scotland will see Ryan Warren of Dads Rock working alongside our Universal Early Years team to support Three Towns dads to give their children the best possible start in life. Working with dads from a wide range of backgrounds who have been referred by their health visitor, family nurse, midwife or perinatal wellbeing team, Ryan can provide one-to-one support for dads that will impact on the whole family and improve outcomes for children, whether that be parenting advice, confidence building or support with general wellbeing. Thomas Lynch, CEO of Dads Rock, said: "This is fantastic news for families. We're proud to be part of this collaboration with North Ayrshire Health and Social Care Partnership. It's a chance to give dads more space and recognition for the positive impact they have on their children's lives and offers a great opportunity for dads to come together and learn from one another. We look forward to seeing this develop in North Ayrshire." 2.6 On Carers Rights Day, a fantastic event was held at West Kilbride Village Hall to launch the expanded North Ayrshire Carers Gateway service. Attended by carers, staff of the Carers Gateway and NAHSCP, representatives from Third Sector organisations, North Ayrshire Provost Anthea Dickson and North Ayrshire Carers Champion Councillor Nairn McDonald, the event offered a chance to network, hear more about the service and find out more about additional sources of support locally. Having delivered services to North Ayrshire’s unpaid carers for over 20 years, Unity’s wealth of experience in supporting those caring for family members and friends has led to them successfully being awarded the contract to deliver support for a further period of three years, with significant resources being provided by NAHSCP to expand, improve and rebrand the services offered to both adult and young unpaid carers. This substantial investment will see a number of positive changes, including a three-fold increase in the number of support staff, increased routes to carers assessments and support, and the development of more community-based outreach services. This will see unpaid carers being able to access support closer to home in places they already visit and includes a dedicated worker for residents on the Isle of Arran. 42
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20 With an estimated 14,000 unpaid carers in North Ayrshire, the new outreach service will provide extended opportunities for Unity to reach more carers, in more places, in more ways and actively seek to connect with carers not yet known to them. 2.7 The Garnock Valley and North Coast Family Care Team had a busy summer taking part in local events to boost public knowledge of the team’s role and lend a helping hand to local families. As well as attending a family fun day at the Salvation Army premises in Kilbirnie, where the team raised awareness around child protection and the work of social work and family care teams in North Ayrshire, a community event was also held in the Area Office, which was attended by a general mix of staff, members of the public and families the team works with. The day was a great success, with the children enjoying a visit from Zoolab, who brought along a variety of critters ranging from tarantulas to snakes. They were also entertained by Jim Gibb and his robots. Library staff were in attendance to support individuals with membership, and the Family Care Team informed parents about cost-of-living support, holiday school meals and free activities available throughout the summer. A community school uniform day was then held in August, where members of the community and families the team works with were invited along to choose from a selection of new and preloved school uniforms, as well as shoes and toiletries. Free haircuts for the children were also available provided by Cut N Dry of Kilbirnie. 2.8 The ‘How We See Ourselves’ project saw members of Neighbourhood Networks, and staff and customers of Trindlemoss Day Opportunities, working alongside poet Simon Lamb, visual artist Lynn McNally and filmmaker Jim Gibb to create a diverse range of poetry and art. The project culminated in a successful multi-media exhibition that ran during September and October 2023 at the Harbour Arts Centre in Irvine. This featured the newly-created poetry and art – alongside animations combining both disciplines – all moving the lives, interests, talents and challenges of people with learning disabilities – as well as those who support them – from being a marginal conversation within communities to a central focus. A short film was created and shown as part of the exhibition, featuring interviews with artists and staff involved in the project, as well as showcasing the inspiring work produced throughout the duration of the project. You can now watch the film on the NAHSCP YouTube page. 2.9 The quality of North Ayrshire’s adult support and protection work was described as “commendable” in a report published by the Care Inspectorate. A joint inspection of NAHSCP, which included the roles of NHS Ayrshire & Arran and Police Scotland in the adult protection process, took place from September to December 2023 and focused on whether adults at risk of harm were safe, protected and supported. 43
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21 Inspectors found that overall, initial inquiries around adults who were thought to be at risk of harm were of a high quality, prompt, and competently determined whether to proceed to full investigation. Where cases did require to be further investigated, the quality and competence of the process was noted in the report as being a “clear strength”, with effective multi-agency contributions and a high standard of risk assessment and protection planning. The report also indicated that the Partnership’s strategic leadership team was effective and demonstrated major strengths that supported positive experiences and outcomes for adults at risk of harm, with adult support and protection found to be clearly prioritised within the organisations and supported accordingly by senior staff. A positive adult support and protection culture was also noted by inspectors. The report concludes: “Overall, the quality of North Ayrshire’s adult support and protection work across social work and health is commendable. While there is always room for improvement, performance was strong and collaborative in every area of core adult support and protection business, including inquiries, investigations, risk assessments and protection planning. This reflected our findings in the 2017 inspection and was evidence of the Partnership’s sustainability and push for excellence.” National Indicators Indicators NAHSCP Scotland Carers who feel supported to continue in their caring role 32% 31% Adults who are supported at home who agreed they felt safe 67% 73% Premature mortality rate (Under 75s age-standardised death rates for all causes per 100,000 population 527 (2022-23) 442 (2022-23) 44
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22 Enable Communities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 7 People who use health and social care services are safe from harm. 45
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23 3.1 North Ayrshire continues to welcome New Scots into our local communities. Our Refugee Support Team, alongside multi agency partners continue in their endeavours to help all integrate into their local communities, making everyone feel safe and included. During August we hosted two events to support our families from Syria and Ukraine to become more familiar with their local community and local attractions, in order to support their health and wellbeing. 20 Ukrainian families and 16 Syrian families attended. Please visit New Scots Summer Fun for more detail in relation to these events. 3.2 During 2023 to 2024, 68 compliments were received by the Health and Social Care Partnership relating to the services provided and the professionalism demonstrated by partnership staff. Compliments Our Family would like to thank you and your team for coming in to help with our mother. It took mum a little while to get used to the ladies coming in to help heat her soup, but she enjoyed her wee visits and chats. Mums care changed to personal care beginning in May, which started with the two ladies mum was familiar with, the task was proving harder than we thought but your team came up trumps again and came in twos, twice a day. As a family this extra help was a God send. You have no idea how your team helped us… many thanks to everyone that was involved with mums care. It’s much appreciated. Please accept my respect, admiration, and lasting gratitude for all the help and support you have kindly provided to my mum across the years. She has benefitted greatly, both socially and psychologically, from your team's input, and the effect of this has been to foster her sense of ownership and independence, which have encouraged her to remain active and vital. The speed and attention to detail and to understand the autistic mind was special to see. My daughter, family and I can not praise the kindness of [name] and [name] and their speed of putting my daughter's needs first. Thank you. You simply gave my daughter back her independence. I really am very grateful. [name] and [name] listened, truly listened and offered the support needed. Customer wishes to thank the engineer who attended her property today to fix her Alert alarm, he was very kind and did a great job. Thanks very much for looking after [name] this past week. You all do a fantastic job. If it wasn't for people like yourselves what would we all do? I want to thank you personally for giving [name] your care and compassion. Thank you from the bottom of my heart. 46
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24 3.3 A total of 111 complaints were received during the year and were across all service areas, with 15 complaints being upheld. Complaint Topic Number Service provision/delivery 47 Staff behaviour (incl. alleged or perceived) 23 Communication 21 Other 11 Staff behaviour (including alleged or perceived) 2 Waiting times 2 Quality of care 2 System issues 1 Incorrect information provided 1 Sensitive issue 1 3.4 Alzheimer’s Scotland commenced a new agreement for the delivery of day services from its Ardrossan service and, with an increase in staffing and the introduction of transport to the service; is able to operate at full capacity offering day services provision across 7 days per week. This compliments the development of a revised model of Older People’s day services which commenced in Quarter 1 to fully recruit to deliver an enhanced outreach model of day opportunities. This also includes a day services pilot on the island of Arran, offering an outreach day service in the more remote villages. 3.5 Self-Directed Support (SDS) & Ayrshire Independent Living: For the reporting year 2023 to 2024, the following information indicates how people have arranged and directed their support in North Ayrshire. Self-Directed Support offers four options. These are: • Option 1 – a direct payment, which is a payment to you or third party to pay for your own support • Option 2 – you direct the available support 47
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25 • Option 3 – the local council arranges the support • Option 4 – a mix of the above This continues to demonstrate that traditional support options are offered and accessed most with 87% of people receiving Option 3, where little choice and control is exercised and support is chosen, arranged and directed by the Health and Social Care Partnership. North Ayrshire Health & Social Care Partnership has awarded a final contract extension year on a pan Ayrshire basis to continue to commission independent SDS advice and information services from Ayrshire Independent Living Network (AILN). In the calendar year 2023 AILN reported supporting 457 people with 30% resident in North Ayrshire. Almost 180 new referrals were received across Ayrshire from people seeking information and guidance on how to direct their care. AILN have also continued to support partners such as social care teams as well as student and new workers, dementia services, attended jobs fairs at Lockart Campus and hosted a Transitions Event with Equal Employment. The service development work of AILN has been framed into a Business Action Plan 2023 to 2025 which has been shared with the three local authorities to work in partnership. 3.6 The Peer Support Volunteer Development Programme commenced in 2022. Four individuals with lived mental health experience participated in the programme to help them develop skills and knowledge to enable them to offer support to others within Acorn, a Mental Health day hospital, based at Ailsa. Over the course of the year, they participated in Scottish Mental Health First Aid and Safe Talk Training along with weekly training sessions facilitated by Acorn staff. During this time, they also completed two SQA Awards facilitated by Ayrshire College. They are now registered as NHS Volunteers and are now offering a weekly peer led drop in and support for new patients attending Acorn. 48
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26 Within the next 12 months the group will be offered regular individual and group supervision. They intend to participate in Peer2Peer Training Programme, facilitated by Acorn staff, alongside the SQA Award in Volunteering, facilitated by Ayrshire College. As their confidence grows their supportive role will develop within Acorn. The goal is to be able to develop the role of the peer worker into a paid position and support all of the strategic objectives. 3.7 Case Study: Your Next Move A pilot scheme was set up by the Council’s Your Next Move employability team in partnership with NAHSCP and supported by We Work for Families and Community Enterprise In Scotland (CEIS) Ayrshire. Throughout the six-month-long pilot project – believed to be the first of its kind in Scotland – a group of five young women, who had either never worked or had not been in employment for a long time, completed a five-week course that covered writing a CV, interview practise and an introduction to the care sector. The candidates involved in the innovative scheme, which ended earlier this year, then went on to undertake paid, mentored, vocational placements with North Ayrshire Health and Social Care Partnership, before attending interviews to join the Care at Home team. After success at interview, the group have all now taken up permanent employment within the team, where they have undergone accredited training and are now working shifts for Care at Home that fit in with their childcare needs and other family commitments. A mother of one from Dalry completed the pilot project and said it has been a “life-changing” experience. “It has made a big difference to my life. Before, when I was unemployed and on benefits, I was very stressed about money quite a lot. Now I am not worrying about it anywhere near as much. This scheme is based around my needs, so I work during my wee girls’ nursery hours which has really helped with my confidence because before I felt really isolated being in the house.” All candidates have continued to thrive in their new roles and have become valued members of their teams. A mother of three from Irvine completed the project and reflected on her experience since joining the Irvine Care at Home Team saying: “I have really enjoyed the opportunity I was given as part of the scheme; It really has changed not only my life but also my children’s lives for the better. As a single parent it has given me better financial stability which allows me to enjoy more quality time doing things with my children. I was given all the training and induction to the service that I required, and I felt fully supported throughout the training period, the support I have received since gaining my permanent position from my team mates and care at home manager has been amazing, they are always there to help me when needed. I have gained valuable experience that I am still 49
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27 building on by undertaking further training opportunities offered to me. I felt welcomed into the team and I now class my colleagues as friends.” Marlene Fleming, Care at Home Manager for The Three Towns, said the pilot has worked brilliantly for everyone involved – the trainees, the service and most importantly those we support in our community. She explained: “Their confidence has been boosted, they are excited to go to work and they go to work with a smile on their face. This has been extremely valuable to the service, supporting the care at home workforce and giving these women much needed experience and skills to help with their future careers. The pilot went extremely well and has really supported the Care at Home team.” North Ayrshire Council’s top priorities include tackling child poverty and supporting residents through the Cost-of-living Crisis. The three key drivers of child poverty are income from employment, income from social security and the cost of living. Councillor Tony Gurney, Cabinet Member for Economy and Climate Change, said: “It is fantastic to see how successful this pilot scheme has been, and I would like to congratulate everyone involved, and wish the candidates well for the future.” 3.8 North Ayrshire has committed to #KeepThe Promise which provides a benchmark for corporate parents, carers, practitioners, managers, our care experienced community and importantly decision makers in fulfilling the goal to meet the collective and individual needs of all our care experienced children and young people. On the 13 December 2023, we held our second Annual Promise conference within Saltcoats Town Hall, where we brought together a range of services who are responsible for supporting our care experienced community of children and young people. On the day, we had over 40 care experienced young people in attendance, all of whom helped services to consider what we are already doing well, what we could be doing better and what we haven’t even considered yet. The day was a great success – with conversations focusing on 4 main areas: • Working together • Supporting potential • Brothers and Sisters • Moving on 50
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28 The event generated much feedback and suggestion regarding how we can strengthen our responses to our population of care experienced children and young people and what work is still required so we can ensure we are keeping the Promise by 2030. 3.9 CLASP (Community Led Action & Support Project) is a charity based in Stevenston. Its HOPE Goes Digital project provides six free sessions on essential digital skills for anyone aged 50 plus living in North Ayrshire – using their smartphone, tablet or laptop – which will be held in local venues. Alongside digital skills sessions, HOPE Goes Digital offers telephone befriending, 1-2-1 befriending in the Three Towns area, digital groups, lunch clubs, arts and crafts, health and wellbeing activities and social outings. People can be referred for digital skills sessions and come along to activities. For more information, contact 01294 602 711 or email info@clasps.org.uk. 3.10 June saw the launch of two exciting new initiatives aimed at brewing up confidence and promoting valuable employability and life skills among those who use the Day Opportunities service for adults with a learning disability at Trindlemoss in Irvine. Baristamoss and The Glam Hideaway were officially opened by Sheriff Iona McDonald, Lord Lieutenant of Ayrshire and Arran, and North Ayrshire Provost Anthea Dickson, with staff, families and guests invited along to learn more about the schemes. Baristamoss is a mobile unit that can be taken out to events to provide delicious hot drinks, allowing those involved to learn barista and customer service skills. It is also hoped that the scheme can become part of plans for a future community café at Trindlemoss. New beauty room ‘The Glam Hideaway’ will see participants being supported by qualified trainers to develop practical beauty skills including hair, nail and make-up treatments, with the potential to provide services as a community enterprise as the project progresses. These exciting projects will help adults with a learning disability to access vocational training and potentially gain recognised qualifications – which could lead to future employment opportunities – as well as providing social opportunities, valuable transferable skills and boosting well-being. 3.11 A group from Trindlemoss Day Opportunities achieved a Gold Award as part of the RSPB’s Wild Challenge Awards programme. Stewart Baird, Mark Stevenson, Darren Cousar and Elaine Rae have been busy taking part in the scheme, which has seen them discovering, learning about, and helping wildlife in its natural habitat. 51
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29 Having already completed the Bronze and Silver levels, the team worked extremely hard over a number of weeks to achieve the highest accolade in the Gold award, with each level of the programme requiring the completion of a total of six activities. Each award level is split into two categories, a ‘Help Nature’ section that involves making our outdoor spaces wildlife friendly, and an ‘Experience Nature’ section, where participants get up close and personal with wildlife and explore the amazing world of nature on our doorsteps. The group took part in a host of activities throughout the challenge, including building bat boxes, bird boxes and bee houses, local plant and mini-beast safaris, and creating a fantastic mini-pond within the garden area at Trindlemoss. They’ve also enjoyed a visit to Eglinton Park, where they tried pond dipping and discovered some newts, as well as RSPB Lochwinnoch to explore the various wildlife habitats there. 3.12 Arran Community and Voluntary Service aims to increase networking opportunities for partners and third sector services as well as increase awareness of all services available across North Ayrshire to promote joint working between statutory and third sector and community organisations. During 2023 to 2024 it ran workshops in partnership with Outside the box on Human Rights and Equalities, ‘what does a good life look like’. It also supported the Whole Family Wellbeing Fund award panel and brought applicants together for collaborative discussions. Furthermore, it supported the roll out of the North Ayrshire Council no wrong door policy, including facilitating at a tackling poverty event and inviting along relevant key speakers from the third sector. The work of the Arran Community and Voluntary Service has led to improved referral pathways for people needing to access services and support available from within the third sector as well as an increase in the number of people accessing community resources to support improved mental health. The Arran Community and Voluntary Service collated impact data and specific feedback as part of monitoring returns and were able to track improvement in attendance at activities and outcomes being delivered. Impact is also evidenced by the fact that groups and organisations as well as individuals from within the HSCP regularly seek out input and support, and proactively approach the service for guidance and ideas, or introductions to other organisations. 3.13 The new ‘Building Caring Communities’ unpaid carer strategy for 2023 to 2025 was launched in October at an event held at Ardeer Community Centre in Stevenston. Co-hosted with our strategic partner Unity Enterprise, the launch event welcomed over 50 guests and partners including adult and young carers, our constituted carer groups from Three 52
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30 Towns and North Coast, Alzheimer Scotland’s Dementia Carers Group and colleagues from North Ayrshire Council. The event was opened by Chief Social Work Officer Scott Hunter, who shared the strategy’s aims, intentions and key priorities, which are that all carers are identified, supported and valued, as well as being afforded an opportunity to live, work, thrive and stay connected to their communities and enjoy a life alongside their caring role. Unity went on to describe the expansion plans for the new North Ayrshire Gateway Carers Service, with an increase in carer staff, extended service hours and plans for an outreach model that will see support more accessible on carers’ doorsteps. National Indicators Indicators NAHSCP Scotland Adults receiving any care or support who rated it as excellent or good 68% 70% People with positive experience of the care provided by their GP practice 60% 69% Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections 83% 77% 53
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31 Develop and Support Our Workforce National Outcomes 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. 9 Resources are used effectively and efficiently in the provision of health and social services. 54
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32 4.1 At our celebration of care event, otherwise known as the Partnership Awards, which were held on the 20 June at the Volunteer Rooms in Irvine, we celebrated the contribution of our staff, both individually and collectively alongside the crucial role that our volunteers and partner agencies also play. Winners included Lisa Kerr (Individual trailblazer award) and Geraldine Cairns (Partnership Champion award), both from the Justice Service Teams. In terms of Team Awards the Refugee and Resettlement Team were chosen as Partnership Champions and our Breastfeeding Network’s Peer Supporters where crowned Volunteer Champions. The event was a fantastic celebration of the staff, teams and individuals who support or deliver health and social care in North Ayrshire - and importantly, the crucial work of people in our communities who support others to improve their health or well-being. 4.2 The Partnership has experienced significant workforce challenges across the Health and Social Care sector, including and probably the most challenging of these being on the island of Arran. There are a number of plans underway to address current vacancies on the island including specific targeted recruitment campaigns for a number of health and social care vacancies. The new health and social care accommodation, Glenartney, opened its doors in 2023 and has already been a huge benefit in being able to provide high quality accommodation for staff who commute to work on the island. 4.3 Several managers within the Health and Social Care Partnership successfully completed our Systems Leadership course during 2023 to 2024. There is considerable change and reflection ongoing with regards to how we transform the services we deliver, to ensure we maximise outcomes for services users, whilst working within a very challenging financial climate. The course has been designed to introduce social work and social care professionals to system leadership. The training combines theoretical learning, practical application, and collaborative experiences to equip participants with the tools and strategies needed to work and progress in complex human systems. Programme objectives include creating whole 55
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33 system awareness within the organisation, the creation of a peer learning environment, connecting system leadership ideas and practices, offering a range of practical tools and mental models to work with complex systems and to finally provide space for personal reflections and for facilitated support to help progress personal and group change objectives. 4.4 The Emergency Department at Arran War Memorial Hospital treats around 2,500 patients each year, ranging from people who are acutely unwell and who need immediate helicopter- transfer to the mainland; those who can transfer via ferry; those who require admission to the inpatient facility; and those who require to be seen and treated on the same day. The complexity of patients presenting to the hospital is increasing and given that the hospital’s nursing team work across all departments, the level of nursing skill required is also increasing. To support staff and ensure high quality health and care continues to be delivered, a new Nurse Practitioner role was developed along with a training and competency framework. The goal was to develop a more advanced level of nursing, where staff can see, treat, and discharge patients (within their scope of competency). Glasgow Caledonian University has supported Nurse Practitioners via a post-graduate certificate in ‘Advanced Practice’ moulded around remote and rural island practices. Staff on this course are supported by their GP and Advanced Nurse Practitioner colleagues. 4.5 Staff were invited along to an open day at Castleview Hub in Ardrossan in June to have a look around NAHSCP’s newly refurbished training hub for Care at Home staff. Housed in the former Castleview Day Services building in Glasgow Street, the facility will act as a hub for staff working within the service to learn the essential moving and handling skills they require in their day-to-day role, allowing them to move and position clients safely, respectfully, and in a way that promotes their independence, dignity and functional mobility. 4.6 Over the last 3 years our Staff Wellbeing Programme has delivered several successful wellbeing initiatives/activities to support the wellbeing of Primary Care & Social Care staff, GPs, Third & Independent Sector providers who are commissioned by HSCP, Personal Assistants, Volunteers and Unpaid Carers. This work was initially funded by the Scottish Government in 2021/22 and has been funded solely by North Ayrshire’s Integrated Joint Board (NAIJB) for the last 2 financial years. In conjunction with North Ayrshire Leisure, we have delivered online weight management, physical activity and yoga sessions, as well as staff health checks and free gym passes. In 56
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34 addition, staff have had access to Mindfulness sessions, Trauma Release Exercises and a whole host of online sessions delivered by Optima Health, designed to support the health and wellbeing of staff across the above sectors. Feedback from a recent staff survey has recognised the value of teams coming together to undertake team development days and building resilience. Taking into account the feedback from the staff survey, the Staff Wellbeing Programme will continue to provide a range of opportunities to support physical and mental wellbeing by engaging with KA Leisure and Optima Health. 4.7 The Primary Care & Social Care Staff Wellbeing Grant scheme has been available for the last 3 years and staff have applied to fund activities such as resources and materials to host a wellbeing event; outdoor activities such as walks and fun days; the purchase of services such as an exercise instructor/wellbeing coach/ or appropriate teacher, funding to support a colleague to upskill in a wellbeing activity to allow them to cascade to colleagues and other employees, creation of a wellbeing space. There had also been the opportunity for individuals to attend one to one wellbeing activities, reflecting that some people could not join team activities for example a voucher for a coffee or a one-to-one wellbeing activity for example a massage. Our Community Nursing staff were provided with ‘well-being’ experiences, with staff from the Irvine, Kilwinning, Garnock Valley, Ballot Road and Bourtreehill teams all being given the opportunity to benefit from the HSPC Primary & Social Care Grants Scheme. Staff commented that this was "a fantastic team reward for the effort they put in during COVID19…team morale got a real lift from it." Our commitment to high quality services is underpinned by our excellent workforce. We understand the importance of ensuring our team of dedicated staff are supported and provided with mechanisms that support their health and wellbeing. Therefore, the Wellbeing Grant Scheme will focus on team building/development through organised events, as well as the creation of wellbeing spaces for teams. Some examples are: • Golfing activities • Sporting activities • Holistic activities (for example meditation/sound bathing/drumming/forest bathing etc) • Holistic treatments (for example massage/reiki/reflexology) • Group walk/hike • Experience/Escape Rooms • Therapy animals • Art Therapy • Field Days 57
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35 4.8 The Staff Wellbeing Centre at University Hospital Ayr was officially opened by Scottish Government’s Deputy National Clinical Director, John Harden who had this to say: “The staff wellbeing centres recognises the need for our workforce to have a place where they can decompress, out of the public eye. To ensure stable, effective and functioning health and care services we must take care of the people who provide this care. For many of us what we see in our day-to-day work, and what we lived through in the pandemic, has made it harder to find meaning and satisfaction in our work. Yet it is by finding meaning and satisfaction in what we do that is so crucial in preventing burnout and disillusionment. 4.9 The Three Towns Locality and CASST team held a development day in Saltcoats Town Hall, with 34 members of staff attending. Special thanks go to facilitators David Roxburgh and Lynn Robertson from Learning and Development, as well as Team Managers Christine Hoggan and Drew Maxwell. The day was a roaring success and revitalised the team in terms of morale, inner strength and team spirit. The Child and Adolescent Specialist Substance Team (CASST) works with children and young people (aged 5 to 21) who are affected by alcohol and/or other drug use, whether that be their own use or that of a parent, carer or another member of the family. CASST provides an intensive support service to young people and their families by delivering a tailored programme based around their needs, as identified during an initial assessment. 4.10 We were delighted to have a visit from Project Wingman during the summer who are a wellbeing charity aiming to support the wellbeing of frontline healthcare staff via converted double decker buses which have bespoke mobile lounges. This was a joint enterprise with East and South Health & Social Care Partnerships. 58
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36 Project Wingman provided a unique facility to allow staff the opportunity to simply sit down, decompress, de-stress and unwind during their working day in the community. Staff at all the sites were really grateful for the chance to relax away from the working environment and thoroughly enjoyed the onboard chair and foot massagers. Project Wingman was a success at all the locations the bus visited and we wish to thank the Project Wingman Crew for being so welcoming. 4.11 An innovative new group for North Ayrshire’s Recovery Development Workers held an inaugural meeting at Caley Court in Stevenston. The North Ayrshire Recovery Development Worker Forum offers an opportunity for lived experience support workers from NAHSCP’s Alcohol and Drug Recovery Service (NADARS), Service Access and Justice Services team, as well as their counterparts from Turning Point and Barnardo’s, to come together and share their experiences, learn more about the work of the other services, identify training requirements or shadowing opportunities, and provide support for each other as they move forward in their roles. As paid staff members within their individual teams, Recovery Development Workers provide support to some of North Ayrshire’s most vulnerable clients, proving to them that recovery is possible and supporting them in a number of ways, both in group and one-to-one sessions. 4.12 As part of the NAHSCP Learning and Development Strategy 2023-28 we stated that we are committed to making sure that staff are supported to Be The Best They Can Be. As part of this commitment, we are delighted to say we have been working in Partnership with The Skills Network to develop new and Free learning opportunities for our staff. These courses are funded through The Scottish Funding Council and are distance learning providing staff with the opportunity to learn at a time that suits them. A snapshot of some of the courses available: • Allergy Awareness Adult Social Care • Awareness of Mental Health Problems • Certificate in Counselling Skills • Certificate in Falls Prevention Awareness • Equality and Diversity 59
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37 • Principles of End-of-Life Care • Understanding Mental Health National Indicators Indicators NAHSCP Scotland Readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 101 104 Percentage of adults with intensive needs receiving Care at Home (all levels of CAH) 78% 65% Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1,000 population 1,087 902 60
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38 Improve Mental and Physical Health and Wellbeing National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 5 Health and social care services contribute to reducing health inequalities. 9 Resources are used effectively and efficiently in the provision of health and social services. 61
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39 5.1 In early April, we opened applications for our bespoke Mental Health & Well Being fund. This fund allows applications for support for up to £500 per child, young person or carer/parent. This may be for a specific one off spend or a more regular payment of support over a longer period of time. The fund is designed to specifically target issues of mental and emotional distress and wellbeing rather than mental illness. It supports an approach based on prevention and early intervention. This fund is to assist Children and Families staff to work in partnership with a child/young person and their family to coproduce a support package that will provide positive solutions to support and improve their mental health and wellbeing needs. Support and services should be provided to children and young people who will benefit from additional help to promote, manage, and improve their mental health and wellbeing and to help them develop coping strategies and resilience. This support may be required for a variety of reasons and may be of a holistic nature, some issues though not exhaustive that may be as follows associated with distress; anxiety, attachment distress, bereavement support, depression (mild to moderate), emotional and behavioural difficulties associated with neurodevelopmental disorders, gender identity, repetitive/perseverative behaviours, self-harm, self- injury, substance misuse, trauma. Supports can also relate to Positive Mental Health and Wellbeing and may include issues such as: body image and self-esteem, building resilience and coping strategies (emotional regulation), healthy and positive relationships, healthy digital interaction, parenting support for children and young people of all ages. 5.2 As of November 2022, and following an extensive data collection and analysis exercise exploring activity and pressures, the number of beds available within Ward 7A was permanently reduced from 10, to 7. As a result of this change, the ward has seen a variety of benefits, including reduced levels of behaviours perceived as challenging, and space to explore new developments, with a view to improving the care environment and client experience. Its ongoing involvement in the Scottish Patient Safety Programme learning collaborative has provided a vehicle for gathering data to reflect this and other changes within the ward, with reductions evident since the change in bed numbers in rates of restraint, and incidents of violence and self-harm. 62
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40 5.3 During the summer holidays, a fun day took place for families involved in our Family Centred Wellbeing Service with a focus on promoting health and wellbeing. The event saw partnership working with Active Schools co-ordinators who helped to facilitate various physical activities such as archery, tennis and football for the children and their families. The aim was to involve young people and their families in a range of activities that they could continue to access within their local areas after the fun day concluded. Despite the rain, everyone made the effort to come along, and a great time was had by all. In total, there was 40 children and adults who attended. 5.4 In October 2023, we received the written findings of a recent Care Inspectorate unannounced inspection of one of our residential Children’s Houses, Abbeycroft, within the town of Kilwinning. The service was inspected in relation to the following key area: • How well do we support children and young people’s rights and wellbeing. The service received a scoring of 5 (in evaluating quality, a six-point scale is used where 1 is unsatisfactory and 6 is excellent). The inspection feedback contained information such as “young people within Abbeycroft were supported to be kept safe, young people had the opportunity to undertake activities that were age and stage appropriate. Staff worked alongside young people to try and help them understand risks they were involved in and how to support them to ensure their safety and wellbeing.” 63
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41 Feedback also intimated that “the management team were committed to ensuring that trauma informed practice continued to develop within the service, excellent resources were developed to help analyse staff’s understanding of trauma. This led to staff being highly skilled and having a good understanding of the young people they support.” Furthermore, evidence was also found “to support that the young people were supported with their physical and mental health and that here was good knowledge within the staff team around mental health and that staff have undertaken training to enhance their knowledge in this area.” 5.5 Case Study: Mind and Be Active Working alongside KA Leisure, the ‘Mind and Be Active’ initiative aims to improve the mental health and wellbeing of local people, by providing support to increase levels of physical activity. The model builds on the understanding that physical activity can enhance wellbeing, by increasing mental alertness, energy, positive mood and self-esteem - whilst reducing stress and anxiety. People can self-refer or a referral may be via a health professional. People who use the service receive support and encouragement from specially trained members of staff, who guide them to a more active lifestyle. Feeback from service users has been very positive: “Just to say when I was feeling very low and in a very dark place and on medication, I had phoned the [metal health] nurse who then referred me to The Active Lifestyle team at Vikingar to participate in their referral exercise classes. So, I went along and was made to feel really welcome and met lots of people. It was hard at first but eventually I recovered and managed to come of my medication. It was the social aspect and the exercise “It saved me “and I am still going to this day. I am living my best life too!!” “I am grateful for someone taking a chance on me and believing there was something worth saving”. 5.6 A report produced by NHS Ayrshire & Arran’s Prevention and Service Support Team has highlighted the positive impact of Naloxone distribution and use in North Ayrshire. This safe and easy-to-administer medication temporarily counteracts the effects of opioids, such as heroin, methadone, codeine, morphine and buprenorphine, and can save lives by reversing an overdose for 20 to 40 minutes until emergency help arrives. 1,710 Naloxone kits were handed out in Ayrshire between April 2022 and March 2023 (846 of which were in North Ayrshire), with 51 lives reported to have been saved in that time (31 in North Ayrshire). However, the true number of lives saved is thought to be higher, with many instances of Naloxone use going unreported. In addition, a total of 1.311 people received overdose awareness training across Ayrshire in the same time period, with a further 378 people attending a virtual or face to face Naloxone awareness course. 5.7 An Alcohol Brief Intervention (ABI) is a short, evidence-based and structured conversation about alcohol consumption with a patient/client. It seeks - in a non-confrontational way - to motivate and support the individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm. 64
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42 The Scottish Government set the NHS in Scotland a target of delivering 149,449 brief interventions on alcohol between 2008 and 2011, known as the HEAT (Health Improvement, Efficiency, Access & Treatment) H4 target. The Local Delivery Plan (LDP) Standards now replace the system of HEAT Targets and are set and agreed between the Scottish Government and NHS Boards to provide assurance on NHS Scotland performance. Ayrshire and Arran has a target delivery of 4,275 ABIs within the local delivery plan. It is expected that at least 80 per cent of delivery will continue to be delivered in the priority settings. The remaining 20 per cent can be delivered in wider settings in accordance with national guidance. Monitoring and reporting of ABI activity is undertaken within the Prevention and Service Support Team (PSST) within NHS A&A’s Alcohol and Drug Services. Both targets were met within the reporting period of April 2022 to March 2023, with 4,933 ABIs delivered within the priority settings and 1,207 ABIs delivered within wider settings. 5.8 Trindlemoss Day Opportunities in Irvine held its first ever festival event in September. ‘TM Fest’ was a day to remember, with musical entertainment provided by customers and staff, all of whom had put a lot of effort into their costumes, props and acts. A performance of ‘Shang-a-lang’ was voted the best of the day, with the winning participants receiving medals for their efforts. Those attending, who included friends and families of Trindlemoss customers and other invited guests, also enjoyed a disco, bongo bingo, lunch, a raffle, and a visit from two beautiful donkeys. A great time was had by all, with everyone heading home happy (and exhausted) afterwards. 5.9 There have been a number of planned visits from the Mental Welfare Commission to inpatient areas including Warrix Avenue and Ward 6 which was visited for the first time. Feedback has been very positive with comments on the high-quality environment at Warrix describing this as peaceful and bright with spacious, well equipped individualised flats. Feedback from patients was that they feel the environment is more "relaxed and quieter than hospital". Person centred care plans evidenced patient and carer involvement and clear nursing intervention that "support positive progress and transition plans towards discharge". Supported by individually tailored activity programme to support patient needs and specific to proposed discharge area. The Mental Welfare Commission were impressed by the enthusiasm and commitment shown by the team in Ward 6. Patients spoke highly of the team and felt involved in their care and decisions. The care plans are person centred and reflective of patients’ needs with evidence of robust regular review of risk assessments. The patients valued the activities on offer as "it gave a sense of purpose and value" and provided positive recognition of the benefits of attending the Low Intensity psychological groups to support their progress. 65
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43 5.10 North Ayrshire Libraries won the Scottish Library & Information Council (SLIC) Project Excellence Award for their pioneering work in supporting those recovering from problematic alcohol and/or other drug use. The awards recognise the outstanding levels of commitment, creativity and value that libraries can offer the communities they serve. The partnership between North Ayrshire Libraries and North Ayrshire Drug and Alcohol Recovery Service saw the creation of a safe, supported, non-clinical environment in Kilwinning Library on a weekly basis for NADARS staff, service users and their families to attend. Library staff participated in drug/alcohol awareness and Naloxone training, delivered by the NHS Prevention and Service Support Team, with service users also being able to access a wide range of library services during the sessions. The project was set up to support the Scottish Government's Medication Assisted Treatment (MAT) standards, which address how people are encouraged to engage in and remain in treatment to support their recovery from problematic drug use by accessing support locally. 5.11 Support for people with dementia in North Ayrshire received a boost after the Anam Cara respite centre in Kilbirnie re-opened following an extensive refurbishment project. The specialist dementia respite centre will accommodate up to 9 guests aged 60 years or over, offering critical respite services within single room, en suite accommodation. The refurbishment project included a complete transformation of the main garden area, including new garden furniture, with a ramp installed from the conservatory to allow better access for guests to enjoy the outdoors. An additional, smaller garden area adjacent to the dining area has also had some landscaping improvements made. New flooring has been installed throughout the ground level, with new décor, furniture and soft furnishings creating a welcoming and homely feel for guests and staff. In addition, new TVs have been located in each room and Wi-Fi connection has been improved throughout the building. Artworks for the walls of Anam Cara were very kindly donated by members of both Beith and Irvine camera clubs, featuring recognisable images taken throughout North Ayrshire to help stimulate memories and talking points for guests staying at the facility. National Indicators 66
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44 Indicators NAHSCP Scotland Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 68% 70% Proportion of last six months of life spent at home or in community setting 88% 89% 67
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45 MSG Indicators Indicators Value Emergency admissions to acute hospitals 18,135 Emergency admissions to acute hospitals (Rate per 1,000) 135.6 Admissions from emergency department 8,852 Admissions from emergency department (Rate per 1,000) 66 Percentage of people at emergency department who go onto ward stay (conversion rate) 26.6% Unscheduled ‘hospital bed days’ in acute hospital 138,144 Unscheduled ‘hospital bed days’ in acute hospital (Rate per 1,000) 1029.6 Unscheduled ‘hospital bed days’ in long stay mental health hospital 26,605 Unscheduled ‘hospital bed days’ in long stay mental health hospital (Rate per 1,000) 198 Unscheduled ‘hospital bed days’ in geriatric long stay 5,831 Unscheduled ‘hospital bed days’ in geriatric long stay (Rate per 1,000) 52.8 Emergency department attendances 33,270 Emergency department attendances (Rate per 1,000) 248.4 Percentage of people seen within 4hrs at emergency department 66.70% 68
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46 MSG Indicators – Delayed Discharges Indicators Value Delayed discharges bed days (all reasons) 23,995 Delayed discharges bed days (all reasons) (rate per 1,000) 219.6 Delayed discharges bed days (code 9) 8,917 Delayed discharges bed days (code 9) (rate per 1,000) 81.6 Delayed discharges H&SC Reasons 15,078 Delayed discharges H&SC Reasons Rates 138 69
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47 National Health and Wellbeing Indicators The Scottish Government identified 23 (4 remain in development) indicators that were felt evidenced the 9 National Health and Wellbeing Outcomes. Nine indicators come from the biennial Health and Care Experience Survey (see below) and the additional 14 indicators (also below), which evidence the operation of NAHSCP, come from the NHS Information Services Division (ISD) survey. This survey represents a sample of the community and asks about the collective services received whether it be from Social Services, NHS, the collective HSCP, Private or Voluntary organisations. The survey responses do not separate each organisation’s service provision. The information below represents the most up-to-date information with further updates accessible from – Public Health Scotland. Health and Social Care Experience Indicators 2015 to 2016 2017 to 2019 2019 to 2020 2021 to 2022 2023 to 2024 Scottish Average Percentage Rank against Family Group Adults able to look after their health very well or quite well 94% 91% 92% 89% 89% 91% 2 Adults supported at home who agreed that they are supported to live as independently as possible 82% 84% 84% 81% 67% 72% 7 Adults supported at home who agreed that they had a say in how their help, care, or support was provided 78% 70% 75% 73% 51% 60% 8 Adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 73% 74% 76% 64% 55% 61% 7 70
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48 Health and Social Care Experience Indicators 2015 to 2016 2017 to 2019 2019 to 2020 2021 to 2022 2023 to 2024 Scottish Average Percentage Rank against Family Group Adults receiving any care or support who rated it as excellent or good 81% 78% 77% 76% 68% 70% 5 People with positive experience of the care provided by their GP practice 83% 80% 73% 61% 60% 69% 6 Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 83% 82% 79% 78% 68% 70% 6 Carers who feel supported to continue in their caring role 41% 39% 31% 31% 32% 31% 6 Adults supported at home who agreed they felt safe 80% 80% 85% 83% 67% 73% 7 To support service improvement, the Scottish Government has identified local authority / Partnership benchmarking families. These family groups are made up of eight local authorities that share similar social, demographic and economic characteristics. Comparing our performance information with our family group should provide a more meaningful comparison with similar areas and allow for greater opportunities for shared learning and best practice. Rankings are on a scale of 1–8, where 1= best performing, 8=worst performing. North Ayrshire is partnered in its family group with: East Ayrshire, Dundee, Western Isles, Glasgow, Inverclyde, North Lanarkshire, and West Dunbartonshire. 71
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49 Indicators based on administrative data 2019 to 2020* 2020 to 2021* 2021 to 2022* 2022 to 2023* 2023 to 2024* Scottish Average Percentage Difference Rank against Family Group Premature mortality rate. (Under 75s age-standardised death rates for all causes per 100,000 population). 501 516 568 527 Unavailable 442 4 Rate of Emergency Hospital Admissions for adults (per 100,000 population) 16,142 13,860 14,269 13,449 14,009 11,707 5 Rate of emergency bed days for adults. 156,904 138,799 155,206 151,553 142,222 112,883 7 Readmissions to hospital within 28 days of discharge. 108 122 113 100 101 104 5 Proportion of last 6 months of life spent at home or in community setting. 87% 89% 89% 88% 88% 89% 6 Falls rate per 1,000 population aged 65+ 22 18 20 20 22 23 4 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections. 88% 87% 79% 78% 83% 77% 2 72
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50 Indicators based on administrative data 2019 to 2020* 2020 to 2021* 2021 to 2022* 2022 to 2023* 2023 to 2024* Scottish Average Percentage Difference Rank against Family Group Percentage of adults with intensive needs receiving Care at Home. (All levels of CAH) 74% 73% 77% 77% 78% 65% 8 Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1000 population) 1,329 382 805 1,038 1,087 902 6 *Column contents are the most up to date data information received from Scottish Government statisticians. As well as the National Health and Wellbeing indicators, we regularly report on local measures to help us to evidence performance against the nine National Health and Wellbeing Outcomes and our Strategic Priorities. The list of local indicators can be found in Appendix 1. The full list of indicators can be found in Appendix 2. 73
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51 Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes 74
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52 Children’s Outcomes Outcome 1: Our Children have the best start in life and are ready to succeed. Outcome 2: Our young people are successful learners, confident individuals, effective contributors, and responsible citizens. Outcome 3: We have improved the life chances for children, young people and families at risk. 1.1 The Promise is a large-scale, complex 10-year change programme with multiple objectives and interlinked activities, across multiple partners that sets out a clear commitment for all corporate parents to have an enhanced understanding of the experiences of those who have spent time in care. Progress continued this year focusing on: Social Media A new North Ayrshire Will Keep The Promise Instagram Channel is now created and growing to reinforce that The Promise is a shared duty between corporate parents but to also share relevant information to our care experienced young people in a trending way. Care Experienced Youth Groups Formed a Care Experienced Youth Group within all Secondary Schools within North Ayrshire to give care experienced young people a platform to use their voice to initiate real change as well as having a safe space to communicate with staff and one another. The young people involved will help to support the rights of fellow care experienced young people in North Ayrshire. Awareness Raising and Training The Corporate Parenting team have worked alongside young people to create a presentation that will be delivered within secondary schools and colleges to raise basic awareness of care experience and provide an insight into what rights and entitlements are out there. 1.2 Our North Ayrshire Champions Board have created a Care Experienced App named "CE4U". The app has lots of tips, advice, and information that we believe will help Care Experienced young people throughout their journey and beyond. The app has a little bit about everything from housing support, learning how to cook using recipes, tips on how to look after yourself physically and mentally, travel support as well as key contacts and events happening in your area. North Ayrshire Champions Board used their own experiences and journeys to produce the idea for an app as they often found they didn't know a lot of the information that was out there or they simply didn't know who or what to ask to find it for them, and so Scotland's very first Care Experienced app was created. 75
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53 1.3 Case Study: Short Break Carer “There’s so many little things that just make you smile.” That’s how one short break carer has summed up her experience in the role so far. Alison has been a short break carer for North Ayrshire Health and Social Care Partnership (NAHSCP) for just over a year, having previously been a foster carer in Edinburgh. Providing regular midweek and weekend short break care to children in her own home, Alison’s offers respite to kinship carers and full-time foster carers, as well as birth families who are affected by child protection issues such as parental alcohol and/or other drug use or neglect. For some families this may be a one-off requirement, while others may need regular short breaks to assist them in caring for their children. Alison said: “I currently provide regular short breaks to five children, aged from 5 to 8 years, as well as one-off breaks of up to a week or two, normally during holiday periods. “While there can be challenges, it’s so rewarding seeing the kids change and grow in confidence as they experience new things. Children often get the opportunity to try new activities that they might not be able to at home, for a number of reasons. For example, they may live with older grandparents who aren’t physically able to do things outdoors that involve a lot of walking. “I enjoy getting to know each child as an individual and love getting out and about exploring Ayrshire from a young person’s point of view. It’s also really great being able to meet up with other carers and their children.” Short break carers work closely with parents or carers of the children they look after, which offers an insight into a child’s background, interests, likes and dislikes, as well as any behavioural triggers that they might experience. Alison added: “Some children like routine and structure, whereas other don’t need that as much. Some enjoy visits to Bounce Station or a museum, while others will prefer to do some baking at home, watch a film or dig channels on the beach for the tide to fill up. I try to do both indoor and outdoor activities with all of the children I look after. “We also enjoy preparing and trying new foods together There’s so many little things that just make you smile.” Alison, who works four days a week from home as a Charity Fundraising Manager, also praised the support she receives from NAHSCP as part of her role. She added: “I have a designated social worker who I can contact by telephone or email if I need to, and the training I have received has been invaluable, covering all sorts of topics such as communicating with children and managing behaviour, attachment and trauma, Theraplay, and autism and ADHD training. 76
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54 “I find that the face-to-face training sessions offer a great opportunity to meet up and chat with other carers, and we also have a WhatsApp group where carers keep in touch and offer advice and moral support.” Alison said: “When I first applied to be a short break carer, I wasn’t sure I’d be accepted, as I was single and over 50. However, it turned out that wasn’t a barrier, and I’d advise anyone who is thinking about applying to just contact NAHSCP ask those questions.” Councillor Margaret Johnson, Cabinet Member for Health and Social Care at North Ayrshire Council, said: “Some children and young people may experience difficulties in their home lives, for a variety of reasons. “The Short Break Service gives them the opportunity to spend time in a home environment where they feel safe, secure and well cared for, and can also provide stability to their families or carers by lending additional support and giving them a break from their caring responsibilities. “This is an extremely important and rewarding role, and I’d urge anyone who is interested in applying to please get in touch to find out more.” 1.4 Health and Social Care have begun the implementation of the ‘Signs of Safety’ assessment and planning model. This model places parents, children and everyone naturally connected to the child at the centre of the assessment, decision-making and planning and is a significant paradigm shift for children’s services, where the dominant culture is for professionals to define the problems and what is required to solve them. The Signs of Safety practice principles support our vision that the best place for children and young people to grow up is within their families and networks where they have the potential to care for them safely. When this is not possible, we will provide a secure, stable home, and help them achieve their full potential. We went fully live with Signs of Safety for all new cases in September for Children and Families Locality teams and the Child Protection team. Prior to then we had a period from June where we used the approach with a small amount of practice in order to build workforce confidence and knowledge. Since then, we have utilised this practice framework with over 300 children and young people This is great progress, but we recognise there is ongoing work to build all our confidence in establishing the approach. The focus is on recognising and acknowledging families’ strengths and encouraging them to identify solutions to any identified worries or to assist them to reduce harm, alongside the support of services. We are moving into our second year of a 5-year implementation plan to fully embed the model in practice. Over the next year we will transition all work with families over to a Signs of Safety model approach. Social Work Children and Families Teams will be working to ensure this support model is implemented for all children and young people receiving a service. 1.5 Our Children and Adolescent Specialist Support team (CASST) were able to create a modern apprentice opportunity thanks to CORRA foundation funding, It was agreed that the team would benefit hugely from recruiting someone with lived experience of substance use in order to support the team in their endeavours to deliver positive interventions to children and 77
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55 young people who are either involved directly in substance use themselves or live within a household where there is problematic substance use. Our modern apprentice has only been in post for a short period of time; however, they have been able to capitalise on their previous adversities and utilise them in a positive way to assist our young people who are currently being supported by the CASST team. In fact, during the recruitment process for the Modern Apprentice, a number of candidates showed wonderful potential, and our Learning and Development team engaged with them in order to help them seek other opportunities within the HSCP and wider Council. 1.6 Case Study: Young Carer A young carer was the only person in his under 13 ice hockey team to be invited to play competitively for Scotland in Bratislava. This would open further opportunities to represent his country at other games over the coming year, help to find sponsorship and potentially offer pathways beyond school and his caring role for an older relative whilst mum worked. Ice hockey is his break from caring and the family were experiencing financial difficulties, with £1,200 the young carer was accompanied to be part of trial competitions, it relieved him from his caring role and mum did not have to take on extra work and could provide more care to her mother… good news … the young carer made it to the final selection for the 2024 Scotland team due to his attendance, ability, commitment and effort. 1.7 From 1st April 2023 to 31st March 2024, the Rosemount Project received referrals to work with 127 families across North Ayrshire. There were nine referral sources, with the Three Towns Children & Families (C&F) locality the most prolific referral source (28%). This was followed by the Families for Children team (25%), and then by the Irvine C&F locality team (20%). The varied referral sources out with this were – the Garnock Valley/North Coast C&F team (14%), Kilwinning C&F team (5%), Service Access/MAASH (4%), Kinship (2%), the Children and Families Disabilities Team (1%), and the Programmes Approach Team (1%). This gives an indication of the diverse needs and complex difficulties that the Rosemount team encounters, working alongside colleagues across our services to support children, young adults, and parents/carers in different settings, each with their own challenging circumstances. There has been a significant uplift in referrals from the Families for Children team from the previous year, which is partly due to Rosemount having ongoing access to a Family Wellbeing Support Worker, whose post is funded via The Promise. The need for this post has been influenced by both the findings from the independent care review in Scotland, and lobbying by sibling’s rights groups, which has informed amendments to the Children (Scotland) Act 1995. The service will continue to work towards the implementation of Signs of Safety, with a focus on how we can work even more effectively with colleagues, parents/carers, and wider family networks to ensure as many children as possible are supported to remain within their communities and at home with their families. 1.8 The Whole Family Wellbeing Fund (WFWF) is a £500 million investment by the Scottish Government to support the whole system transformational change required to reduce the need for crisis intervention and shift investment towards prevention and early intervention. Within North Ayrshire multiple activities have been actioned to make use of available funds: 78
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56 Family Centred Wellbeing Service The Family Centred Wellbeing Service (FCWS) is a partnership between North Ayrshire HSCP and Education, targeting early intervention support to school aged children and their families. WFWF has allowed the service to expand to all areas of North Ayrshire, as well as to secondary-aged children. Intensive and Therapeutic Counselling Support for Care Experienced and Vulnerable Young People The WFWF has allowed more children to benefit from intensive therapeutic counselling from the Notre Dame Centre with criteria widened from experience of sexual abuse to wider, significant trauma. Support in the Early Years The WFWF is supporting the expansion of the Early Years Social Worker team within North Ayrshire. This will enable a focus on both early intervention and prevention, recognising the increasing level of need in critical areas in respect of parental mental health and domestic abuse. Dads’ Support Worker A partnership between national charity Dads Rock and the Universal Early Years service, supported by WFWF, has introduced a Dads Support Worker to the service. Providing 1-1 and group-based support to dads in the Three Towns area, the role will also allow the service to consider how it engages dads and other male caregivers in the health visiting pathway and associated support. Vicarious Trauma Support and Specialist Counselling for Staff Staff across health, social work and education currently support a number of families experiencing distress, including but not exclusive to bereavement, domestic violence, child neglect and abuse. WFWF will allow staff to be supported through traumatic experiences whilst also providing preventative, supportive training to all staff. Community Charge Nurse for Care Experienced Young People based in Throughcare/Aftercare Team The post will allow for care experienced young people to be seen by a specialist mental health nurse without delay and on an early intervention basis. Neighbourhood Networks Expansion of the two adult neighbourhood networks to include a transitions network for young people with additional support needs who are moving from children’s to adult services and based on their specific needs. Barnardos Stronger Families 79
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57 Barnardo’s have received WFWF funding to scale-up the existing Stronger Families service, providing a focus on Kinship Families who have been affected by substance use. Stronger Families is trauma-responsive and adopts a whole family approach, aligning with the National Principles of Holistic Whole Family Support, The Promise and Children’s Rights. In the short time it has been operating, it has proven to be an effective and successful approach to supporting Children, Young People and Families impacted by substance use. Impact Arts Through WFWF investment, Impact Arts plan to run two six-month programmes a year for two years in different localities in North Ayrshire, working with ten to twelve parents or kinship carers in each programme, to support them to: better understand their child(ren)’s behaviour; develop tools to connect, communicate and support their child(ren) including approach (for example activities being led by the child; being curious), language and play activities; identify their own needs and develop coping strategies for themselves; connect with other parents, access peer support, and develop their local support networks by linking in with other local organisations which can support other aspects of family life. Ko-nekt Delivery of three 15 week “Nurturing and Positive Parenting” Courses for parents/carers who are currently awaiting referrals, are on the periphery of social work care and/or are at the point of crisis. This is a new element to the existing work of Ayrshire Children’s Services with the overall aim of developing a Family Wellbeing Service. Neurodevelopmental activity WFWF has allowed further investment in the Neurodevelopmental Empowerment and Strategy Team (NEST) including recruitment of a Project Co-ordinator for North Ayrshire who has supported the mapping of family supports for children with a suspected or confirmed Neurodevelopmental disorder. 80
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58 Justice Outcomes Outcome 1: Community Safety and Public Protection. Outcome 2: The Reduction of re-offending. Outcome 3: Social inclusion to support desistance from offending. 2.1 A group of six clients of North Ayrshire’s Unpaid Work team have received recognition certificates from the Koestler Awards for their original artworks, with one participant also receiving a Highly Commended certificate for a unique wooden birdhouse. The Koestler Awards for arts in criminal justice started in 1962. Each year, over 3,500 people in custody and in the community share their creative work by taking part. The Koestler Awards provide feedback and encouragement to entrants of all abilities in visual art, design, writing and music. 2.2 Case Study: Women’s Service “Having recently completed my order, I can say my experience working with the women’s team has been a valuable one. I moved to Scotland from England to start afresh following the death of my mother and my Community Order was transferred with me. I had managed to come off drugs, but my mental health was not in a good place as I struggled to come to terms with my loss. I remember one night specifically in December 2022, I had strong feelings to end my life, longing to be with my mum. I took a lot of painkillers, after which I reached out to my social worker. She remained on the phone talking to me while trying to access emergency services, however, my GP could not do anything as it was after hours and ambulance services were up to a three hour wait. My worker came and got me at my home, transported me to the hospital and remained with me until I was assessed by a medical professional. This, for me, was a turning point. I felt valued as a person and my being here mattered to someone. I had no-one else who I could have turned to that night. From here, I was able to get the help and support to move forward with my life and have never looked back. I experienced probation services in England before 81
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59 but never have I felt such vested interest and level of connection from staff, I believe this is the difference with the women’s service.” 2.3 As a result of having an established Prevent Multi Agency Panel process North Ayrshire are one of only three HSCP’s in Scotland to be selected to participate in the Prevent Multi Agency Panel Hydra training sessions that the Home Office and College of Policing run nationally for Prevent Multi Agency Panel Chairs, their Prevent Police colleagues and standing panel members. Training has been well received and is a key element of their response to the Parsons Green findings. As part of a national training programme, and as part of professional development, the Hydra training has been redesigned this year incorporating much of the feedback received from practitioners. The Hydra training took place in Glasgow in March and is a training platform originally developed for the Police, providing decision-making training for Police functions ranging from investigations to child protection to kidnap situations. The Home Office and College of Policing developed a one-day Prevent Multi Agency Panel -specific training package. The training was a great opportunity to upskill and maintain the focus of colleagues from partner agencies and remind colleagues across the authority of the importance of engaging with the Prevent Multi Agency Panel. 2.4 Case Study: Multi-Agency Public Protection Arrangements Staff Development Day Managing the risk posed by serious offenders was the topic of a Multi-Agency Public Protection Arrangements (MAPPA) staff development day held at Dumfries House in Cumnock on Tuesday 19 March 2024. Multi-Agency Public Protection Arrangements aims to protect the public by providing a framework for local authorities, the police, NHS and prison service to work together to assess and manage the risks posed by sex offenders who are subject to notification requirements under the Sexual Offences Act 2003, as well as mentally disordered restricted patients and other individuals who - by reason of their conviction - are assessed as posing a risk of serious harm to the public. Partners can employ a range of safeguards such as electronic tagging, curfews, sexual offence prevention orders and other civil orders, with a shared aim of reducing the risk of harm to the wider population. Additionally, a number of agencies are required to co-operate in managing the risks posed by high-risk offenders, including Social Security Scotland, registered social landlords, voluntary organisations and companies providing electronic monitoring of offenders. Representatives from Southwest Scotland’s Multi-Agency Public Protection Arrangements Strategic Oversight Group, including senior officers from NHS Ayrshire & Arran, NHS Dumfries & Galloway, Police Scotland, the Scottish Prison Service and all four local authorities in Ayrshire and Dumfries and Galloway, were invited to come together at the event to discuss current developments affecting the Multi-Agency Public Protection Arrangements Attendees at the event heard from retired Detective Superintendent Gail Johnston, who shared some important learning drawn from a recent Significant Case Review, as well as Emeritus Professor Hazel Kemshall - a prominent expert on Multi-Agency Public Protection Arrangements - about what it takes to be an effective Strategic Oversight Group. 82
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60 2.5 The latest Government statistics on Community Payback Orders (CPOs) (2022 to 2023) show that North Ayrshire had the highest of the Ayrshires with 490 Community Payback Orders however was the median of the Ayrshires at 47.3 per 10,000 population. In comparison, East Ayrshire had 488 Community Payback Orders and sits at 51.4 per 10,000 population and South Ayrshire had 399 Community Payback Orders and sits at 46.2 per 10,000 population. The Scottish average is 33.0 per 10,000 population. There was a significant decline in the number of Criminal Justice Social Work Reports (CJSWs) in 2020 to 2021 thought largely to be due to the result of COVID-19, however numbers rose by 40% from the previous year in 2021 to 2022 and continued to rise in 2023 to 2024, albeit at a lesser rate of 15% from the previous year. The latest Government statistics on CJSWs for 2022 to 2023 reveal North Ayrshire to continue to be the lowest of the Ayrshires at 75.7 per 10,000 population. In comparison, East Ayrshire sits at 81.9 and South Ayrshire sits at 85.2. The Scottish average is 68.6 per 10,000 population. Our Justice Services continue to have a positive impact on the local community through the Community Payback Order unpaid work scheme. For over a decade, the eleventh year in fact we have continuously over-achieved against targets for Community Payback Orders level 1 and level 2. 2023-24 saw 73 out of 75 level 1 Community Payback Orders completing within timescales and 146 out of 152 level 2 Community Payback Orders completing within timescales. The targets set for unpaid work are pan-Ayrshire targets. 83
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61 2.6 Following a slight ‘dip’ in Drug Treatment and Testing Order (DTTO) Assessments in 2022 to 2023, the following chart illustrates a marked increase in the recent financial year, with sentencers at both Ayr and Kilmarnock Sheriff Court requesting these reports more regularly due to recent successes and the service adapting to incorporate changes in recent drug trends from depressant substances to stimulant, thus taking into consideration a host of differing offence-types and the focus of therapeutic interventions to promote change. Of the 66 individuals assessed, 47 Orders were imposed across Ayrshire. Due to the nature of the Order, rigorous supervision and much support is provided to all and more recently through the employment of two Recovery Development Workers from CORRA Funding, we have now incorporated active outreach, additional practical supports and community reintegration to complement our existing service. Success is not only measured through an absence of offending behaviour but also progress being made in several areas of life to ensure resilience and to promote longer-term lifestyle changes. 2.7 Diversion from Prosecution (Diversion) has been available since 1997, within this past year we have experienced a further increase across Ayrshire in assessment referrals from the Procurator Fiscal. Referrals have increased at a significant rate from 2018. Although this disposal is early intervention and low-level offending, the presenting need of service users is extremely high, thus resulting in more staff time being allocated and closer partnership working with other agencies to provide identified services. The number of assessment reports submitted are relatively lower than the number requested due to limited resources, which has resulted in waiting lists within each local authority area. In comparison with last year, 2023 to 2024 notes a decrease in the number of Diversion cases imposed. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. In this time many positive changes could have taken place, and individuals are actively seeking and engaging with services to address any issues which they may have, thus reducing their risk of further offending. In these instances, no interventions are required due to positive reasons. 84
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62 2.8 North Ayrshire Council has received Recruit with Conviction Ambassador status. Working in collaboration with the organisation, ‘Recruit with Conviction’, North Ayrshire Council’s new Ambassador status recognises efforts to offer safe and sustainable employment for individuals with current/historical convictions, ensuring that our internal policies and practices are both current and proportionate. 2.9 Case Study: Impact on Families “It’s only now as I sit back and think about what I put my mum and dad through that I really realise the impact I’ve had on their lives.. and no in a good way! I had a good upbringing and my parents were so kind and caring but when I was wee an uncle abused me and I just never got over it. I don’t think I ever will. I’ve buried my head in drugs forever to try and block it out and to be honest... it does work sometimes. But then it all comes back to you and you feel worse. I’ve stolen from my mum and dad and treated them like rubbish. I’ve disappointed them so often and I’ll need to live with that. I would describe myself as being in recovery nowadays... am I perfect? Naw, but at least I’m trying. And I think they can see that. Recently I asked my mum what life has been like with me and we sat and spoke about it over a cup of tea and a wee scone (felt good being able to treat her to one of those by the way!). She admitted that she has been disappointed in me in the past and that was hard to hear. I asked her what it was like visiting her only child in prison and she admitted that she had actually found it really scary at first. She thought the staff seemed nice but all the procedures of getting checked and patted down and the drug dog sniffing you to see if you’re allowed in... that all made her feel uncomfortable and like she had done something wrong. This talk with my mum made me realise the impact our choices have on everyone around us. It made me more determined to succeed in my recovery and not put them through anything like this again. Prison isn’t somewhere anyone wants to be, but it shouldn’t be something our families and loved ones have to experience when they’ve never done anything wrong. At the end of our wee talk my mum told me she isn’t disappointed in me anymore.. I’m hoping it’s not just the scone talking.. but it was brilliant to hear anyway!” 85
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63 Reporting on localities North Ayrshire is home to approximately 134,220 people, all living in its many towns, villages, and islands. These places are home to many different communities, each with their own characteristics and needs. We recognise that a one – size all approach to services delivery is not appropriate. A blanket service may be of great benefit to one community and of little value to another. That is why we are now designing local services based on local need, identifying the health and social care priorities in communities and developing services that help people access the right services at the right time. 86
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64 Locality Planning Locality Planning is the local mechanism for strategic planning in which local priorities are developed for smaller geographical areas across the local authority. In 2023 it was decided that the framework for carrying out Locality Planning would be revised in order to involve new methods for community engagement and ensuring continued leadership through new Locality Chairs. Throughout late 2023 and early 2024 this new process was further developed in order to collect robust data and information about each locality in order to develop Locality Plans. Engagement: Locality Conversations Twice per year, Locality Conversations will be held within each locality in order to collect information from different people within the communities, and feedback what we are doing with the information. The first set of Locality Conversations are set to take place in April 2024, in the form of 2-hour workshops with local staff and members of the public invited to intend. This will allow us to explain a bit about the new process and collect initial community perceptions and challenges. The next set of Locality Conversations will be held in September 2024 when the focus of the engagement will be groups of shared characteristics, where we will seek the views of targeted groups. Locality Conversations will continue twice a year until locality plans can be developed in each area. Local data: Locality Profiles The Strategic Commissioning Plan is developed using a Strategic Needs Assessment provided by Public Health Scotland, outlining local health and care data and inequalities across North Ayrshire. Public Health Scotland also provides more local data for each locality, where it is possible to obtain data at that level. These locality profiles will be used to identify key inequalities within each locality in order to understand where targeted effort may be required. Local Services: Review of access There are many health and care services that are carried out within each locality, and there are others that people across the authority would need to travel to another locality to access. In order to understand how services are accessed and where some of the access challenges lie, we will be carrying out a mapping exercises of the health and care services available within each locality. This will include primary care, but also local third sector services and wellbeing in the community. Community Priorities: Community Planning The Integration Joint Board is a member of North Ayrshire Community Planning Partnership, which has a separate requirement to carry out Locality Planning with more involvement of the community to develop general community priorities. The established priorities for each area 87
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65 will be considered within the HSCP Locality Planning Process as these were developed alongside the local community. Governance All the above information will be collected, collated, and analysed over the course of 2024 and 2025, which will allow four periods of engagement and a greater depth of information and understanding of each area will be developed. Information will be analysed and plans and actions will be developed by the Locality Planning Review Group for each area, who will also enable delivery and monitoring of the plans. Each Locality Planning Review Group will meet twice per year, following each period of engagement. Group membership will be tailored to the specific needs of each community but will be Chaired by a Head of Service to ensure consistency and continued leadership. Locality Plans will be developed by late 2025. Arran The outlined method for Locality Planning will apply to the five primarily mainland localities of Irvine, Kilwinning, Three Towns, Garnock Valley and North Coast and Cumbrae, though there are current discussions within the Community Planning Partnership regarding the current arrangements for specific challenges for residents of Cumbrae. Arran has an established locality planning arrangement which has been in place for many years due to the specific and persistent challenges of the Island. These arrangements have a governance that sits under the Island Plan and the Health and Social Care Partnership will develop health and social care priorities for Arran under this existing governance structure, and using engagement that has already been carried out with the islanders. This will occur using the same timescales as our mainland localities. 88
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66 Transformation Programme North Ayrshire HSCP’s Transformation Team support Partnership teams to identify, develop and deliver system wide change to local services and improve outcomes for the people of North Ayrshire 89
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67 Transformation in 2023 to 2024 Transformation Plan Approval The Transformation Plan is an ambitious programme of change consisting of a range of improvement projects across all service areas, each aiming to improve the quality of our services and contribute to the long-term sustainability of health and care in North Ayrshire. The plan is aligned with our Strategic Priorities and one or more of the following key drivers: savings/overspend reduction; investment in services to ensure we continue to deliver safe and effective care now and in the future, in line with relevant policies and legislation; and/or to improve the quality and safety of our services, improving outcomes for individuals and communities. The plan was drafted in collaboration with Heads of Service, and it stretches across all areas of the HSCP. It was approved by IJB on 14 March and the implementation will now be overseen by the refreshed Transformation Board, supported by the Transformation Team, in collaboration with services. Children, Families and Justice Services In March 2024, we launched the beginning of our transformational activity within the Children and Families service referred to as Brighter Pathways: Remodelling of Children’s Care Options. A programme board of multi-agency partners has been established to assist in proposing solutions, advice, and guidance across North Ayrshire to work collaboratively to ensure best outcomes for our young people (and to help reduce associated costs). A variety of workstreams will sit directly under the Programme Board and will have lead responsibility to work in a focussed way to radically reform the care options we have available for our children and young people to ensure that they have the right access to the appropriate resources and supports as they progress into adulthood. In addition to the work that will be undertaken to improve outcomes for children who are already looked after away from home, we will also have a heavy focus on ensuring that appropriate tailored flexible support is available to children, young people and their families with the sole purpose of keeping children and young people in their local communities and keeping families together where possible. Health and Community Care Self-directed Support The SDS Learning Review Board concluded phase 1 in May 2023 with a final report which highlights a range of collective recommendations and actions to take forth to begin to improve current Social Work practice, with SDS being a key change mechanism to enable improvement. The identified actions will be taken forward in partnership commencing 2024 with Horizons Research our commissioned research, policy, leadership and service redesign specialist service. 90
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68 Both the process of the SDS Learning Review including the output report, and phase two implementation plan have been agreed by an SDS Review Board, all Heads of Service and wider Senior Management staff as necessary to address and support some of the systemic weaknesses in our offer and delivery of assessment, informed choice and control, and personalised support. Progressing this work ensures North Ayrshire Health & Social Care Partnership (NAHSCP) embodies the ethos and principles of the Social Care (Self-directed Support) (Scotland) Act 2013 and assuredly meets our statutory responsibilities therein. It is also to ensure NAHSCP has the capacity and ability to deliver on the National SDS Improvement plan 2023 to 2027 and SDS National Standards and Framework as well as all subsequent/ relevant legislative frameworks for the provision of assessment and social care support. Equally, it enhances staffs understanding and confidence to deliver Social Work which is more responsive and person-centred making sure that people can get the support that is right for them and in a way that supports their rights of choice, dignity and being able to take part in the life of their communities. Key areas identified that impact on current Social Work practice and delivery were highlighted and themed under the following topics: • Varied practitioner understanding of SDS as a delivery tool and the legal framework. • The most precious resource is time and there are pressures on this which limit the opportunity for good practice and good/ equal conversations with people. • The assessment process is unwieldy and adds little value beyond access to limited resource. • The inequity within the system is noticed and causes ethical dilemmas for staff across services. • The role of leadership and management in the implementation and application of SDS as an enabling tool is variable. Analysis of the learning and findings from the above topics allowed for further consideration to offer proposals which were grouped into the recommendations below. • Create the space and conditions to continue the Social Work/ SDS conversation. • Develop and embed an Ethical Care Framework across all services. • Invest in workforce learning & development at all levels. • Develop clear Information and access to early help and support. • Explore Community Social Work Models and Liberated Methods. • Explore worker autonomy and delegated decision making. 91
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69 • Improve timely and safe transition process and planning. • Develop Self-employed Personal Assistant Models further. • Maintain good governance & report impact. The amount and level of work requiring action is vast with many of the recommendations and actions relying on each other and feeding into other development areas such as the review of the front door, unpaid carers and transition process, but priority discussions with senior management staff were largely similar and most agreed that the recommendations to take forward primarily are as follows with a firm understanding that governance and reporting are essential to ensure continued quality assurance and supportive direction: • Workforce learning and development • Clear information, early help and support • Development and embedding of an ethical care framework • Continue to explore community social work approaches • Worker autonomy Unpaid Carers Local Strategy NAHSCP launched a revised interim local carer strategy: Building Caring Communities 2023 to 2025, in Summer 2023 with clear aspirations to reach more carers and provide vital information and links to support. The aim is that all North Ayrshire carers are identified, supported and valued and are afforded an opportunity to live, work, thrive and stay connected to their communities enjoying a life alongside caring. The ambition is that all unpaid carers have their voices heard and ideas considered in the design and delivery of information and support services provided across North Ayrshire. Carers Gateway North Ayrshire The Strategy was developed in conjunction with a threefold investment in reprovisioning the local carer service which continues to be delivered by Unity Enterprise but has been rebranded and was relaunched in October 2023 as a more visible locality-based ‘Carers Gateway North Ayrshire’. Areas of focus for the Carers Gateway service in the initial months of expansion have been: • Continuity and monitoring of current provision as the service grows. • Recruitment – team expanded from 4.5 to 15 staff with adult locality workers more present in community spaces sharing the Carer Gateway aspirations with existing and new networks. The young carers team are also operational across schools with each worker supporting three clusters across their area. 92
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70 • Partnership mapping to promote the new service. • Marketing of the rebranded ‘Gateway’ carer service. • Digital developments with Bridgit Digital Carer Support Services, a 24/7 digital resource to reach and identify more carers, provide access to online self-help, access to referral and registration with the Carer Gateway Service, local and national information and support, access to build personal plans, WhatsApp and multi- channel support for regular contact. The resource also has built in analytics and reporting for service tracking and development. • Improvements to the website to correlate with and showcase the changes to the new approach and model, and ensuring more current, correct information is available for local carers’ Carers Gateway Information, support and advice for carers of all ages. This went live in March 2024. The service are also making full use of Carers Gateway North Ayrshire Facebook which is a lively hub for identifying, communicating, engaging and promoting information and support. • Financial planning and property discussions to establish a new office base. Carers Assessments For 2023/2024, NAHSCP adult services completed 116 adult carer support plans which is an increase of just over 50% from the previous year. 56% of this total were completed by the Carer Support Officer (CSO) within the Carers Team who offers an alternative route to early and preventative carer support, for those who are not already known to Social Work teams, where the cared-for does not meet eligibility thresholds for services or for young carers aged 16 to 18 years who are not in school. Across North Ayrshire primary and secondary schools 348 young carer statements have been completed with young carers under 18 years which is a 52% increase from the previous year and is representative of the good partnership links with Education Services and strength of messaging. Breaks from Caring Carers Gateway received £77,000 for breaks from caring from Shared Care Scotland for 2023 to 2024 which allowed four phases of carer breaks and hardship options with around 400 carers and families being supported. Over the festive period Carers Gateway also used £7,000 to support families who were struggling with food vouchers and presents in addition to the annual festive activities. NAHSCP has also supported 110 young carer requests for a break from caring this financial year through the HSCP/ Education fund at a total cost of £20,047. For adult carers in 2023/24 there have been 127 requests but not all required access to funding but through these conversations we have supported carers with a variety of breaks at a cost of £9,722. 2022 to 2023 funding trickled through into this financial year which secured 240 KA Leisure memberships for young carers across North Ayrshire as a route to improved wellbeing and social opportunities with peers. All memberships have been allocated and 25 young carers 93
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71 through a survey issued have told us that this has been good for their physical and mental health. For some it helped with feelings of anger, for some they could go swimming with mum as it was the least painful activity for her, it was about family time, for some it was about body positivity and for many it reduced the financial barriers of being able to join in and be with friends whilst taking a break from caring. Carer Involvement NAHSCP Carer Development Officer has been working with the HSCP Transformation Team, Arran CVS, Arran schools, Brodick Patient Participation Group and the Carers Gateway Arran family worker following a period of initial engagement on the Island which highlighted the need to increase carer awareness, information, advice and support on the Island. A phased plan of activity is underway (March to October 2024) to explore staffs understanding and use of adult carer support plans, young carers statements and Carers Gateway service. The work will investigate young people’s understanding of caring and explore the impact caring has on future life options and choices, along with the general populations understanding of the caring role, carer rights, and use of the Carers Gateway service. The final phase will identify specific carer needs, gaps in information and carer support. Mental Health and Learning Disabilities NHS Ayrshire and Arran Child and Adolescent mental Health Services (CAMHS) fully implemented the NHS Scotland National CAMHS Service Specification published in February 2020 on 1 August 2023 after papers going to each of the three IJB’s (Integrated Joint Boards) between March and May 2023. The specification describes the role of CAMHS as providing access to multi-disciplinary teams that provide: • Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. • Training, consultation, advice, and support to professionals working with children, young people, and their families. As a Tier 3 service CAMHS will see young people who present with mental health problems that are causing significant impairments in their day-to-day lives. Prior to the implementation of the specification CAMHS saw an all-time high number of referrals in June 2023 of 330 and 69% of these were requesting a Neuro assessment. All these young people needed to be seen within 18 weeks and involved additional assessments by all clinicians and even some of the Team Leaders and Service Managers did assessments. CAMHS in Ayrshire Referral to Treatment is the best in Scotland sitting at between three to four weeks to be seen for initial assessment and the teams are continuing to work on all the waiting lists within the service. N-CAMHS specifically see those children and young people whose Neurodevelopmental Disorder co-exists with a clearly defined and treatable mental–illness. This service offers specialist clinical support, assessment and diagnosis for children and young people 94
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72 experiencing the combined challenges of mental ill-health with conditions such as Autism or Attention Deficit Hyperactivity Disorder (ADHD). CAMHS are working alongside health, social care, education and NEST (Neurodevelopmental Empowerment & Strategy Team) in the three Ayrshire’s to ensure young people who are referred for a Neuro assessment, that do not meet the CAMHS Specification, are sign posted to the relevant services and supports. CAMHS Urgent Assessment and Intensive Treatment service operates across seven days which complements our more traditional service model. CAMHS workforce continues to evolve to meet the service need and the employment of Advanced Clinical Nurse Specialists, Pharmacy Prescribers and Nurse prescribers have significantly helped CAMHS over the last year when there have been a shortage of psychiatry staff and medication. Accommodation West Road in Irvine will be the new Specialist CAMHS Assessment & Treatment Centre for Ayrshire as well as the operational base for the Community Eating Disorders Services by September 2024. Open seven days per week specialist CAMHS Neuro, ADHD, play Therapy and other Clinical Interventions will be delivered from this re-fitted facility. Hosting flexible working space for staff with 5 clinic rooms and two large meeting rooms, it is envisaged that the facility will become a centre of excellence in the care and treatment of child and adolescent mental ill-health and eating disorders. Accommodation for the Unscheduled Care Service remains a challenge. The wider CAMHS Service will also require a review of accommodation in due course and the service aspires to a specific facility for the care and treatment for moderate to complex mental ill-health. CAMHS continue to explore the feasibility of providing in-patient care for children and young people closer to home in Ayrshire. 95
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73 Reporting on lead partnership responsibility North Ayrshire Health and Social Care Partnership has lead responsibility for: Mental health services (including psychology, CAMHS, learning disability assessment and treatment) Child health services (including child immunisation and infant feeding) East Ayrshire Health and Social Care Partnership has lead responsibility for primary care and urgent care services. Primary care refers to the four independent contractors who provide the first point of contact for the Ayrshire and Arran population. These contractors are General Practitioners (GPs), Community Pharmacists, Optometrists, and General Dental Practitioners. South Ayrshire Health and Social Care Partnership is the lead partnership for the Integrated Continence Service, Community Equipment Store, and the Family Nurse Partnership (FNP). This lead responsibility relates to the delivery of continence care and education across Ayrshire, provision of equipment to people living in the community and supporting first-time mothers aged 19 and under through an intensive preventative home visiting programme delivered by FNP. 96
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74 Mental Health Services 1.1 The long-term conditions team are continuing to develop and enhance services to ensure people receive the right care at the right time and in the right place. One example of this has been the recent proposal of a pilot within Ward 2 in Woodland View. Following a series of Whole System Events at University Hospital Crosshouse it was recognised that the pathway to access care and support within Ward 2 could be improved. As such a proposal was developed to commence direct referral to Ward 2 from North Ayrshire GP’s via a joint assessment with the North Ayrshire Community District Nursing Service. It is anticipated that this will reduce unplanned unscheduled care presentations of people with unstable end of life symptoms and those affected by complex conditions. Engagement has been ongoing with key partners including the Community District Nursing Team, GP’s, Ward 2 Staff, the Ayrshire Hospice and others to enable this work and make it a success. 1.2 Montrose House Care Home received an unannounced inspection on 14 September 2023 which was a follow up to the initial inspection which took place in June 2023. Key messages from the inspection included: • The service had made improvements since the last inspection and managers were aware of the continued areas for development • Medication recording had improved • The staff team had been working on improving recording in relation to personal plans and health and wellbeing • The service had made good links with local health professionals which was supporting ongoing developments Links to each Inspection report can be found below, clicking the link will download the report in pdf format. Montrose House Inspection June 2023 Montrose House Inspection September 2023 Montrose House Inspection March 2024 The service is continuing to implement a robust improvement plan and is working alongside wider Health and Social Care Partnership colleagues to build on the improvements made since the last inspection. 1.3 Mental Health and Wellbeing in Primary Care – strategic thinking continues to take place regarding the development of a mental health and wellbeing in primary care service in line with Scottish Government national strategy. • Collaborative engagement work between primary and secondary care continues to be undertaken during Quarter 2. 97
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75 • The overarching pan Ayrshire working group has continued to meet, with an under- arching writing group, to provide proposed strategic plans for 2024 to 2026. With the launch of the national Mental Health and Wellbeing Strategy – a pan Ayrshire implementation group has been formed to consider the impact of delivery and workforce planning both locally and on a Pan Ayrshire basis, this will be called the Strategic Leadership Group. The Learning Disability service continues to experience workforce pressures across a number of its elements, in particular Trindlemoss House: within that setting, a number of vacancies are currently unfilled, including 3 Band 5 posts. Recruitment and retention issues are also evident within Ward 7A. While 2 newly qualified nurses started in November, this still leaves 1.86WTE vacancies, as well as creating a new balance with regard to skills/experience mix which will need accommodated. Further fragility is introduced by the need to cover maternity leave as well as the departure of 2 experienced Support Workers to join Foxgrove. 1.4 Case Study: Discharge Support This story relates to a 75-year-old gentleman who has been supported at home by the Discharge Support Facilitator who is based in ward 4, Woodland View Hospital. He is a retired Royal Air Force engineer officer who served in various conflicts throughout his career. He bore witness to the unimaginable and as a result was diagnosed with Post Traumatic Stress Disorder. (PTSD). On leaving the Royal Air Force he became self- employed and worked in Health & Safety. He and his wife moved to Scotland to follow this career. Shortly after moving the gentleman suffered from a cerebral vascular episode resulting in him sustaining disabilities and having to give up his work. Over time his mood lowered, he started to drink heavily and symptoms of PTSD worsened resulting in thoughts of suicide. He had regular reviews from his GP and had input from the Community Mental Health Team for Elderly. Due to a further deterioration, he required admission to Woodland View Hospital. He was admitted to Ward 4 for further assessment and treatment of his mental state. Following a period of twenty days he was identified by his Consultant Psychiatrist and his nursing team as being suitable for discharge with support. His wife, on learning of this plan reported she had not been coping with the trauma of her husband’s admission. She was referred to the discharge facilitator for support. Consent was gained from the gentleman to allow the discharge facilitator to discuss aspects of his care and follow-up arrangements. Pre and post discharge supports were arranged resulting in the following post discharge outcomes: Carer’s services have been in contact and have completed a carer’s assessment. Wife has an allocated worker with a carer’s support plan in place. Carer’s needs have been assessed to allow social work to identify a respite plan should this be required. Social work are looking into grants to assist with adaptions to their home. They did not require a package of care South Ayrshire Hub have assisted with applications for benefits. 98
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76 The gentleman has been allocated a worker from Combat Stress to support with PTSD and has referred this couple to the Royal Air Force Association (RAFA) for support. Combat Stress have arranged for him to attend their groups. This support will be ongoing. RAFA have been in contact and have allocated a worker. They have indicated they will assist with paying for adaptions to the home. They will arrange for this gentleman to attend ex- servicemen/women’s groups. They will assist with holidays for him and his wife. This support will be ongoing. His wife has been allocated a RAFA family liaison officer to assist her to support her husband. They will support her to have time for herself. The gentleman has made contact with the With -You service and has arranged to attend once weekly to support him with alcohol issues. He has been encouraged to drink non-alcohol drinks. The gentleman and his wife have been contacted by their local community connector link worker. They now have information with regards to becoming involved in activity in their local area which will be of benefit to them both. The gentleman and his wife continue to be monitored by CPN services as required. 1.5 The Social Work Team has seen significant improvements with regard to staffing levels, which has enhanced its capacity to respond to issues such as overdue reviews. None-the- less, the service is very conscious of the continuing pressure on the team and the fragility which this engenders. Additional investment still remains a necessary consideration there, specifically with regard to the establishment of a senior social worker/senior practitioner post to work alongside the Team Manager and provide support in relation to issues such as supervision. Staffing is also an issue with regard to the establishment of the Intensive Support Service, with recruitment to a Speech and Language Therapy post within the team proving particularly challenging. The service is now almost fully recruited except for this post and a social work vacancy. This reflects broader issues regarding availability of Speech and Language Therapy (SLP) posts pan-Ayrshire, which is known to be presenting significant issues (and risks) across a variety of settings in relation to concerns such as dysphagia and swallowing assessment. A review of the workforce plan is being undertaken to address this. 1.6 Trindlemoss Day Opportunities continues to make good progress with regard to furthering the diversity of opportunities it can link its customers to, including the opening of its Community Café and Baristamoss, and the Glam Hideaway, all of which provide opportunities for skill development and enjoyment for individuals. Trindlemoss Day Opportunities has also been a contributor to the successful delivery of the How We See Ourselves poetry/art animation project, within a project led by Neighbourhood Networks. Following a successful run of the associated exhibition within the Harbour Arts Centre, the animations and interview linked to that work are now viewable on the NAHSCP’s Youtube channel. Ward 7A has also successfully completed its collaboration with the Glasgow School of Art around the implementation of an internship within the ward for 2 students, focused around the theme of connected transitions. 99
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77 1.7 The Scottish Government’s Communities Mental Health and Wellbeing Fund for Adults was established in October 2021 and to date has distributed around £36 million to community initiatives supporting mental health and wellbeing across Scotland. The fund has a strong focus on prevention and early intervention and aims to support grass roots community groups in tackling mental health inequalities and addressing the priority issues of social isolation and loneliness, suicide prevention, and tackling poverty and inequality. Funds were distributed by Arran Community & Voluntary Service (Arran CVS), as a partner in the Third Sector Interface North Ayrshire with the Ayrshire Community Trust. In Year 1, 61 North Ayrshire projects collectively received funding to the value £813,345, which benefitted significantly from inclusion of £353,134 in support from North Ayrshire Council (NAC). In Year 2, due to budget constraints, the level of contribution from NAC was understandably impacted. The Green Health Partnership included provision of a contribution amounting to £46,125 in Year 2, for projects specifically focussed on ‘green health’ related activity. This resulted in a total of £516,107 being distributed to 55 projects across North Ayrshire. Early monitoring demonstrates that so far, an additional 5,000 North Ayrshire residents have already benefitted from the Year 2 projects. There will be a continued emphasis in Year 3 on responding to the cost-of-living crisis and on those facing socio-economic disadvantage. The fund aims to take a preventative approach and allow communities to develop their own solutions, including developing stronger partnerships. 1.8 A Drug and Alcohol Services report from North Ayrshire Drug and Alcohol Recovery Service (NADARS) and North Ayrshire Alcohol and Drug Partnership (NAADP) has highlighted some of the positive work being undertaken to prevent drug and alcohol related deaths locally. The report details some of the work carried out over the past year, including the ongoing implementation of the Scottish Government’s Medication Assisted Treatment (MAT) Standards, providing additional support to individuals following a non-fatal overdose, increasing access to residential rehabilitation programmes, and the continued roll-out of the life-saving medication Naloxone across North Ayrshire, which reverses the effects of an opioid overdose. In addition, the report outlines local and national drug and alcohol related targets and standards, all of which were met in North Ayrshire during 2022 to 2023. In March 2023, 96 percent of clients commenced treatment to support their recovery within three weeks of being referred (against a national target of 90 percent), with100 per cent of clients waiting less than six weeks, again meeting the national target. North Ayrshire had also been set a target of increasing the number of individuals in treatment from 882 in 2020 to 959 by March 2024, with 2023 figures (1011) already exceeding the 2024 target. An additional target of supplying 420 Naloxone kits in North Ayrshire during 2022 to 2023 was also exceeded, with 846 kits distributed. 31 lives were reported to have been saved in North Ayrshire due to the use of Naloxone during that period, however this number could be significantly higher, as lives saved via the use of Naloxone often go unreported. 100
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78 Medication Assisted Treatment availability, where individuals have the option to start a treatment of their choosing from the day of presentation – as well as receiving psychological and social support – was expanded during 2022 to 2023 to include all six North Ayrshire localities. National and NAADP funding has allowed the recruitment of additional staff to help deliver this, including addiction workers, additional prescribing capacity and recovery development workers with lived experience. Access to local residential rehabilitation is provided by Ward 5 at Woodland View in Irvine, which has ten beds for residential care for anyone who has an alcohol and/or other drug problem and mental health issues. Ward 5 provides access to residential detoxification, rehabilitation and day attendance support, with seamless pathways of support in place for individuals before, during and after their placement via local community alcohol and drug services. In addition, North Ayrshire Health and Social Care Partnership was instrumental in supporting Phoenix Futures to open Harper House in Saltcoats in 2022, which provides additional residential rehabilitation support for vulnerable families, who can stay together at the facility. The past year has also seen a focus on providing access to external residential rehabilitation, with national funding having been made available to NAADP. Individuals wishing to access this can now do so through NADARS, who will support the development of a care plan, identify a suitable provider, seek funding and support individuals into, throughout and after their placement. 1.9 Case Study: Recovery Story “Thirteen years ago, I was stuck as a heroin addict, and I had been using for the past thirteen years. At this time of my life, I never knew where to turn as there was not as much help then as there is today. I decided one night that I was ready to say goodbye to life. I remember standing in my living-room trying to pluck up the courage, but I couldn’t do it. I needed drink to go through with it. On the way to my local shop to buy some I bumped into a stranger who ushered me into a building out the freezing cold. I remember sitting amongst a group of older ladies who were kind and offered me a hot drink. They asked me to join them in a service and when I followed them into the other room, I realised I was in a church. I sat up the back and listened to all the speakers. There was one individual whom I clicked with. This person connected me with the Teen Challenge Rehab Ministry in Largs and from there I went into rehab on December 1 2010, exactly 13 years ago that I am sitting telling this story, with nothing but the clothes on my back. I entered rehab a broken man, with no education. I had nothing. However, I successfully completed a 12-month programme in the Scottish borders because I knew I had to, not only for me, but for the other people in my life too. After completing this programme, I was offered full-time employment within the rehab as a support worker. I was put through my SVQ3 in Social Care which was a massive accomplishment for me. I continued to work in this service for four years and in this time, I found that my mess had turned into a message of hope for others. 101
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79 Since then, I have gained experience working in a night shelter in Glasgow, and I returned home to live in Ayrshire. I worked on the streets of Glasgow providing support to individuals affected by addiction, rough sleeping, and poor mental health. More recently I started in a new role with North Ayrshire HSCP supporting families who are impacted by substance use. I am really enjoying my new role. I get to use my lived experience and my experiences from my previous roles to help people within my local area! Today I absolutely love life and I love to live again. I am in a position where I get to help people and introduce them to new activities. I suppose this story, like many others, shows the importance of being kind to strangers as we have no idea what silent battles someone may be going through. Kindness from a stranger on the street saved me that night and it is something I think we should all strive to do”. 102
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80 Child Health Services 2.1 Breastfeeding has been a longstanding priority for staff working in North Ayrshire. The integrated community infant feeding team which includes midwives, health visitors, Family Nurses, support staff, Community Infant Feeding Nurse, and Support Nurse, as well as colleagues from the Breastfeeding Network (BfN) work closely with families to help them make an informed choice about feeding. Staff have all received regular high-quality training to ensure they are knowledgeable and skilled in relation to infant feeding. In North Ayrshire our rates of exclusive breastfeeding have decreased slightly, with exclusive breastfeeding rates at the first health visitor contact dropping from 22.7% in 2022, to 21.2% in 2023, and at the six to eight review exclusive breastfeeding has dropped from 20.1% in 2022 to 17.8% in 2023. However, our overall breastfeeding rates (mixed breast and formula) have increased from 40.6% in 2022 to 41% in 2023 at the first health visitor contact and at the six to eight week review our overall breastfeeding rates have increased from 31% in 2022, to 31.7% in 2023. This means that more babies in North Ayrshire are receiving breastmilk that at any time since the start of tracking this data. 2.2 The Health Visiting service in North Ayrshire continues to fully implement the national Universal Health Visiting Pathway, with all children under five and their families offered a minimum of 11 visits from the ante-natal period through to the child starting school. Developmental assessments are undertaken at 13-15 months; 27-30 months and four to five years. Since 2020, the percentage of children with one or more developmental concern at these assessments has increased as shown in the table below: 103
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81 This trend is being observed across Scotland and the Scottish Government has commissioned an Early Years Transformation Programme which will, in part, seek to understand this. Locally, we are reviewing the supports we offer families to ensure they remain fit for purpose. Our Early Years Support Team works alongside the Health Visiting team to provide support to families when developmental concerns are identified or when a family requests additional support in other areas. During 2023 to 2024, 846 families were supported with areas such as communication, toileting, behaviour, sleep and parental mental wellbeing. In October 2023, we welcomed a Dads Support Worker to the service in partnership with national charity Dads Rock. The role aims to build confidence and empower dads to be actively involved in their child’s life, celebrating the positive role dads play in child development. Between October and March, 15 dads were supported on a one to one basis and a further 21 through group based “dad and baby” activities. 2.3 All school clusters in North Ayrshire have at least one school nurse aligned to them offering support to children and young people in line with the national pathway. School nurses can offer support in relation to: • Child protection • Looked after children and young people • Low level mental and emotional wellbeing • Domestic violence • Sexual health and relationships • Justice • Homelessness • Transitions • Young carers • Substance use The school nursing team has responsibility for offering all school-aged children and young people who are looked after, either at home or away from home, an initial health assessment which is followed up with an annual review. During 2023 to 2024, 75% of looked after young people in North Ayrshire had been offered a health assessment, a significant improvement on previous years. The service has also been developing innovative ways to improve accessibility for young people including the use of QR codes for self-referrals, and the testing of a podcast to share health and wellbeing information for care experienced young people. 2.4 In May 2023, in response to the increased number of Ukrainians moving to Scotland as a result of the war in Ukraine, a nursing team was established to provide initial health support to Ukrainian Displaced People and support them into mainstream health services. The remit of the team expanded in October 2023 to include those arriving in North Ayrshire seeking 104
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82 asylum. Formed of two staff nurses and a Bilingual Liaison Officer, the team has supported 202 individuals, of which 70 have been children under the age of 18 years, including Unaccompanied Asylum Seeker Children (UASC). For the 70 children: • 68 (97%) have had a health assessment completed • 55 (79%) migrant screenings completed for Tuberculosis and blood borne viruses • 56 (80%) supported to complete their immunisations to ensure they met the UK immunisation schedule 2.5 Throughout 2023 to 2024, the team continued to fully deliver the routine childhood immunisation schedule to eligible children and young people in North Ayrshire. Whilst our uptake rates are good, we continued to see differences in rates between communities. The team is implementing some new approaches, including offering weekend appointments to try and address this. In the last 12 months European countries saw a resurgence of measles. As a preventative measure, additional clinics were delivered in March for North Ayrshire families where children had not received the Measles, Mumps and Rubella (MMR) vaccines in line with the schedule. This was supplemented with a large-scale media campaign to promote MMR uptake. The seasonal flu programme for children and young people was delivered during September and December and vaccination uptake in North Ayrshire was higher than the Scottish average. 2.6 Child healthy weight is a public health priority. Over the last three decades, obesity levels in children and, indeed, the wider population have increased, with inequalities observed across our communities. Maintaining a healthy weight throughout childhood is associated with many health benefits both in the short-term and the medium term. Child healthy weight is monitored throughout the universal Health Visiting pathway but also when a child moves into Primary 1. The most recent data for 2022 to 2023 was released in December 2023. For North Ayrshire: • 76.7% of P1 children were of a healthy weight. The highest percentage since 2008 to 2009 • 12.7% of P1 children were at risk of overweight. The lowest percentage since 2005 to 2006 • 9.7% of P1 children were at risk of obesity. The lowest percentage since 2008 to 2009 105
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83 106
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84 Inspection of service The Partnership works closely with independent care providers to ensure that the care and support provided is being delivered in line with peoples’ outcomes, offers best value, meets regulatory requirements, and keeps people healthy and well. Care services provided by Partnership teams also undergo external inspections and are subject to rigorous review and inspection. Working together, we ensure that all required standards of quality and safety are met. 107
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85 Independent Care Providers who provide care services on our behalf Where we commission care and support from independent and third sector Providers services based within the North Ayrshire area, we monitor these services via the Contract Management Framework. The Framework focusses on ensuring a joint approach to evaluating the quality of care and where appropriate provides an approach to supporting Providers to progress improvements. We use a range of methods to monitor performance, including: • Formal Contract Management meetings on a sox monthly basis and an Annual Joint Evaluation of Contract to ensure that services are safe, effective and most of all, that they meet people’s needs. • Review of compliments, complaints and feedback from staff, carers and people who use services. • Information that we collect, before visits, from the provider or from our records. • Local and national information, for example, Care Inspectorate reports • Visits to providers, including observing care and support and looking at records and documents. The information below represents how those service which are registered with Care Inspectorate and are based in North Ayrshire are currently performing. Registered Services – Minimum Grades across all themes Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Adoption Service Not applicable 0 0 0 1 0 1 108
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86 Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Adult Placement Service Not applicable 0 0 0 2 0 2 Care Home Service Older People 0 4 10 2 0 16 Care Home Service Children & Young People 1 0 3 6 3 13 Care Home Service Alcohol & Drug Misuse 0 0 1 0 0 1 Care Home Service Learning Disabilities 0 1 2 0 0 3 Care Home Service Mental Health Problems 0 0 1 0 0 1 Care Home Service Respite Care and Short Breaks 0 0 2 0 0 2 Child Minding Not applicable 1 6 61 44 2 114 109
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87 Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Day Care of Children Not applicable 1 8 42 16 0 67 Fostering Service Not applicable 0 0 1 0 0 1 Housing Support Service Not applicable 0 2 7 6 2 17 School Care Accommodation Service Not applicable 0 0 2 5 0 7 Support Service Care at Home 0 2 12 7 0 21 Support Service Other than Care at home 0 0 7 0 1 8 Grand Total Not applicable 3 23 151 89 8 274 110
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88 Inspection of Local Services Throughout 2023 to 2024, a total of nine inspections took place by the Care Inspectorate, all nine were unannounced. There was also one joint inspection of Adult Support and Protection. • Health and Community Care - three inspections with two follow up inspections. • Children and Families & Justice Services - three inspections • Adult Services - one inspection Within Health and Community Care, two follow up inspections took place at Montrose House after an initial inspection in June 2023. The first of these took place on the 15 of September 2023 and examined the requirements listed in the June inspection. Of these requirements, two were met, two unmet and four not assessed. A further follow up inspection took place on the 14 February 2024 examining the outstanding 6 requirements for the facility. Of these requirements 2 were met and 4 unmet. A further inspection within Health and Community Care related to Dementia Support Service (Core Assurance Inspection – Pilot). This was a pilot inspection known as Core Assurance Inspection – No gradings were provided, therefore previous gradings remain. Previous grading from February 2020 were: • Quality of Care and Support – 4 Very Good • Quality of Staffing – 4 Very Good A joint inspection of Adult Support and Protection was published in February 2024. The joint inspection took place between September and December 2023, scrutinising the records of adults at risk of harm for the preceding two-year period, September 2021 to September 2023. While no gradings were given, the report does provide Priority areas for Improvement. Two priorities for improvement were noted, they are: • Access to independent advocacy was limited. The partnership aimed to address this through their refreshed advocacy strategy. This should be a priority area for improvement. • Police Scotland inconsistently applied policy and practice across several areas, which when combined weakened the operational effectiveness of the partnership’s adult support and protection activity. These require to be promptly addressed to ensure parity of service levels across the partnership. Gradings for the 6 further inspections the Partnership also received can be found below. Inspection reports can be found on the Care Inspectorate website - Inspection Reports. 111
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89 Inspection Date Service/Unit Wellbeing Leadership Staffing Environment Care & Support 19 June 2023 Montrose House 3 3 3 4 3 18 August 2023 The Meadows Children’s House 2 0 0 0 0 29 September 2023 Abbeycroft Children’s House 5 0 0 0 0 3 November 2023 Irvine, Garnock Valley & Community Alarm 5 5 4 0 4 27 February 2024 Canmore Children’s House 2 0 0 0 0 13 March 2024 Trindlemoss House 4 4 0 0 0 The Care Inspectorate use a six-point scale to grade inspections: 1 Unsatisfactory Major weaknesses – urgent remedial action required 112
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90 2 Weak Important weaknesses – priority action required 3 Adequate Strengths just outweigh weaknesses 4 Good Important strengths, with some areas for improvement 5 Very Good Major strengths 6 Excellent Outstanding or sector leading 113
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91 Financial performance and best value Financial information is part of our performance management framework with regular reporting of financial performance to the IJB. This section summarises the main elements of our financial performance for 2023 to 2024. 114
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92 Partnership Revenue Expenditure 2023 to 2024 Strong financial planning and management is paramount to ensure our limited resources are targeted to maximise the contribution to our objectives. Delivery of services in the same way is not financially sustainable. The updated strategic plan approved for 2022 to 2030 is underpinned by the need to learn from the pandemic and ensure opportunities are maximised to transform care models and find new solutions to ensure the future sustainability of high- quality heath and care services. In 2023 to 2024 the IJB agreed a one-year balanced budget which included an overall savings requirement of £4.963 million. The ability to plan based on the totality of resources across the health and care system to meet the needs of local people is one of the hallmarks of integrated care. Medium term financial planning is key to supporting this process and identifying the transformation and planned shift in resources to provide sustainable services to the local community over the medium term. Financial information is part of the performance management framework with regular reporting of financial performance to the IJB. This included an integrated approach to financial monitoring, reporting on progress with savings delivery, financial risks and any variations and changes to the delegated budget. There were significant financial challenges during the period. The main challenges during the year were residential placements for children, care at home, supplementary staff in wards and Unplanned Activities (UnPACs) within the lead partnership for mental health. Work is ongoing to further improve the projected position and minimise the overspends continuing into 2024 to 2025. This work is built on the following general principles: • No adverse impact on delayed discharges or patient flow during Winter • Exercising professional judgement around the use of waiting lists where this may have an impact elsewhere in the system • Reviewing the need for more active management of non-frontline vacant posts • The non-recurring use of reserves • Working with East and South on lead partnership projections There is a reported overspend of £4.483 million pre-earmarking. The Integration Scheme outlines that there is an expectation that the IJB take account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken, however it is useful to note that this overall position consists of an overspend of £4.630 million in social care services and an underspend of £0.147 million in health services. This position is before the earmarking of funds for use in future years. After earmarking the overspend of £7.464 million consists of an overspend of £6.634 million in social care services and an overspend of £0.830 million in health services. 115
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93 As a contingency there was provision of £2 million non-recurring funding set aside in the reserves contribute towards the 2023 to 2024 position and this has been applied. The overall financial performance against budget for the financial period 2023 to 2024 (after adjusting for new earmarked reserves) was an overall overspend of £5.464 million. This consisted of £4.634 million of overspend in social care services and £0.830 million overspend in health services. 2022 to 2023 Budget £000 2022 to 2023 Actual £000 Variance (Fav) / Adv £000 Service 2023 to 2024 Budget £000 2023 to 2024 Actual £000 Variance (Fav) / Adv £000 85,261 85,286 25 Health and Community Care 91,174 95,625 4,451 96,133 92,731 (3,402) Mental Health 100,990 98,639 (2,351) 38,076 40,290 2,214 Children, Families and Justice 40,135 43,431 3,296 51,357 51,277 (80) Primary Care 52,865 52,863 (2) 9,532 9,463 (69) Allied Health Professionals 10,098 10,098 0 (175) (6,460) (6,285) Management and Support Costs 10,740 9,288 (1,452) 1,194 1,197 3 Change Programme 0 0 0 2,570 866 (1,704) Chief Social Work Officer 1,852 1,317 (535) 0 0 0 Financial Inclusion 1,671 1,630 (41) 0 0 0 National Commissioned Service 3 3 0 116
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94 2022 to 2023 Budget £000 2022 to 2023 Actual £000 Variance (Fav) / Adv £000 Service 2023 to 2024 Budget £000 2023 to 2024 Actual £000 Variance (Fav) / Adv £000 283,948 274,650 (9,298) TOTAL EXPENDITURE 309,528 312,894 3,366 (283,948) (283,948) 0 TOTAL INCOME (309,528) (309,528) 0 0 (9,298) (9,298) OUTTURN ON A MANAGED BASIS 0 3,366 3,366 0 1,360 1,360 Lead Partnership Allocations 0 1,117 1,117 0 (7,938) (7,938) OUTTURN ON AN IJB BASIS 0 4,483 4,483 0 4,219 4,219 New Earmarking 0 2,981 2,981 0 0 0 Draw on Reserves 0 (2,000) (2,000) 0 (3,719) (3,719) FINAL OUTTURN POSITION 0 5,464 5,464 The main areas of variance during 2023 to 2024 are noted below: Health and Community Care – overspend of £4.451 million mainly relates to overspends in care at home, agency costs within integrated Island Services, supplementary staffing in rehab wards and district nursing staffing costs offset by underspends in care home placements, reablement services and care packages for people with a physical disability. Mental Health – underspend of £2.351 million which relates to underspends in community mental health, non-employee costs at Trindlemoss and the Lead Partnership for mental health (psychology, child and adolescent mental health services (CAMHS), Action 15 and psychiatry). These underspends are predominantly related to the level of vacant posts in these areas. There is also an underspend in the Alcohol and Drugs Partnership which will be earmarked for use in 2023 to 2024. These underspends are partially offset by an overspend in learning disability services. 117
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95 Children, Families and Justice – overspend of £3.296 million which is mainly related to overspends in services for care experienced children (residential care, respite care and employee costs) and services for children with a disability (residential care, respite care). These were partially offset by an underspend in the Whole Family Wellbeing Fund which will earmarked for use in 2024 to 2025. Management and Support Costs – underspend of £1.452 million mainly relates to underspends in transition funding, an over-recovery of payroll turnover due to the level of vacant posts being higher than assumed when setting the budget and an underspend in multi-disciplinary team (MDT) funding. These underspends are partially offset by an overspend in the apprenticeship levy and the unfunded element of the pay award. Medium Term Financial Outlook A Medium-Term Financial Outlook (MTFO) is a critical part of the strategic planning process. The financial context for public services remains very challenging and so it is vital that the IJB’s strategic ambitions are set against the financial resources which are anticipated to be available. The MTFO provides key information on the possible financial position of the IJB over future years. It identifies the financial challenges which will be faced by the IJB enabling the IJB to see the impact of current and future decisions on its medium-term financial health. The MTFO will also be used to identify pressure points and inform decisions which are required to ensure the Partnership remains financially sustainable. There are a range of factors which influence the financial planning of the IJB. These are considered through the MTFO and include the following: • Demographic changes • Local priorities • Workforce challenges • The UK and Scottish Economy • Policy and Legislation • Cost and demand pressures • Available funding As in previous years, a Medium-Term Financial Outlook has been prepared to identify what the financial position may look like moving into 2025 to 2026 and 2026 to 2027. This has not been published in full at the present time as the Scottish Government indicated in the Scottish Budget that its Medium-Term Financial Strategy will be updated and published in May 2024. Following this, a full update report will be brought to IJB in September 2024, covering the period 2025 to 2026 to 2027 to 2028. 118
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96 Reporting on Localities The Partnership has arrangements to consult and involve localities via their Locality Forums. The IJB has established six Locality Planning Forums, reflecting the previously agreed local planning areas. These provide Board Members with the opportunity to be involved in considering the priorities for each area and outline the role for each Community Planning Partner in meeting these priorities in conjunction with the local communities. This spend has been split into localities by initially allocating spend which could be directly identified to a locality, and the remainder which was not locality specific was allocated on a population basis. 65.4% (63.9% in 2022 to 2023) of spend was allocated based on population, which means at this stage the spend per locality can only be used as a guide and will not fully reflect actual locality usage of services. The population information used can be seen in the following table and was taken from the 2022 mid-year population statistics (sourced from NRS). Allocation Method Percentage Total allocated on population basis 65.4% Age Group Irvine Kilwinning Three Towns Garnock Valley North Coast Arran Total % of spend allocated Children aged 0 to 15 31.3% 13.1% 25.6% 14.0% 13.5% 2.5% 100% 11.8% Adults aged 16 to 64 29.7% 11.8% 24.5% 15.2% 15.6% 3.2% 100% 26.6% Older People aged 65 and over 25.7% 10.3% 21.9% 13.6% 23.7% 4.8% 100% 18.4% Share of total population 28.9% 11.7% 24.1% 14.7% 17.1% 3.5% 100% 8.6% 119
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97 Allocation Method Percentage By Locality 34.6% Total 100% This resulted in the following spend per locality - Expenditure Irvine £000’s Kilwinning £000’s Three Towns £000’s Garnock Valley £000’s North Coast £000’s Arran £000’s Total £000’s 2022 to 2023 Expenditure 94,651 33,212 73,415 45,617 51,530 14,469 312,894 % share of spend 30.2% 10.6% 23.5% 14.6% 16.5% 4.6% 100% % of total population 28.9% 11.7% 24.1% 14.7% 17.1% 3.5% 100% 120
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98 Appendix 121
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99 Local Indicators – 2023 to 2024 These local indicators are those related to our strategic plan outcomes for 2022 to 2030 Performance Indicator 2023/24 Target Status Number of service users referred to employability service 79 36 Employability mentors - No of service users being supported into employment, training, education. 39 28 Number of PRI sessions which have taken place 1 8 Support four formerly cared for young people to move into independent living each year. 14 4 Support 45 children and young people into kinship care placements each year. 41 45 Recruit six new foster carers each year. 9 6 People attending the emergency department will be seen within 4 hours from arrival at hospital (Arran) 99.1% 95% Increase the number of Naloxone Kits distributed per annum (387 per year – 97 p/q) 679 387 Deliver 4,275 ABIs each year (pan Ayrshire) 7,497 4,275 CAMHS – Seen within 18 weeks (RTT) 98.6% 90% 122
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100 Performance Indicator 2023/24 Target Status Psychological Therapies – Seen within 18 weeks (RTT) 87.0% 90% Reduce out of hours admissions for people aged 65 and over (MH) 19 32 No under 18 should be admitted onto the Adult Intensive Psychiatric Care Unit (Ward 8) 0 0 All accepted referrals to the Intensive CPN team from non- mental health referrers will receive contact within four hours 98.5% 90% People subject to level 1 Community Payback Order (CPO) Unpaid Work completed within three months 97.3% 57% Individuals subject to level 2 Community Payback Order (CPO) Unpaid Work completed within six months 96.1% 67% 123
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101 MSG Indicators Performance Indicator 2020-21 2021-22 2022-23 2023-24 Target Status Emergency admissions to acute hospitals 1,439 1,376 1,560 1,674 1,836 Emergency admissions to acute hospitals (rate per 1000) 10.70 10.30 11.60 12.50 13.6 Admissions from emergency department 813 769 699 819 1,173 Admissions from emergency department (rate per 1000) 6.10 5.70 5.20 6.10 8.7 % people at emergency department who go onto ward stay (conversion rate) 35.30% 27.10% 26.70% 27.60% 33 Unscheduled ‘hospital bed days’ in acute hospital 11,097 11,434 11,725 11,424 12,320 Unscheduled ‘hospital bed days’ in acute hospital (rate per 1000) 82.70 85.20 87.40 85.10 91 Unscheduled ‘hospital bed days’ in long stay mental health hospital 2,756 2,677 2,117 2,362 6,782 124
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102 Performance Indicator 2020-21 2021-22 2022-23 2023-24 Target Status Unscheduled ‘hospital bed days’ in long stay mental health hospital (rate per 1000) 20.50 19.90 15.80 17.60 50.1 Unscheduled ‘hospital bed days’ in geriatric long stay 451 585 630 295 1,772 Unscheduled ‘hospital bed days’ in geriatric long stay (rate per 1000) 3.40 4.40 4.70 2.20 13 Emergency department attendances 2,304 2,836 2,620 2,972 3,292 Emergency department attendances (rate per 1000) 17.20 21.10 19.50 22.10 24.4 % people seen within 4 hrs at emergency department 82.10% 67.50% 65.50% 59.80% 95 Delayed Discharges bed days (all reasons) 1,165 1,776 1,852 1,785 1,515 Delayed Discharges bed days (all reasons) (rate per 1000) 10.60 16.20 16.90 16.30 13.9 Delayed Discharges bed days (code 9) 393 764 893 548 770 125
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103 Performance Indicator 2020-21 2021-22 2022-23 2023-24 Target Status Delayed Discharges bed days (Code 9) (rate per 1000) 3.60 7.00 8.20 5.00 7 126
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104 Where to find more information If you would like more information on IJB strategies, plans and policies and our performance and spending, please refer to the following websites. • North Ayrshire Health and Social Care Partnership • NHS Ayrshire & Arran - How we perform • North Ayrshire Council - Strategies, plans, and policies • North Ayrshire Council - Performance and spending Additional financial information for Ayrshire wide services can be found in: • East Ayrshire HSCP – Strategic Plan 2021 to 2031 • South Ayrshire HSCP – Strategic Plan 2021 to 2031 127
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Integration Joint Board 22nd August 2024 Subject : 2024-25 – Month 3 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at month 3 (June). Recommendation : It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2024-25 and the current overall projected year- end overspend of £6.555m, reduced to £3.143m through already identified financial recovery actions; (b) notes the progress with delivery of agreed savings; (c) notes the actions which are being taken to progress financial recovery and that a further recovery plan will be presented to the IJB in September; (d) notes the remaining financial risks for 2024-25; and (e) approves the budget reductions which are detailed at paragraph 2.10 (f) agrees the Terms of Reference for the Finance Working Group which are included at Appendix F. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health CAMHS Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework 128
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1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report refers to the position at the end of June, further work is undertaken following the month end to finalise projections, therefore the projected outturn position is as current and up to date as can practicably be reported. 1.2 The projected outturn is a year-end overspend of £6.555m (2.0%) for 2024-25, reduced to £3.143m through already identified financial recovery actions. There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions: TOTAL Health/NHS AA Social Care/NAC Projected Overspend @ mth3 £6.555m £0.586m £5.969m Financial Recovery Plan Projections £3.617m £0.381m £2.826m Residual Risk £2.938m £0.205m £3.143m 1.3 From the core projections, overall, the main areas of pressure are care at home, residential placements for children, physical and learning disability care packages, supplementary staff in wards, staff costs in Montrose House and Unplanned Activities (UnPACs) within the lead partnership for mental health. 1.4 The projected IJB outturn position has been adjusted to reflect the impact of Lead Partnership services. The underspend in relation to North Lead Partnership services for Mental Health is not fully attributed to the North HSCP as a share has been allocated to East and South HSCPs, similarly the impact of the outturn on East and South led services has been shared with North, both on an NRAC basis in line with the agreed risk sharing mechanism. 2. CURRENT POSITION 2.1 The report includes an overview of the financial position including commitments against the available resource, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL PERFORMANCE – AT MONTH 3 At month 3 against the full-year budget of £320.076m there is a projected year-end overspend of £6.555m (2.0%). The Integration Scheme outlines that there is an 129
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expectation that the IJB takes account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken, however it is useful to note that this overall position consists of a projected overspend of £5.969m in social care services and a projected overspend of £0.586m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. The projections for some areas will be subject to fluctuations as they depend on recruitment plans for new funding and also the capacity of providers to take on work. 2.3 Health and Community Care Services Against the full-year budget of £90.054m there is a projected overspend of £5.987m (6.6%) and the main variances are: a) Care home placements - the budgeted number of permanent placements was 765 and at month 3 there were 779 placements. The projected overspend is £0.551m on permanent placements and respite placements are projected to be £0.023m underspent. A plan is in place to manage down the number of permanent placements to reach the target. Income recovered from charging orders is projected to be £0.550m over recovered. This income is challenging to predict as it depends on the length of the legal process and time taken to sell the property that the charging order is registered to. b) Care at home (in house and purchased) is projected to be £3.254m overspent. The position reflects the cost of meeting the significant demand and level of provision for care at home support. These projections include the estimated cost of bringing the purchased services inhouse. The projection is complex due to services being brought in-house at different times, the number of posts and vacancies transferred, the estimated time to fill all of the posts and the costs of covering the required hours (plain time versus overtime) until the posts are filled. The projection is historically based on average costs to date but the data for month 1 – 3 is skewed because of the transfer of the purchased service at different points so this will be reviewed and refined in month 4 and 6 when there will be more representative data. c) Physical Disability Services – projected overspend of £0.652m split as follows: £0.966m over in residential placements, £0.042m over in direct payments and £0.356m under in community care packages. 130
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d) Integrated Island Services is projected to overspend by £0.686m. The most significant variance is a projected overspend at Montrose House of £0.582m which relates to the net overspend on agency staff (i.e. net of underspend on employee costs). e) Specialist Rehab wards – projected overspend of £0.135m (Redburn ward £0.148m overspend and Douglas Grant £0.013m underspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.765m due to use of supplementary staffing. 2.4 Mental Health Services Against the full-year budget of £106.951m there is a projected overspend of £0.591m (0.6%) prior to the reallocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.596m across community care packages, direct payments and residential placements. • Community Mental Health services are projected to underspend by £0.400m which is mainly due to a projected underspend of £0.528m in community packages and an overspend in residential placements of £0.134m and direct payments of £0.056m. The main reason for underspend is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.141m in relation to the cost of Hospital Based Complex Continuing Care (HBCCC), this reflects the impact of change in provision for these services. • The Lead Partnership for Mental Health is projected to be £0.521m overspent and the main variances are as follows: • Adult Inpatients – overspent by £0.384m due to overspends in supplementary staff for enhanced observations (1:1 and 2:1) and use of bank staff. • The UNPACS (Unplanned Activities) budget – projected overspend is £0.727m based on current placements and an allowance for one further placement. The actual cost of the future placements may be different from the estimated cost assumed in the projection. These placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, 131
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people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium or long term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed. A new group has been established to review the UnPACS budget and placements with a wider service representation. • Learning Disability Services – projected to underspend by £0.549m. This position is after recharging other areas on a cost basis for two outwith authority placements which have incurred additional costs in relation to usage of supplementary staffing due to sustained enhanced observations. There is a risk in relation to recovering this income as the two areas receiving the charges are currently refusing to pay and legal advice is being sought. • Elderly Inpatients – projected overspend of £0.411m due to the use of supplementary staffing. There are several patients who are on enhanced observations and bank costs remain high. • MH Pharmacy – is projected to overspend by £0.486m due to increased demand and cost of medicines. Innovation Fund – projected underspend of £0.112m due to slippage within some of the projects and not all of the funding has been allocated. Action 15 – projected online as any underspend will be carried forward for use in 25-26. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over recovery of the vacancy savings target of £0.819m in 2024-25. Further information is included in the table below: Vacancy Savings Target (£1.116m) Projected to March 2025 £1.935m Over/(Under) Achievement £0.819m 132
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2.5 Children and Justice Services Children’s Services Against the full-year budget of £43.902m there is an overspend of £1.583m (3.6%) pre earmarking and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £1.721m. The main areas within this are noted below: • Following budget investment of £4m the children’s residential placements are overspent by £2.041m based on 35 placements at month 3 and assuming that these placements will remain until the year end. There are a number of factors leading to this challenging position: • We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy for some time, leading to increased use of external placements where residential care is required. • The requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire. • A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. • Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. Children’s Services are continuing to work with other services including Education and Housing to address the challenges through the work of the ‘Brighter Pathways’ Programme Board and associated workstreams. This forms part of the Transformation Plan which was approved at the March IJB. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.701m underspent. • Children with disabilities – there is a net projected overspend of £0.124m across residential placements, direct payments and community packages. • Residential respite – placements are overspent by £0.058m. These short- term placements are used to prevent an admission to full time care or to avoid placement breakdown. b) Head of Service – is projected to underspend by £0.471m. This is made up a projected overspend due to the planned saving of £0.233m in relation to the staff reconfiguration in the children’s houses which was not achieved in 23- 133
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24 and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children, which is projected to over-recover by £0.765m and which covers costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.261m mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) The non-employee costs element of the AHP services are projected to be on-line. All underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER There is a projected underspend of £0.062m mainly due to a delay in spend in the Carers Strategy funding. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £1.361m and the main areas of underspend are: • There is projected slippage on the LD and MH transition funding of £0.586m due to delays in children transitioning into adult services and actual costs being less than estimated. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • The 2024-25 budget included a budgeted deficit on the social care side of £0.437m which is offset by a budgeted surplus of £0.437m on the health side of the budget. The net impact is neutral, but Appendix A shows this position for each element. • An over-recovery of payroll turnover of £0.500m for social care services and an over-recovery of payroll turnover of £0.488m for health services as outlined in the table below. The turnover targets and achievement for the financial year for Health and Social Care services outwith the Lead Partnership is noted below: Social Care Health Vacancy Savings Target (3.301m) (1.522m) Achieved to March 2025 3.801m 2.010m Over/(Under) Achievement 0.500m 0.488m 134
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The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. The partnership significantly over-achieved on turnover targets last financial year which helped greatly to support the overall financial position. The early projections for 24-25 indicate a reduction in the turnover being projected, which reflects a more optimistic position for recruitment and reduced vacancies but clearly has an impact on the ability to use this to offset overspends in other budget areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. The turnover target for the North Lead Partnership for Mental Health services is detailed within the Lead Partnership information at section 2.4. 2.9 Savings Progress a) The approved 2024-25 budget included £10.290m of savings. BRAG Status Position at Budget Approval £m Position at Month 3 £m Red - - Amber 0.523 0.675 Green 9.767 0.600 Blue - 9.015 TOTAL 10.290 10.290 b) The main area to note is that the amber savings have increased as the care home budget is currently projecting an overspend but this will be managed into an online position. Appendix B provides an overview of those service changes which do have financial savings attached to them and the BRAG status around the deliverability of each saving. 2.10 Budget Changes The Integration Scheme states that “either party may increase it’s in year payment to the Integration Joint Board. Neither party may reduce the payment in-year to the Integration Joint Board nor Services managed on a Lead Partnership basis…. without the express consent of the Integration Joint Board.” Appendix C highlights the movement in the budget position following the initial approved budget. 135
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Reductions Requiring Approval: Ref Description Amount (£000) 1 * Pecos Nurse Post – spend to save initiative re wound management supplies (18) 2 * Script Switch To Pharmacy – contribution to increased contract costs for Script Switch (2) 3 Tier 3 Weight Management – North’s contribution to the project as per the 24/25 approved budget (99) 4 Training Grade Adjustment - June (54) 5 * Prescribing Saving – North elements (Ambush North Rx Cres) (1,477) 6 Office 365 - North’s contribution to the project as per the 24/25 approved budget (73) 7 Prison Pharmacy Contract- North’s contribution to the project as per the 24/25 approved budget (93) 8 GIRFEC – realign to the Connected Communities Team (73) 9 ICT transfers (6) *these budget adjustments relate to the prescribing budget, the budget is delegated to the IJB but the financial position/outturn on prescribing is not, therefore there is no impact on the IJB position from any budget adjustments relating to prescribing. In 2023-24 there was a pan-Ayrshire budget reduction of £0.243m in relation to the Ayrshire and Arran contribution to Foxgrove. This contribution required further due diligence with NHS Ayrshire and Arran and NSD. This figure should have been £0.060m and this is adjusted in the 2024/25 financial year, with the NHS AA Director of Finance confirming a rebate will be processed. 2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside Lead Partnerships: - The IJB position is adjusted to reflect the impact of Lead Partnership services. The outturn for all Lead Partnership services is shared across the 3 Partnerships on an NRAC basis. The outturn in relation to North Lead Partnership services is not fully attributed to the North IJB as a share is allocated to East and South Partnerships; similarly, the impact of the outturn on East and South led services is shared with North. At Month 3 the MH lead partnership is projected to overspend by £0.521m (£0.171m NRAC share for East and £0.149m for South). South HSCP – projected overspend of £0.551m of which £0.204m will be allocated to North. The variance is mainly due to an overspend of £0.512m in the community store. This includes the costs of replacing mattresses, repairs and maintenance contract and equipment costs. There is also a projected overspend of £0.069m in the continence service and an underspend £0.030m in the Family Nurse Partnership. 136
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East HSCP (note that this in month 2 projection info) – projected underspend of £0.032m in total (of which £0.012m will be allocated to North). This includes assumed future Scottish Government funding to offset projected expenditure on Covid-19 Therapeutics and Urgent Care Pathway within Primary Care. The main projected variances are as follows: Primary Care (including Dental) - The £0.112m projected overspend at month 2 largely relates to additional staffing costs in Ayrshire Urgent Care Services and Primary Medical Services, partially offset by recruitment slippage, mainly in Dental services. Prison and Police Healthcare - The £0.224m projected underspend at month 2 largely relates to recruitment slippage, with posts anticipated to be filled in the second half of the financial year. Allied Health Professions - The £0.172m projected underspend at month 2 largely relates to recruitment slippage. Other Lead Services - The £0.252m projected overspend at month 2 relates to additional staffing costs in Area Wide Evening Services. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how this compares to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The 2023/24 usage is now available as is Q1 of 2024/25 and these will be presented to Ayrshire Finance Leads for validation. IJB Baseline at 2022/23 prices (£) East 26,215,888 North 35,007,962 South 28,371,789 Total 89,595,639 The annual budget for Acute Services is £430.6m. The directorate overspent by £8.2 million after 3 months. This was caused by overspends on agency medical and nursing staff, together with drug expenditure including the New Medicines Fund, 137
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equipment and supplies. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland. 144 additional unfunded beds remained open across both main hospital sites during March. There is a material underlying deficit caused by: • Unachieved efficiency savings • Length of Stay (LoS) in NHS Ayrshire and Arran acute hospitals is above the Scottish average • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. Initial work has commenced to develop a joint strategic commissioning plan for the provision of unscheduled care services, which will outline these services will be delivered over the medium-term using the set aside resources available. This will support a shift in the balance of care into the community and support a reduction in the number of acute beds. 2.12 FINANCIAL RISKS There are a number of financial risk areas that impact or may impact on the financial position. • The recent announcement by Scottish Government in relation to public sector finances may impact on current and future funding, including for 2024-25 pay awards, which have not yet been settled for local government or NHS. • Continued growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The provider market and the ongoing ability to source packages of care for service users. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges, for example the joint mission for delayed discharge improvement. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • The ongoing review of the Integration Scheme. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The wider system financial challenges, especially the financial position of NHS Ayrshire and Arran Health Board, their financial deficit and the risks around further escalation in the national framework for financial escalation. North Ayrshire IJB have already discussed our position in relation to the request for payment for delayed discharges last financial year. 138
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• The underlying levels of overspend which are recurring into 2024-25 and may impact on the Partnership’s ability to continue to sustain service levels in the future. • The IJB free general fund reserves are estimated to be fully utilised during this financial year, leading to an increased risk of requiring additional in-year financial contributions from NHS Ayrshire and Arran and North Ayrshire Council to break-even. • High risk areas of low volume / high-cost services areas e.g. Children’s residential placements, Learning Disability care packages and complex care packages; • Lead / hosted service arrangements, including managing pressures and reporting this across the 3 IJBs. • The impact on Lead Partnership and acute services from decisions taken by other Ayrshire areas. • The use of supplementary staffing for enhanced observations across a number of service areas. • The use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. These risks will continue to be monitored during 2024-25. 2.13 RESERVES The IJB reserves position is summarised in the table below. The opening ‘free’ general fund balance of £0.357m is held as a contingency balance and does not meet the target range of 2%-4%. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2024 0.357 3.379 1.774 5.510 The £1.774m HSCP earmarked reserve relates to the Service Redesign and Change Fund; of this total only £0.049m remains uncommitted with the balance being committed to investment in an early intervention approach within Children and Families social work and supporting the delivery of the transformation programme across 2024-25 and 2025-26. There is no flexibility to free up this resource as it is mostly funding additional posts with the HSCP. Further detail on the opening reserves is given in Appendix D. 139
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2.14 Financial Recovery Plan The IJB set a balanced budget for 2024/25 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290m of savings to achieve financial balance. Following the finalisation of the 2023/24 outturn position, the IJB agreed some initial recovery actions at the meeting in June. In line with the requirements of the integration scheme, a more detailed financial recovery plan has now been developed and is presented for approval by the IJB; this is outlined in Appendix E. There has been progress towards some of the targets which were agreed in June, and these are already reflected in the current projected outturn of £6.555m overspend. Further work is required to deliver on the balance of these targets as well as the additional targets which have now been identified. Services will work towards implementing the recovery plan to deliver on these cost reduction targets while carefully managing the level of risk. This will include the preparation of equality impact assessments. It is recognised that there needs to be further savings identified to move towards a breakeven position. Any decisions to implement changes which have significant impact on service delivery and the wider system will be discussed at the Finance Working Group before being brought back to the IJB for further approval as part of the financial recovery plan. MANAGEMENT ACTIONS/CONTROLS: Other management actions which have been implemented include: • Review of expenditure authorisation levels across the Partnership and escalation of specific decisions to senior officers. In particular, a new governance group has been introduced, involving the Director and Heads of Service, to oversee the agreement of higher value packages of care (above £40,000 per annum). • Staff communication in relation to discretionary/non-essential spend. • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service and a recruitment freeze will be implemented for all but essential frontline posts. • Ongoing review of future year savings or transformation programmes to identify scope for acceleration. • Maximise opportunities from the recently reopened Independent Living Fund (ILF) Scotland. 140
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GOVERNANCE: • In order to facilitate greater scrutiny of the financial position and the delivery of the financial recovery plan during 2024/25, the IJB agreed at the June meeting to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. The Director and Heads of Service will be members of the group. This will meet monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. A ‘terms of reference’ document has been developed and is attached at Appendix F for IJB approval. Meetings have now been scheduled to the end of the year and expressions of interest will be sought from IJB members. • Strengthened support from Finance Team to front line services and increased engagement with Heads of Service and Senior Management Teams, including line by line reviews of all budget areas. Review and enhancement of frequency and level of financial information provided to support oversight and decision making in line with financial constraints, with an added focus on areas of underspend to maximise opportunities to delay or stop spend and contribute to the overall financial challenge. INTEGRATION SCHEME The Integration Scheme describes the required approach where there is a projected overspend: The Chief Officer will deliver the Outcomes within the total delegated resources (paid and Set Aside) and where there is a forecast overspend against an element of the operational budget, the Chief Officer, the Chief Finance Officer of the Integration Joint Board and the appropriate finance officers of the Parties must agree a recovery plan to balance the overspending budget, which recovery plan shall be subject to the approval of the Integration Joint Board. If the recovery plan is not successful the Parties will consider making interim funds available based on the agreed percentage contribution for joint responsibilities, as outlined above, with repayment in future years on the basis of a revised recovery plan agreed by the Parties and Integration Joint Board. There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions and illustrates the current estimated risk exposure to the IJBs funding partners: TOTAL Health/NHS AA Social Care/NAC Projected Overspend @ mth3 £6.555m £0.586m £5.969m Financial Recovery Plan Projections £3.617m £0.381m £2.826m Residual Risk £2.938m £0.205m £3.143m 141
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3. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services in 2024-25 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan. 3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2024- 25. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £6.555m (2.0%). The report outlines the main variances for individual services. There IJBs unearmarked reserve balance is projected to be zero by the end of the financial year and there is an ongoing risk in relation to the £3.1m of the overspend where financial recovery improvement actions require to be identified. This current position poses a financial risk to North Ayrshire Council and NHS Ayrshire and Arran. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements are in place for the HSCP. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk Para 2.12 highlights the financial risks. The report falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk on our strategic risk register has increased the risk score to reflect the 23/24 outturn and current projected 24/25 overspend. 142
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4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2024-25 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2024-25. If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Paul Doak, Head of Finance and Transformation Eleanor Currie, Principal Manager Finance [pdoak@north-ayrshire.gov.uk/eleanorcurrie@north-ayrshire.gov.uk]- 143
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PUBLIC INFORMATION 2024-25 Budget Monitoring Report–Objective Summary as at 30th June 2024 Appendix A Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 COMMUNITY CARE AND HEALTH 71,309 76,220 4,911 18,745 19,821 1,076 90,054 96,041 5,987 : Locality Services 30,401 31,150 749 5,356 5,402 46 35,757 36,552 795 : Community Care Service Delivery 35,946 39,393 3,447 0 0 0 35,946 39,393 3,447 : Rehabilitation and Reablement 2,099 2,134 35 0 0 0 2,099 2,134 35 : Long Term Conditions 987 1,001 14 9,399 10,312 913 10,386 11,313 927 : Community Link Workers 358 359 1 0 0 0 358 359 1 : Integrated Island Services 1,518 2,183 665 3,990 4,107 117 5,508 6,290 782 MENTAL HEALTH SERVICES 34,320 34,531 211 72,631 73,011 380 106,951 107,542 591 : Learning Disabilities 25,688 26,284 596 542 542 0 26,230 26,826 596 : Community Mental Health 6,591 6,191 (400) 1,729 1,729 0 8,320 7,920 (400) : Addictions 2,041 2,056 15 1,908 1,908 0 3,949 3,964 15 : HBCCC 0 0 0 353 212 (141) 353 212 (141) : Lead Partnership Mental Health NHS Area Wide 0 0 0 68,099 68,620 521 68,099 68,620 521 CHILDREN & JUSTICE SERVICES 38,986 40,276 1,290 4,916 5,209 293 43,902 45,485 1,583 : Irvine, Kilwinning and Three Towns 3,046 3,071 25 0 0 0 3,046 3,071 25 : Garnock Valley, North Coast and Arran 3,206 3,246 40 0 0 0 3,206 3,246 40 :Intervention Services 1,716 1,723 7 0 0 0 1,716 1,723 7 : Care Experienced Children & Young people 27,049 28,770 1,721 0 0 0 27,049 28,770 1,721 : Head of Service - Children & Families 1,082 611 (471) 0 0 0 1,082 611 (471) : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 : C&F Health Team 415 383 (32) 4,200 4,493 293 4,615 4,876 261 : Lead Partnership NHS Children's Services 0 0 0 716 716 0 716 716 0 CHIEF SOCIAL WORK OFFICER 1,561 1,499 (62) 0 0 0 1,561 1,499 (62) PRIMARY CARE 0 0 0 53,109 53,067 (42) 53,109 53,067 (42) ALLIED HEALTH PROFESSIONALS 0 0 0 10,329 10,329 0 10,329 10,329 0 MANAGEMENT AND SUPPORT COSTS 9,187 8,819 (368) 4,013 3,020 (993) 13,200 11,839 (1,361) FINANCIAL INCLUSION 970 957 (13) 0 0 0 970 957 (13) OUTTURN ON A MANAGED BASIS 156,333 162,302 5,969 163,743 164,457 714 320,076 326,759 6,683 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget 144
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PUBLIC INFORMATION Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Return Hosted Over/Underspends East 0 0 0 0 (171) (171) 0 (171) (171) Return Hosted Over/Underspends South 0 0 0 0 (149) (149) 0 (149) (149) Receive Hosted Over/Underspends South 0 0 0 0 204 204 0 204 204 Receive Hosted Over/Underspends East 0 0 0 0 (12) (12) 0 (12) (12) OUTTURN ON AN IJB BASIS 156,333 162,302 5,969 163,743 164,329 586 320,076 326,631 6,555 Partnership Budget - Objective Summary 2024/25 Budget Council Health TOTAL 145
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PUBLIC INFORMATION 2024-25 Savings Tracker Appendix B Social Care: Description Deliverability Status at budget setting Deliverability Status at Month 3 2024/25 Saving Description of the Saving Children, Families & Criminal Justice Service redesign Amber Blue 0.123 Restructure areas of specialist service provision including substance use and corporate parenting, embedding the roles and functions of those teams within our locality-based early intervention approaches and strategic planning including engagement. Community Care & Health Review of Day Care provision Amber Blue 0.100 Carry out a review and streamline day care provision. Sensory Impairment Team Green Blue 0.062 Remove the dedicated management post and realign the team into core social work teams. Care Home places Green Amber 0.375 Reduce the number of funded care home places by 15, leaving budgetary provision for 765 places at average cost. Charging for community alarm provision to sheltered housing tenants Amber Amber 0.200 Introduce a charge for community alarm provision in council sheltered housing units to ensure an equitable approach across all housing tenures. Montrose House capacity Green Blue 0.111 Restrict the capacity at Montrose House care home to the current level of residency. Voluntary Early Release Green Blue 0.174 Recurring savings achieved by the release of back-office staff through the council's voluntary early release scheme. Carers Strategy funding Green Blue 0.384 Utilise the remaining Carer's Strategy funding to invest in respite provision and short breaks for carers and to support existing investments in services which support unpaid carers. Increase to charging Green Blue 0.131 Increase charges for non-residential care by 10% and charges for residential care by 5% Remove vacant posts Green Blue 0.280 Remove a number of vacant posts across support services. Employers' superannuation contributions Green Blue 7.238 Align the budget to the new employer superannuation contribution rates from 1st April 2024. Payroll Turnover Green Blue 0.077 Increase targets for payroll turnover through the recruitment process. TOTAL SOCIAL CARE SAVINGS 9.255 North Ayrshire Health and Social Care Partnership 2024/25 Savings Support Services and Partnership-wide savings 146
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 3 2024/25 Saving Description of the Saving Hospital Based Complex Continuing Care (HBCCC) provision Green Green 0.500 Align the budget to the level of ongoing need for HBCCC provision. Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.021 Apply an inflationary increase to the recharge to East Ayrshire HSCP. Community Recovery and Rehab provision Amber Amber 0.100 Review and streamline a range of current provisions to remove duplication. Enhanced ICT Green Green 0.100 Carry out a review of the service delivery model and release recurring staffing savings. Payroll Turnover Green Blue 0.314 Increase targets for payroll turnover through the recruitment process. TOTAL HEALTH SAVINGS 1.035 TOTAL NORTH HSCP SAVINGS 10.290 147
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PUBLIC INFORMATION 2024-25 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 156.190 Adjustments to baseline (0.574) Less Resource Transfer 23/24 (24.640) Revised Budget 130.976 Resource Transfer 24/25 1-3 P 24.861 Realign Girfec Team To Connected Communities 1-3 P (0.073) ICT Budget Transfers 1-3 P (0.006) CJSW Funding 2425 1-3 T 0.053 Children’s Living Wage Allocation 1-3 T 0.525 Roundings 1-3 (0.003) Social Care Budget Reported at Month 3 156.333 HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 157.894 Add Resource Transfer 23/24 24.640 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. (0.033) Revised Budget P 182.501 Add resource Transfer 24/25 (24.861) North Superannuation 24/25 uplift 1 1.134 MH: Anticipate Hollybush Combat Stress 24/25 1 1.424 MH: Anticipate Delivery of Veteran Funding 24/25 1 0.105 MH: Anticipate Perinatal MH, Infant MH (inc MNPI) 24/25 1 0.750 Training grade ADJ - April 1 0.063 Pecos Nurse Post 1 (0.018) Script Switch To Pharmacy 1 (0.002) Breastfeeding Pay Award - South 2 0.005 Nest - South 2 0.066 24-25 Foxgrove North 2 0.033 24-25 Breast Feeding - North 2 0.005 24-25 Huntingtons North 2 0.005 24-25 NEST North 2 0.066 Phlebotomy Admin Returned 2 0.005 148
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PUBLIC INFORMATION 23-24 - 50% North Share to East - Tier 3 Weight Management 2 (0.077) 24-25 North Share to East - Tier 3 Weight Management 2 (0.022) Anticipate ADP Afc Pay Uplift 3 0.091 Anticipate ADP Drug Prevalence 3 0.084 Anticipate ADP Lived & Living Exp 3 0.013 Anticipate ADP Mat 3 0.250 Anticipate ADP National Mission 3 0.296 Anticipate ADP Residential Rehab 3 0.134 Anticipate ADP Whole Family Approach 3 0.094 Training Grade Adj - Jun 3 (0.054) Prescribing (Ambush) North Rx 3 1.573 Prescribing (Ambush) North Rx Cres 3 (1.477) 24-25 North Budget Paper - Office 365 (to East) 3 (0.073) 24-25 North Budget Paper - Prison Pharm Contract (to East) 3 (0.093) South Mat Funding - Psychiatrist 3 0.029 Hd198: Early Intervention In Psychosis/ Body Image And Social Media Resource 3 0.242 Hd203: Digital Mental Health Programme Licence & Support 3 0.005 Anticipated budgets assumed in the report but not yet allocated 1.449 Roundings 3 (0.002) Health Budget Reported at Month 3 163.743 TOTAL COMBINED BUDGET 320.076 149
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PUBLIC INFORMATION 24-25 Opening IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2024 Earmarked Funds : Alcohol & Drug Partnership 641 : Mental Health Action 15 57 : Service Redesign / Challenge Fund 1,774 : Community Living Change Fund 377 : Family Wellbeing Fund 1,313 : Wellbeing Fund 50 : Breast Feeding Network 26 : MH Recovery and Renewal 546 : Buvidal 23 : Brooksby 5 : Cossette Funding 4 : Expansion of Primary Care Estates 55 : GP Premises Improvements - tranches 1 and 2 63 : Mental Health Wellbeing in Primary Care 81 : Dental Practice Improvement 29 :Appropriate Adult Scheme 2 :Adult Tier 3 Weight Management Service 19 : Phlebotomy 22 : LD Health Checks 66 Total Earmarked 5,153 Unallocated General Fund 357 General Fund 5,510 150
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E FINANCIAL RECOVERY PLAN £m £m £m Projected Overspend at Month 3 6.555 SERVICE AREA Cost reduction target Achieved in projected outturn Still to be achieved Target set? Health and Community Care Reduce care home placements in line with budget saving (0.700) (0.149) (0.551) June IJB Reduce CAH capacity/delay recruitment/in- house efficiencies (1.000) 0.000 (1.000) June IJB Community Wards - reduce supplementary staffing and review bed capacity (0.500) (0.235) (0.265) June IJB MH and LD (North Ayrshire) Freeze adult community support approvals outwith transitions 0.000 0.000 0.000 June IJB Respite provision - ensure use of in-house capacity is maximised 0.000 0.000 0.000 June IJB HBCCC mitigation plan (0.150) (0.150) 0.000 August IJB MH and LD (Lead Partnership) Ward staffing (adults/elderly inpatients) (0.300) 0.000 (0.300) August IJB Psychiatry (use of agency) (0.312) (0.312) 0.000 August IJB CEDS/CAMHS (0.202) (0.202) 0.000 August IJB North Ayrshire share (38.6%) (0.116) Children and Families Reduce children's external placements - early reduction from Brighter Pathways work (0.500) (0.377) (0.123) June IJB Additional target re-placements and staffing (0.500) 0.000 (0.500) August IJB Cross Partnership Vacancy management and temporary posts (0.500) 0.000 (0.500) June IJB Use of remaining reserve balance (0.357) 0.000 (0.357) August IJB STILL TO BE ACHIEVED (3.412) Remaining projected overspend 3.143 151
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PUBLIC INFORMATION Appendix F - North Ayrshire Integration Joint Board Finance Working Group Terms of Reference 1 Introduction 1.1 The North Ayrshire Integration Joint Board agreed on 13th June 2024 to establish a Finance Working Group to provide enhanced scrutiny in relation to the IJB financial position and the delivery of a financial recovery plan. The Group will also provide a forum for further development of future year budget proposals. 2 Chair 2.1 The Finance Working Group will be chaired by the Vice Chair of the IJB. This will rotate in line with the rotation of the role of IJB Chair between the NHS Board and the Council. 3 Group Membership 3.1 The finance working group will consist of senior officers from the HSCP and members of the IJB. 3.2 The officer membership will be: • Director of Health and Social Care/IJB Chief Officer • Head of Service (Finance and Transformation)/Section 95 Officer • Head of Service (Health and Community Care) • Head of Service (Children, Families and Justice) • Head of Service (Mental Health) • Chief Social Work Officer • Principal Manager (Finance) • Senior Manager (Strategic Planning and Transformation) Other officers will also be invited to attend to provide further detail or information at the discretion of the Chair. 3.3 All IJB Members (voting and non-voting) will have the opportunity to participate in the working group, with membership finalised following an invitation for expressions of interest. 3.4 Members should send an appropriate deputy to cover their absence from any meetings of the working group. 4 Meeting Frequency 4.1 The group will meet monthly with meetings to be arranged by the Team Manager (Governance). 152
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PUBLIC INFORMATION 5 Remit 5.1 The group will have the following remit: • Detailed scrutiny of in-year financial projections ahead of regular reporting to the Integration Joint Board • Monitor the delivery of the financial recovery plan • Monitor the progress with delivery of the Transformation Plan • Review of the 3-year Medium-Term Financial Outlook • Detailed scrutiny of budget planning for the next financial year. 5.2 5.3 The Integration Joint Board will continue to receive financial monitoring reports throughout the financial year and will also receive 6 monthly updates on progress with the Transformation Plan with individual service transformational change programmes also reporting to IJB. The role of Performance and Audit Committee will be unaffected with the working group enhancing the scrutiny, governance and oversight of the financial position. 6 Authority 6.1 The Budget Working Group is not a decision-making group and all decisions in relation to the budget which require formal agreement will continue to be made by the Integration Joint Board. 7 Governance Map 7.1 The Finance Working Group will interact with other key governance groups as shown in the map below: These terms of reference were approved by North Ayrshire IJB on 22nd August 2024. Integration Joint Board (IJB) Finance Working Group Partnership Senior Management Team (PSMT) Transformation Board 153
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Integration Joint Board 22nd August 2024 Subject : Accounts Commission: Integration Joint Boards Finance and Performance Purpose : • Awareness • Discussion Recommendation : That the IJB note the recently published Accounts Commission report and the findings from their national analysis of IJBs. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership 1. EXECUTIVE SUMMARY 1.1 This report summarises the key findings from the recently published Accounts Commission report: ‘Integration Joint Boards Finance and Performance’. 1.2 The Accounts Commission report notes the highly challenging landscape faced by IJBs in delivering community health and social care services, including increasing demand for support, insufficient funding, recruitment and retention challenges across the workforce and the uncertainty caused by the plans for a National Care Service. 1.3 Although the report presents the national position, most of the challenges highlighted clearly reflect the position in North Ayrshire. 2. BACKGROUND Introduction 2.1 In 2022 and 2023, the Accounts Commission published a bulletin setting out the financial position of the 30 Scottish IJBs. These were shared with the Performance and Audit Committee. 154
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This year’s report expands on this and provides a high-level independent analysis of IJBs, commenting on: • the financial performance of IJBs in 2022/23 and the financial outlook for IJBs in 2023/24 and beyond. • performance against national health and wellbeing outcomes and targets alongside other publicly available performance information. • a ‘spotlight’ focus on commissioning and procurement of social care. 2.2 The report focuses solely on IJBs. While it comments on how they interact and perform within the wider system, the audit does not comment on the work of councils, NHS boards or the Scottish Government or make recommendations to these bodies. It is noted that future reports will expand the scope to include these other bodies. This will allow the Accounts Commission to consider community health and social care as a whole system and look at how different parts work together when planning and delivering services. Key Messages 2.3 The report notes that Integration Joint Boards (IJBs) face a complex landscape of unprecedented pressures, challenges and uncertainties. These are not easy to resolve and are worsening, despite a driven and committed workforce. The health inequality gap is widening, there is an increased demand for services and a growing level of unmet and more complex needs. There is also variability in how much choice and control people who use services feel they have, deepening challenges in sustaining the workforce, alongside increasing funding pressures. 2.4 The Accounts Commission report that there isn’t significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs. IJBs operate within complex governance systems that can make planning and decision making difficult. They cannot address the issues across the sector alone. Whole system collaborative working is needed as part of a clear national strategy for health and social care that will promote improved outcomes across Scotland but reflects the need to respond to local priorities. 2.5 The workforce is under immense pressure reflecting the wider pressures in the health and social care system. Across the community health and social care sector there are difficulties in recruiting and retaining a skilled workforce. The Covid-19 pandemic, the cost-of-living crisis, and the impact of the withdrawal from the European Union have deepened existing pressures. Unpaid carers are increasingly relied on as part of the system but are also disproportionately affected by the increased cost-of-living. Without significant changes in how services are provided and organised, these issues will get worse as demand continues to increase and the workforce pool continues to contract. 155
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2.6 Uncertainty around the direction of the plans for a National Care Service and continued instability of leadership in IJBs across the country have also contributed to the difficult context for planning and delivering effective services. There are many examples of IJBs trying to work in new and different ways, but there is a lack of collaboration and systematic shared learning on improvement activities. 2.7 The financial outlook for IJBs continues to weaken with indications of more challenging times ahead:- • In common with other public sector bodies, financial pressures arising from rising inflation, pay uplifts and Covid-19 legacy costs are making it difficult to sustain services at their current level and, collaborative, preventative and person-centred working is shrinking at a time when it is most needed. • The financial outlook makes it more important than ever that the budget process involves clear and open conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. • Overall funding to IJBs in 2022/23 decreased by nine per cent in real terms or by one per cent in real terms once Covid-19 funding is excluded. The total reserves held by IJBs almost halved in 2022/23, largely due to the use and return of Covid- related reserves. The majority of IJBs reported notable savings, but these were largely arising on a non-recurring basis from unfilled vacancies. • IJBs have had to achieve savings as part of their partner funding allocations for several years. The projected funding gap for 2023/24 has almost tripled, in comparison to the previous year, with over a third anticipated to be bridged by non- recurring savings, with a quarter of the gap bridged using reserves. This is not a sustainable approach to balancing budgets. 2.8 Current commissioning and procurement practices are driven largely by budgets, competition, and cost rather than outcomes for people. They are not always delivering improved outcomes and are a risk for the sustainability of services. Improvement to commissioning and procurement arrangements has been slow to progress but is developing. There are some positive examples of where more ethical and collaborative commissioning models are being adopted. Recommendations 2.9 This report and the recommendations focus on IJBs, however, to respond to the significant and complex challenges in primary and community health and social care all the bodies involved need to work collaboratively on addressing the issues – IJBs alone cannot address the crisis in the sector. 156
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The next iteration of this annual report will be produced jointly between the Accounts Commission and the Auditor General for Scotland and will take a whole system approach and make recommendations to the Scottish Government, councils, NHS boards as well as IJBs, as appropriate. 2.10 The Accounts Commission recommends that IJBs should: • ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges • ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. • work collaboratively with other IJBs and partners to systematically share learning to identify and develop: – service redesign focused on early intervention and prevention – approaches focused on improving the recruitment and retention of the workforce. • work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. • evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. 3. PROPOSALS 3.1 It is proposed that the IJB note the recently published Accounts Commission report and the findings from their national analysis of IJBs. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 157
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4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk None. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 No consultation has been required in the preparation of this report. Caroline Cameron, Director Author Name: Paul Doak, Head of Service (Finance and Transformation), pdoak@north-ayrshire.gov.uk Appendices • Appendix 1, Accounts Commission Report: Integration Joint Boards Finance and Performance. 158
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Integration Joint Boards Finance and performance 2024 Prepared by Audit Scotland July 2024 159
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2 Contents Key messages 3 Recommendations 6 1. Introduction 7 2. The context 11 3. Financial performance 15 4. Performance 26 5. Commissioning and procurement 42 Endnotes 48 Appendix 1 50 Appendix 2 58 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Audit team The core audit team consisted of: Kathrine Sibbald, Zoe McGuire, Chris Lewis, Chris Dorrian and Philip Keane, under the direction of Carol Calder. 160
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3Key messages Key messages Key messages Key messages 1 Integration Joint Boards (IJBs) face a complex landscape of unprecedented pressures, challenges and uncertainties. These are not easy to resolve and are worsening, despite a driven and committed workforce. The health inequality gap is widening, there is an increased demand for services and a growing level of unmet and more complex needs. There is also variability in how much choice and control people who use services feel they have, deepening challenges in sustaining the workforce, alongside increasing funding pressures. 2 We have not seen significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs. They operate within complex governance systems that can make planning and decision making difficult. They cannot address the issues across the sector alone. Whole- system collaborative working is needed as part of a clear national strategy for health and social care that will promote improved outcomes across Scotland but reflects the need to respond to local priorities. 3 The workforce is under immense pressure reflecting the wider pressures in the health and social care system. Across the community health and social care sector there are difficulties in recruiting and retaining a skilled workforce. The Covid- 19 pandemic, the cost-of-living crisis and the impact of the withdrawal from the European Union have deepened existing pressures. Unpaid carers are increasingly relied on as part of the system but are also disproportionately affected by the increased cost-of-living. Without significant changes in how services are 161
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4Key messagesKey messages provided and organised, these issues will get worse as demand continues to increase and the workforce pool continues to contract. 4 Uncertainty around the direction of the plans for a National Care Service and continued instability of leadership in IJBs have also contributed to the difficult context for planning and delivering effective services. We are seeing examples of IJBs trying to work in new and different ways, but there is a lack of collaboration and systematic shared learning on improvement activities. 5 The financial outlook for IJBs continues to weaken with indications of more challenging times ahead. • In common with other public sector bodies, financial pressures arising from rising inflation, pay uplifts and Covid- 19 legacy costs are making it difficult to sustain services at their current level and, collaborative, preventative and person-centred working is shrinking at a time when it is most needed. • The financial outlook makes it more important than ever that the budget process involves clear and open conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. • Overall funding to IJBs in 2022/23 decreased by nine per cent in real terms or by one per cent in real terms once Covid-19 funding is excluded. The total reserves held by IJBs almost halved in 2022/23, largely due to the use and return of Covid-related reserves. The majority of IJBs reported notable savings, but these were largely arising on a non-recurring basis from unfilled vacancies. 162
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5Key messagesKey messages • IJBs have had to achieve savings as part of their partner funding allocations for several years. The projected funding gap for 2023/24 has almost tripled, in comparison to the previous year, with over a third anticipated to be bridged by non-recurring savings, with a quarter of the gap bridged using reserves. This is not a sustainable approach to balancing budgets. 6 Data quality and availability is insufficient to fully assess the performance of IJBs and inform how to improve outcomes for people who use services with a lack also of joined up data sharing. However, available national indicators show a general decline in performance and outcomes. 7 Current commissioning and procurement practices are driven largely by budgets, competition, and cost rather than outcomes for people. They are not always delivering improved outcomes and are a risk for the sustainability of services. Improvement to commissioning and procurement arrangements has been slow to progress but is developing. There are some positive examples of where more ethical and collaborative commissioning models are being adopted. 163
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6RecommendationsRecommendations Recommendations This report and the recommendations focus on IJBs, however to respond to the significant and complex challenges in primary and community health and social care all the bodies involved need to work collaboratively on addressing the issues – IJBs alone cannot address the crisis in the sector. The next iteration of this annual report will be produced jointly with the Auditor General for Scotland and will take a whole system approach and will make recommendations to the Scottish Government, councils, NHS boards as well as IJBs, as appropriate. Integration Joint Boards should: • ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges • ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability • work collaboratively with other IJBs and partners to systematically share learning to identify and develop: – service redesign focused on early intervention and prevention – approaches focused on improving the recruitment and retention of the workforce • work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches • evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. 164
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71. Introduction 1. Introduction About this report 1. In 2022 and 2023 the Accounts Commission published a bulletin setting out the financial position of the 30 Scottish IJBs. This year’s report expands on this and provides a high-level independent analysis of IJBs, commenting on: • the financial performance of IJBs in 2022/23 and the financial outlook for IJBs in 2023/24 and beyond • performance against national health and wellbeing outcomes and targets alongside other publicly available performance information • a ‘spotlight’ focus on commissioning and procurement of social care. 2. This report focuses solely on IJBs. While it comments on how they interact and perform within the wider system, the work does not comment on the work of councils, NHS boards or the Scottish Government or make recommendations to these bodies. In future reports we will expand the scope to include these public bodies. This will allow us to consider community health and social care as a whole system and look at how different parts work together when planning and delivering services. 3. Supporting this report we have also published: • a supplement collating the performance information considered in the report • a checklist of questions, based on the issues raised in this report, for IJB board members to consider • a summary of the discussion at a stakeholders’ roundtable session we hosted in February 2024 that has helped inform this report. 165
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1. Introduction 8 What is an IJB? 4. An IJB is responsible for the governance, planning and resourcing of social care, primary and community healthcare and unscheduled hospital care for adults in its area. 5. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires the 32 Scottish councils and 14 territorial NHS boards to work together in partnerships to integrate how social care and community healthcare services are provided. IJBs were created as part of the Act as separate legal bodies. Exhibit 1 (page 9) sets out how these IJBs operate. 6. There are 31 partnerships across Scotland. Stirling and Clackmannanshire councils have formed a single partnership with NHS Forth Valley. The majority of NHS boards have a partnership with more than one IJB and five IJBs cover the same geographical area as their health boards. 7. Highland follows a different arrangement, a Lead Agency model.1 This Accounts Commission report focuses on the work of the IJBs and does not comment on the performance of the Highland Health and Social Care Partnership as its scrutiny sits with the Auditor General for Scotland rather than the Accounts Commission. 8. The aim of integration is to ensure that people receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care; improving the outcomes for patients, people who use services, carers and their families. The services are provided by a mixture of public, private and third sector providers dependent on who is most suitable to deliver those services. 9. The Act sets out which services are required to be delegated by councils and NHS boards to the IJBs as a minimum. This includes social care and primary and community healthcare. Services within this scope include for example, services for adults with physical disabilities, mental health services, drug and alcohol services and unscheduled health care. Some IJBs have also integrated other services. For example, 11 IJBs also have strategic responsibility for children’s social care services and 16 IJBs have strategic responsibility for criminal justice social work. 166
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1. Introduction 9 Exhibit 1. How IJBs work IJB • Responsible for planning health and care services • Has full power to decide how to use resources and deliver delegated services to improve quality and people’s outcomes Jointly accountable to: council and NHS board through its voting membership and reporting to the public Council • Delegates specific services to the IJB • Provides money and resources Accountable to: the electorate NHS board • Delegates specific services to the IJB • Provides money and resources Accountable to: Scottish ministers and the Scottish Parliament, and ultimately the electorate Service delivery • IJB directs the NHS board and council to deliver services • The extent of the IJB’s operational responsibility for delivering services is defined by the level of detail included in its directions to each partner. The more detailed its directions, the more it will monitor operational delivery. NHS board and council accountable to IJB for the delivery of services as directed IJB accountable for overseeing the delivery of services NHS board and council Level of operational responsibility IJB Source: What is integration? A short guide to the integration of health and social care services in Scotland, April 2018, Audit Scotland 167
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1. Introduction 10 10. Audit Scotland has published reports and is currently undertaking work, on behalf of the Accounts Commission and the Auditor General for Scotland, on some of these service areas. • Adult mental health Report published 13 September 2023. • Children and young people who need additional support for learning Blog published 17 May 2022. • Drug and alcohol services: An update Report published 8 March 2022 and Drug and alcohol services – audit scope Ongoing work to be published Autumn 2024. • Social care briefing Report published 27 January 2022. • General Medical Services contract progress Audit scope report to be published spring 2025. 168
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112. The context 2. The context IJBs face a complex landscape of considerable challenges and uncertainties 11. Social care and primary and community healthcare services in Scotland currently face complex and unprecedented pressures and challenges. These challenges are not easily resolved and are worsening. There is an increased demand for services, deepening challenges in sustaining the workforce, alongside increasing financial pressures. These longstanding challenges have been exacerbated by the cost-of-living crisis, increasing cost of provision of services and a changing policy landscape. The Covid-19 pandemic has also had a lasting impact on this sector, given the impact on health and social care staff and the need to continue to protect vulnerable people. 12. The Independent Review of Adult Social Care2 (Feeley Review) (published in February 2021), and the scrutiny of the National Care Service (Scotland) Bill has stimulated a lot of public debate and consideration of the need for change in the sector. But, to date there has been limited change for people experiencing or working in social care. It is important to emphasise that this is not a reflection on individuals working in the sector. Our experience, through this work, is that those involved, at all levels, are driven and passionate about improving the lives of people who need support. 13. IJBs cannot address the issues across the sector alone, whole- system collaborative working is needed as part of a clear national strategy. In the Auditor General for Scotland’s NHS in Scotland 2023 report, he stated that ‘there are a range of strategies, plans and policies in place for the future delivery of healthcare, but no overall vision. To shift from recovery to reform, the Scottish Government needs to lead on the development of a clear national strategy for health and social care. It should include investment in preventative measures and put patients at the centre of future services’. IJBs are facing significant financial sustainability challenges and cost pressures are only increasing 14. In common with other public sector bodies, financial pressures arising from rising inflation, pay uplifts, the cost-of-living crisis and Covid-19 legacy costs are making it difficult to sustain services at their current level. IJBs are also experiencing an increase in prescribing costs. IJBs have had to achieve savings as part of their partner funding allocations for several years and achieving these savings, while maintaining service levels, has become increasingly difficult. IJBs are now having to consider more significant options as statutory duties have to be prioritised. This 169
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2. The context 12 includes ending funding for some care and support services, to ensure financial sustainability in the medium to long term. The demand and need for services continue to increase and become more complex 15. Demographic changes and the increasing complexity of care needed are driving an increase in the demand for services. For example, an estimated one in 25 people of all ages in Scotland received social care support and services at some point during 2022/23. It is estimated that 76 per cent of these people are aged 65 and over, and 63 per cent are aged 75 and over.3 An estimated 20 per cent of Scotland’s population is aged over 65. In many rural and island areas this population group is even higher, for example 27 per cent of the population in Argyll and Bute and the Western Isles are over 65.4 16. The proportion of the population over the age of 65 is projected to grow by nearly a third by mid-2045. Since currently around three-quarters of people receiving social care support are aged 65 or over, this means that there will likely be a substantial rise in the number of people requiring social care support. It is likely this pattern reflects the challenges across most other services commissioned by IJBs. A recent study found that 93 per cent of people aged over 65 who received social care had two or more medical conditions simultaneously.5 People over 75 are around twice as likely to require outpatient or inpatient care compared to those aged in their mid-20s.6 The workforce is under immense pressure 17. Across the primary and community health and social care sector there are difficulties in recruiting and retaining a skilled workforce. Without significant changes in how services are provided and organised, this issue will get worse as demand continues to increase and the workforce pool continues to contract. The number of people aged 25-44 is predicted to fall from 1.4 million to 1.3 million by 2045. Meanwhile the number of people aged over 75 will rise from 469,000 in 2021 to 774,000 in 2045.7 18. We have previously highlighted how the effects of the pandemic worsened existing pressures on the social care workforce causing experienced staff to leave their posts. Our ongoing monitoring and discussions with stakeholders show that these issues remain and the cost-of-living crisis and the ongoing impact of withdrawal from the European Union have added to the pressures. 19. The staff vacancy rates across social care and support services in Scotland is high. At 31 December 2022, 49 per cent of services reported vacancies; 63 per cent of these services with vacancies reported problems filling them. The percentage of care services reporting vacancies had been consistent over time up to and including 2020, before a large increase of 11 percentage points reported in 2021.8 170
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2. The context 13 20. Almost 90 per cent of social care providers stated recruitment and retention was problematic for them in a survey carried out by Scottish Care.9 This survey also found that a quarter of staff leave an organisation within the first three months of joining. Providers find they are competing for staff: • across other public, independent and third sector providers with differences in pay and terms and conditions • with the hospitality and retail sectors, who pay more for less demanding roles • with the health sector with an increasing disparity between health sector and social care sector wages – the current pay gap is 19 per cent between adult social care workers and NHS entry level pay. The cost-of-living crisis is affecting the demand for services as well as the ability to provide them 21. The increased costs of living have exacerbated the workforce challenges as the low wages are making it a less favourable career choice. This is particularly an issue for those providing care at home services who are experiencing an increase in petrol costs and are not always reimbursed in a timely manner, or, in some cases, at all for all their journeys. 22. Unpaid carers are also disproportionately affected by the increased cost-of-living crisis. People in the most deprived areas are more likely to provide 50 or more hours of unpaid care a week compared to people living in the least deprived areas.10 23. The cost of provision of services has also increased. Homecare costs per hour have increased by 19 per cent between 2016/17 and 2022/23. Residential care costs per week (for those aged 65 and over) have increased by 23 per cent between 2016/17 and 2022/23. There are also significant cost differences between urban and rural areas.11 24. In particular, for smaller, independent and third sector service providers, increased costs are causing problems for the sustainability of services. For example, in residential care homes, an increase in fuel costs to heat and provide power for residents has made their financial viability increasingly challenging. IJBs operate within complex governance systems that can make planning and decision making difficult 25. We previously reported in our Health and social care integration: update of progress report, that the current model of governance is complicated, with decisions made at IJB, council and health board level. We found that cultural differences between partner organisations are a barrier to achieving collaborative working and achieving key priorities. These challenges have not been resolved. An unpaid carer is anyone who cares for someone who is ill, disabled, older, has mental health concerns or is experiencing addiction and is not paid by a company or council to do this. Primarily, this is a family member or friend. 171
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2. The context 14 Instability of leadership continues to be a challenge for IJBs 26. A notable turnover of senior leadership positions since the start of health and social care integration continues to be a concern. Half of all IJBs experienced turnover in either their chief officer and/or chief finance officer posts in the last two years. Across 2021/22 and 2022/23, seven Chief Officers, 11 Chief Financial Officers, one IJB chair and one chief social work officer changed. Instability in leadership teams has the potential to disrupt strategic planning at a time when difficult and significant decisions need to be made. It can affect the culture of an organisation at a time when the workforce is under pressure. Plans for a National Care Service have brought uncertainty for IJBs 27. In June 2022, the Scottish Government introduced the National Care Service (Scotland) Bill to Scottish Parliament. The Bill was intended to ensure: • consistent delivery of high-quality social care support to every single person who needs it across Scotland, including better support for unpaid carers • that care workers are respected and valued. 28. The main elements of the Bill were the proposed creation of a National Care Service, including a national board, making Scottish Ministers accountable for social work and social care support. The original Bill also set out to transfer social care and social work council functions, staff and assets to Scottish Ministers or local care boards. This put in question the role and responsibility of IJBs and caused uncertainty for IJBs on the timescales for implementing the proposed National Care Service and what form it would likely take. This has complicated IJBs ability to undertake medium- and long-term financial planning. 29. After some delays, Stage 1 of the Bill was passed in March 2024. Amendments planned for the NCS Bill now mean IJBs will be reformed rather than replaced by 2029/30. IJBs should therefore ensure they have effective medium- and longer-term planning in place and continue to drive improvements in how they commission and deliver services. 172
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153. Financial performance 3. Financial performance The financial health of IJBs continues to weaken and there are indications of more challenging times ahead IJB funding has decreased in real terms compared to 2021/22 30. IJBs receive their funding as annually agreed contributions from their council and NHS board partners. Funding is largely received to cover in-year expenditure on providing services but can also be received for specific services and national initiatives to be funded in future years. 31. Funding to IJBs in 2022/23 decreased by £1.1 billion (nine per cent) in real terms to £11.0 billion; a £342 million decrease in cash terms Exhibit 2. IJBs received £1.0 billion of additional funding in 2021/22 to support their response to the Covid-19 pandemic. Excluding the 2021/22 Covid-19 related funding, this shows an underlying decrease of £68 million in real terms, representing a 1.0 per cent decrease. Exhibit 2. Real terms movement in IJB funding Partner funding (real terms) Covid-19 funding (real terms) 2022/232021/222020/21 £553m £10,987m £1,024m £11,025m £10,957m Source: IJB audited annual accounts 2020/21, 2021/22 and 2022/23 and ONS deflators 173
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3. Financial performance 16 Non-recurring savings, largely arising from unfilled vacancies, led to the majority of IJBs reporting a surplus on the cost of providing services 32. Nineteen IJBs reported a surplus on the cost of providing services, but these underspends were driven largely by vacancies and staff turnover (Exhibit 3, page 17). Three IJBs reported a break-even position and the remaining eight IJBs recorded an overspend of two per cent, or under, of their net cost of services. The three IJBs reporting a break-even position did so after receiving additional funding allocations from their partner bodies. The net underspend position on the costs of providing services across IJBs was £110 million. 33. The IJBs ability to meet the rising demand for their services and maintain service quality, is weakened by unfilled vacancies. The IJBs reporting a surplus would be unlikely to do so if the workforce was at full capacity. The majority of the total planned savings were achieved, but over a third were achieved only on a one-off basis 34. IJBs achieved 84 per cent of their £77 million planned savings target in 2022/23. Over a third of this was achieved on a non-recurring basis. This means that these savings will be carried forward to be found again in future years. Identifying and achieving savings every year on a recurring basis, and moving away from relying on one-off savings, is essential for IJBs to maintain financial sustainability. Total reserves held by IJBs have almost halved in 2022/23 due largely to the use or return of Covid-19 related reserves 35. By the end of 2022/23, all IJBs reported a reduction in their total level of reserves, decreasing by £560 million to £702 million, a 44 per cent reduction. 36. The decrease in the overall reserves balance was largely the result of a reduction in the reserves of funding that the Scottish Government specifically provided for the response to the Covid-19 pandemic. The Covid-19 related reserves decreased by 97 per cent, from £502 million to £14 million. Auditors confirmed that over two-thirds (£333 million) of the Covid-19 reserve reduction was a result of unused balances being returned to the Scottish Government. 174
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3. Financial performance 17 Exhibit 3. Operational surplus as a proportion of net cost of service -3 -2 -1 0 1 2 3 4 5 6 7 Shetland Aberdeenshire Scottish Borders Aberdeen Midlothian West Lothian Glasgow West Dunbartonshire Orkney Dumfries & Galloway Edinburgh East Lothian East Renfrewshire Clackmannanshire & Stirling Renfrewshire North Ayrshire Fife Inverclyde Falkirk Perth & Kinross South Lanarkshire East Dunbartonshire Dundee East Ayrshire Argyll & Bute Moray Angus North Lanarkshire South Ayrshire Eilean Siar Percentage Source: IJB audited annual accounts 2022/23 175
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3. Financial performance 18 37. The exceptional impact of Covid-19 reserve movements can obscure underlying reserve movements. When Covid-19 reserve movements are excluded, the total value of reserves was reduced by 10 per cent (£72 million) from £760 million to £687 million. 38. IJBs hold reserves for a variety of reasons, including reserves held to address specific local or national policy initiatives or to mitigate the financial impact of unforeseen circumstances. The reserves held by IJBs consisted largely of four main areas (Exhibit 4, page 19), as follows: • Earmarked reserves of £426 million (£426 million in 2021/22) held by individual IJBs for a range of local planned purposes, such as reserves for multidisciplinary teams, interim care beds, as well as more generic reserves associated with winter planning and local reserves to support newer innovative practices that contribute towards strategic change. • Ring-fenced reserves of £79 million (£185 million in 2021/22) provided to support Scottish Government national policy objectives. Examples include the Primary Care Improvement Fund, Mental Health Recovery and Renewal, Mental Health Action 15, Community Living Change Fund and Alcohol and Drug Partnership funding. • Contingency reserves of £183 million (£148 million in 2021/22) that have not been earmarked for a specific purpose. IJBs have more flexibility on the use of this type of reserves which are often used to mitigate the financial impact of unforeseen circumstances. • Covid-19 related reserves of £14 million (£502 million in 2021/22), representing all unspent funding received to support the impact of the pandemic on IJB services. 176
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3. Financial performance 19 Exhibit 4. 2022/23 Reserves 61% Earmarked reserves 26% Contingency reserves 11% Ringfenced reserves 2% Covid-19 reserves Source: IJB audited annual accounts 2022/23 39. Reserves ring-fenced to support Scottish Government national policy objectives saw a 57 per cent reduction of £106 million to £79 million. These national initiatives include programmes for primary care improvement and mental health programmes. 40. These reserve balances largely represent non-recurring amounts of money that can only be used for specific and defined national policy priorities. As these non-recurring reserves are utilised, funding will need to be identified to fund any continuing associated initiatives on a sustainable basis. 41. The reduction in reserves was slightly offset by increases in the contingency reserves and other locally earmarked reserves. Contingency reserves have continued to increase, largely as a result of unplanned vacancy savings, and now represent a quarter of the total year end reserves balance. 177
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3. Financial performance 20 Exhibit 5. Year end IJB reserves as a proportion of net cost of services 0 2 4 6 8 10 12 14 16 Shetland Edinburgh Moray Dumfries & Galloway East Renfrewshire West Lothian Scottish Borders Orkney Aberdeenshire East Lothian Argyll & Bute Glasgow Fife North Ayrshire South Lanarkshire Perth & Kinross Aberdeen East Ayrshire Midlothian South Ayrshire Dundee Clackmannanshire & Stirling East Dunbartonshire Renfrewshire Falkirk Angus West Dunbartonshire Inverclyde North Lanarkshire Eilean Siar Percentage Contingency as a proportion of net cost of service Ringfenced/ earmarked reserves as a proportion of net costs of services Source: IJB audited annual accounts 2022/23 178
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3. Financial performance 21 42. Contingency reserves are uncommitted funds held by IJBs to mitigate the financial impact of unforeseen circumstances and the amount held will vary depending on individual IJB reserve policies. A review of a sample of ten IJB reserve policies showed that the majority (eight) had a contingency reserve target of two per cent of annually budgeted expenditure. There is no statutory maximum or minimum level of contingency reserves. 43. Seventeen IJBs reported an increase in their contingency reserves leading to a net increase of 24 per cent (£35 million) to £183 million between 2021/22 and 2022/23. Across the IJBs, contingency reserves, as a proportion of the net cost of services, ranged from zero per cent to four per cent (Exhibit 5, page 20). Two thirds of IJBs had contingency reserve levels of over two per cent of the net cost of services. Five IJBs had no contingency reserves. The projected financial position is set to worsen 44. Twenty five IJBs agreed their 2023/24 budget before the start of the financial year. Delays in the agreement of savings plans and uncertainty around NHS partner funding were the most common reasons for IJBs not agreeing a balanced budgets before the start of the financial year. 45. IJBs do not always receive notification of funding allocations from NHS boards before the start of the financial year. This adversely affects the IJBs’ ability to plan expenditure, can cause delays to decision-making and lead to vacancies being held unfilled due to uncertainty over funding. 46. The projected funding gap for 2023/24 has almost tripled in comparison to the previous year. All IJBs reported an increase in their projected funding gap with the exception of Orkney IJB. The 2023/24 projected funding gap was £357 million representing a 187 per cent increase from the 2022/23 projected funding gap (£124 million). Funding gaps, as a proportion of the 2022/23 net cost of services, ranged from one to ten per cent (Exhibit 6, page 22). 179
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3. Financial performance 22 Exhibit 6. Funding gap as a proportion of net cost of service 0 2 4 6 8 10 Inverclyde South Ayrshire Dundee East Dunbartonshire Orkney North Ayrshire Aberdeenshire Angus North Lanarkshire East Ayrshire Shetland Aberdeen West Lothian Clackmannanshire & Stirling Glasgow Renfrewshire West Dunbartonshire East Lothian Fife South Lanarkshire Argyll & Bute Moray Midlothian East Renfrewshire Perth & Kinross Falkirk Edinburgh Scottish Borders Eilean Siar Dumfries & Galloway 2023/24 funding gap as proportion of net cost of service 2022/23 funding gap as proportion of net cost of services Percentage Source: Auditor data return 180
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3. Financial performance 23 47. Of the total funding gap, 53 per cent (57 per cent in 2021/22) is anticipated to be met by identified savings, 24 per cent from the use of reserves, with actions yet to be identified to bridge the remaining gap Exhibit 7. Exhibit 7. 2023/24 IJB funding gap planned action 43% Agreed savings - recurring 24% Use of reserves 16% Unidentified savings (includes savings for which no detailed or agreed plans are in place) 11% Agreed savings - non- recurring 6% Other Source: Auditor data return 181
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3. Financial performance 24 The increasing reliance on non-recurring sources of income is not sustainable 48. At the time of the 2023/24 budget setting, over a third of the projected funding gap was anticipated to be bridged by one-off sources of funding, ie on a non-recurring basis. A quarter of the projected funding gap was planned to be bridged by the use of non-recurring reserves and a further fifth of the identified savings were anticipated to be non- recurring. 49. In addition, a significant proportion of the funding gap did not have planned savings action agreed against it at the time of budget setting. These unidentified savings made up 16 per cent of the total projected funding gap and were the result of eight IJBs not starting the 2023/24 financial year with a balanced budget. 50. The increased reliance on non-recurring sources of income to fund recurring budget pressures is unsustainable in the medium to long term. The identification and delivery of recurring savings and a reduced reliance on drawing from reserves to fund revenue expenditure will be key to ensuring long-term financial sustainability. Financial sustainability risks have been identified by auditors in the vast majority of IJBs 51. Auditors identified financial sustainability risks for 80 per cent of IJBs as part of their 2022/23 audits. Findings suggested that there was a reliance on non-recurring savings and sources of income to achieve financial balance. 52. As recurring savings get more difficult to identify and achieve, the need for a more significant transformation of services, in order to achieve financial sustainability, becomes more important. 53. IJBs are currently facing a range of significant and growing challenges and uncertainties impacting financial sustainability and service provision, including: • uncertainty around the level and terms of future funding settlements and funding allocations for specific initiatives • significant recruitment and retention challenges, both with the IJB and partner bodies and with external providers in the sector • rising demand and increasing complexity of care arising from the demographic challenges of an ageing population • cost-of-living crisis and inflationary cost pressures, including prescribing costs, making it more expensive to maintain the same level of services 182
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3. Financial performance 25 • ongoing legacy cost impacts of Covid-19, including vaccination programmes, testing and Personal Protective Equipment costs. 54. An initial analysis of 2024/25 budget setting reveals that the projected funding gap for IJBs has increased again to £456 million. This increase underlines the importance of IJB board members having clear and frank conversations not only at the board level, but with partners, providers and the wider public, about the decisions that will be required to achieve future savings and the likely implication these decisions will have on the services individuals currently receive. Medium-Term Financial Plans need to be updated to reflect all cost pressures currently known 55. The majority of IJBs have an up to date Medium-Term Financial Plan in place, but auditors found a third needed to update their plan. It is essential that IJBs ensure Medium-Term Financial Plans are updated, reflecting all known and foreseeable costs, to allow informed decision- making on the delivery of sustainable service provision and reform in the future. 183
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264. Performance 4. Performance Data quality and availability is insufficient to fully assess the performance of IJBs, but national indicators show a general decline in performance and outcomes Data quality and availability is insufficient to fully assess the performance of IJBs and inform actions to improve outcomes for service users with a lack of joint data across the system 56. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out nine National Health and Wellbeing Outcomes. These seek to measure the impact that integration is having on people’s lives. These national outcomes are underpinned by 23 associated national indicators, although four indicators have not been finalised for reporting. These national indicators have been developed from national data sources to provide consistency in measurement. IJBs are also encouraged to devise their own performance indicators for their area. Each IJB produces an annual performance report which sets out publicly its performance against key performance indicators. 57. Our review of IJB annual performance reports for 2022/23 shows the majority report against the key national performance indicators. All set out performance against their own identified strategic priorities. Some IJBs have developed their own indicators, as suggested in the Act, to help demonstrate how they are working towards their strategic outcomes. This allows for flexibility in reporting on local performance but means that describing a comprehensive national picture of performance is not possible. 58. Published performance information is not always clearly linked to the National Health and Wellbeing Outcomes with some gaps in the completeness of national performance information. Nine of the national integration performance indicators are based on the biennial Health and Care Experience Survey (HACE). Response rates for the HACE are generally quite low, with more deprived areas experiencing the lowest response rates. This increases the risk that there may be underrepresentation of the experience of certain groups of people and areas. The IJB Performance Supplement to this report sets out the performance of each IJB against the 19 national indicators available under the National Health and Wellbeing Outcomes. 184
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4. Performance 27 59. In our engagement with stakeholders, we heard a consistent message that data is key to a whole system approach and performance management needs to be redefined to reflect this. They indicated a range of challenges around data that is currently collected: • The current data does not provide good evidence on how the performance of one part of the system impacts on either other parts of the social care system or the system as a whole. This means the current performance data is of limited use in helping to inform system changes which might improve performance and deliver better long-term outcomes. • There is too much emphasis on data that is used by individual organisations for their governance and operational purposes rather than the collective partnership focus on its priorities. Current arrangements do not reflect a ‘whole-systems’ approach to performance management and reporting. • A lack of good data on primary care as it is voluntary for GP’s to report. • Data is more routinely collected and published on health services than social care services. Work to improve the data sets is at an early stage but is progressing 60. Work is being carried out by the Scottish Government and Public Health Scotland to improve data and allow the comparison of performance including the development of the Care & Wellbeing dashboard. This was launched in November 2023 and is populated with management information and updated on a weekly basis. IJB chairs and chief officers have access to the system to monitor significant shifts in performance and anomalies in the data. The system is still in its early stages of development and use. 61. There are other resources that can be utilised to assist in the analysis of data. In our Health and social care integration: update of progress 2018 report we set out the existence of Local Intelligence Support Team (LIST) analysts. Using a LIST analyst to tailor and interpret local data helps IJBs to better understand local need and demand and to plan and target services. 62. There are also examples of individual IJBs starting to manage their data in more innovative ways, for example at Midlothian IJB. (Case study 1, page 28) 185
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4. Performance 28 Case study 1. Midlothian IJB outcome mapping Midlothian IJB coordinates health and social care support to nearly 97,000 people. To better understand how the IJB contributes to personal outcomes for people, it asked all Midlothian HSCP services to track their contribution to improving outcomes using an outcome mapping approach by January 2024. Outcome mapping is a way to understand how services contribute to people achieving the outcomes that matter to them and can help services make more targeted, locally informed decisions about how to design, deliver or commission services. This approach allows them to describe what they do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes in their lives. The outcome mapping approach was developed by ‘a Scottish software and consultancy company in partnership with the Midlothian HSCP Planning and Performance team. Each ‘stepping-stone’ of the outcome map framework includes a set of success criteria aligned to the Care Inspectorate joint inspection framework. The outcome map is colour-coded to show an evaluation of the extent to which the service is making progress towards personal outcomes and confidence in how strong the evidence is to support that progress rating. This results in a two-factor rating system for each ‘stepping-stone’ in the outcome map. The IJB also uses outcome mapping and has developed a Strategic Commissioning Map that provides a real-time picture of the whole system progress towards their strategic aims and the nine National Health and Wellbeing Outcomes by linking to service outcome maps. Outcome mapping is now central to performance measurement in the planning and performance teams. It is part of the triangulation of three types of data: service activity, population experience, and personal outcomes. The information collected from each of these three areas together provides objective, whole system evidence that supports services to develop meaningful action plans for change. Currently 60 per cent of service areas are using the framework. Some services are using this system to articulate, record, examine, and evaluate service provision and actively using this tool to support service redesign. Resourcing pressures continue to present challenges for some areas to find the time and space to complete a first map and a programme of targeted support is in place to help those areas with the most significant delivery pressures. The partnership has shared this work with Healthcare Improvement Scotland (HIS), the Scottish Government team developing the National Improvement Framework for Adult Social Care and Community Health and most recently the team developing a new improvement framework for health that will support person centred care. Source: Midlothian HSCP 186
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4. Performance 29 Available national indicators show a general decline in performance and outcomes for people using social care and primary and community healthcare services 63. As set out in the thematic sections below (and in the performance information supplement) there is a general decline in performance against the national indicators. 64. The following sections draw out performance findings against key themes set out in the bullet points below. Alongside nationally available data, for each theme we also describe the context and challenges. Some case studies of examples are also set out in Appendix 1 (page 50). These illustrate examples of where IJBs are using or developing different working practice to improve performance and outcomes. • Theme 1 – Prevention and early intervention • Theme 2 – Shifting the balance of care • Theme 3 – Person-centred care/choice and control • Theme 4 – Reducing inequalities • Theme 5 – Unpaid carers/community resilience. Theme 1 Indicators – Prevention and early intervention Collaborative, preventative and person-centred working is shrinking at a time when it is most needed. Instead of a focus on care at the right place at the right time, there is a shift to reactive services with little capacity to invest in early intervention and prevention. 65. Addressing individuals’ health and social care needs at an earlier stage through prevention and early intervention promotes better outcomes for individuals, improving their quality of life and independence, and reduces the need for costly support and care later on. The 2021 Independent Review of Adult Social Care in Scotland (Feeley Review) set out the need for an increased focus on preventative, early intervention and anticipatory forms of support and a shift away from a crisis intervention. However, this is difficult to progress when the pressures on services are so acute. 66. As financial pressures have increased, eligibility criteria for individuals accessing social care services have tightened. With this, opportunities to undertake prevention and early intervention focused services have decreased. IJBs and their partner bodies have instead signposted less formalised support in the community, often provided by third and voluntary sector organisations. However, we have found that the financial challenges are leading IJBs and other funding bodies such as NHS boards and councils to reduce grant funding to these service providers reducing the capacity to meet and address these lower level, often more preventative focused needs. 187
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4. Performance 30 67. Leaving lower-level health and social care needs unaddressed until they become more significant tends to lead to increased complexity of need, the requirement for a more resource intensive intervention and less positive outcomes for individuals in the longer term. It is essential that IJBs and their partner bodies find ways to protect and increase the health and social care interventions at an earlier stage. This will be key to addressing future demand pressures arising from demographic shifts to an older population in a more financially sustainable manner. 68. How well individuals consider themselves able to look after their health is indicative of the IJBs’ and partner bodies’ effectiveness in addressing and supporting individual needs to sustain healthy lives in the community. Since 2013/14, there has been a deterioration by four percentage points of adults who are able to look after their health either ‘very well’ or ‘quite well’ Exhibit 8. All the IJBs recorded a reduction in this measure over the period 2013/14 to 2022/23. Fourteen IJBs saw a reduction greater than average over this period, with three IJBs recording a reduction greater than five percentage points. Exhibit 8. Theme 1 indicators Percentage of adults able to look after their health very well or quite well 50 60 70 80 90 100 2023/242021/222019/202017/182015/16 95% 91% -4% Source: Core Suite of Integration Indicators, Public Health Scotland 188
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4. Performance 31 Exhibit 9. Theme 1 indicators Emergency admission rate (per 100,000 population) 8 9 10 11 12 13 2022/23 2021/22 2020/21 2019/20 2018/19 2017/18 2016/17 12,229 11,276 -8% Emergency bed day rate (per 100,000 population) 90 100 110 120 130 140 2022/23 2021/22 2020/21 2019/20 2018/19 2017/18 2016/17 125,979 119,806 -5% Source: Core Suite of Integration Indicators, Public Health Scotland 69. Emergency admissions rate and the emergency bed day rate are often used as indicators of how well IJBs are reducing unnecessary hospital stays and situations where individuals remain in hospital while they are deemed to be fit enough to return to a more community-based setting. 70. Positively, there has been an eight per cent reduction in the emergency admissions rate as well as a five per cent reduction in the emergency bed day rate since 2016/17. Compared to 2020/21 there is an 16 per cent increase in the emergency bed day rate, however this reflects the impact of the Covid-19 pandemic Exhibit 9. 71. Eighteen IJBs recorded a reduction in emergency bed day rate over the period 2016/17 to 2022/23 Exhibit 9. Of the twelve that recorded an increase, two IJBs record an increase of over 10 per cent. 72. Some IJBs have put in place schemes and plans and maintain early intervention and prevention services. For example, Aberdeen City have set up a listening service to offer first-level support for people with low- level mental health challenges, addressing issues such as bereavement, redundancy, and life changes that can impact overall wellbeing. In Fife, a text chat service was launched in November 2022 enabling young people aged 12 to 19 to have direct, confidential access to the school nursing service. Further examples are set out in Appendix 1 (page 50). 189
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4. Performance 32 Theme 2 Indicators – Shifting the balance of care There is a recognition by the Scottish Government, councils and NHS boards that the balance of care needs to shift out of hospital to the community. Although this was the intention of the creation of IJBs, we have not seen significant evidence of this happening. 73. Part of the aims of the integration of health and social care was to help shift resources away from the institutional settings, such as hospitals and residential care institutions, and into more community- based services. The rationale for this is that, alongside it often being a more cost-effective way of providing services, it also helps promote greater independence and improved outcomes for the individual. 74. There has been an increase in the provision of services in the community, with an increase in the percentage of adults with intensive care needs receiving care at home and in the proportion of end-of-life care provided at home or in a community setting. At the same time, the percentage of expenditure on institutional and community-based Adult Social Care services has largely remained static with a small increase in the proportion spent on accommodation-based services. 75. Indicators tracking the balance of care and provision of services in the community have largely shown an increase in the number of individuals receiving care at home or in the community. However, these changes are marginal when viewed over the period since the inception of health and social care integration in 2015. There are also indications of pressures impacting the access to community-based services and the capacity of community services (Exhibit 10, page 33). 190
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4. Performance 33 Exhibit 10. Theme 2 indicators Percentage of adults with intensive care needs receiving care at home 50 60 70 80 20232022202120202019201820172016 62% 65% +3% Proportion of last 6 months of life spent at home or in a community setting 50 60 70 80 90 100 2022/23 2021/22 2020/21 2019/20 2018/19 2017/18 2016/17 87% 89% +2% Percentage of patients provided with advanced booking to GP practice (3 or more working days in advance) 50 60 70 80 90 100 2022/232020/212019/202017/182015/162013/14 77% 50% -27% Number of days people aged 75+ spend in hospital when they are ready to be discharged (per 1,000 population) 500 600 700 800 900 1000 2023/24 2022/23 2021/22 2020/21 2019/20 2018/19 2017/18 2016/17 841 902 +7% Source: Core Suite of Integration Indicators, Public Health Scotland 191
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4. Performance 34 76. At the same time there has been a deterioration in the experience of those receiving those services in the community nationally Exhibit 11. Exhibit 11. Theme 2 indicators Percentage of adults supported at home who agree that they are supported to live as independently as possible 2021/222019/20 81% 79% -2% Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life -2% 2021/222019/20 80% 78% Source: Core Suite of Integration Indicators, Public Health Scotland 77. The Auditor General for Scotland NHS in Scotland 2023 report states that ‘lack of social care capacity remains an obstacle to improving patient flow and reducing the number of delayed discharges from hospital. This is supported by data showing that many patients whose discharge is delayed are awaiting the completion of care arrangements to allow them to live in their own home (awaiting social care support), waiting for a place in a nursing home, or awaiting the completion of a post-hospital social care assessment’. 78. Examples of approaches to shift the balance of care from the hospital to community settings are set out in Appendix 1 (page 50). 192
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4. Performance 35 Theme 3 Indicators – Person-centred care: choice and control The amount of choice and control service users feel they have is variable across the country 79. In 2010, the Scottish Government and COSLA set out a ten-year self-directed support (SDS) strategy with the aim of supporting people’s right to direct their own social care support. The Social Care (Self-directed Support) (Scotland) Act 2013 was part of the SDS strategy and set out how councils should offer people options for how their social care is managed.12 80. The Scottish Government, IJBs, councils, providers and service users and their carers recognise the gap between what the SDS legislation is designed to do and what is happening for people trying to access services in parts of Scotland. While there are examples of people being supported in effective ways through SDS, not everyone is getting the choice and control envisaged through the strategy. Some people who use services feel they have a lack of choice and need to accept what is offered with the type of care they receive being driven by the service provider. This is most recently evidenced in the Scottish Parliament’s Health, Social Care and Sport Committee post-legislative scrutiny of the Self-directed Support (Scotland) Act 2013 phase 1 report.13 Examples of increased flexibility, choice and control were given for both individuals and unpaid carers but the Committee also reflected that many areas of improvement are required. For example, a need to improve the consistency of implementation between councils and improve clarity and knowledge around SDS by providing more support and guidance to navigate the process. 81. People who use services and their carers highlight issues accessing services. Either the times at which services are available is unsuitable or the process required to access them is overly complicated. Service users also highlighted a lack of coordination and communication between services, often having to repeat their symptoms or issues multiple times as they move from service to service. Poor data sharing was highlighted as a contributing factor. 82. People who use services described being put to bed at 2pm or left in bed for hours at a time during the day. This was largely attributed to care services being under-resourced and care workers having to schedule their day to fit in additional people. 83. Research14 has found that while those who received SDS generally had positive experiences and found it beneficial, more than one-quarter of people who use SDS had their option chosen by someone else. 84. The percentage of people who are receiving social care support through SDS is increasing, estimated at 88.5 per cent in 2021/22, up from 77.1 per cent in 2017/18. 193
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4. Performance 36 Exhibit 12. Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided Agreed Disagreed 2021/222019/20 25% 29% 71%75% Source: Core Suite of Integration Indicators, Public Health Scotland 85. In general, there has been a deterioration in the proportion of adults who felt that they had a say in how their care is provided Exhibit 12. The latest year of data (for 2023/24) shows that 60 per cent of adults supported at home who disagreed that they had a say in how their help, care or support was provided. Due to how the data is collected this data is not comparable to previous years. 86. The Care Inspectorate amended their approach to inspections of care services in response to the Covid-19 pandemic. Inspection activity was shifted to focus on services where there were concerns or intelligence suggesting that they are a higher risk. The overall trend since 2020/21 has seen a reduction in the number of care services graded as either ‘good’ or better Exhibit 13. Exhibit 13. Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 2023/242022/232021/222020/21 83% 76% 75% 77% Source: Core Suite of Integration Indicators, Public Health Scotland 194
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4. Performance 37 87. There is limited national data on access to GPs. (The Auditor General for Scotland’s upcoming report on the General Medical Services contract will look further at the availability and quality of data.) However, the percentage of people reporting a positive experience of care at their GP practice between 2015/16 and 2023/24 has declined by 17 points Exhibit 14. There has been a decline across all IJBs and the gap between the best and worst performing areas has widened. 88. Some examples of IJBs working with partners to intervene to give people more choice and control and feedback on the services they receive are set out in Appendix 1 (page 50). Exhibit 14. Percentage of people with positive experience of care at their GP practice 0 10 20 30 40 50 60 70 80 90 100 2023/242021/222019/202017/182015/16 Min Scottish average Max Percentage Source: Core Suite of Integration Indicators, Public Health Scotland 195
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4. Performance 38 Theme 4 Indicators – Reducing inequalities The Covid-19 pandemic has exacerbated existing inequalities 89. A recent review15 of health inequalities found that the health of people living in Scotland’s most deprived areas is not keeping up with the rest of society. The health inequality gap is widening, evident through increased drug deaths, infant mortality and a fall in life expectancy in more deprived areas. People living in deprived areas have a significantly lower healthy life expectancy, 26 years less for males and 25 for females in the most deprived decile compared to the least deprived decile. This gap has been widening over the past decade.16 90. Research has found people who access social care, unpaid carers and those who work in the social care sector have been disproportionately impacted (both directly and indirectly) by the Covid- 19 pandemic and mitigation measures.17 The review also highlights that some groups could experience multiple and compounding inequalities. There is a risk that equality groups and people most at risk of having their human rights breached are set back by changes to and reductions in service provision, particularly as finances become tighter. 91. Respondents to a survey about their experiences of social care18 who did not receive support but felt they needed it, were proportionally more likely to be non-white, disabled, living in deprived areas, LGBO (lesbian, gay, bisexual, other) and unpaid carers. The premature mortality rate is increasing with rates higher in more urban and more deprived areas 92. The premature mortality rate is increasing across Scotland Exhibit 15 with a one per cent increase between 2016 and 2022. Exhibit 15. Theme 4 indicator Premature mortality rate per 100,000 population 400 450 500 2022202120202019201820172016 440 442 +1% Source: Core Suite of Integration Indicators, Public Health Scotland 196
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4. Performance 39 93. IJBs were found to have consistently lower rates of premature mortality in areas that were more rural and/or relatively more affluent. Five IJBs, all from more urban and less affluent areas (Dundee, Glasgow City, Inverclyde, North Lanarkshire, West Dunbartonshire), have consistently had relatively high premature mortality rates. Emergency bed day rates are greater in areas with higher levels of deprivation 94. There is a clear relationship between the emergency bed day rate and the deprivation and affluence of an area. Using the Improvement Service’s family groupings of IJB areas, shows that areas with higher levels of deprivation have higher levels of emergency day bed rates than areas that are more affluent Exhibit 16. Family groups are groupings of IJBs that are similar in the type of population they serve (deprivation and affluence levels) as well as the type of area they serve (rural, semi-rural and urban). Exhibit 16. Emergency bed day rate (per 100,000 population): Difference to Scottish rate -40000 -30000 -20000 -10000 0 10000 20000 30000 2022/232021/222020/212019/202018/192017/182016/17 Note: Grouping 1 represents the least deprived/affluent IJB areas and grouping 4 represents the most deprived/affluent Source: Core Suite of Integration Indicators, Public Health Scotland, Improvement Service (deprivation and affluence grouping) 197
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4. Performance 40 95. Example case studies in Appendix 1 (page 50) set out some programmes IJBs have in place to tackle inequalities in their communities and improve outcomes for all. Theme 5 Indicators – Unpaid carers The reliance on unpaid carers is increasing as the social care workforce is under added pressure 96. There is an enormous reliance on unpaid carers to support the social care system. These carers provide support to friends or family who need it. Carers can claim an allowance of £81.90 a week if they care for someone at least 35 hours a week. An additional carer support payment of £288.60 twice a year is also available to some carers. Although the exact number of unpaid carers is not known, as many carers don’t identify themselves as such, there are an estimated 800,000 unpaid carers in Scotland; this includes 30,000 young carers under the age of 18.19 The social care system relies on the contribution of the community and unpaid carers with the value of unpaid care estimated at £36 billion a year in Scotland.20 The Feeley Review stated that ‘The role communities play in supporting adults to remain active in their community simply cannot be overstated.’21 97. This reliance on unpaid carers is increasing as the social care paid workforce is under increased pressure. This is unsustainable. 98. Carers are feeling the mental, physical and financial pressure of a system under strain. Carers Scotland’s latest State of Caring survey22 found that over half (54 per cent) of carers said that their physical health had suffered because of their caring role, with one in five (20 per cent) suffering a physical injury from caring. Forty-four per cent of those on Carers Allowance are cutting back on food and heating. Research23 carried out by the Carers Trust on the experience of older carers found: • 80 per cent said their physical health had been affected by their caring role • 87 per cent said their mental health and wellbeing had been affected by their caring role • 82 per cent felt as though their caring role has financially affected them; 37 per cent have used less gas and electricity in their homes as a way to save money, and 19 per cent have skipped meals in the past 12 months • 46 per cent of carers had missed some form of health appointment due to their caring role. This will have knock effects for the efficiency of the health service. 198
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4. Performance 41 Exhibit 17. Theme 5 indicator Percentage of carers who feel supported to continue in their caring role 30.0 37.5 45.0 2023/242021/222019/202017/182015/16 40% 31% -9% Source: Core Suite of Integration Indicators, Public Health Scotland 99. Caring responsibilities fall disproportionately on women, people living in rural areas and people living in deprived areas. National indicators also illustrate the declining sense of wellbeing for unpaid carers and those needing care Exhibit 17. There are provisions in the NCS Bill to improve support to unpaid carers but this has been subject to ongoing delays. 100. Some IJBs have set up interventions to support unpaid carers such as Falkirk and Clackmannanshire Carers Centre who provide information and signposting to those who are assessed as low or moderate on the unpaid carers eligibility for support. 199
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425. Commissioning and procurement 5. Commissioning and procurement Commissioning and procurement practices for social care services continue to be largely driven by budgets, competition, and cost rather than outcomes for people. Improvements to commissioning and procurement arrangements have been slow to progress but are developing 101. Our 2022 Social Care briefing highlighted commissioning arrangements as a key issue stating: ‘Commissioning tends to focus on cost rather than quality or outcomes. Current commissioning and procurement procedures have led to competition at the expense of collaboration and quality.’ In this section of this report, we focus on this issue and consider what progress is being made. What are commissioning and procurement? 102. Commissioning identifies what is to be provided. It is the process each IJB uses to set out to its partner councils and NHS boards, what it requires them to provide to meet its strategic plan for social care and primary and community health services, based on population needs and available budgets. Procurement establishes how and who will provide the services. It is the process of contracting or purchasing specific services to meet those requirements. The IJBs do not procure the services. This is done by the relevant councils or the NHS and can be from the public, private and third sector. Scotland Excel assists some councils in procuring services and has developed national adult social care frameworks. Currently, the private sector provide 54 per cent of social care services, 24 per cent by councils, 21 per cent by the third sector and the remaining element (one per cent) by health boards.24 103. All IJBs have integration strategic commissioning plans. The 2014 Act sets out requirements for the plans that are also supported by Scottish Government guidance issued in 2015.25 The plans are required to: • be reviewed at least every three years • set out what the arrangements are to carry out the tasks of the IJB over the three years 200
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5. Commissioning and procurement 43 • divide the area geographically into at least two localities for setting out these arrangements with each locality done separately • include how the arrangements are intended to contribute to achieving the national health and wellbeing outcomes. 104. The commissioning of social care and primary and community health services is a cyclical process carried out by a Strategic Planning Group for each IJB. This group must consider the outcomes for people and how the needs and availability of services change. Healthcare Improvement Scotland and the Care Inspectorate have produced a quality framework26 to evaluate the effectiveness of strategic planning. 105. The Independent Review of Adult Social Care in Scotland, considered in detail the arrangements for commissioning and procuring social care services in Scotland. The review identified ten changes needed in commissioning and procurement practices. Improvements to commissioning and procurement arrangements have been slow, with cost rather than outcomes driving decision-making 106. Commissioning and procurement decisions are currently driven largely by achieving the range and volume of services required at the lowest cost. This is understandable given the financial pressures and increased demand faced by IJBs, but the pressure on the service providers to remain competitive can reinforce a focus on driving down prices. This can be at the cost of promoting service quality, equality, innovation and collaboration with others, to improve people’s outcomes. 107. Tenders for support packages for people are often constructed around time and task of the service, rather than the outcomes. This lack of flexibility in the system means that NHS and council resources can get tied up in providing services that aren’t effective in improving outcomes. More flexibility is needed across the system. 108. The cyclical nature of the commissioning and procurement, mean that time and resource are focused on contracts renewal processes instead of a more strategic long-term approach. 109. As set out at paragraph 25, the current model of governance is complicated. This can cause difficulties when trying to commission services in a collaborative way. All stakeholders, including providers and users need to be part the strategic commissioning process in order to reflect what people need and want. This current approach also does not fully allow for innovation of the sector in finding solutions. 110. The current commissioning and procurement system lacks a process of accountability when people do not receive the services they need. People have described the process of accessing social care as 201
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5. Commissioning and procurement 44 ‘notoriously difficult’ and ‘over-complicated’ and needing to ‘fight for’ and ‘justify’ their support where they had a negative experience.27 Current commissioning and procurement practices are a risk for the sustainability of service providers and the workforce 111. Current arrangements are heavily reliant on a stable provider market and workforce but there are exacerbating financial and workforce issues facing providers, risking the viability of some. 112. A consequence of the current cyclical commissioning and procurement arrangements is that many risks around the effective delivery of service are largely put onto the providers. For example, where the cost of energy makes a service more expensive to deliver than the contract provides for, the provider is still required to provide the service, bearing the loss. 113. There is uncertainty for all providers, particularly in the third sector around future funding and their role in service provision. Providers are also experiencing challenges with providing services and fulfilling contracts largely due to difficulties with workforce recruitment and retention: • Private and third sector providers find that council commissioning rates are not enough to deliver social care and support and residential, personal and nursing care, and pay expenses such as staff, training and overheads. These providers say they cannot compete with councils where pay and terms and conditions are better than they can provide due to the flat cash settlement local government receives from the Scottish Government. • Non-committal framework agreements leading to zero hours or short hour contracts for staff. • Contracts that do not cover travel costs, especially challenging in rural Scotland which were particularly badly affected by fuel price rises. • Growth in split shifts and reduction in paid sleepovers for staff. • Although there has been an uplift in adult social care workers’ wages, this has not been universally applied for all social care workers as some roles have been out of scope for the intended policy outcome. This has focused on uprating pay for those on the lowest incomes. There is no equivalent uplift for those with supervisor or manager roles making these positions less desirable. • High levels of overtime and agency costs. • High and ongoing recruitment costs, particularly in more rural areas. 202
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5. Commissioning and procurement 45 114. Local government have been calling for multi-year funding settlements from the Scottish Government to support providers with medium- to long-term planning. This is currently being discussed through the Verity House Agreement and the fiscal framework discussions. 115. As set out in the context section, the workforce feel undervalued in the system and there are unprecedented numbers of vacancies (paragraph 19). The Fair Work Convention Report28 set out that ‘Despite some good practice and efforts by individual employers, the wider funding and commissioning system makes it almost impossible for providers to offer fair work.’ Without urgent progress on the fair working agenda nationally it is likely that the risks to the sustainability of the sector will deepen. Current commissioning and procurement practices are not always delivering improved outcomes for people 116. People who use services are often not involved in commissioning and procurement processes and therefore services are not necessarily reflective of what people need and want. The Independent Review of Adult Social Care in Scotland29 reported that commissioning using generic frameworks based on an hourly rate does not work well for people who have fluctuating needs for support, particularly support for mental health. 117. The Self-directed Support (Scotland) Act 2013 was designed to ensure people had choice and control in how their social care support is provided. As highlighted at paragraph 80, there is a recognised implementation gap in this policy. The Scottish Parliament’s Health, Social Care and Sport Committee post-legislative scrutiny of the Act has highlighted concerns around commissioning in relation to SDS including: • the importance of facilitating collaborative commissioning conversations • a need to develop a marketplace of providers • a need to end competitive tendering and restrictive procurement processes • the disparity in the relative available funding under different SDS options. Fair work is work that offers all individuals an effective voice, opportunity, security, fulfilment and respect. It balances the rights and responsibilities of employers and workers. 203
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5. Commissioning and procurement 46 There is an increasing desire to move towards more ethical and collaborative commissioning models but it has not yet been universally adopted 118. There are examples of IJBs attempting to adopt collaborative and ethical commissioning processes in their strategies but these appear to be at an early stage. Almost a third of IJBs have adopted the Unison Ethical Charter for Social Care Commissioning30 which is based on ethical commissioning principles. 119. IJBs are reaching out for support from IRISS (Institute for Research and Innovation in Social Services) in collaborative commissioning, for example work to improve outcomes-based commissioning with East Dunbartonshire, East Ayrshire and Orkney IJBs with Healthcare Improvement Scotland. IRISS has also been supporting West Dunbartonshire and North Ayrshire IJBs to change commissioning to a more collaborative approach. Both projects are at an early stage but they have highlighted that the relationship between stakeholders are a key aspect of addressing commissioning arrangements. Significant time and resource capacity is needed to work out these relationship issues. 120. There are some strong examples of how IJBs are working to commission in a more collaborative and flexible way including Aberdeen IJB and Fife IJB. Two examples are set out in Appendix 1 (page 50). National approaches to improve commissioning have been slow to progress but are developing 121. Across stakeholders we have engaged with, there is a recognition that commissioning needs to improve. The Feeley Report recommended that the Scottish Government and COSLA develop and agree ethical commissioning principles and core requirements. This is happening through the development of the NCS Bill, an Adult Social Care Ethical Commissioning Working Group was set up (also including the Institute for Research and Innovation in Social Services (IRISS), Social Work Scotland (SWS) and the Coalition of Care and Support Providers in Scotland (CCPS)). This group is developing a framework for ethical commissioning and has identified nine ethical commissioning principles: • Person-led care and support • Outcomes-focused practices • Human rights approach • Full involvement of people with lived experience • Fair working practices • High-quality care and support • Climate and circular economy Ethical commissioning aims to embed ethical standards into the commissioning and procurement process to ensure the process is around equity and quality for people, not just around efficiency and cost. 204
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5. Commissioning and procurement 47 • Financial transparency, sustainable pricing and commercial viability • Shared accountability. 122. Current Scottish Government plans are that the NCS Bill will include a clear and comprehensive definition of ethical commissioning, with a National Care Service Board31 providing national oversight, guidance and practical support.32 205
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48EndnotesEndnotes Endnotes 1 Lead Agency model - In Highland the NHS Board and council have adopted a different model for integration, a lead agency model. NHS Highland leads on adult services and Highland Council leads on children’s services. Therefore, there is no Integrated Joint Board but an Integration Joint Monitoring Committee to monitor the planning and delivery of services. Revisions to the National Care Service Bill currently being developed, propose that Highland adopt a reformed IJB model as these are implemented. 2 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021 3 People supported through Social Care Services: Support provided or funded by health and social care partnerships in Scotland 2022/23, Public Health Scotland, March 2024. 4 Mid-2022 Population Estimates, Scotland, National Records of Scotland, March 2024. 5 Scotland’s Health and Demographic profile, Social Research, Scottish Government, June 2022. 6 Scotland’s Unsustainable Health Service Modelling NHS demand to 2040, Our Scottish Future Health Commission, December 2023. 7 Population projections of Scotland - National Records of Scotland January 2023. 8 Staff vacancies in care services 2022, Care Inspectorate and Scottish Social Services Council, September 2023. 9 Workforce Recruitment and Retention Survey Findings, Scottish Care, September 2021 10 People who access social care and unpaid carers in Scotland, Scottish Government, June 2022 11 Local Government Benchmarking Framework, Improvement Service, February 2024 12 Self-directed support (SDS) aims to improve the lives of people with social care needs by empowering them to be equal partners in decisions about their care and support. Four fundamental principles of SDS are built into legislation – participation and dignity, involvement, informed choice and collaboration. The Social Care (Self-directed Support) (Scotland) Act 2013 gave councils responsibility, from April 2014 onwards, for offering people four options for how their social care is managed: – Option 1: The individual or carer chooses and arranges the support and manages the budget as a direct payment. – Option 2: The individual chooses the support and the authority or other organisation arranges the chosen support and manages the budget. – Option 3: The authority chooses and arranges the support. – Option 4: A mixture of options 1, 2 and 3. 13 Post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013: Phase 1: SP Paper 577, Health, Social Care and Sport Committee, May 2024. 206
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49EndnotesEndnotes 14 My Support My Choice: People’s Experiences of Self-directed Support and Social Care in Scotland National Report, ALLIANCE and Self Directed Support Scotland, October 2020. 15 Leave No-one Behind The state of health and health inequalities in Scotland, The Health Foundation, An Independent Review, David Finch, Heather Wilson, Jo Bibby, January 2023. 16 Health Life Expectancy in Scotland 2019-2021, National Records of Scotland, December 2022. 17 Adult Social Care in Scotland – Equality Evidence Review, Scottish Government, June 2022. 18 Health and Care Experience Survey, Scottish Government, May 2022. 19 Scotland’s Carers Update Release, Scottish Government, December 2022. 20 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021. 21 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021. 22 State of Caring Survey 2023, Carers Scotland, November 2023. 23 Experiences of Older Adult Unpaid Carers in Scotland, Carers Trust Scotland, March 2023. 24 Summary of No. of registered care services at 31 March 2024, Care Inspectorate. 25 Strategic commissioning plans: guidance, Scottish Government, December 2015. 26 Evaluating the Effectiveness of Strategic Planning: Quality Framework, Care Inspectorate and Healthcare Improvement Scotland. 27 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021. 28 Fair Work in Scotland’s Social Care Sector 2019, Fair Work Convention, February 2021. 29 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021. 30 UNISON’s ethical care charter, UNISON. 31 The remit and membership of a National Care Service Board will be determined by at Stage 2 of the National Care Service Bill. The overarching purpose of the Board ‘will be to ensure consistent, fair, human rights-based social care support and community health services, underpinned by effective complaints mechanisms and enhanced advocacy services’. 32 National Care Service (NCS) (Scotland) Bill: Scottish Government Response to Stage 1 report, Letter from Minister for Social Care, Mental Wellbeing and Sport to Health, Social Care and Sport Committee, March 2024. 207
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50Appendix 1 Appendix 1 Case studies These case studies set out some examples of where integrated joint boards are using or developing different working practice to improve performance and outcomes. Case study 2. Early intervention and prevention services Preventing Frailty by Improving Nutrition (Shetland) People providing care and support have an important role in recognising risk and preventing malnutrition. A project in the summer of 2022 led by the dietetics department in collaboration with Shetland residential teams including social care workers, seniors, care home cooks and care at home staff in the community. The project included reviewing dietetic patients care, menu and mealtime observations and advice, training needs analysis and delivery of MUST (Malnutrition Universal Screening Tool) training. The IJB reported that confidence in ability to screen for malnutrition, provide nutrition advice and care, and actioning nutritional care plans was considerably increased following training, which was provided to more than 100 staff across Shetland. Whole Family Wellbeing Funding programme (national scheme) The Whole Family Wellbeing Funding (WFWF) is a £500 million Scottish Government investment in preventative whole family support measures. The aims of the fund are to support the change that is necessary for reducing the need for crisis interventions in families, and to move investment towards early intervention and prevention. The scheme is funded nationally from 2022 to 2026 with any new systems or services funded locally after that period. 208
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Appendix 1 51 The programme is split into three parts: • to provide direct support to Children’s Services Planning Partnerships (CSPPs) to help expand and deliver whole family support services as well as support transformational change • to support local transformation through National Support for Local Delivery • support projects that take a cross Scottish Government approach to system change which progress the aims of WFWF. An evaluation report of year one funding of the first two parts reports that substantial progress has been made so far across most CSPPs. However, they have found it difficult to achieve the pace of progress envisaged by the Scottish Government in year one of the funding. In South Lanarkshire, the funding has enabled the recruitment of peer support workers with lived experience who are able to reduce the stigma of needing support. The funding also enabled the creation of a team of early years staff, based in NHS Lanarkshire, that will give support to families that have children under the age of five. In addition, the funding enabled the expansion of Pathfinders, a school-based family project that aims to reduce the need for later intervention. The funding has supported North Ayrshire to add two further locations to their Family Centred Wellbeing Service. The fund has also seen the expansion of North Ayrshire’s Health Visiting Team, which aims to support early intervention and prevention for children by working with the whole family. Source: Scottish Government and Shetland Health and Social Care Partnership 209
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Appendix 1 52 Case study 3. IJBs shifting the balance of care Home First Response Service (Glasgow) Glasgow’s Home First Response Service has the aim of ensuring frail people spend less time in hospital. The service is community led and made of multi-disciplinary frailty teams. Each team is led by advanced frailty practitioners based in hospitals with 26 now in post following a successful pilot of the service. One in three people identified during the pilot were discharged the same day with a care plan having been put in place. To enable fast access to the community services needed to move frail people out of hospitals and back home, the service uses a hub and spoke service model with each of the six Health Partnerships in Glasgow having their own frailty teams. The teams liaise with other healthcare colleagues in the community including advanced nurse practitioners, pharmacists and allied health practitioners. This ensures that people receive the same level of care that they would in a hospital setting. The Home First Response Service has been achieving, on average, a 50 per cent early turnaround rate per month. Integrated Discharge Hub (West Lothian) The West Lothian Integrated Discharge Hub (IDH) was set up in 2018 at St John’s Hospital to improve delayed discharges and reduce the time it was taking make arrangements for people requiring care and support in the community following discharge from hospital. To plan the safe and timely discharge of patients, an inter-agency team consisting of discharge coordinators, hospital social workers, Carers of West Lothian as well as inhouse care team staff work with patients and their families to plan their discharge and how their ongoing requirements will be met in the community. Since the implementation of the discharge hub the IJB reports that improvements have been seen, with reduced lengths of stay, reduced occupied acute bed days, improved performance for days lost to delays in discharge and improved processes for interim placements when a patient is waiting for care home placement. Between December 2022 and April 2023, the average number of days between a person being admitted to St John’s Hospital and being identified as needing the support of the discharge hub has been reduced by 52 per cent. The length of stay for patients getting help from the discharge hub has also been reduced by 28 per cent during the same period. The success of the discharge hub has drawn interest from other IJBs across Scotland. 210
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Appendix 1 53 The Joint Dementia Initiative (Falkirk) The Joint Dementia Initiative (JDI) is a registered service in the Falkirk Health and Social Care Partnership. It has two main services: a one-to- one support service, which provides care and support at the user’s own home, and a Home from Home service, which provides support to users in a group setting. The JDI service aims to help people with dementia to continue to live the life they want to live by continuing to live at home in their own communities for as long as possible. This is delivered through meaningful engagement with service users, families, and key stakeholders from across Falkirk HSCP following a person-centred approach to the care provided. A review of the JDI was carried out in April 2021 that included arranging engagement events with service users, their families, carers, staff, and stakeholders. The aim was to improve outcomes for families and carers and identify specific areas of concern and gaps in service delivery. Identified as an important issue at the engagement events, the partnership looked at the flexibility of the service and dementia being a 24/7 illness. The partnership is working to provide evening and weekend support for families and carers, due to start in August 2024. These improvements would allow the partnership to achieve outcomes from their strategic plan. A current project is being carried out to change Adult Placement Carers in the Home from Home service from self-employed to employees of the partnership. This change aims to improve recruitment and retention rates for the service. The JDI has been successful in achieving funding from multiple funds including the Dementia Innovation Fund and the Carers Challenge Fund. This has allowed the Initiative to renovate their community space as well as create two part time support worker posts to help provide evening and weekend support to service users Source: NHS Greater Glasgow and Clyde, West Lothian Health and Social Care Partnership, and Falkirk Health and Social Care Partnership 211
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Appendix 1 54 Case study 4. Choice and control Community Brokerage Network (North and South Ayrshire) The Community Brokerage Network is well established in the Ayrshires and provide brokers, who offer free independent information about self-directed support to people and their carers at any stage in their social care journey, whether they are entitled to a formal social care assessment or not. They have successfully connected people with services that have helped them achieve their personal outcomes in a way that works for them. A Brokerage Framework for Scotland has recently been produced by Self-directed Support Scotland and its partners to help encourage the use of this model further across Scotland. Care Opinion (Falkirk) Care Opinion is an online integrated platform where people can safely share their experience of any health service or Care Inspectorate- registered providers of adult social care services. Care Opinion has national scale and visibility and has worked with all Scottish health boards as well as ten HSCPs. Over 29,000 stories have been shared about health and social care services in Scotland on the Care Opinion platform. Care Opinion enables Falkirk HSCP and the commissioned providers to use online feedback as one method of learning from lived experience. The aim is to drive forward quality service improvements, build a reputation for openness, to potentially avoid formal complaints, and develop a culture of transparency across the Partnership. Source: Self Directed Support Scotland, Falkirk Health and Social Care Partnership 212
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Appendix 1 55 Case study 5. Work to reduce inequalities Welfare Advice & Health Partnerships (WAHPs) programme (Glasgow) Scottish Government funding is enabling 84 GP Practices across the most deprived parts of Glasgow to host a dedicated welfare and health adviser one day per week. According to the Partnership this has had a positive impact on patient health, poverty and health inequalities, while also freeing up staff time for clinical care. In the last year, there have been 3,997 referrals made by WAHP practice staff across Glasgow, achieving a reported £3.3 million in financial gains and £1.1 million in debt managed for people. eFRAILTY Power BI dashboard (West Lothian) The eFRAILTY Power BI Dashboard was created with the aim to provide a snapshot of the make-up of frailty within the West Lothian population with the goal of identifying people who could benefit from help, improving the health inequality gap. The dashboard also has the aim of mapping frailty data by GP postcode to enable the targeting of resources. The data in the dashboard uses the Rockwood clinical frailty score from patient and carer self-assessment forms. These forms are collected at vaccination centres each year during the patient’s annual flu jab. The frailty data is collected by the vaccination nurses and then entered into GP systems before being extracted and used to populate the eFRAILTY dashboard. The dashboard is still in the scoping and data-gathering phase, however the Partnership is looking at options for how to put the data to use. An example given by the Partnership for the use of the data was to refer patients graded as having mild frailty to their Xcite Exercise referral scheme. Source: Glasgow City Health and Social Care Partnership, Scottish Government, and West Lothian Health and Social Care Partnership 213
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Appendix 1 56 Case study 6. Granite Care Consortium Established in October 2020, Granite Care Consortium (GCC) is composed of a mix of ten independent and third sector care providers delivering over 12,000 hours of care a week to more than 1,200 people. GCC was set up with the aim of creating market stability, improving outcomes for service users and building a consistent trained and skilled workforce. Competitive methods of commissioning and procurement were identified as presenting a risk of providers reducing their services or exiting the market completely. Providers also often work in silos with little input or communication from other services. Aberdeen City Health and Social Care Partnership (ACHSCP), commissioned GCC to take a collaborative approach, with a focus on the outcomes for the individual. This saw GCC move away from a ’time and task’ model towards one built around the service user. The collaboration between providers allows different types of support to be added to a care plan without the need for time consuming reassessments. For example, someone receiving mental health support who then required personal care could have this added to their care plan in a matter of hours. Collaboration has also enabled greater data sharing and visibility. GCC use data at a local level as well as city wide to inform decision-making. A recent test of change has seen the introducing of hotspots allowing GCC to focus on where demand for care is greatest. Funding is provided in monthly blocks by ACHSCP which allows GCC to flex individual care and support packages without the need for social worker authorisation. This speeds up the process, improving outcomes for individuals. The number of days those aged 75+ in Aberdeen City are waiting to be discharged from hospital (per 1,000 population) stands at 112 as of November 2023. This is down from 579 in 2019/20. GCC faces the same workforce challenges as the wider sector but is using its outcomes focussed model as a positive tool to aid recruitment and retention. Learning and development is also a large part of the workforce strategy with GCC working in partnership with Robert Gordon University to develop new ways of delivering training. I have felt partnership working between ACHSCP and GCC has been stronger than my previous experience before GCC – Social Worker Building trust, both from ACHSCP and the ten partnering service providers, was crucial in delivering this model. Challenging traditional ways of working and thinking was acknowledged by GCC as difficult but it reports that there is now genuine trust between all parties and the culture of collaboration is now embedded within the consortium. 214
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Appendix 1 57 The Scottish Parliament Health, Social Care and Sport Committee have identified this work as a good model to provide the basis to develop best practice in ethical commissioning. Source: LGBF Indicators, GCC Annual Report 2020-21 Case study 7. Fife Care Collaborative Established in 2021 the Care at Home Collaborative was a Collaborative of 16 Independent Care at Home Providers who delivered over 90 per cent of externally commissioned care at home services in the Fife IJB area. The Collaborative in June 2024 are now made up of 41 care at home Providers including Fife Council. The split between service delivery is approximately 30 per cent Council and 70 per cent Collaborative. The aim of the collaborative is to involve all member organisations in active engagement and participation as well as to share best practice and lessons learned. The collaborative also aims to benefit from the economy of scale of working together, for example securing funding to maintain a higher weekend pay rate has helped the retention of staff. One of the members of the collaborative, Cera Care, commented: ‘Since joining the Collaborative we have seen a dramatic improvement in the services we deliver as a whole in Fife. It has given us the opportunity to communicate with Scottish Care, Fife Council and External Providers together to input ideas and suggestions across to help each other and the people we care for.’ The collaborative makes use of a GPS tool called ‘Pin-Point’ which is a live dashboard of services used to manage commissioning. The IJB is able to manage capacity across the whole system by using monitoring and escalation systems that are connected to the collaborative. A recent self-evaluation saw that previous recruitment and retention issues encountered by providers have been continuously improving and attributable to the success of the Collaborative. Source: Fife Health and Social Care Partnership 215
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58Appendix 2 Appendix 2 Methodology Previous work In 2022 and in 2023, the Accounts Commission published bulletins setting out the financial performance of IJBs. Together with the Auditor General for Scotland and Audit Scotland, we have reported more widely on the progress of health and social care integration and social care in Scotland. This includes reports in 2015 and 2018 setting out improvements needed by integration authorities. Our work in 2014 and 2017 set out the progress of the self-directed support legislation implementation and found while implementation was happening successfully in some areas, not everyone was getting the choice and control in their social care support envisaged in the legislation. In January 2022, a joint Social Care briefing set out the significant ongoing challenges impacting the delivery of social care services. We aim to answer the following audit questions in this report: • How well are IJBs responding to contextual challenges and improving their performance and the outcomes for people? • How financially sustainable are IJBs and how are they responding to the financial challenges they face? • How are IJBs using commissioning and procurement to improve performance and deliver improved outcomes in the lives of people who use social care services? Our findings are based upon: • the 2022/23 audited accounts and annual audit reports of IJBs and supplementary returns provided by appointed auditors • the 2022/23 annual performance reports and Chief Social Work Officer reports of IJBs • national data sets including core integration indicators and the Local Government Benchmarking Framework (LGBF) • a review national reports and guidance • a review of relevant published research • interviews with key stakeholders including IJB chief officers and chief finance officers. In February 2024, we hosted a roundtable discussion bringing together key stakeholders to consider the critical issues for IJBs and in particular 216
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59Appendix 2 the provision of social care. The discussion covered immediate challenges as upcoming issues in the medium and long term. The discussion helped to inform this report and also identify future work for the Accounts Commission. The additional output sets out a summary of discussion. Advisory Group To support our work, an Advisory Panel was established to provide challenge and insight at key stages of the audit process. Members sat in an advisory capacity only and the content and conclusions of this report are the sole responsibility of Audit Scotland. Members of the group included representatives from Health and Social Care Scotland, COSLA, Care Inspectorate, The ALLIANCE, Coalition of Care and Support Providers Scotland, Scottish Care and SPICe. We would like to thank them for their support. 217
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Integration Joint Boards Finance and performance 2024 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot ISBN 978 1 915839 44 2 218
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Integration Joint Board 22 August 2024 Subject : Chief Social Work Officer Annual Report 2023/24 Purpose : To present the Integration Joint Board with the annual Chief Social Work Officer report which is required by Scottish Government. Recommendation : IJB are asked to note :- 1. The contents of the report, in particular the successes and challenges; 2. The skilled and compassionate interventions of our practitioners and managers. 3. The worsening financial context and associated impact on all ages within our community both in terms of wellbeing and risk. 4. Ask the CSWO to submit the annual report to the Office of the Chief Social Work Adviser in Scottish Government. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership CSWO Chief Social Work Officer SOLACE Society of Local Authority Chief Executives ASP Adult Support and Protection 1. EXECUTIVE SUMMARY 1.1 There is a requirement for every Local Authority to appoint a professionally qualified Chief Social Work Officer (CSWO) and this is contained within Section 3 of the Social Work (Scotland) Act 1968 as amended by Section 45 of the Local Government (Scotland) Act 1994. 1.2 In line with the legislation and guidance, the CSWO is required to prepare an annual report for the Council, on all statutory, governance and leadership functions of the CSWO role. 219
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1.3 This report will be submitted to NAC Cabinet on 27th August 2024. 2. BACKGROUND 2.1 In 2014, the Office of the Chief Social Work Adviser, following consultation with CSWOs across Scotland, SOLACE and others, identified a more standardised approach to prepare the annual reports. 2.2 The report provides an overview by the CSWO of the partnership structures, governance arrangements and the performance of social services in the context of the demographic landscape of North Ayrshire. It looks more closely at the statutory functions of the service and the quality and workforce development within our services. 2.3 The report highlights the range of Social Work activity throughout the year and places that in the context of the socioeconomic challenges faced locally. Within the report there are four key issues I would like to bring to the attention of IJB :- Practice • Practice generally remains strong. We have a skilled workforce and services have worked hard to support newly qualified workers and those new into management posts. Our work continues to recover Social Work practice back into a person- centred activity. Less of a culture of care management and more of a culture of people and relationships taking primacy. We have indicators that this strategic approach is working through our workforce sufficiency data and crucially through our strategic inspection of adult support and protection which reflected on strong practice and strong governance and leadership. We don’t always get it right and when these circumstances present Social Work services are committed to listening, learning and resolving wherever it can. Public Protection • Our approaches to child protection and our commitment to support families to remain together wherever possible continues to be a key Social Work activity. Our number of child protection concerns continues on the downward trajectory that started in 18/19 as does our number of children subject to Statutory Orders. Finally, in relation to another core Social Work task, it is pleasing to see the number of permanence orders finally recover to pre covid levels. • Our justice services continue to deliver exceptionally high levels of success in relation to the completion of community payback orders while the number of diversion report requests remained on a par with last year. 220
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• Mental health services have had to manage exceptional rises in demand over the year. There are many medical and socio economic reasons for this but what is clear was our support to communities with worsening mental ill health at the acute end of wellbeing. Short term detentions requests rose to 182 while pre covid this figure was 67. The covid years and the post covid context have seen this intervention rise significantly and in a sustained way. Our Local Authority Guardianship have also increased in the year past to 121 from 85 last year. These two examples quantify the increased demand on services to not only protect from harm but to fulfil the key Social Work task of protecting the rights of individuals who lack capacity. • Our adult support and protection activity has also seen an uplift in activity from last year in relation to ASP referral (915 from 722); ASP investigations (112 from 72) and ASP case conferences (57 from 41). Despite these increased levels of activity the strategic inspection gave us assurance that practice was strong and governance in place. Out of Authority Placements in North Ayrshire • The disruption in the care home sector has seen an increasing number of local providers seeking to offer care to the most complex individuals from across Scotland. This has brought with it real challenges for North Ayrshire HSCP in relation to residents of other authority areas living in North Ayrshire care homes. These challenges have often had at their root either a lack of oversight, namely out of sight out of mind, or sufficient sharing of high-risk information with the provider and NAHSCP. In these circumstances the outcomes for individuals are usually poor and interventions are required under Adult Support and Protection or Adult with Incapacity legislation. Regardless of the intervention pathway, the additional time and resource taken in the year past to manage these situations has been significant across all levels of the organisation. • Human and financial resource to manage risk, to manage relationships, to coordinate responses, to liaise with the regulatory bodies as well as the placing authorities, NHS Boards and Scottish Government. • The inertia in dealing with the representation of this issues tells us much about how difficult it truly is to affect the whole system change on a national level. The Impact of the financial context Our risk exposure is growing with every passing month. In the social work and social care sector the ability to manage services is critically driven by demand and capacity variables. Everything we stop, or reduce, results in a loss that is rarely acceptable. Against this backdrop the professional view has been clear in relation to leaving no one at risk of significant harm, a view supported by the Partnership and IJB. 221
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We continue to see a growing number of people in our community waiting for services as our system pursues its obsession with delayed discharge. With so much unmet need pent up those residents reach crisis point and enter hospital with more complex needs requiring higher degrees of intervention and support at discharge than may otherwise have been required. Either way reduced resource coupled to increasing complexity is the perfect storm and Social Work services will continue to mitigate as best it can the impact of this on our most vulnerable residents. 3. PROPOSALS 3.1 It is proposed that IJB notes the key themes and challenges detailed in the report and that it endorses the report as set out in Appendix 1 and asks the CSWO to submit this to Scottish Government. 3.2 Anticipated Outcomes That North Ayrshire Council, the Integration Joint Board, and the Scottish Government are made aware of the positive impact of Social Work Services in North Ayrshire as well as the significant challenges that are being faced. 3.3 Measuring Impact Impact will be measured in terms of the direction and support to continue to transform the delivery of Social Work Services. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk The delivery of Social Work Services is a statutory duty placed on North Ayrshire Council and delegated to the Integration Joint Board and on to the HSCP. 4.6 Community Wealth Building None. 222
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4.7 Key Priorities This report covers matters which contribute to the key priorities around vulnerable children and adults within the Council and IJB Strategic Plans. 5. CONSULTATION The Extended Partnership Senior Management Team and operational services have contributed to the contents of this report. Caroline Cameron, Director For further information, please contact Scott Hunter, Chief Social Work Officer on scotthunter@north-ayrshire.gov.uk Appendices • Appendix 1 – Chief Social Work Officer Annual Report 2023-24 223
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/ Chief Social Work Officer Report 2023 – 2024 224
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Contents Introduction .............................................................................................................. 1 Demographics .......................................................................................................... 3 Locality Planning...................................................................................................... 4 1. Governance, Accountability and Statutory Functions ................................... 7 1.1 Overview of the North Ayrshire Health and Social Care Partnership ......... 10 Visions, Values and Priorities ............................................................................ 10 2. Service Quality and Performance ................................................................... 11 2.1 Children, Families and Justice Services .................................................... 11 The Promise ...................................................................................................... 11 North Ayrshire Champions Board ...................................................................... 11 CASST ............................................................................................................... 12 Signs of Safety................................................................................................... 12 Child Protection Registrations............................................................................ 13 Breastfeeding..................................................................................................... 13 Rosemount Project ............................................................................................ 13 School Nurse ..................................................................................................... 14 Childhood Immunisations .................................................................................. 15 Key Performance Indicators .............................................................................. 16 2.2 Adults ......................................................................................................... 19 North Ayrshire Drug and Alcohol Service .......................................................... 19 North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) ........................................................................................................................... 20 Learning Disabilities ........................................................................................... 21 Care at Home .................................................................................................... 21 Carers ................................................................................................................ 22 Money Matters ................................................................................................... 23 Mental Health..................................................................................................... 24 Suicide Prevention ............................................................................................. 25 Self-Directed Support & Ayrshire Independent Living ........................................ 25 Older Peoples Day Services .............................................................................. 26 Community Link Workers ................................................................................... 27 Trindlemoss Day Opportunities.......................................................................... 27 Alcohol and Drugs ............................................................................................. 28 225
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Dads’ Support Worker ....................................................................................... 29 Community Wards ............................................................................................. 29 Out of Hours Social Work Service ..................................................................... 30 2.3 Criminal Justice .......................................................................................... 31 Prevent Multi Agency Panel ............................................................................... 31 Recruit with Conviction ...................................................................................... 31 Koestler Awards ................................................................................................. 31 Refugee Support Team ..................................................................................... 32 Community Payback Orders .............................................................................. 32 Drug Treatment and Testing Order .................................................................... 33 Diversion from Prosecution ................................................................................ 34 Key Performance Indicators .............................................................................. 35 3. Resources ........................................................................................................ 38 3.1 Financial Pressures ................................................................................... 38 2024-25 Budget ................................................................................................. 39 3.2 Financial Performance ............................................................................... 40 3.3 Medium Term Financial Outlook ................................................................ 41 4. Workforce ......................................................................................................... 43 4.1 Workforce Planning .................................................................................... 43 4.2 Workforce Support and Development ........................................................ 44 226
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1 Introduction Welcome It is a pleasure to introduce this year’s annual Chief Social Work Officer report for North Ayrshire which covers the period 1st April 2023 through 31st March 2024. As our policy and professional worlds relentlessly continue to pursue specialisation and centralisation in equal measure, I find myself seeking a common language that unites Social Work in North Ayrshire. I constantly revisit the Social Work (Scotland) Act 1968. Section 12 speaks to the Social Work task – the promotion of social welfare by making available advice, guidance and assistance on such a scale as appropriate for their local authority area and describes the principle of helping at the earliest time to avoid greater expense further down the line. Now, more than ever, North Ayrshire needs a strong Social Work voice. A voice anchored in an understanding and commitment to the values of the social justice and social welfare. This year there are a couple of issues that I would wish to highlight that the report template doesn’t easily lend itself to: Firstly, as we experience diminishing resources and increased levels of need, the year past has seen North Ayrshire beginning to manage increasing service wait lists across the partnership. The cost of this unmet need on a human level plays out every day in our communities as services strive to make the available resource go as far as possible. The other result of the increase in service waits is the requirement to manage the associated increase in risk. This places further demands on front line teams and careful attention is taken by management teams to ensure that thresholds of risk are not diluted. Secondly, the disruption in the care home sector has seen an increasing number of local providers seeking to offer care to the most complex individuals from across Scotland. This has brought with it real challenges for North Ayrshire HSCP in relation to residents of other authority areas living in North Ayrshire care homes. These challenges have often had at their root either a lack of oversight, namely out of sight out of mind, or sufficient sharing of high-risk information with the provider and NAHSCP. In these circumstances the outcomes for individuals are usually poor and interventions are required under Adult Support and Protection or Adult with Incapacity legislation. Regardless of the intervention pathway, the additional time and resource taken in the year past to manage these situations has been significant across all levels of the organisation. Human and financial resource to manage risk, to manage relationships, to coordinate responses, to liaise with the regulatory bodies as well as the placing authorities, NHS Boards and Scottish Government. The inertia in dealing with the representation of this issue tells us much about how difficult it truly is to affect whole system change on a national level. The data tells us that our communities can experience the impact of drug and alcohol use, the lasting impact of enduring poor physical and mental health and our children and young people experience the highest level of child poverty in Scotland 227
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2 out with of Glasgow City. In this context I hope you will have time to read some, or all, of this report and feel the difference our practitioners and teams are making to strengthen communities and improve life chances in North Ayrshire. There are many examples of hope, inspiration and perspiration described, but they all have in common a belief in the value and potential of the individuals and communities we serve, and most importantly a belief that change and a better future is possible. I am conscious that the need for Social Work and Social Care support today far outstrips the human and financial resources that are available. There are growing numbers of our residents waiting for services and it is the voices of these residents, and all those in our community managing day to day, with family or without, that need to be heard in the context of the challenging situation our society now finds itself in. Finally, I would like to place on record my appreciation for the compassion and commitment displayed day in, day out by our practitioners, managers, business support staff and partners to ensure that Social Work and Social Care services are delivered to the very best of our abilities. Scott Hunter Chief Social Work Officer North Ayrshire Health and Social Care Partnership 228
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3 Demographics North Ayrshire is home to approximately 133,490 people, (National Records for Scotland, Mid-2022 Population Estimates Scotland) all living in its many towns, villages, and islands, with slightly more females (52.2%) than males (47.8%). 15.9% of the population are aged 0 to 15 years, 9.2% are aged 16 to 24 years, 21.5% are aged 25 to 44, 29.5% are aged 45 to 64 years of age, 13.2% ages between 65 to 74 years of age, with 10.7% of our population aged 75 years and above. The latest update of the Scottish Index of Multiple Deprivation has reconfirmed the deep structural challenges faced by many communities in North Ayrshire, despite steady progress by North Ayrshire Council in its ongoing commitment to eradicate poverty. North Ayrshire is ranked as the fifth most deprived council area in Scotland. Some of the area’s most heavily affected by deprivation are concentrated in the Three Towns and Irvine areas but areas in Kilwinning and the Garnock Valley also have above average deprivation. 229
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4 Locality Planning The themes of the strategic plan are how the HSCP will plan services and seek positive outcomes across the whole of North Ayrshire, but each community within North Ayrshire will have unique challenges and different inequalities. As such, the HSCP is required to develop planning in a smaller geographic area for different localities, which in North Ayrshire are: • Arran • Garnock Valley • Irvine • Kilwinning • North Coast and Cumbrae, and • Three Towns A new method for carrying out local planning in these areas has been developed over the last year and is currently being implemented in order to develop priorities and actions in the form of published Locality Plans, to be developed by 2025. This method will analyse local data, engagement, and service information, and ensure continued community feedback and leadership to develop robust, informed plans. Locality Planning is the local mechanism for strategic planning in which local priorities are developed for smaller geographical areas across the local authority. In 2023 it was decided that the framework for carrying out Locality Planning would be revised in order to involve new methods for community engagement and ensuring continued leadership through new Locality Chairs. Throughout late 2023 and early 2024 this new process was further developed in order to collect robust data and information about each locality in order to develop Locality Plans. Engagement: Locality Conversations Twice per year, Locality Conversations will be held within each locality in order to collect information from different people within the communities, and feedback what we are doing with the information. The first set of Locality Conversations are set to take place in April 2024, in the form of 2-hour workshops with local staff and members of the public invited to intend. This will allow us to explain a bit about the new process and collect initial community perceptions and challenges. The next set of Locality Conversations will be held in September 2024 when the focus of the engagement will be groups of shared characteristics, where we will seek the views of targeted groups. Locality Conversations will continue twice a year until locality plans can be developed in each area. 230
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5 Local data: Locality Profiles The Strategic Commissioning Plan is developed using a Strategic Needs Assessment provided by Public Health Scotland, outlining local health and care data and inequalities across North Ayrshire. Public Health Scotland also provides more local data for each locality, where it is possible to obtain data at that level. These locality profiles will be used to identify key inequalities within each locality in order to understand where targeted effort may be required. Local Services: Review of access There are many health and care services that are carried out within each locality, and there are others that people across the authority would need to travel to another locality to access. In order to understand how services are accessed and where some of the access challenges lie, we will be carrying out a mapping exercises of the health and care services available within each locality. This will include primary care, but also local third sector services and wellbeing in the community. The partnership also began a review of its front door in January 2024. This work has quickly established key issues around the number of networks, duplication of assessment and referral process and the complexity of presenting needs. This work is helping to develop our thinking and approaches based around the concepts of a liberated services model. This is exciting and challenging in equal measure and the work is due to report by December 2024 with recommendations for consideration. Community Priorities: Community Planning The Integration Joint Board is a member of North Ayrshire Community Planning Partnership, which has a separate requirement to carry out Locality Planning with more involvement of the community to develop general community priorities. The established priorities for each area will be considered within the HSCP Locality Planning Process as these were developed alongside the local community. Governance All the above information will be collected, collated, and analysed over the course of 2024 and 2025, which will allow 4 periods of engagement and a greater depth of information and understanding of each area will be developed. Information will be analysed, and plans and actions will be developed by the Locality Planning Review Group for each area, who will also enable delivery and monitoring of the plans. Each Locality Planning Review Group will meet twice per year, following each period of engagement. Group membership will be tailored to the specific needs of each community but will be Chaired by a Head of Service to ensure consistency and continued leadership. Locality Plans will be developed by late 2025. Arran The outlined method for Locality Planning will apply to the five primarily mainland localities of Irvine, Kilwinning, Three Towns, Garnock Valley and North Coast and 231
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6 Cumbrae, though there are current discussions within the Community Planning Partnership regarding the current arrangements for specific challenges for residents of Cumbrae. Arran has an established locality planning arrangement which has been in place for many years due to the specific and persistent challenges of the Island. These arrangements have a governance that sits under the Island Plan and the Health and Social Care Partnership will develop health and social care priorities for Arran under this existing governance structure, and using engagement that has already been carried out with the islanders. This will occur using the same timescales as our mainland localities. 232
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7 1. Governance, Accountability and Statutory Functions The Chief Social Work Officer is a statutory appointment by virtue of Section 3 of the Social Work (Scotland) Act 1968. The Chief Social Work Officer is appointed for the purposes of the Council's functions under the 1968 Act and under those other enactments listed in Section 5(1B) of that Act. In broad terms, those functions cover all social work and social care services whether provided directly by the council, in partnership with other agencies, or procured by the council and provided by others on its behalf. Those functions are referred to as “social work services”. The qualifications required for the post are set out in the Qualifications of Chief Social Work Officers (Scotland) Regulations 1996. The Chief Social Work Officer is required by section 5(1) of the 1968 Act to carry out the duties of the post under the general guidance of the Scottish Ministers. The Scottish Ministers issued revised and finalised guidance in January 2010. The overall powers of the Chief Social Work Officer post are:- (a) To oversee the discharge of the council's statutory social work duties; (b) To ensure the provision of effective professional and objective advice to elected members and officers of the Council in the Council's provision of social work services; (c) To secure the effective provision of social work services. The powers of the Chief Social Work Officer fall into two broad categories; service provision and corporate responsibility: Service provision • To establish and develop social work services focussed on the needs of service users, to promote the continuous improvement of those services, and to monitor and raise standards of their delivery; • To ensure the effective governance of the balance of need, risk and civil liberties in the provision of social work services in accordance with professional practice; • To provide advice on all aspects of workforce planning including safe recruitment practice, supervision, monitoring and assessment of social work students, securing of professional qualifications and continuous learning and development for staff, and supporting and advising managers in all aspects of staff supervision; • To ensure the existence of systems to both promote good practice and identify and address poor practice in the provision of social work services; • To ensure that significant case reviews are undertaken of all critical incidents either resulting in, or which may have resulted in, serious harm or death; and 2. Corporate Responsibilities 233
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8 Corporate responsibility The Chief Social Work Officer has the following corporate powers which require direct access to the Council's Chief Executive’, Elected Members of the Council and the Chief Officer, and the provision of forthright and independent advice to them:- • To ensure compliance with the Council’s statutory duties to prepare, publish and review plans for the provision of social work services. • To promote, communicate, support and review values and standards of professional practice, and to ensure that they are adhered to. • To establish, in conjunction with the Council's Corporate Management Team, appropriate experience and qualified cover for the post of Chief Social Work Officer during the post-holder's absence or incapacity. • To report to the Chief Executive and Chief Officer any failure in the Council's corporate policy or governance arrangements designed to reflect the proper balance amongst need, risk and civil liberties in the provision and management of social work services. • To report to the Chief Executive and Chief Officer any weaknesses and failures in the systems in place to promote good practice and identify and address poor practice in the provision of social work services. • To report and provide independent comment where necessary to the Chief Executive, Elected Members of the Council and the Chief Officer on the findings of significant case reviews and relevant performance reports and on any other social work related issues. • To provide an annual report to the Council on all of the statutory, governance and leadership functions of the role of the Chief Social Work Officer North Ayrshire continues to invest in its oversight of Social Work activity through the provision of a standalone Chief Social Work Officer, further supported by a formal Depute CSWO. The CSWO reports directly to the Director of the NAHSCP and has a direct line to the Chief Executive of the Council. The CSWO represents Social Work within a range of strategic groups including: IJB, IJB Performance and Audit Committee, IJB Strategic Planning Group, NAHSCP Health Care Governance Committee, HSCP Partnership Senior Management Team, Alcohol and Drugs Partnership, Child Protection Committee, Adult Protection Committee, Chief Officers Group, Carers Advisory Group, Children’s Services Strategic Planning Partnership; Corporate Parenting Board, Transitions Strategic Group amongst others. The CSWO also provides professional oversight as a member of the Care Home Oversight Group and the Care at Home Oversight Group. These groups continue to fulfil key governance activity in relation to the Social Care sector. These groups have worked closely in the year past to manage high risk situations in relation to market failure in the Care at Home Sector and the closure of a residential care home following poor inspection reports. 234
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9 The CSWO has regular contact with the Independent Chair of CPC and APC to ensure public protection oversight. The year past has seen North Ayrshire commission one learning review. As often happens, the timescale for reporting remain unclear as a result of ongoing activity with our Police and Fiscal colleagues. Professional support and guidance over the year has been offered in relation to high- risk justice cases including our first management of a lifelong restriction order, as well as in relation to Prevent activity. The CSWO also sits on the pan Ayrshire Strategic Oversight Group for the implementation of the new Joint Investigative Process. Social Work and Social Care matters are regularly reported to the IJB and Clinical and Care Governance Committee. There is a particular focus on the impact of policy and external scrutiny activity. The CSWO maintains regular calls with our Care Inspectorate strategic link to share developments and hear of national developments that support activity in North Ayrshire. The CSWO also contributes to quarterly calls with the inspectorate and the broader PSMT. The primary governance of practice matters remains the Social Work Governance Board. The board terms of reference and membership have been refreshed in the current year with the support of the professional leadership group. The board has had a full agenda of issues over the year and has provided support and governance in relation to a range of matters including: • The development of a framework for practice where virtual methods are not suitable to promote good quality social work practice • Practice enhancement notices in relation to adult support and protection • Safe Holding and associated Governance • Developing Community Social Work models and discourse • Contextual safeguarding • Guidance to practitioners on the ASP / CP interface for 16 & 17 Year Olds • Practice standards for MHO’s annual accreditation 235
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10 1.1 Overview of the North Ayrshire Health and Social Care Partnership Visions, Values and Priorities Our Partnership includes health and social care services within Health and Community Care Services (H&CC), Mental Health and Learning Disability Services and Children, Families and Justice Services. In this report, we look back on the progress we have made, share some of our successes and reflect on some areas that have proved challenging. This report aligns with our “Caring Together” Strategic Commissioning Plan 2022- 2030. This is the first time the Health and Social Care Partnership has set out such a long-term plan for how we intend to improve services and the health and wellbeing of the local community. The plan set out our pandemic recovery intentions, as well as offering a longer-term vision for local health and social care services. Over the period of this strategic plan, the Health and Social Care Partnership will seek to: We see these priorities as interlinked, and we expect that where we see success against one priority, it’s effect will positively impact against others. People who use our services and North Ayrshire residents will experience our Partnership values in the way our staff and volunteers engage with you and how we behave. We will treat you with: 236
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11 2. Service Quality and Performance 2.1 Children, Families and Justice Services The Promise The Promise is a large-scale, complex 10-year change programme with multiple objectives and interlinked activities, across multiple partners that sets out a clear commitment for all corporate parents to have an enhanced understanding of the experiences of those who have spent time in care. Progress continued this year focusing on: Social Media A new North Ayrshire Will Keep The Promise Instagram Channel is now created and growing to reinforce that The Promise is a shared duty between corporate parents but to also share relevant information to our care experienced young people in a trending way. Care Experienced Youth Groups Formed a Care Experienced Youth Group within all Secondary Schools within North Ayrshire to give care experienced young people a platform to use their voice to initiate real change as well as having a safe space to communicate with staff and one another. The young people involved will help to support the rights of fellow care experienced young people in North Ayrshire. Awareness Raising and Training The Corporate Parenting team have worked alongside young people to create a presentation that will be delivered within secondary schools and colleges to raise basic awareness of care experience and provide an insight into what rights and entitlements are out there. North Ayrshire Champions Board Our North Ayrshire Champions Board have created a Care Experienced App named "CE4U". The app has lots of tips, advice, and information that we believe will help Care Experienced young people throughout their journey and beyond. The app has a little bit about everything from housing support, learning how to cook using recipes, tips on how to look after yourself physically and mentally, travel support as well as key contacts and events happening in your area. North Ayrshire Champions Board used their own experiences and journeys to produce the idea for an app as they often found they didn't know a lot of the information that was out there or they simply didn't know who or what to ask to find it for them, and so Scotland's very first Care Experienced app was created. 237
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12 CASST Our Children and Adolescent Specialist Support team (CASST) were able to create a modern apprentice opportunity thanks to CORRA foundation funding, It was agreed that the team would benefit hugely from recruiting someone with lived experience of substance use in order to support the team in their endeavours to deliver positive interventions to children and young people who are either involved directly in substance use themselves or live within a household where there is problematic substance use. Our modern apprentice has only been in post for a short period of time; however, they have been able to capitalise on their previous adversities and utilise them in a positive way to assist our young people who are currently being supported by the CASST team. In fact, during the recruitment process for the Modern Apprentice, a number of candidates showed wonderful potential, and our Learning and Development team engaged with them in order to help them seek other opportunities within the HSCP and wider Council. Signs of Safety Health and Social Care have begun the implementation of the ‘Signs of Safety’ assessment and planning model. This model places parents, children and everyone naturally connected to the child at the centre of the assessment, decision-making and planning and is a significant paradigm shift for children’s services, where the dominant culture is for professionals to define the problems and what is required to solve them. The Signs of Safety practice principles support our vision that the best place for children and young people to grow up is within their families and networks where they have the potential to care for them safely. When this is not possible, we will provide a secure, stable home, and help them achieve their full potential. We went fully live with Signs of Safety for all new cases in September for Children and Families Locality teams and the Child Protection team. Prior to then we had a period from June where we used the approach with a small amount of practice in order to build workforce confidence and knowledge. Since then, we have utilised this practice framework with over 300 children and young people This is great progress, but we recognise there is ongoing work to build all our confidence in establishing the approach. The focus is on recognising and acknowledging families’ strengths and encouraging them to identify solutions to any identified worries or to assist them to reduce harm, alongside the support of services. We are moving into our second year of a 5-year implementation plan to fully embed the model in practice. Over the next year we will transition all work with families over to a Signs of Safety model approach. Social Work Children and Families Teams will be working to ensure this support model is implemented for all children and young people receiving a service. 238
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13 Child Protection Registrations In 2023/24 there were 187 Child Protection registrations and 140 De-registrations. The greatest number of registrations were found in December, when there were 27 registrations within the month. The lowest number of registrations occurred in March, when there were 8 registrations within the month. The median number of registrations per month across the year was 15. Breastfeeding Breastfeeding has been a longstanding priority for staff working in North Ayrshire. The integrated community infant feeding team which includes midwives, health visitors, Family Nurses, support staff, Community Infant Feeding Nurse, and Support Nurse, as well as colleagues from the Breastfeeding Network (BfN) work closely with families to help them make an informed choice about feeding. Staff have all received regular high-quality training to ensure they are knowledgeable and skilled in relation to infant feeding. In North Ayrshire our rates of exclusive breastfeeding have decreased slightly, with exclusive breastfeeding rates at the first health visitor contact dropping from 22.7% in 2022, to 21.2% in 2023, and at the 6-8 review exclusive breastfeeding has dropped from 20.1% in 2022 to 17.8% in 2023. However, our overall breastfeeding rates (mixed breast and formula) have increased from 40.6% in 2022 to 41% in 2023 at the first health visitor contact and at the 6-8 week review our overall breastfeeding rates have increased from 31% in 2022, to 31.7% in 2023. This means that more babies in North Ayrshire are receiving breastmilk that at any time since the start of tracking this data. Rosemount Project From 1st April 2023 to 31st March 2024, the Rosemount Project received referrals to work with 127 families across North Ayrshire. There were nine referral sources, 239
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14 with the Three Towns Children & Families (C&F) locality the most prolific referral source (28%). This was followed by the Families for Children team (25%), and then by the Irvine C&F locality team (20%). The varied referral sources out with this were – the Garnock Valley/North Coast C&F team (14%), Kilwinning C&F team (5%), Service Access/MAASH (4%), Kinship (2%), the Children and Families Disabilities Team (1%), and the Programmes Approach Team (1%). This gives an indication of the diverse needs and complex difficulties that the Rosemount team encounters, working alongside colleagues across our services to support children, young adults, and parents/carers in different settings, each with their own challenging circumstances. There has been a significant uplift in referrals from the Families for Children team from the previous year, which is partly due to Rosemount having ongoing access to a Family Wellbeing Support Worker, whose post is funded via The Promise. The need for this post has been influenced by both the findings from the independent care review in Scotland, and lobbying by sibling’s rights groups, which has informed amendments to the Children (Scotland) Act 1995. The service will continue to work towards the implementation of Signs of Safety, with a focus on how we can work even more effectively with colleagues, parents/carers, and wider family networks to ensure as many children as possible are supported to remain within their communities and at home with their families. School Nurse All school clusters in North Ayrshire have at least one school nurse aligned to them offering support to children and young people in line with the national pathway. School nurses can offer support in relation to: • Child protection • Looked after children and young people • Low level mental and emotional wellbeing • Domestic violence • Sexual health and relationships • Justice • Homelessness • Transitions • Young carers • Substance use The school nursing team has responsibility for offering all school-aged children and young people who are looked after, either at home or away from home, an initial health assessment which is followed up with an annual review. During 2023/24, 75% of looked after young people in North Ayrshire had been offered a health assessment, a significant improvement on previous years. The service has also been developing innovative ways to improve accessibility for young people including 240
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15 the use of QR codes for self-referrals, and the testing of a podcast to share health and wellbeing information for care experienced young people Childhood Immunisations Throughout 2023/24, the team continued to fully deliver the routine childhood immunisation schedule to eligible children and young people in North Ayrshire. Whilst our uptake rates are good, we continued to see differences in rates between communities. The team is implementing some new approaches, including offering weekend appointments to try and address this. In the last 12 months European countries saw a resurgence of measles. As a preventative measure, additional clinics were delivered in March for North Ayrshire families where children had not received the Measles, Mumps and Rubella (MMR) vaccines in line with the schedule. This was supplemented with a large-scale media campaign to promote MMR uptake. The seasonal flu programme for children and young people was delivered during September and December and vaccination uptake in North Ayrshire was higher than the Scottish average. 241
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16 Key Performance Indicators Child Protection 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Child Protection Concerns 920 849 885 756 570 361 Child Protection Investigations (CP1s) 374 447 443 432 375 197 Child Protection Initial Conferences 126 123 121 119 76 83 Pre – Birth Conferences 43 41 29 34 17 22 CP Initial/Pre-Birth Conferences 4 7 4 9 1 Looked after Children 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Children newly accommodated in North Ayrshire 69 84 63 49 61 46 ** Where the number of children accommodated = the number of children either admitted into any placement type except “At Home with Parents”/”With Friends/Relatives” OR moved from “At Home with Parents”/”With Friends/Relatives” to any other placement type 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Foster Carers 104 98 103 99 96 105 242
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17 Permanency Planning 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Number of permanency plans approved - 30 10 21 19 15 Adoption – approved and placed 10 3 8 5 7 4 Adoptions granted 7 8 4 5 5 7 Permanence orders approved 7 11 3 7 7 7 Permanence orders granted 9 8 0 1 2 9 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Children Subject to Compulsory Supervision Orders 395 393 351 342 298 271 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Children with Compulsory Supervision Orders Terminated 157 140 102 101 102 117 Emergency Placements 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Child Protection Orders 25 32 39 11 18 14 Secure Placements 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022-23 2023-24 Number of secure placements 1 4 1 2 0 2 243
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18 Justice Services 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Number of reports submitted to the courts (CJSW reports, Section 203, Short Notice CJSW & Supplementary CJSW) 754 763 430 606 606 668 Number of home leave and background reports submitted 114 (49 leave reports, 65 background reports) 151 (66 leave reports, 85 background reports) 114 (39 leave reports, 75 background reports) 93 (30 leave reports, 63 background reports) 91 (28 leave reports, 63 background reports) 112 (41 leave reports, 71 background reports) Unpaid Work Requirements 403 360 94 172 313 310 2018–19 2019–20 2020-21 2021–22 2022-23 2023-24 Level 1 Mappa 181 163 152 172 190 174 Level 2 Mappa 2 7 10 14 27 11 Level 3 Mappa 1 5 3 7 2 2 244
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19 2.2 Adults North Ayrshire Drug and Alcohol Service The North Ayrshire Drug and Alcohol Service (NADARS) has continued to demonstrate high levels of performance by meeting national and local standards and targets, such as access to treatment waiting times, provision of alcohol brief interventions (ABIs), the roll-out of Naloxone supplies and increasing patient choice regarding Opiate Substitution Therapy (OST) medications. The team continues to identify new ways of working to provide a more agile and streamlined service and further improve performance. This work has been evidenced by the delivery of early intervention services in the delivery of Alcohol Brief Interventions (ABI) in both priority (Primary Care, A&E and Antenatal) and wider settings. 245
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20 North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) The North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) utilises multidisciplinary holistic interventions to focus on providing high-quality care and support, through proactive early intervention and preventative action. They aim to assist patients presenting with falls, frailty, low grade infections and general functional decline to avoid hospital admission where possible and facilitating early discharge home from hospitals. The North Ayrshire Enhanced Intermediate Care Team brings together the expertise of dedicated Physiotherapists, Occupational Therapists, Technical Instructors, Dieticians, Community Psychiatric Nurses, Pharmacists, Admin workers, Rehabilitation Nurses, Advanced Nurse Practitioners, and Intermediate Care GP with special interest into one single multidisciplinary and interdisciplinary team; focused on problem-solving for patients in their own homes across all of mainland North Ayrshire. The seven-day rehabilitation service facilitates early discharge from hospital and provides a rapid Indicator 2021-22 2022-23 2023-24 Target set by Scottish Government – Priority Settings 3,420 3,420 3,420 Total ABI delivery in Priority Settings (Ayrshire & Arran) 5,776 4,933 6,398 Indicator 2021-22 2022-23 2023-24 Target set by Scottish Government in Wider Settings 856 856 856 Total ABI delivery in Wider Settings (Ayrshire & Arran) 1,027 1,207 1,210 246
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21 alternative to acute hospital admissions. The Enhanced part of the team addresses medical and clinical issues that limit a patient’s ability to engage in rehabilitation via a shared care model with the patients registered GP. Learning Disabilities Trindlemoss Day Opportunities continues to make good progress with regard to furthering the diversity of opportunities it can link its customers to, including the opening of its Community Café and Baristamoss, as well as the Glam Hideaway, all of which provide opportunities for skill development and enjoyment for individuals. Trindlemoss Day Opportunities has also been a contributor to the successful delivery of the How We See Ourselves poetry/art animation project, within a project led by Neighbourhood Networks. Following a successful run of the associated exhibition within the Harbour Arts Centre, the animations and interview linked to that work are now viewable on the NAHSCP’s Youtube channel. Ward 7A has also successfully completed its collaboration with the Glasgow School of Art around the implementation of an internship within the ward for 2 students, focused around the theme of connected transitions. The Learning Disability service continues to experience workforce pressures across a number of its elements, in particular Trindlemoss House: within that setting, a number of vacancies are currently unfilled, including 3 Band 5 posts. Recruitment and retention issues are also evident within Ward 7A. While 2 newly qualified nurses started in November, this still leaves 1.86WTE vacancies, as well as creating a new balance with regard to skills/experience mix which will need accommodated. Further fragility is introduced by the need to cover maternity leave as well as the departure of 2 experienced Support Workers to join Foxgrove. Care at Home The Partnership’s Care at Home Team continue to offer exceptional support to the people of North Ayrshire. The Care at Home service has registrations split over two areas on a locality basis. In November 2023, The Irvine, Kilwinning, Garnock Valley and Community Alarm localities were inspected by the Care Inspectorate, receiving very positive feedback that staff demonstrated “passion and commitment to providing the best 247
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22 care possible” noting service users and their families spoke “warmly and gratefully for the services they received and the difference [it] made to their lives”. The inspector also recognised the good partnership working between the team and District Nurses, GP's, the Hospice, and many others – all with the goal of supporting and meeting the needs of our service users. The inspection found that staff spoke of their pride in being part of the service, of job satisfaction and of making a difference to service users’ daily lives, recognising the guidance, training, and development they received to help them do so. Staff were invited along to an open day at Castleview Hub in Ardrossan in June to have a look around NAHSCP’s newly refurbished training hub for Care at Home staff. Housed in the former Castleview Day Services building in Glasgow Street, the facility will act as a hub for staff working within the service to learn the essential moving and handling skills they require in their day-to-day role, allowing them to move and position clients safely, respectfully, and in a way that promotes their independence, dignity and functional mobility. Carers On Carers Rights Day, a fantastic event was held at West Kilbride Village Hall to launch the expanded North Ayrshire Carers Gateway service. Attended by carers, staff of the Carers Gateway and NAHSCP, representatives from Third Sector organisations, North Ayrshire Provost Anthea Dickson and North Ayrshire Carers Champion Councillor Nairn McDonald, the event offered a chance to network, hear more about the service and find out more about additional sources of support locally. Having delivered services to North Ayrshire’s unpaid carers for over 20 years, Unity’s wealth of experience in supporting those caring for family members and friends has led to them successfully being awarded the contract to deliver support for a further period of three years, with significant resources being provided by NAHSCP to expand, improve and rebrand the services offered to both adult and young unpaid carers. This substantial investment will see a number of positive changes, including a three-fold increase in the number of support staff, increased routes to carers assessments and support, and the development of more community-based outreach services. This will see 248
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23 unpaid carers being able to access support closer to home in places they already visit and includes a dedicated worker for residents on the Isle of Arran. With an estimated 14,000 unpaid carers in North Ayrshire, the new outreach service will provide extended opportunities for Unity to reach more carers, in more places, in more ways and actively seek to connect with carers not yet known to them. Money Matters Our Money Matters Team once again supported the most vulnerable people in our communities, accessing entitled benefits to the incredible sum of £20,081,590.91, an increase of over £1.5 million pounds from 2022-23. In total 5,739 referrals were received in 2023/24. 249
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24 Mental Health NHS Ayrshire and Arran Child and Adolescent mental Health Services (CAMHS) fully implemented the NHS Scotland National CAMHS Service Specification published in February 2020 on the 1st August 2023 after papers going to each of the 3 IJB’s (Integrated Joint Boards) between March and May 2023. The specification describes the role of CAMHS as providing access to multi-disciplinary teams that provide: • Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. • Training, consultation, advice, and support to professionals working with children, young people, and their families. As a Tier 3 service CAMHS will see young people who present with mental health problems that are causing significant impairments in their day-to-day lives. Prior to the implementation of the specification CAMHS saw an all-time high number of referrals in June 2023 of 330 and 69% of these were requesting a Neuro assessment. All these young people needed to be seen within 18 weeks and involved additional assessments by all clinicians and even some of the Team Leaders and Service Managers did assessments. CAMHS in Ayrshire Referral to Treatment is the best in Scotland sitting at between 3-4 weeks to be seen for initial assessment and the teams are continuing to work on all the waiting lists within the service. N-CAMHS specifically see those children and young people whose Neurodevelopmental Disorder co-exists with a clearly defined and treatable mental–illness. This service offers specialist clinical support, assessment and diagnosis for children and young people experiencing the combined challenges of mental ill-health with conditions such as Autism or Attention Deficit Hyperactivity Disorder (ADHD). CAMHS are working alongside health, social care, education and NEST (Neurodevelopmental Empowerment & Strategy Team) in the 3 Ayrshire’s to ensure young people who are referred for a Neuro assessment, that do not meet the CAMHS Specification, are sign posted to the relevant services and supports. CAMHS Urgent Assessment & Intensive Treatment service operates across seven days which complements our more traditional service model. CAMHS workforce continues to evolve to meet the service need and the employment of Advanced Clinical Nurse Specialists, Pharmacy Prescribers and Nurse prescribers have significantly helped CAMHS over the last year when there have been a shortage of psychiatry staff and medication. 250
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25 Accommodation West Road in Irvine will be the new Specialist CAMHS Assessment & Treatment Centre for Ayrshire as well as the operational base for the Community Eating Disorders Services by September 2024. Open seven days per week specialist CAMHS Neuro, ADHD, play Therapy and other Clinical Interventions will be delivered from this re-fitted facility. Hosting flexible working space for staff with 5 clinic rooms and two large meeting rooms, it is envisaged that the facility will become a centre of excellence in the care and treatment of child and adolescent mental ill-health and eating disorders. Accommodation for the Unscheduled Care Service remains a challenge. The wider CAMHS Service will also require a review of accommodation in due course and the service aspires to a specific facility for the care and treatment for moderate to complex mental ill-health. CAMHS continue to explore the feasibility of providing in-patient care for children and young people closer to home in Ayrshire. Suicide Prevention Preventing Suicide in North Ayrshire: ‘Creating Hope Together: Scotland’s Suicide Prevention Strategy 2022-2032’ Staff from across North Ayrshire HSCP were joined by colleagues from NHS A&A, East and South HSCPs and Third Sector partners for a suicide prevention event at Saltcoats Town Hall in October. The theme of the event was ‘Creating Hope Together’, recognising that suicide prevention is everybody’s business and that we can all take action - no matter how big or small - to prevent suicide. The aims of the day were to encourage discussion and generate ideas for taking action to prevent suicide in North Ayrshire; share our knowledge so far about suicide prevention and highlight areas of good practice; inspire a call to action across all sectors to work and learn together to drive change in North Ayrshire, and consider what more can be done to prevent suicide and identify the support needed to ensure everyone can play their part. As well as staff from NAHSCP/NAC/NHS A&A, representatives of Arran CVS, Dalry Men’s Shed and dsm-firmenich also delivered thought-provoking presentations on the day, with attendees taking part in two workshop sessions that will help to shape our next steps. Self-Directed Support & Ayrshire Independent Living Self-Directed Support (SDS) & Ayrshire Independent Living: For the reporting year 2023/24, the following information indicates how people have arranged and directed their support in North Ayrshire. Self-Directed Support offers 4 options. These are: • Option 1 – a direct payment, which is a payment to you or third party to pay for your own support 251
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26 • Option 2 – you direct the available support • Option 3 – the local council arranges the support • Option 4 – a mix of the above This continues to demonstrate that traditional support options are offered and accessed most with 87% of people receiving Option 3, where little choice and control is exercised and support is chosen, arranged and directed by the Health and Social Care Partnership. North Ayrshire Health & Social Care Partnership has awarded a final contract extension year on a pan Ayrshire basis to continue to commission independent SDS advice and information services from Ayrshire Independent Living Network (AILN). In the calendar year 2023 AILN reported supporting 457 people with 30% resident in North Ayrshire. Almost 180 new referrals were received across Ayrshire from people seeking information and guidance on how to direct their care. AILN have also continued to support partners such as social care teams as well as student and new workers, dementia services, attended jobs fairs at Lockart Campus and hosted a Transitions Event with Equal Employment. The service development work of AILN has been framed into a Business Action Plan 2023 – 2025 which has been shared with the 3 Local Authorities to work in partnership. Older Peoples Day Services Alzheimer’s Scotland commenced a new agreement for the delivery of day services from its Ardrossan service and, with an increase in staffing and the introduction of transport to the service; is able to operate at full capacity offering day services provision across 7 days per week. This compliments the development of a revised model of Older People’s day services which commenced in Quarter 1 to fully recruit to deliver an enhanced outreach model of 252
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27 day opportunities. This also includes a day services pilot on the island of Arran, offering an outreach day service in the more remote villages. Community Link Workers Community Link Workers continue to support people age 16+ on a wide range of issues affecting health and well-being, such as money worries, unemployment, social isolation, bereavement, alcohol, and drug use, managing stress, low mood and anxiety and living a healthier lifestyle. Over 2,000 clinics were provided in North Ayrshire GP Surgeries with over 6,000 patient contacts made. Community Link Workers have increased their reach by being involved in the roll out of North Ayrshire Council’s No Wrong Door policy, this policy builds on existing efforts to ensure that residents can access the funding or support that they need during the cost-of-living crisis. Residents can now access advice and support from a number of key services including, financial inclusion, employability, homelessness, digital access/skills and community link workers, by completing a simple online form. As part of for this initiative the team worked closely with the NAHSCP communications officer to create an online A-Z list of services that can assist with a wide range of wellbeing, emotional and practical support services. This addition to the NAHSCP has been well received and is now one of the most viewed pages. The webpage can be found here. Trindlemoss Day Opportunities A group from Trindlemoss Day Opportunities achieved a Gold Award as part of the RSPB’s Wild Challenge Awards programme. Stewart Baird, Mark Stevenson, Darren Cousar and Elaine Rae have been busy taking part in the scheme, which has seen them discovering, learning about, and helping wildlife in its natural habitat. 253
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28 Having already completed the Bronze and Silver levels, the team worked extremely hard over a number of weeks to achieve the highest accolade in the Gold award, with each level of the programme requiring the completion of a total of six activities. Each award level is split into two categories, a ‘Help Nature’ section that involves making our outdoor spaces wildlife friendly, and an ‘Experience Nature’ section, where participants get up close and personal with wildlife and explore the amazing world of nature on our doorsteps. The group took part in a host of activities throughout the challenge, including building bat boxes, bird boxes and bee houses, local plant and mini-beast safaris, and creating a fantastic mini-pond within the garden area at Trindlemoss. They’ve also enjoyed a visit to Eglinton Park, where they tried pond dipping and discovered some newts, as well as RSPB Lochwinnoch to explore the various wildlife habitats there. Alcohol and Drugs A report from North Ayrshire Drug and Alcohol Recovery Service (NADARS) and North Ayrshire Alcohol and Drug Partnership (NAADP) has highlighted some of the positive work being undertaken to prevent drug and alcohol related deaths locally. The report details some of the work carried out over the past year, including the ongoing implementation of the Scottish Government’s Medication Assisted Treatment (MAT) Standards, providing additional support to individuals following a non-fatal overdose, increasing access to residential rehabilitation programmes, and the continued roll-out of the life-saving medication Naloxone across North Ayrshire, which reverses the effects of an opioid overdose. In addition, the report outlines local and national drug and alcohol related targets and standards, all of which were met in North Ayrshire during 2022-23. In March 2023, 96 percent of clients commenced treatment to support their recovery within 3 weeks of being referred (against a national target of 90 percent), with100 per cent of clients waiting less than six weeks, again meeting the national target. North Ayrshire had also been set a target of increasing the number of individuals in treatment from 882 in 2020 to 959 by March 2024, with 2023 figures (1011) already exceeding the 2024 target. An additional target of supplying 420 Naloxone kits in North Ayrshire during 2022-23 was also exceeded, with 846 kits distributed. 31 lives were reported to have been saved in North Ayrshire due to the use of Naloxone during that period, however this number could be significantly higher, as lives saved via the use of Naloxone often go unreported. 254
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29 Medication Assisted Treatment availability, where individuals have the option to start a treatment of their choosing from the day of presentation – as well as receiving psychological and social support – was expanded during 2022-23 to include all six North Ayrshire localities. National and NAADP funding has allowed the recruitment of additional staff to help deliver this, including addiction workers, additional prescribing capacity and recovery development workers with lived experience. Access to local residential rehabilitation is provided by Ward 5 at Woodland View in Irvine, which has ten beds for residential care for anyone who has an alcohol and/or other drug problem and mental health issues. Ward 5 provides access to residential detoxification, rehabilitation and day attendance support, with seamless pathways of support in place for individuals before, during and after their placement via local community alcohol and drug services. In addition, North Ayrshire Health and Social Care Partnership was instrumental in supporting Phoenix Futures to open Harper House in Saltcoats in 2022, which provides additional residential rehabilitation support for vulnerable families, who can stay together at the facility. The past year has also seen a focus on providing access to external residential rehabilitation, with national funding having been made available to NAADP. Individuals wishing to access this can now do so through NADARS, who will support the development of a care plan, identify a suitable provider, seek funding and support individuals into, throughout and after their placement. Dads’ Support Worker The recruitment of a Dads’ Support Worker within the integrated Universal Early Years’ team will allow an expansion of the offer of early help for children under the age of 5 and their families, which has been recognised by the Scottish Government as an example of good practice. The post will be responsible for developing and delivering specific programmes for Dads, including practical parenting workshops; working in partnership with Dads Rock and learning from the established programmes and approaches they have developed. The post will aim to test how, from an early years’ perspective, we can better engage with dads and other male caregivers to encourage a more active parenting role. Community Wards The Community Wards continue to embark on a number of initiatives to improve the experience of their patients. The efforts of the Ward 2 team (Ayrshire Central Hospital) has been so successful their work has secured a ‘Greatix Award’ – a network which celebrates excellence. The award recognises that having identified that the number of acquired pressure ulcers was well above the normal, interventions were put in place, which over a period of only 6 months not only reversed the trend, but reduced incidents to below previous levels. The team has now also appointed ‘Pressure Ulcer Champions’ to continue this excellent work. 255
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30 Out of Hours Social Work Service The Ayrshire Out of Hours Social Work Service has now been operational for 12 years. Despite another challenging year with increased and more complexed referrals, as well as ongoing issues with recruitment and absence, the team have continued to provide uninterrupted service throughout this period. Recruitment for vacant posts was concluded in March 2024, and there is now full complement of staff, with 18 sessional staff members supporting service delivery. During the period from 1st April 2023 to 31st March 2024 there were a total of 9,094 referrals made to the service. These are broken down as below: Date Period North Ayrshire South Ayrshire East Ayrshire Total 2019-2020 4219 2460 2955 9634 2020-2021 4165 2337 2800 9302 2021-2022 4000 2202 2613 8815 2022-2023 3185 1783 2366 7334 2023-2024 3832 2103 3159 9094 During the same period in 2023 there were a total of 7334 referrals from Out of Hours to Day Services. These were as below: North Ayrshire 3185 South Ayrshire 1783 East Ayrshire 2366 256
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31 2.3 Criminal Justice Prevent Multi Agency Panel As a result of having an established Prevent Multi Agency Panel (PMAP) process North Ayrshire are one of only 3 HSCP’s in Scotland to be selected to participate in the PMAP Hydra training sessions that the Home Office and College of Policing run nationally for PMAP Chairs, their Prevent Police colleagues and standing panel members. Training has been well received and is a key element of their response to the Parsons Green findings. As part of a national training programme, and as part of professional development, the HYDRA training has been redesigned this year incorporating much of the feedback received from practitioners. The Hydra training took place in Glasgow in March and is a training platform originally developed for the Police, providing decision-making training for Police functions ranging from investigations to child protection to kidnap situations. The Home Office and College of Policing developed a one-day PMAP-specific training package. The training was a great opportunity to upskill and maintain the focus of colleagues from partner agencies and remind colleagues across the authority of the importance of engaging with PMAP. Recruit with Conviction North Ayrshire Council has received Recruit with Conviction Ambassador status. Working in collaboration with the organisation, ‘Recruit with Conviction’, North Ayrshire Council’s new Ambassador status recognises efforts to offer safe and sustainable employment for individuals with current/historical convictions, ensuring that our internal policies and practices are both current and proportionate. Koestler Awards A group of six clients of North Ayrshire’s Unpaid Work team have received recognition certificates from the Koestler Awards for their original artworks, with one participant also receiving a Highly Commended certificate for a unique wooden birdhouse. The Koestler Awards for arts in criminal justice started in 1962. Each year, over 3,500 people in custody and in the community share their creative work by taking part. The Koestler Awards provide feedback and encouragement to entrants of all abilities in visual art, design, writing and music. 257
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32 Refugee Support Team North Ayrshire continues to welcome New Scots into our local communities. Our Refugee Support Team, alongside multi agency partners continue in their endeavours to help all integrate into their local communities, making everyone feel safe and included. During August we hosted two events to support our families from Syria and Ukraine to become more familiar with their local community and local attractions, in order to support their health and wellbeing. 20 Ukrainian families and 16 Syrian families attended. Please click on the link for more detail in relation to these events. New Scots Summer Fun Community Payback Orders The latest Government statistics on Community Payback Orders (CPOs) (2022-23) show that North Ayrshire had the highest of the Ayrshires with 490 CPOs however was the median of the Ayrshires at 47.3 per 10,000 population. In comparison, East Ayrshire had 488 CPOs and sits at 51.4 per 10,000 population and South Ayrshire had 399 CPOs and sits at 46.2 per 10,000 population. The Scottish average is 33.0 per 10,000 population. There was a significant decline in the number of Criminal Justice Social Work Reports (CJSWs) in 2020-21 thought largely to be due to the result of COVID-19, however numbers rose by 40% from the previous year in 2021-22 and continued to rise in 2023- 24, albeit at a lesser rate of 15% from the previous year. The latest Government statistics on CJSWs for 2022-23 reveal North Ayrshire to continue to be the lowest of the Ayrshires at 75.7 per 10,000 population. In comparison, East Ayrshire sits at 81.9 and South Ayrshire sits at 85.2. The Scottish average is 68.6 per 10,000 population. Our Justice Services continue to have a positive impact on the local community through the Community Payback Order (CPO) unpaid work scheme. For over a decade, the eleventh year in fact we have continuously over-achieved against targets for CPO level 1 and level 2. 2023-24 saw 73 out of 75 level 1 CPO’s completing within timescales and 146 out of 152 level 2 CPO’s completing within timescales. The targets set for unpaid work are pan-Ayrshire targets. 258
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33 Drug Treatment and Testing Order Following a slight ‘dip’ in Drug Treatment and Testing Order (DTTO) Assessments in 2022-2023, the following chart illustrates a marked increase in the recent financial year, with sentencers at both Ayr and Kilmarnock Sheriff Court requesting these reports more regularly due to recent successes and the service adapting to incorporate changes in recent drug trends from depressant substances to stimulant, thus taking into consideration a host of differing offence-types and the focus of therapeutic interventions to promote change. Of the 66 individuals assessed, 47 Orders were imposed across Ayrshire. Due to the nature of the Order, rigorous supervision and much support is provided to all and more recently through the employment of two Recovery Development Workers from CORRA Funding, we have now incorporated active outreach, additional practical supports and community reintegration to complement our existing service. Success is not only measured through an absence of offending behaviour but also progress being made in several areas of life to ensure resilience and to promote longer- term lifestyle changes. 259
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34 Diversion from Prosecution Diversion from Prosecution (Diversion) has been available since 1997, within this past year we have experienced a further increase across Ayrshire in assessment referrals from the Procurator Fiscal. Referrals have increased at a significant rate from 2018. Although this disposal is early intervention and low-level offending, the presenting need of service users is extremely high, thus resulting in more staff time being allocated and closer partnership working with other agencies to provide identified services. The number of assessment reports submitted are relatively lower than the number requested due to limited resources, which has resulted in waiting lists within each local authority area. In comparison with last year, 2023-2024 notes a decrease in the number of Diversion cases imposed. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. In this time many positive changes could have taken place and individuals are actively seeking and engaging with services to address any issues which they may have, thus reducing their risk of further offending. In these instances, no interventions are required due to positive reasons. 260
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35 Key Performance Indicators MHO Service Mental Health (Care and Treatments) 2003 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 Emergency Detentions 54 54 81 96 92 99 Short Term Detentions 74 67 134 There have been a total of 171 requests (of which consent was given to 134, with the other 37 being assessed but consent not given) There have been a total of 127 requests (of which consent was given to 108, with the other 19 being assessed but consent not given) There have been a total of 182 requests (of which consent was given to 151, with the other 31 being assessed and consent not given) 261
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36 Compulsory Treatment 38 51 59 There have been a total of 70 new CTOs granted (of which 27 had been Interim CTOs, with 14 of these moving to full CTO following a further Mental Health Tribunal) There have been a total of 60 new CTOs granted (of which 17 had been Interim CTOs, with 12 of these moving to full CTO following a further Mental Health Tribunal) There have been a total of 47 new CTOs granted (of which 10 had been Interim CTOs, with 4 of these moving to full CTO following a further Mental Health Tribunal) Warrants Undertaken 1 6 6 4 4 3 Criminal Justice Act Scotland 1995 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 Compulsion Order and Restriction Order 4 3 3 2 0 0 Compulsion Orders 2 6 6 3 3 3 Hospital Directions 1 1 1 0 0 0 Assessment Orders 2 2 2 6 5 6 Treatment Orders 4 2 2 6 2 3 Transfer for Treatment 2 1 3 1 1 1 262
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37 Adults with Incapacity Act (Scotland) 2000 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 Private Welfare Guardianships 411 (58 new) 272 (67 new) 314 (57 new) 402 (102 new) 371 (99 new) 422 (125 new) CSWO Guardianships 40 (16 new) 64 (24) 71 (24) 91 (26) 85 (27 new) 121 (54 new) Financial Intervention Order (LAG) 26 31 n/a n/a n/a n/a MHO Report PWG Application 38 104 75 156 139 141 Adult Protection 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 ASP Referrals (AP1) 457 568 558 643 722 915 ASP Investigations (AP2) 88 108 132 102 72 112 ASP Case Conferences 47 66 64 40 41 57 Protection Orders 1 0 3 1 0 1 Adult Concern Reports 1838 2335 2215 2070 2370 2103 263
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38 3. Resources 3.1 Financial Pressures The Scottish Government published an updated Medium-Term Financial Strategy (MTFS) in May 2023 which covers the period to 2027-28. It compares the funding and spending scenarios to assess the scale of the challenge. The role of the MTFS is to set out Scotland's fiscal outlook over the coming years, including financial opportunities and risks that may impact on the fiscal position. In line with the recommendations of the Budget Process Review Group, the document does not set out new spending plans or explain how prioritisation decisions will be made to meet policy objectives. These decisions are made in the Scottish Government budget. The Scottish Government’s funding is comprised of five high level categories: 1. The Block Grant – this is the single largest source of funding for the Scottish Government. The Barnett Formula determines the Block Grant and annual growth is dependent on the UK Government’s overall fiscal plans and its spending priorities. 2. Devolved taxes – the Scottish Government receives the revenue from these taxes, the largest of which is Scottish Income Tax. The Scottish Budget is then reduced based on how quickly revenues of the corresponding tax have grown in the rest of the UK (rUK) on a per head basis. 3. Non-domestic rates (NDR) – this revenue is raised by Local Authorities on non- domestic properties. All revenue raised is ultimately returned to Local Government via the Local Government Settlement. 4. Social Security Block Grant Adjustments – this is funding provided by the UK Government for devolved social security payments, based on the growth in expenditure on the corresponding payment in UK on a per head basis. 5. Other income and expenses – other revenue and costs including resource borrowing and associated costs as well as revenues from the Scottish Crown Estate The MTFS notes that the funding available to Scottish Government is expected to grow steadily from £45,260 million in 2023-24 to £50,971 million by 2027-28, an overall cash increase of 12.6% and real terms increase of 6.8%. This is due to increases in the Block Grant and significant growth in the net tax position over this period. However, these increases will vary significantly between years. Pressures on funding will be most severe in 2024-25 when overall resource funding (including NDR) is forecast to grow by only 1.2% in real terms. The Scottish Government MTFS models three scenarios (a central resource funding outlook and an upside and downside scenario, indicating plausible alternative funding paths) and outlines the immediate and longer-term pressures on public spending which need to be considered when developing spending plans to ensure that they meet the needs of a changing population and build resilience for the future. 264
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39 The Scottish Government intends to publish an updated Medium-Term Financial Strategy during 2024, alongside a refreshed Medium-Term Financial Framework for Health and Social Care. These documents were scheduled for publication in June but have been delayed due to the General Election in July. These will form the basis of the funding assumptions in the next update of our Medium-Term Financial Outlook which will cover the period 2025-2028. 2024-25 Budget As part of the Scottish Government budget and finance settlement funding letters were issued to NHS Boards and Councils, these detailed the requirements in relation to the level of funding to be delegated to IJBs in 2024-25. The specific requirements are as follows: • Compared to 2023-24 budgets, territorial NHS Boards will receive a total increase of 4.3% for 2024-25 to cover costs related to the 2023-24 pay deals, as well as the baselining of £100 million sustainability and NRAC funding provided in 2023-24. • The Partnership receives an appropriate share of the pay award funding, and this is already included in our base budget calculation; the sustainability and NRAC funding is not shared with the IJB. • The funding letter also notes that additional funding is expected to be provided when the 2024-25 pay award is settled and the expectation is that the IJB will receive an appropriate share of any pay award funding. • The Health and Social Care Portfolio will transfer net additional funding of £241.5 million to Local Government to support social care and integration. The overall transfer to Local Government includes additional funding of £230 million to deliver a £12 per hour minimum pay settlement for adult social care workers in private and third sectors, in line with the Real Living Wage Foundation rate. In addition, an inflationary uplift on Free Personal Nursing Care rates (£11.5 million) is provided. These amounts are reflected in the North Ayrshire Council figures. • The funding allocated to Integration Authorities for Free Personal and Nursing Care and adult social care pay in third and private sectors should be additional and not substitutional to each Council's 2023-24 recurring budgets for adult social care services that are delegated. Where there is evidence funding is not passed across to be used for the policy intent, the Scottish Government reserves the right to look at reclaiming funding allocated. • In previous years territorial health boards have received a baseline uplift on core budgets, for example in 2023-24 this was 2%, and on that basis, there was a specific directive from Scottish Government that payments to IJBs for delegated functions delivered the same uplift. As noted, for 2024-25 the Scottish Government has committed the £100 million sustainability funding for non-pay costs, but beyond this and the NRAC funding provided in 2023-24, Boards will be expected to manage pressures within existing envelopes and there will be no new baseline funding uplift. On this basis, there is no funding uplift from NHS Ayrshire and Arran for 2024-25. 265
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40 The IJB approved a one-year balanced budget for 2024-25 on 14 March 2024. More information about the 2024-25 Budget. This budget included new budget pressures for health and social care services totalling £16.131m. These were developed in partnership, with Finance supporting front line services to identify current and emerging financial pressures considering historic demand and costs and potential future variations. The provision of funding for pressures has the impact of increasing the budget gap to be addressed through savings, therefore the pressures are only included in budget plans where these are absolutely unavoidable. The new cost and demand pressures resulted in a requirement to identify and approve additional savings of £10.290m 3.2 Financial Performance Strong financial planning and management is paramount to ensure our limited resources are targeted to maximise the contribution to our objectives. Delivery of services in the same way is not financially sustainable. The updated strategic plan approved for 2022-30 is underpinned by the need to learn from the pandemic and ensure opportunities are maximised to transform care models and find new solutions to ensure the future sustainability of high-quality heath and care services. The ability to plan based on the totality of resources across the health and care system to meet the needs of local people is one of the hallmarks of integrated care. Medium term financial planning is key to supporting this process and identifying the transformation and planned shift in resources to provide sustainable services to the local community over the medium term. In 2023-24 the IJB agreed a one-year balanced budget which included an overall savings requirement of £6.215m. Financial information is part of the performance management framework with regular reporting of financial performance to the IJB. This included an integrated approach to financial monitoring, reporting on progress with savings delivery, financial risks and any variations and changes to the delegated budget. There were significant financial challenges during the period. The main challenges during the year were residential placements for children, care at home, supplementary staff in wards and Unplanned Activities (UnPACs) within the lead partnership for mental health. From the initial budget monitoring report in month 3 the projected position has been an overspend. The Integration Scheme requires the preparation of a recovery plan if an overspend position is being projected to plan to bring overall service delivery back into line with the available resource. Heads of Service have closely reviewed expenditure and have implemented actions which have reduced some areas of overspend, however these areas of improvement have been countered by adverse movements in Care at Home, Integrated Island Services, Wards 1 and 2 at Woodland View, UNPACS and intervention services. 266
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41 As a contingency there was provision of £2m non-recurring funding set aside in the reserves contribute towards the 2023-24 position and this has been applied. The overall financial performance against budget for the financial period 2023-24 (after adjusting for new earmarked reserves) was an overall overspend of £7.464m. This consisted of £6.634m of overspend in social care services and £0.830m overspend in health services. Our health and social care services should reflect and respond to the needs of local people. To support this, we will help to build greater capacity in our communities and provide more ways for service users and local people to share their views with us to help shape services. We are fully committed to planning and designing services together with local people, our staff and our key partners including acute health services, housing, community planning and the third and independent sectors. Growing evidence suggests that the pandemic has had negative socio-economic effects that have led to increased health inequalities and contributed to an increase in both poor mental wellbeing and mental health. The IJB, through the refreshed Strategic Plan, outlines the belief that together we can transform health and social care services to achieve the joint vision for the future “all people who live in North Ayrshire are able to have a safe, healthy and active life.” Moving into 2023-24, we are working proactively to address the financial challenges, while at the same time, providing high-quality and sustainable health and social care services for the communities in North Ayrshire. 3.3 Medium Term Financial Outlook A Medium-Term Financial Outlook (MTFO) is a critical part of the strategic planning process. The financial context for public services remains very challenging and so it is vital that the IJB’s strategic ambitions are set against the financial resources which are anticipated to be available. The MTFO provides key information on the possible financial position of the IJB over future years. It identifies the financial challenges which will be faced by the IJB enabling the IJB to see the impact of current and future decisions on its medium-term financial health. The MTFO will also be used to identify pressure points and inform decisions which are required to ensure the Partnership remains financially sustainable. There are a range of factors which influence the financial planning of the IJB. These are considered through the MTFO and include the following: • Demographic changes. • Local priorities. • Workforce challenges. • The UK and Scottish Economy. 267
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42 • Policy and Legislation. • Cost and demand pressures. • Available funding. As in previous years, a Medium-Term Financial Outlook has been prepared to identify what the financial position may look like moving into 2025-26 and 2026-27. The Integration Joint Board, in common with most Public Sector bodies, is facing a period of significant financial challenge with cost and demand pressures. The most significant financial pressures continue to be pay awards for staff, inflationary cost increases for contracted services and demographic changes driving increased demand for services - funding these unavoidable pressures year-on-year drives our savings requirement. There are a number of highlighted financial risk areas that may impact on the 2024-25 budget during the year, these include: • Care at Home overspend. • Current overspend areas, especially in low volume / high-cost services e.g. Children’s residential placements, UNPACs, and supplementary staffing across community, mental health and learning disability wards. • High levels of inflation over several years which have impacted on costs incurred directly by the Partnership and on our partner providers. • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The provider market and the ongoing ability to source packages of care for service users. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • The Local Government and NHS pay awards are not settled for 2024-25; as outlined in the report, a 3% increase has been assumed for the social care workforce and for NHS it is anticipated that additional funding will be allocated once the pay award has been settled. If the pay awards are not fully funded then this will present an in-year cost pressure. • Unearmarked reserve balances do not meet the recommended threshold of 2% of annual spend and this reduces the ability to absorb in-year variances. • The ongoing review of the Integration Scheme. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. These risks will be monitored during 2024-25 and the financial impact reported to the IJB 268
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43 4. Workforce 4.1 Workforce Planning Following the launch of the HSCP “ Be the Best You Can Be” Learning & Development Strategy (Social Work and Social Care) in September 2023 there has been a clear indicator of the HSCP organisational offer and expectations in relation to professional development for the social work and social care workforce. The strategy outlines our approach to articulating to our practitioners how much we are investing in their development and begins to articulate in broader terms the development of leadership and management capabilities. The issues in relation to professional staff sufficiency remain across all areas of social work both locally and nationally. It is recognised and highlighted most recently by the Social Work Scotland ‘Setting the Bar’ report, which is impacting on the pressure being experienced across all the health and social care systems. The strategy outlines how we can continue to offer annual sponsorship opportunities for the Undergraduate Social Work Degree and widen the sponsorship offer to include Traineeship Programmes and “fast track” routes including the Post Graduate Diploma in Social work. As a direct result of the “Growing Our Own” programme we have 12 employees undertaking a social Work qualification and a further 2 employees who have completed a social work qualification and will graduate in the autumn. To further support the “Growing Our Own” programme we have included opportunities for practitioner to undertake the Practice Development Award in Practice Learning which has resulted in the HSCP having 5 more qualified Practice Educators. As part of the strategy and the Growing Our Own programme there is a visual pathway which demonstrates from school leavers to senior levels what is on offer including the opportunity to undertake an HNC in Social Services & Healthcare and 12 employees were supported to begin this qualification. Following the decision to reshape our strategic approach to the professional development of the workforce with the withdrawal from the Learning Network West on 31st March 2024 there has been an encouraging response from universities and colleges around a more direct way of working. From building relationships, we will ensure SVQ, degree level, post graduate and post qualification contexts continue to be on offer and practice learning opportunities is one of our optimum responsibilities. Our commitment to the provision of Mental Health Officers within the organisation is another key component of the Learning & Development Strategy and with the delivery of the mental health qualification from a different HEI the aim is to offer a more bespoke and flexible qualification with a local context for 4 employees who will be sponsored on this course. The strategy seeks to strengthen the newly qualified first year for Social Workers in cognisance of the directive from the implementation of SSSC Newly Qualified Workers Supported Year. This is critical as the first year greatly influences professional autonomy 269
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44 and authority which are key to good social work practice. With the introduction of mentoring training and support for teams who will have NQSW’s and an offer to extend our support to NQSW’s from 12 months to 18 months with a monthly planned programme delivered by the social work practice team this will nourish new social workers. Leadership & Role Modelling has been seen as one of the key areas where managers and supervisors can influence professional standards and practice and promote a leadership culture. With Aspiring Leaders Programmes for aspiring/new managers and Systems Management Programmes for senior managers these programmes offer reflective space and coaching to allow practitioners to explore complex systems and leadership at all levels within an organisation. Both of these courses have been delivered with extremely successful outcomes in the development of practitioners. In relation to the key area of Good reflective Supervision outlined in the document “Supervision Standards” have been developed following the ongoing work in relation to supervision practice being undertaken by external consultant Bridget Rothwell. The standards are contained in the “Be The Best You Can Be” Learning and Development Strategy. The Supervision Standards outline expectations in relation to good reflective supervision, values and conduct which can be used to develop bespoke service specific supervision guidance and there is clear guidance around expectations and usefulness of face to supervision provision. The strategy includes an overarching focus on the wellbeing of the workforce and is included as a key component of the supervision standards. In relation to ongoing in house training we have been able to increase the number of courses on offer by more than 100% . The variation of courses on offer has increased following consultation with the workforce and driven by other national agendas including Trauma Informed Practice which has been given considerable consideration and a full training programme being implemented in the Autumn. Following the launch of the strategy the “appetite” for development from the workforce is evident with the participation at events and information sessions. 4.2 Workforce Support and Development The HSCP has recognised the value of employees with lived experience in areas such as drug and alcohol recovery. In November 2023, we held our first peer mentor meeting for our recovery development workers within the organisation. The partnership recognises the impact that individuals with lived experiences bring to our workforce when we are trying to make a difference and reach individuals who are impacted by addiction. Whilst our recovery development workers have had a positive impact on those who require support with alcohol and drug use, we also recognise that we have created a sense of hope, direction and achievement for individuals who previously were very much removed from the labour market due to their history with addiction. We have recovery development workers within our Justice Services and Service Access teams. The following is an extract from a recovery development worker currently employed within Justice Services. 270
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45 “Just a wee email to say thank you for your patience with me, my jobs amazing and the privileged nature of the roles not lost on me. It has been a life changing thing for me. I’m grateful for the people around me and the good guidance. In all fairness I do absolutely love my job and my role, it has been a total game changer for me. Having a really supportive team around me and good management is the biggest thing I think that has seen me settle and slot into the team as well as I have. It’s a real privilege to work in the place that helped me so much to change my life, I hope to do the same for the people who I come into contact within the role. The fact I’ve got an amazing management who trust me, encourage me, and value my input makes it all the better.” A pilot scheme was set up by the Council’s Your Next Move employability team in partnership with NAHSCP and supported by We Work for Families and Community Enterprise In Scotland (CEIS) Ayrshire. Throughout the six-month-long pilot project – believed to be the first of its kind in Scotland – a group of five young women, who had either never worked or had not been in employment for a long time, completed a five-week course that covered writing a CV, interview practise and an introduction to the care sector. The candidates involved in the innovative scheme, which ended earlier this year, then went on to undertake paid, mentored, vocational placements with North Ayrshire Health and Social Care Partnership, before attending interviews to join the Care at Home team. After success at interview, the group have all now taken up permanent employment within the team, where they have undergone accredited training and are now working shifts for Care at Home that fit in with their childcare needs and other family commitments. A mother of one from Dalry completed the pilot project and said it has been a “life- changing” experience. “It has made a big difference to my life. Before, when I was unemployed and on benefits, I was very stressed about money quite a lot. Now I am not worrying about it anywhere near as much. This scheme is based around my needs, so I work during my wee girls’ nursery hours which has really helped with my confidence because before I felt really isolated being in the house.” All candidates have continued to thrive in their new roles and have become valued members of their teams. A mother of three from Irvine completed the project and reflected on her experience since joining the Irvine Care at Home Team saying: “I have really enjoyed the opportunity I was given as part of the scheme; It really has changed not only my life but also my children’s lives for the better. As a single parent it has given me better financial stability which allows me to enjoy more quality time doing things with my children. I was given all the training and induction to the service that I required, and I felt fully supported throughout the training period, the support I have received since gaining my permanent position from my team mates and care at home 271
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46 manager has been amazing, they are always there to help me when needed. I have gained valuable experience that I am still building on by undertaking further training opportunities offered to me. I felt welcomed into the team and I now class my colleagues as friends.” Marlene Fleming, Care at Home Manager for The Three Towns, said the pilot has worked brilliantly for everyone involved – the trainees, the service and most importantly those we support in our community. She explained: “Their confidence has been boosted, they are excited to go to work and they go to work with a smile on their face. This has been extremely valuable to the service, supporting the care at home workforce and giving these women much needed experience and skills to help with their future careers. The pilot went extremely well and has really supported the Care at Home team.” North Ayrshire Council’s top priorities include tackling child poverty and supporting residents through the Cost-of-living Crisis. The three key drivers of child poverty are income from employment, income from social security and the cost of living. Councillor Tony Gurney, Cabinet Member for Economy and Climate Change, said: “It is fantastic to see how successful this pilot scheme has been, and I would like to congratulate everyone involved, and wish the candidates well for the future.” The Partnership has experienced significant workforce challenges across the Health and Social Care sector, including and probably the most challenging of these being on the island of Arran. There are a number of plans underway to address current vacancies on the island including specific targeted recruitment campaigns for a number of health and social care vacancies. The new health and social care accommodation, Glenartney, opened its doors in 2023 and has already been a huge benefit in being able to provide high quality accommodation for staff who commute to work on the island. Several managers within the Health and Social Care Partnership successfully completed our Systems Leadership course during 2023/24. There is considerable change and reflection ongoing with regards to how we transform the services we deliver, to ensure we maximise outcomes for services users, whilst working within a very challenging financial climate. The course has been designed to introduce social work and social care professionals to system leadership. The training combines theoretical learning, practical application, and collaborative experiences to equip participants with the tools and strategies needed to work and progress in complex human systems. Programme objectives include creating whole system awareness within the organisation, the creation of a peer learning environment, connecting system leadership ideas and practices, offering a range of practical tools and mental models to work with complex systems and to finally provide 272
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47 space for personal reflections and for facilitated support to help progress personal and group change objectives. Our commitment to high quality services is underpinned by our excellent workforce. We understand the importance of ensuring our team of dedicated staff are supported and provided with mechanisms that support their health and wellbeing. Our Community Nursing staff were provided with ‘well-being’ experiences, with staff from the Irvine, Kilwinning, Garnock Valley, Ballot Road and Bourtreehill teams all being given the opportunity to benefit from the HSPC Primary & Social Care Grants Scheme. Staff commented that this was "a fantastic team reward for the effort they put in during COVID19…team morale got a real lift from it." Over the last 3 years our Staff Wellbeing Programme has delivered several successful wellbeing initiatives/activities to support the wellbeing of Primary Care & Social Care staff, GPs, Third & Independent Sector providers who are commissioned by HSCP, Personal Assistants, Volunteers and Unpaid Carers. This work was initially funded by the Scottish Government in 2021/22 and has been funded solely by North Ayrshire’s Integrated Joint Board (NAIJB) for the last 2 financial years. In conjunction with North Ayrshire Leisure, we have delivered online weight management, physical activity and yoga sessions, as well as staff health checks and free gym passes. In addition, staff have had access to Mindfulness sessions, Trauma Release Exercises and a whole host of online sessions delivered by Optima Health, designed to support the health and wellbeing of staff across the above sectors. Feedback from a recent staff survey has recognised the value of teams coming together to undertake team development days and building resilience. Taking into account the feedback from the staff survey, the Staff Wellbeing Programme will continue to provide a range of opportunities to support physical and mental wellbeing by engaging with KA Leisure and Optima Health. 273
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48 Independent Care Providers who provide care services on our behalf Where we commission care and support from independent and 3rd sector Providers services based within the North Ayrshire area, we monitor these services via the Contract Management Framework. The Framework focusses on ensuring a joint approach to evaluating the quality of care and where appropriate provides an approach to supporting Providers to progress improvements. We use a range of methods to monitor performance, including: • Formal Contract Management meetings on a 6 monthly basis and an Annual Joint Evaluation of Contract to ensure that services are safe, effective and most of all, that they meet people’s needs • Review of compliments, complaints and feedback from staff, carers and people who use services • Information that we collect, before visits, from the provider or from our records • Local and national information, for example, Care Inspectorate reports • Visits to providers, including observing care and support and looking at records and documents The information below represents how those service which are registered with Care Inspectorate and are based in North Ayrshire are currently performing. Registered Services – Minimum Grades across all themes – Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Adoption Service Not applicable 0 0 0 1 0 1 Adult Placement Service Not applicable 0 0 0 2 0 2 Care Home Service Older People 0 4 10 2 0 16 Care Home Service Children & Young People 1 0 3 6 3 13 274
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49 Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Care Home Service Alcohol & Drug Misuse 0 0 1 0 0 1 Care Home Service Learning Disabilities 0 1 2 0 0 3 Care Home Service Mental Health Problems 0 0 1 0 0 1 Care Home Service Respite Care and Short Breaks 0 0 2 0 0 2 Child Minding Not applicable 1 6 61 44 2 114 Day Care of Children Not applicable 1 8 42 16 0 67 Fostering Service Not applicable 0 0 1 0 0 1 Housing Support Service Not applicable 0 2 7 6 2 17 School Care Accommodation Service Not applicable 0 0 2 5 0 7 Support Service Care at Home 0 2 12 7 0 21 Support Service Other than Care at home 0 0 7 0 1 8 Grand Total Not applicable 3 23 151 89 8 274 275
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50 Inspection of Local Services Throughout 2023/2024, a total of nine inspections took place by the Care Inspectorate, all nine were unannounced. There was also one joint inspection of Adult Support and Protection. • Health & Community Care - 3 inspections with 2 follow up inspections. • Children & Families & Justice Services - 3 inspections • Adult Services - 1 inspection Within Health & Community Care 2 follow up inspections took place at Montrose House after an initial inspection in June 2023. The first of these took place on the 15th of September 2023 and examined the requirements listed in the June inspection. Of these requirements, 2 were met, 2 unmet and 4 not assessed. A further follow up inspection took place on the 14th February 2024 examining the outstanding 6 requirements for the facility. Of these requirements 2 were met and 4 unmet. A further inspection within Health & Community Care related to Dementia Support Service (Core Assurance Inspection – Pilot). This was a pilot inspection known as Core Assurance Inspection – No gradings were provided, therefore previous gradings remain. Previous grading from February 2020 were: • Quality of Care and Support – 4 Very Good • Quality of Staffing – 4 Very Good A joint inspection of Adult Support and Protection was published in February 2024. The joint inspection took place between September and December 2023, scrutinising the records of adults at risk of harm for the preceding two-year period, September 2021 to September 2023. While no gradings were given, the report does provide Priority areas for Improvement. Two priorities for improvement were noted, they are: • Access to independent advocacy was limited. The partnership aimed to address this through their refreshed advocacy strategy. This should be a priority area for improvement. • Police Scotland inconsistently applied policy and practice across several areas, which when combined weakened the operational effectiveness of the partnership’s adult support and protection activity. These require to be promptly addressed to ensure parity of service levels across the partnership. Gradings for the 6 further inspections the Partnership also received can be found below. Inspection reports can be found on the Care Inspectorate website - Inspection Reports. 276
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51 Inspection Date Service/Unit Wellbeing Leadership Staffing Environment Care & Support 19 - June - 23 Montrose House 3 3 3 4 3 18 - August - 23 The Meadows Children’s House 2 0 0 0 0 29- September - 23 Abbeycroft Children’s House 5 0 0 0 0 03 - November - 23 Irvine, Garnock Valley & Community Alarm 5 5 4 0 4 27 - February - 24 Canmore Children’s House 2 0 0 0 0 13 - March - 24 Trindlemoss House 4 4 0 0 0 The Care Inspectorate use a six-point scale to grade inspections: 1 Unsatisfactory Major weaknesses – urgent remedial action required 2 Weak Important weaknesses – priority action required 3 Adequate Strengths just outweigh weaknesses 4 Good Important strengths, with some areas for improvement 5 Very Good Major strengths 6 Excellent Outstanding or sector leading 277
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Integration Joint Board 22 August 2024 Subject : North Ayrshire – Being Trauma Informed and Responsive Purpose : To update Integration Joint Board on the ongoing work to develop our approach and response to trauma. Recommendation : IJB are asked to endorse the progress being made to strengthen our trauma informed approach in North Ayrshire. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership COSLA Convention of Scottish Local Authorities NES NHS Education for Scotland CSSP Children’s Strategic Services Planning Group CPP Community Planning Partnership ACE’s Adverse Childhood Events STILT Scottish Trauma Informed Leaders Training 1. EXECUTIVE SUMMARY 1.1 This paper provides IJB with an overview of current activity in relation to the trauma informed agenda. Following a report presented to North Ayrshire Council in June 2019, the Council agreed a motion on 1st November 2023 to receive updates on progress on how the Council, HSCP and wider CPP partners were progressing the ambition to reduce childhood abuse and trauma in local communities and embed a trauma-informed approach across services. 1.2 This paper describes specific pieces of work that are currently being progressed and it will also detail the short medium and long-term plans to further build on the Trauma Informed approach across council services. 278
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1.3 A trauma informed and responsive organisation should have in place systems and practices where the impact of trauma is understood by staff, where policies, processes and service design have a trauma responsive approach embedded within them and ways of working are adapted accordingly for both staff and the communities that they serve. 2. BACKGROUND 2.1 The Scottish Government defines trauma-informed practice as a way of working with people that recognises the impact traumatic experiences may have had on them and aims to avoid causing further trauma. This approach is based on five core principles: 1. Safety: Helping people feel physically and emotionally safe. 2. Choice: Giving people meaningful choices and a voice in decisions that affect them. 3. Collaboration: Involving people in considering how their needs can be met. 4. Trust: Being clear so that people know what to expect and doing what you say you will. 5. Empowerment: Validating people’s feelings and supporting them to make decisions. This practice is designed to support recovery, do no harm and recognise and support people’s resilience. 2.2 The Scottish Government and COSLA have a shared ambition for a trauma-informed workforce across Scotland, which can help support children, young people and adults affected by psychological trauma by reducing barriers to accessing general services, preventing any further harm and supporting recovery. 2.3 To enhance the delivery of training and support on offer from NHS Education for Scotland (NES), and through the allocation of funding to local authorities from the Scottish Government the HSCP in North Ayrshire have employed a designated Trauma Informed Practice Adviser (for 3 years) who commenced in post in Spring 2024. 2.4 Various papers and professional contributions to Council and IJB over the last two years have made reference to ethical stress. Another key issue often referred to is the issue of long term staff absence and observations on workforce sufficiency. Both these issues have vicarious trauma as a significant contributory factor. 279
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2.5 Vicarious trauma is the emotional residue of exposure to traumatic stories and experiences of others through work; witnessing fear, pain, and terror that others have experienced on a daily basis. This can manifest in a number of ways but critically includes practitioners becoming overly involved emotionally, experiencing bystander guilt, shame, feelings of self-doubt and being preoccupied with thoughts of clients outside of the work situation. The CSSP has allocated funding from the Whole Family Wellbeing Fund to commission a support service providing vicarious trauma support and specialist counselling for staff, this is available for any staff within Children and Families services, Education and Communities teams with consideration of the third sector and wider CPP partners. 2.6 The further development of our trauma sensitive approaches to practice will aim to not only support the practitioner / client relationship but also support the practitioner / organisation relationship. 2.7 The trauma informed practice advisor will work alongside committee teams including the Child Protection and Adult Support and Protection committees to ensure that the Trauma Principles, use of language are threaded throughout everyday practice. In particular this will support ongoing practice themes including work around “The Promise” and “Signs of Safety” in children’s services and in our approaches to supporting those who are experiencing critical mental health issues. 2.8 We know from research that living through a traumatic event is more common than previously realised. Preventing and effectively responding to trauma and adverse childhood experiences (ACEs) is essential for Scotland’s National Performance Framework’s ambition of increasing wellbeing, creating opportunities to flourish and improving outcomes for people and communities. 2.9 A Roadmap for Creating Trauma Informed and Responsive Change was published by the National Trauma Transformation Programme along with COSLA and Scottish Government in August 2023. The purpose of this roadmap is to highlight the different components of a trauma informed and responsive approach and what this looks like within an organisation. 2.10 A trauma informed and responsive organisation should have in place systems and practices where the impact of trauma is understood by staff, where policies, processes and service design have a trauma responsive approach embedded within them and ways of working are adapted accordingly for both staff and the communities that they serve. 280
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2.11 Being trauma informed is also woven into the Psychological Therapies and Interventions National Specification published in September 2023 and is endorsed, or core, among a growing number of policies and standards which sit across health and social care, for example as part of the Medication Assisted Treatment Standards for supporting people with addictions. The Director of Psychological Services for NHS Ayrshire and Arran, and as part of the North Ayrshire HSCP, is further developing the approach in NHS Ayrshire and Arran and for the HSCP to further strengthen trauma informed practice, by bringing together capacity and learning from across Ayrshire and Arran. 3. PROPOSALS 3.1 Short Term (First Year) It is proposed in the short term that the focus will be around the delivery of Trauma Informed training across the Council and the HSCP commencing in Autumn 2024. This will be centred around different levels of training which will be aimed at the appropriate roles of staff members within the council and HSCP. The training will include:- • Level 1 Trauma Informed Awareness, this will be Mandatory and available through the I-Learn platform • Level 2 Trauma Skills • Level 3 Trauma Skills (Enhanced) • Psychological First Aid It is anticipated that all staff council wide will undertake Level 1 Awareness training as a minimum requirement, and this will be refreshed annually. It is anticipated that with the introduction of Level 1 Trauma Awareness Training which will be mandatory training council wide we will be able to introduce the principles of trauma informed and responsive practice to the NAC workforce with the requirement staff members annually refresh their knowledge in this area. It is also estimated that an additional 1,000 HSCP staff members also access Level 2 Trauma Skilled Training within the first year of training implementation. Additionally in the short term the Trauma Informed Practice Advisor will develop and deliver sessions to HSCP staff around specific areas of practice including children and young people, dementia care and mental health. Following the offer of a variety training there will be the opportunity for staff members to complete the Professional Development Award in Approaches to Trauma Informed Practice and ongoing reflective activities and discussions which will enhance the practice of staff members including Newly Qualified Social Workers. 281
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3.2 Medium Term (Second Year) Whilst the suite of training opportunities will continue to be delivered on an ongoing basis it is envisaged that in the NAHSCP that a network of Trauma Champions is established to promote and guide work on trauma within services. Create greater opportunities for power sharing with people who have lived experience of trauma. Improve and embed feedback loops for effective continuous improvement. Our commitment to Trauma Informed Leadership will also include that all managers attend STILT training (Scottish Trauma Informed Leaders Training) ensuring a strategic approach to embedding the trauma approach. 3.3 Long Term (Third Year) The long-term approach will include taking a trauma informed lens to policies, processes and service design and delivery whilst taking cognisance of other existing and emerging themes. This will include the use of language and an awareness around environments for those who are accessing services. Create staff lived experience working groups to look at service improvement and to work with HR colleagues to develop individual staff wellbeing plans and how these can be formalised as part of all contracts and supervision. In September 2023 the NAHSCP launched a five-year Learning and Development Strategy (Social Work & Social Care) “Be The Best You Can Be” which encompassed the offer to the workforce around the theme of Trauma Informed Practice. The revised version of the strategy to be issued in the Autumn will outline the short, medium and long term training and development plans in detail. 3.4 Anticipated Outcomes With the training on offer it is more likely that staff will become more competent and confident to report an increased understanding of the prevalence and impact of trauma on themselves and the people and communities that they serve. A trained competent trauma informed workforce is also more likely to report feeling confident, supported and empowered to translate knowledge and skills into practice changes whilst leaders at all levels are more likely to understand, drive and inspire a trauma-informed approach across their sphere of influence. Staff are more likely to report that their wellbeing is valued and prioritised and that they have time and space to access relevant proactive and reactive development opportunities in line with NAHSCP Learning and Development Strategy 2023/28. 282
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With the delivery of a short, medium and long-term plan which will seek to embed a trauma informed responsive practice this means people with lived experience of trauma are more likely to experience services and systems that consistently offer choice, trust, safety, collaboration and empowerment. People with lived experience of trauma are more likely to report that services and systems proactively welcome feedback about their experiences to support continuous improvement and people with lived experience of trauma are more likely to report having positive experiences of engaging with services and systems. Services and systems will also be created and delivered with an understanding of trauma as an essential element of their design. 3.5 Measuring Impact Building on the approach to be being a trauma informed and responsive organisation will be reflected in the workforce demonstrating an embedded approach towards working with people who have or may be affected by trauma. This will be measured by evaluating knowledge at the post training stage. This will be continued by supporting HSCP services with the guidance from The National Improvement Service to implement suggested evaluation tools which will create feedback loops. This includes the “Taking a Trauma Informed Lens Walk Through” which will inform how Trauma Informed Practice is being implemented and received. 4. IMPLICATIONS 4.1 Financial Funding has been provided by the Scottish Government to support the employment of a dedicated post. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk None. 4.6 Community Wealth Building None. 4.7 Key Priorities The development of trauma informed practice delivers against the HSCP strategic plan. There is increased focus and recognition of the impact of trauma on our communities with this recognised more and more within national and local strategies, policies and initiatives. 283
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5. CONSULTATION The development of the approach described has been developed in partnership with front line services Caroline Cameron, Director For further information please contact Lesley Higgins, Service Manager Practice Standards , on 07931 815 204 284
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1 of 3 Paper # NHS Ayrshire & Arran Meeting: Ayrshire and Arran NHS Board Meeting date: Monday 12 August 2024 Title: Whistleblowing Annual Report 2023-2024 Responsible Director: Jennifer Wilson, Nurse Director Report Author: Karen Callaghan, Corporate Governance Coordinator 1. Purpose This is presented to the NHS Board for: • Discussion This paper relates to: • Scottish Government policy This aligns to the following NHSScotland quality ambition(s): • Safe • Effective • Person Centred 2. Report summary 2.1 Situation The NHS Board is asked to receive and discuss this report on organisational activity in relation to whistleblowing for 2023-2024. 2.2 Background Each NHS Board is required to provide an annual report to provide assurance that the Board has discharged its role as set out in The National Whistleblowing Standards. Once approved by the NHS Board, the report is submitted to the Independent National Whistleblowing Officer (INWO). 2.3 Assessment The report summarises and builds on the quarterly reports produced by the board, including performance against the requirements of the Standards, Key Performance Indicators (KPIs), the issues that have been raised and the actions that have been or will be taken to improve services as a result of concerns. The report provides a 285
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2 of 3 range of information to provide assurance to Governance Committee and Board members on our implementation and compliance with the Standards. Key Messages • An ‘At a glance’ infographic provides a summary of key findings for 2023/24 at the beginning of the report. • Several areas of improvement identified and implemented following whistleblowing investigations. • A short anonymous survey was used to provide a snap shot of staff awareness on how to raise concerns. The outcome being that 70% of staff are confident on how to do so. • To date 66% of managers have accessed and completed the Turas Learn modules. • Following a benchmarking exercise against other territorial Boards 2022/23 annual reports, it is reassuring to note the number of stage 1 and 2 concerns received by Boards of a comparable size to NHS Ayrshire & Arran are low, this provided assurance the NHS Ayrshire and Arran are not an outlier. • Speak Up Week afforded the opportunity to further promote the whistleblowing process, the new Confidential Contacts, Speak Up Advocates and the training available. • Our plans for 2024-2025 and exploring new ways to gain feedback and improve communication across all staff groups. 2.3.1 Quality/patient care An open and transparent whistleblowing process ensures good-quality outcomes for cases raised through a thorough but proportionate investigation. The approach to handling whistleblowing concerns ensures that learning and improvement is progressed for upheld whistleblowing concerns and are shared across all relevant services. 2.3.2 Workforce The Standards support our ambition for an open and honest organisational culture where staff have the confidence to speak up and all voices are heard. This is focused through our organisational Values of ‘Caring, Safe and Respectful’ and promoting a culture of psychological safety. 2.3.3 Financial There are no financial implications as a result of this annual report. 2.3.4 Risk assessment/management Failure to have in place an open and honest whistleblowing process that delivers the requirements of The National Whistleblowing Standards could have an impact as valid concerns about quality, safety or malpractice may not be raised. The opportunity to investigate and address these concerns will have been lost, with potentially adverse impact on quality, safety and effectiveness of services in NHS Ayrshire & Arran. There is also a wider risk to organisational integrity and reputation if staff do not believe they will be listened to and do not feel senior leaders in NHS Ayrshire & Arran are fulfilling the organisation’s Values of ‘Caring, Safe and Respectful’ and promoting a culture of Psychological Safety. 2.3.5 Equality and diversity, including health inequalities 286
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3 of 3 This is an annual report on organisational activity in relation to whistleblowing and an impact assessment is not required for the report. A local Equality Impact Assessment (EQIA) which assesses the impact of the Standards on staff and those who provide services is available on our public facing webpage. 2.3.6 Other impacts This will support the requirements of the National Whistleblowing Standards. • Best value: Governance and accountability and Performance management. The delivery of an effective process for whistleblowing concerns will support the Board’s commitment to safe, effective and person-centred care. Effective handling of concerns supports the delivery of the Healthcare Quality Strategy . • Compliance with Corporate Objectives - Create compassionate partnerships between patients, their families and those delivering health and care services which respect individual needs and values; and result in the people using our services having a positive experience of care to get the outcome they expect. 2.3.7 Communication, involvement, engagement and consultation There is no requirement for formal engagement with external stakeholders to produce this annual report. 2.3.8 Route to the meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • Whistleblowing Oversight Group on 11 July 2024 • Staff Governance Committee on 01 August 2024. 2.4 Recommendation For discussion. NHS Board Members are asked to discuss this Annual Report on organisational activity in relation to whistleblowing complaints April 2023 – March 2024 and confirm they are assured by the performance reported and future plans to review and improve our processes in accordance with the Standards. 3. List of appendices Appendix 1 – NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024. 287
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Appendix 01 Whistleblowing Annual Report 2023-2024 Author: Karen Callaghan Corporate Governance & Whistleblowing Coordinator Updated 03/07/2024 288
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 2 of 20 Contents Introduction .......................................................................................................................... 3 1. Background ............................................................................................................... 4 2. At a glance ................................................................................................................ 5 3. Learning, changes or improvements to service or procedures (KPI-1) ...................... 6 4. Experience of individuals raising concern/s (KPI-2) .................................................. 7 5. Level of staff perception and awareness and training (KPI-3) ................................... 7 6. Whistleblowing concerns received (KPI-4) ................................................................ 9 7. Concerns closed (KPI-5) ......................................................................................... 11 8. Concerns outcomes (KPI-6) .................................................................................... 12 9. Average Response times (KPI-7) ............................................................................ 13 10. Timescales (KPI-8, 9 and 10) .................................................................................. 14 11. Whistleblowing themes, trends and patterns ........................................................... 15 12. Concerns raised by Service .................................................................................... 16 13. Primary Care and contracted services ...................................................................... 16 14. Anonymous Concerns ............................................................................................. 17 15. Independent National Whistleblowing Officer .......................................................... 17 16. Whistleblowing and Speaking Up ............................................................................ 18 17. Our plans for 2024/2025 ......................................................................................... 18 18. Conclusion .............................................................................................................. 19 289
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 3 of 20 Introduction This is the third NHS Ayrshire & Arran annual report which has been produced in line with the National Whistleblowing Standards (the Standards). It has been another interesting and busy year as we continue to learn from each concern that is raised and taken forward to investigation. Since the go-live date of the Standards on 1 April 2021, an agreed process has been in place in NHS Ayrshire & Arran (NHSAA) to gather Whistleblowing information raised across all NHS Services to which the Standards apply. Within NHSAA, anyone who provides a service for NHSAA can raise a concern about the delivery of a health service using the same reporting mechanism which is in place for those staff employed by NHSAA. This includes former employees, agency workers (and others on short or insecure contracts such as locums and bank staff), contractors (including third-sector service providers), trainees and students, volunteers, non-executive directors, and anyone working alongside NHS staff, such as our colleagues in health and social care partnerships. Whistleblowing is an ethical and moral thing to do, and NHSAA is supportive of any member of staff who raise concerns through this process. The decision to whistleblow is rarely taken lightly, and we in NHSAA are committed to offering a compassionate and objective whistleblowing service. Whistleblowing is an important form of feedback and provides the opportunity to receive direct and candid accounts of staff concerns. This in turn offers a key opportunity to learn and strive for improvement. Whistleblowing can also help the organisation in identifying risks and mitigating against any risks identified. We recognise that whilst risks can be to the service users, they can also be to the service providers/the organisation itself. This annual report provides details of whistleblowing concerns raised across the organisation by staff and those who provide services on behalf of NHSAA. This will demonstrate our performance in the key performance indicators as required by the INWO and includes key areas of whistleblowing handling, as well as highlighting outcomes and providing more detail on whistleblowing themes. Over time, this approach will illustrate trends and more importantly, allow us to evidence necessary improvement and learning in response to the trends and themes demonstrated. Jennifer Wilson, Nurse Director Executive Lead for Whistleblowing 290
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 4 of 20 1. Background All NHS organisations and providers in Scotland are required to follow the National Whistleblowing Principles and Standards. The Principles and Standards explain what is expected of NHS organisations and contractors about their handling of whistleblowing concerns. The National Whistleblowing Standards set out how the Independent National Whistleblowing Officer (INWO) expects all NHS service providers to handle concerns that are raised with them and which meet the definition of a ‘whistleblowing concern’. As part of the ‘Once for Scotland’ Workforce Policies Programme, the Whistleblowing Policy directs NHS Scotland Boards to The Whistleblowing Standards (The Standards). Under The Standards all NHS Scotland Boards are required to publish their Annual Whistleblowing Report, which must also be shared with the INWO. In order to deliver successful implementation of the Standards across the organisation and our partners, our Nurse Director, as Executive Lead, initially formed a Whistleblowing Steering Group (WBSG) to develop an implementation programme. This group included appropriate Directors, the Board’s Non-Executive Whistleblowing Champion, the Employee Director and Area Clinical Forum Chair to ensure wide representation. As the work progressed this group developed into the Whistleblowing Oversight Group supported by an Implementation Group to deliver the detailed implementation programme. This implementation group involved sector leads, Nurse Director and Corporate Governance team representatives. NHS Ayrshire & Arran successfully implemented The Standards, with the majority of actions completed by the publication date of 1 April 2021, signed off as complete at the end of June 2021. The Implementation Plan included a detailed Communication and Training plan to support the roll out of The Standards across the organisation. As part of this implementation NHS Ayrshire & Arran developed the current Speak Up model of Confidential Contacts and Speak Up Advocates. This includes a dedicated Speak Up Helpline telephone number and dedicated email contact. Access to the helpline and mailbox is limited to ensure that confidentiality is maintained for those who require assistance or wish to raise a concern. Following implementation it was agreed to retain the Whistleblowing Oversight Group (WBOG), when the implementation team stood down. The WBOG continue to meet quarterly to provide oversight of our processes and systems and to ensure compliance with The Standards is maintained, recognising that this is a learning process. The WBOG includes the Executive Lead for Whistleblowing and our Whistleblowing Champion, the Employee Director and representation from HR and Corporate Governance. Required quarterly and annual performance reports are provided to our Staff Governance Committee and NHS Board meetings to provide assurance that the organisation is delivering the requirements of the Standards. 291
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 5 of 20 2. At a glance 292
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 6 of 20 3. Learning, changes or improvements to service or procedures (KPI-1) 3.1 NHS Ayrshire & Arran is committed to learning and improving from whistleblowing complaints. For each complaint that is upheld or partially upheld a documented improvement plan is put in place to address any learning. The improvement plan is agreed by the Director responsible for commissioning the investigation under the standards with progress monitored through the appropriate governance route. We recognise that system-wide learning, changes or improvements to services can be limited by the need to maintain confidentiality of individual whistleblowers. Although the concern received in 2023/24 was not upheld learning actions were identified and an improvement plan was put in place to address the actions. Table 1 below shows the numbers and status of improvement and learning plans from 2021 - 2024. Year Number of Improvement Plans Number of Learning Plans In Progress Closed In Progress Closed 2021-2022 - 4 - 1 2022-2023 2 1 - - 2023-2024 1 - - - Table 1 It is worth noting that two of the improvement/action plans from 2022/23 remain open. Progress continues to be monitored through Directorate Governance routes until such times as the Investigation Commissioner is satisfied that all actions have either been completed or have moved into a business as usual process. Feedback on closure is provided to the Whistleblowing Oversight Group. 3.2 Identified Improvements To date recommendations from investigations closed in 2023/24 have resulted in: Improvement to local staff induction and training support Work place environments i.e. increased work space and introduction of agile working. Review of departmental annual leave processes Implementation of departmental annual audit programme Record keeping with improved use and access to digital systems Improved communication within teams Departmental training programme for managers Protected learning time for staff Review of departmental risk assessments Culture work to improve work place environment 293
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 7 of 20 Review of staff skill mix Review of staff workload Introduction of Wellbeing sessions for staff Improved staff knowledge on use of HR policies to support staff 3.3 System Wide Learning Ensure Lead Investigators have the capacity to undertake and complete investigations in a timely manner. Ensure Lead Investigators are aware of their responsibility to inform the Corporate Governance Coordinator of any leave planned or otherwise that will impact on the progress of the investigation. Consideration to be given to buddying experienced Lead Investigators with less experienced. Consideration to be given to the content of the stage 2 outcome letter with regard the level of explanation and information provided. Responses to include information on how the investigation was undertaken, the outcome, recommendations and explanation when concerns are not upheld. 4. Experience of individuals raising concern/s (KPI-2) All those who raise concerns are given the opportunity to provide feedback, through an anonymous survey, on their experience of using the Whistleblowing procedure in order that we can learn and make any improvements in our processes as appropriate. As at the 31 March 2024 no feedback has been received from those involved in the process where the investigations were closed during 2023/24. Feedback will be gathered from all those involved in the whistleblowing process. This will aid the improvement of the process and identify areas of improvement and learning. 5. Level of staff perception and awareness and training (KPI-3) 5.1 Staff perception and awareness NHS Ayrshire & Arran have continued to raise awareness of the Standards with staff in 2023/24. It is difficult to quantify staff perceptions, however there has been a wide- ranging communication exercise across the organisation. This has included: 5.2 Speak Up Week - October 2023: Speak Up Week provided an opportunity to engage staff about the benefits of speaking up and the difference it can make within the NHS in Scotland. It was also an opportunity to raise awareness about local arrangements for speaking up and to promote the role of our Confidential Contacts and Speak Up Advocates. The overall theme being the benefits of speaking up. 294
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 8 of 20 Information on Speak Up Week was disseminated to staff prior to the event as a Stop Press communication which was included in the eNews and Daily Digest. It was also emailed directly to all managers and staff. The Stop Press included details of where staff could access information online and in person at six location across the organisation, this included Acute and Health and Social Care Partnership sites. Approximately 150 staff visited the face to face sessions which were supported by the Confidential Contacts, Speak Up Advocates and Whistleblowing Champion. Staff were provided information on how to raise a concern and who they could speak with. Information shared included information about the new Confidential Contacts, the Speak Up Advocates and the Whistleblowing process. The response from staff in relation to raising concern was generally positive and staff welcomed the information about Confidential Contact and the Speak Up Advocates and were reassured that any contact would be confidential. An Ask me Anything Session was held on MS Team, led by Jennifer Wilson, Nurse Director and Whistleblowing Lead who was supported by Sukhomoy Das, Board Non-Executive Whistleblowing Champion and Ewing Hope, Employee Director. The session went well and those who attended were engaged in the conservation and asked appropriate questions. The Confidential Contacts and Speak Up Advocates highlighted the importance of Speaking up to their colleagues within their department. A short anonymous survey was used to provide a snap shot of staff awareness on how to raise concerns. The outcome being that 70% of staff are confident on how to do so. This is an increase of 13% on the previous year as shown in chart 1. Chart 1 5.3 Other methods: Communications via Daily Digest and e-News promoting raising concerns in NHS Ayrshire & Arran and guidance on how to raise a concern. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Strongly Agree Agree Slightly Agree Slightly Disagree Disagree Strongly Disagree Chart 1: Question-I know how to raise concerns with NHS AA 2022 2023 295
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 9 of 20 Raising awareness by attending team meetings, development session and recruitment events. Internal and external web pages for Whistleblowing are available and updated. Internally on the organisation’s Athena intranet with a one-click access button enabling easy access for users and a Whistleblowing web page on the NHSAA external website. The pages provide a wide range of information on the requirements of The Standards including guidance for users. The external page ensures access for all those who can raise a concern through the Standards. A Sway communication was shared across the organisation via Daily Digest, eNews and by email to the 800+ line managers, to introduce and raise awareness of the new Confidential Contacts. 5.4 Training Training is available through NES Turas Learn for anyone who provides services on behalf of the NHS in Scotland, including students, contractors and volunteers. This provides learning on the National Whistleblowing Standards and the role of the Independent National Whistleblowing Officer (INWO). We will continue to monitor uptake, effectiveness and appropriateness of training and will review and refine, as required. Through our communications on whistleblowing and how staff can raise concerns in general, we continue to promote the TURAS learning modules. To date 66% of managers have accessed and completed the Turas Learn modules. A further 25% of managers have accessed but not yet completed. The organisation is continuing to encourage users to complete the appropriate modules through regular communications. Line Managers are required to complete the appropriate modules as mandatory learning. This will continue to be developed and communicated through our Organisation and Human Resource Development team including through leadership programmes. The Corporate Induction programme for new staff joining the organisation contains a dedicated section on whistleblowing and raising concerns as does the Manager Development Support programme. All planned Organisational Development sessions focus on culture and are designed to promote our desired culture of openness and psychological safety which includes reference to the Whistleblowing standards. 6. Whistleblowing concerns received (KPI-4) 6.1 Total concerns received 2021 – 2024 Chart 2 below demonstrates the total number of concerns raised since the implementation of the National Whistleblowing Standards in 2021. In total 29 concerns have been received through the Whistleblowing route. This is an increase in numbers when compared with numbers of whistleblowing concerns raised prior to publication of The Standards. This may be reflective of the work which has been undertaken to promote The Standards with staff feeling more confident in both the process of raising concerns and the support provided by the Standards and the INWO. 296
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 10 of 20 Chart 2 6.2 Concerns 2023/2024 Chart 3 below, shows the breakdown of concerns received in 2023-24. As of the 31 March 2024, NHS Ayrshire & Arran had received a total of 15 concerns, 14 were not appropriate for the whistleblowing process. Feedback was provided to those whose concerns were not taken forward as whistleblowing. They were directed to the most appropriate route and/or policy under which to pursue their concerns supported by the Confidential Contacts as appropriate. These were managed through the Boards HR policies, Fraud Liaison team and Health & Social Care Partnership for progress. The one concern appropriate for whistleblowing was taken forward for full investigation at Stage 2 of the process. Chart 3 6.3 Benchmarking As the number of Whistleblowing concerns received in NHS Ayrshire & Arran remain low we carried out a benchmarking exercise against other territorial Boards’ annual reports 8 6 15 0 5 10 15 2021/22 2022/23 2023/24 Chart 2: Total Concerns raised as Whistleblowing April 2021-March 2024 0 1 2 3 4 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Chart 3: Breakdown of concerns received as Whistleblowing 2023-24 Investigated WB Not Appropriate 297
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 11 of 20 for 2022-2023 to review how we compared. Chart 4 below shows the number of concerns reviewed as whistleblowing at stage 1 and stage 2. It is reassuring to note the number of stage 1 & stage 2 concerns received by Boards of a comparable size to NHS Ayrshire & Arran are low, this provides assurance that NHS Ayrshire & Arran is not an outlier. Chart 4 7. Concerns closed (KPI-5) 7.1 Concerns closed at Stage 1 and Stage 2 Table 1 7.2 Stage 1: as at 31 March 2023, no stage 1 concerns has been received. This is similar to last year and although the reason for this is not fully understood this may indicate that concerns are being dealt with under business as usual processes or that they are more complex and require to be raised directly under the stage 2 process. 7.3 Stage 2: as at the 31 March 2024, one stage 2 concern has been received and closed. 0 5 10 15 20 Chart 4: Territorial Boards Stage 1 & 2 2022/23 Stage 1 Stage 2 298
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 12 of 20 8. Concerns outcomes (KPI-6) This section provides detail on concerns upheld, partially upheld and not upheld at each stage of the whistleblowing procedures. 8.1 Concern outcomes 2023/2024: Table 2 details the outcome of the concern closed as at the 31 March 2024, all concerns are closed. Total Number Concerns 2023/24 Not Upheld Partially Upheld Fully Upheld Total Stage 1 - - - - - - - - Stage 2 1 1 100% - - - - 1 Table 2 8.2 Concern outcomes 2022/23: the three concerns which were ongoing and being investigated at 31 March 2023 were subsequently closed at stage 2 in 2023/24. All three concerns were recorded as being partially upheld. This means that following investigation and review of evidence some of the concerns raised in these whistleblowing case were upheld and some were not. 8.3 Concern outcomes 2021- 2024: Chart 5 shows the outcome of all concerns investigated through the Whistleblowing process from 1 April 2021 to 31 March 2024. Chart 5 0 1 2 3 4 5 6 Not Upheld Partially Upheld Fully Upheld Chart 5: Concern Outcome 2021 - 2024 2021/22 2022/23 2023/24 299
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 13 of 20 9. Average Response times (KPI-7) 9.1 Stage 1: as at 31 March 2024, no stage 1 concerns received. 9.2 Stage 2: as at 31 March 2024, one concern investigated and closed at stage 2 of the process. As shown in Table 3 the investigation period from receipt to closure was 183 days, this was due to the complex nature of the case. Average response time in working days Stage 1 (5 days) Q1 Q2 Q3 Q4 Average time in working days for responses - - - - No of cases closed at stage 1 within timescale as % - - - - No of stage 1 cases extended - - - - Stage 2 (20 days) Q1 Q2 Q3 Q4 Average time in working days for responses - 183 - - No of cases closed at stage 2 within timescale as % - 0% - - No of stage 2 cases extended - 1 (100%) - - Table 3 9.3 Chart 6 shows the average days to a full response for stage 2 concerns for 2023/24 compared to previous years. Due to the complexity and the low number of concerns the average days to response remains high. It is worth noting two of investigations undertaken in 2022/23 were impacted by the unexpected absence of the investigators. Chart 6 0 50 100 150 200 250 2021/22 2022/23 2023/24 Chart 6: Average days to full response Stage 1 Stage 2 300
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 14 of 20 10. Timescales (KPI-8, 9 and 10) 10.1 Concerns closed within the set timescales: Table 4 shows the number and percentage of concerns at Stage 1 and Stage 2 closed within the set timescales of 5 and 20 working days. Table 4 The INWO expects that there will be a thorough investigation of stage 2 concerns, and as a result they recognise that the 20 working day timeline may not always be achieved, especially given the often complex nature of concerns and the requirement for support and confidentiality. The timescale is provided to ensure that organisations take prompt action, and that there is an ongoing focus on investigating and addressing the concern. NHS Ayrshire & Arran aims to respond to Stage 2 concerns within 20 working days but will ensure that the time needed for a thorough investigation is given with additional time requested to extend the investigation period as appropriate. 10.2 Extension to timescale: Table 5 below shows the number of concerns where an extension has been authorised at Stage 1 and Stage 2 in 2023/24. Concern Number received Extension Authorised As % of all concerns Stage 1 - - - Stage 2 1 1 100% Table 5 10.3 Chart 7 below shows the number of concerns where an extension has been authorised at stage 2 of the process in 2023/24 compared to previous years. 301
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 15 of 20 Chart 7 10.4 Due to the complexity of the stage 2 concerns received it is taking more than 20 working days to conclude investigations and for the outcome of the investigation to be communicated to the Whistleblower. The Whistleblower is kept fully informed throughout the whistleblowing investigation, this includes when there is a requirement to extend the time scale. Appendix 1 provides a summary Year End Report for 2023/24for KPI-4 to KPI-10. 11. Whistleblowing themes, trends and patterns Analysis of the concerns raised by key themes is provided below. Where possible comparisons have been made against the Whistleblowing cases received April 2021 to 31 March 2024. This information will aid identification of any improvement priorities, and to progress learning in a targeted manner. Theme 2021/22 2022/23 2023/24 Q1–Q4 Q1–Q4 Q1–Q4 Patient Care 4 2 1 Patient Safety 4 2 1 Poor Practice 3 2 0 Unsafe working conditions 0 1 1 Fraud 1 0 0 Changing or falsifying information about performance 0 1 0 Breaking legal obligations 0 1 0 Abusing Authority 0 1 0 Table 6 * more than one theme may be applicable to a single Whistleblowing concern 0 1 2 3 20 days > 20 days > 50 day > 100 days > 150 days > 200 days Chart 7: Stage 2 concerns closed on target 2021/22 2022/23 2023/22 302
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 16 of 20 12. Concerns raised by Service Chart 8 below shows the breakdown of concerns by service for 2023/24 and previous years. Chart 8 13. Primary Care and contracted services 13.1 Primary care contractors Primary Care contractors (GP practices, dental practices, optometry practices and community pharmacies) are also covered by the Standards. All practices and community pharmacies are aware of the National Whistleblowing Standards for the NHS in Scotland and the requirements for local policies and information on the reporting process. Primary care contractors are aware of how to access NHSAA Speak up Service for guidance through the process. Primary Care contractors have a dedicated confidential contact within NHSAA who will help with raising concerns. Each contractor group are required to report in line with the same key performance information as NHSAA. In instances where no concerns have been raised within wider primary care or other contracted services there is no need to provide a quarterly return to the Board, but annual reports must still be submitted, setting out the concerns that have been raised. There were no concerns recorded during 2023/24. Acute UHA Acute UHC EAHSCP NAHSCP SAHSCP 2021/22 0 2 0 2 2 2022/23 1 1 1 0 0 2023/24 1 0 0 0 0 0 1 2 3 Chart 8: Breakdown By Service 2021-2024 2021/22 2022/23 2023/24 303
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 17 of 20 Primary Care Contractor (PCC) Current PCC Cohort No of concerns received Stage 1 Stage 2 GP Practices 53 0 0 Dental Practices 64 0 0 Optometry Practices 49 0 0 Community Pharmacy 99 0 0 Table 7 13.2 Other Contracted Services The Procurement team have collated information from local suppliers, who are not contracted through the National Procurement Framework and this information has informed a Contract Register providing a list of all local contracts that the Board have in place. This will ensure a process for reporting Whistleblowing concerns in accordance with the requirements of The Standards. An update to National Procurement provisions was incorporated into NHS AA’s standard terms & conditions to ensure suppliers provide the protections contained within the Standards to their own employees. There were no concerns recorded during 2023/24. NHS National Procurement Services are responsible for those contracts covered by the National Procurement Framework. A National process is in place which supports the requirements of the Standards for reporting and recording. 14. Anonymous Concerns Concerns cannot be raised anonymously under the Standards, nor can they be considered by the INWO. However, good practice is to follow the whistleblowing principles and investigate the concern in line with the Standards, as far as practicable. NHS Ayrshire & Arran has decided that anonymous concerns will be recorded for management information purposes. The definition of an anonymous concern is ‘a concern which has been shared with the organisation in such a way that nobody knows who provided the information’. All anonymous concerns will be considered and investigated by the organisation as appropriate. In 2023/24 no anonymous concerns were received. 15. Independent National Whistleblowing Officer A clear indicator of the satisfaction of those who raise concerns can be derived from the number of concerns that are escalated to the Independent National Whistleblowing Officer (INWO). At the end of the third year we were advised that we had been referred to the INWO. A whistleblower complained to the INWO regarding the Stage 2 outcome response letter provided. The INWO were advised a feedback meeting was arranged with the whistleblower and the investigators and it was agreed that a follow up Stage 2 outcome letter with more detail to explain the outcome would be provided. The letter was also shared with the INWO at their request. 304
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 18 of 20 16. Whistleblowing and Speaking Up The NHS Ayrshire & Arran Speak Up model supports the organisations culture of psychological safety where all staff are encouraged to be confident to bring forward any concerns. The Speak Up model provides access to Confidential Contacts and a cohort of Speak Up Advocates who work alongside the Confidential Contacts to broaden access for those with concerns, ensuring that we can provide access to a contact and support for those raising concerns across the organisation at all levels. Following the review of the Board’s arrangements for Confidential Contacts the recruitment of new Confidential Contacts took place during the summer of 2023. There were four successful candidates who took up the role of Confidential Contact in August 2023. A Sway communication was shared across the organisation via Daily Digest, eNews and by email to the 800+ line managers, to introduce and raise awareness of the new Confidential Contacts. Of the concerns received during the reporting year these have been received via the Confidential Contacts, Speak Up Advocates, the SpeakUp mailbox or the Speak Up phone number. 17. Our plans for 2024/2025 • To continue to learn, review and identify improvements for change in our process. We will review feedback from users of the process, best practice from colleagues in other boards and the Independent National Whistleblowing Officer (INWO). • We will continue to link with the INWO to seek guidance. • We will continue to promote the Standards and how to raise concerns safely within the organisation and a systematised approach to sharing learning. • We will work with investigators and Directors, to review learning from the process and share as appropriate across the organisation. • We will continue to engage with our Confidential Contacts and Speak Up Advocates to address any barriers identified by staff about raising concerns. • We will provide communications on a quarterly basis using the mediums of Daily Digest and eNews and our 7-minute briefing format. • We will continue to develop and support our Confidential Contacts and Speak Up Advocates in their roles, for example, through local and national training and engagement, peer group meetings, links to our whistleblowing champion. • We will consider ways to gain feedback on awareness across the organisation. • We will consider alternative ways to communicate with staff in areas where access to computers is not routine. • We will consider ways in which learning or improvements as a result of a concern can be highlighted or shared further with staff. 305
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 19 of 20 • We will build on the experience of last year’s Speak Up Week by increasing the number of engagement sessions, taking the opportunity to raise awareness about local arrangements for speaking up and to promote the role of our Speak Up Advocates and Confidential Contacts. 18. Conclusion Speak Up Week afforded us the opportunity to further promote the whistleblowing process, the new Confidential Contacts, the Speak Up Advocates and the training available. The face to face sessions and the MS Teams Ask me Anything sessions were invaluable in linking with staff at all levels within the organisation, we plan to build on this success as we develop a programme for the next Speak Up week in October 2024. In line with the National Whistleblowing Standards, we reiterate our commitments to dealing responsibly, openly and professionally regarding any whistleblowing concern. Continuing to encourage all those involved to raise any concerns as early as possible. It is hoped that continued improvements in process, continued communications and using feedback from colleagues will enable NHSAA to develop its culture so that all those who might have a concern feel able to Speak Up freely without fear of any adverse impact against them. It is recognised, as noted in Our Plans above, that this is a continuous improvement process and the learning gained from the first year will inform improvements as we go forward. The organisations Whistleblowing Oversight Group (WBOG) will continue to meet to provide oversight of our processes and systems, recognising that this is a learning process and performance reports will continue to be provided to our Staff Governance Committee and Board meetings to provide assurance that the organisation is delivering the requirements of the Standards. 306
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NHS Ayrshire & Arran Whistleblowing Annual Report 2023-2024 20 of 20 Appendix 1 307
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1 of 5 Paper # NHS Ayrshire & Arran Meeting: Ayrshire and Arran NHS Board Meeting date: Monday 12 August 2024 Title: Whistleblowing Report – Quarter 1, April - 30 June 2024 Responsible Director: Jennifer Wilson, Nurse Director Report Author: Karen Callaghan, Corporate Governance Coordinator 1. Purpose This is presented to the NHS Board for: • Discussion This paper relates to: • Government policy/directive This aligns to the following NHSScotland quality ambition(s): • Safe • Effective • Person Centred 2. Report summary 2.1 Situation The National Whistleblowing Standards and Once for Scotland Whistleblowing policy (the Standards) were introduced on 1 April 2021. NHS Board Members are asked to discuss the report on organisational activity in relation to Whistleblowing concerns raised in 2024/25 Quarter 1 (April - 30 June 2024). 2.2 Background The National Whistleblowing Standards (the Standards) set out how the Independent National Whistleblowing Officer (INWO) expects all NHS Boards to manage, record and report whistleblowing concerns. It is a requirement of the Standards that whistleblowing data is reported quarterly to the NHS Board and under our local governance arrangements to NHS Board. The Standards also require that Boards publish an annual report setting out performance in handling whistleblowing concerns. The annual report summarises and builds on the quarterly reports produced by the board, including performance against the requirements of the Standards, Key Performance Indicators (KPIs), the issues that have been raised and the actions that have been or will be taken to improve services as a result of concerns. 308
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2 of 5 In NHS Ayrshire & Arran the agreed governance route for reporting on whistleblowing is to Staff Governance Committee and then to the NHS Board. The NHS Board report will be shared with Integration Joint Boards following the NHS Board meeting. 2.3 Assessment 2.3.1 In Quarter 1 (Q1) one concern received via the Speak Up Mailbox. The complainant wishes to remain anonymous. The concerns related to a Primary Care Contractor. The concern was acknowledged by email and provided information on raising concerns anonymously, the protection afforded by the Standards and how to contact the Confidential Contacts. Reassurance was also given that should they decide to remain anonymous the concerns will be highlighted to the Director responsible for Primary Care to be investigated. As the concern received in Q1 was not taken forward as Whistleblowing it is not possible to provide a detailed report, and therefore an update on recent whistleblowing activity to support the Standards is provided below. 2.3.2 Improvement plans: Table 1 reports the status of improvement plans from whistleblowing concerns raised in 2022-23 and 2023-24. One improvement plan was closed in Q1 with the approval of the Commissioning Director, the three remaining plans are in progress. Improvement plans are monitored through the relevant department’s governance group as agreed with the Commissioning Director, with feedback on closure to the Whistleblowing Oversight Group. Progress is monitored by the Corporate Governance Coordinator. Year Numbers of Improvement Plans Number of Learning Plans In Progress Closed In Progress Closed 2022-23 3 2 1 - - 2023-24 1 1 0 - - Table 1 2.3.3 Training update: Monthly reports continue to be produced to monitor completion of the Turas Whistleblowing eLearning modules. As at 30 June 2024, 43% of all staff had completed the Turas Whistleblowing e-Learning modules. Communication continues to be shared through Daily Digest and eNews that it is mandatory for line managers and leaders to complete the relevant Turas whistleblowing module. Total Complete Increase Total No of staff % staff completed 31/03/2024 30/06/2024 An overview (Staff) 3712 3929 217 10627 37% For Line Managers 179 199 20 980 66% For Senior Managers 443 446 3 Table 2 Monthly reports continue to be produced to monitor completion of the Turas Whistleblowing eLearning modules. 2.3.4 Communications: We continue to issue communications across the organisation to remind staff about whistleblowing, the Standards and how to raise a Whistleblowing concern. This is supported by our Communication Team through Daily Digest and 309
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3 of 5 eNews. We are working on the Annual Whistleblowing Newsletter which will be shared across the organisation. An offer has been extended to Directors for a member of our whistleblowing team to attend any upcoming directorate team meetings. The purpose of the session will be to provide an overview of the whistleblowing standards, to raise awareness among staff, with focus on any specific aspects of the process that may be of interest or concern. 2.3.5 Speak up week: Preparations are ongoing for this year Speak Up Week, which take place from 30 September – 4 October. This year’s theme is Enabling Speaking Up. To support the prep for the week a Short Life Working Group (SLWG) has been formed which includes representation from our confidential contacts, speak up advocates and colleagues from Communications and Engagement Teams. Our communication and engagement team colleagues will support the dissemination of information prior to and during Speak Up Week via the Daily Digest, eNews and Social Media. This will include the programme of communications and events planned by the INWO. As we continue to build on the success of previous years, we plan to visits various site, during the week, to engage with staff face to face, to increase the number of Ask Me Anything sessions held on teams and offer online learning session/s. As part of this year’s campaign Directors will be asked to sign up to the Speak Up Pledge. Hopefully directors will be able to come along and support the onsite visits during Speak Up Week. 2.3.6 INWO Stage 3 Learning and Improvement Reports: The INWO receives complaints from whistleblowers who are unhappy with how their whistleblowing concerns have been investigated and responded to in Boards. The INWO investigate each case independently and reports on the findings, outcomes and learnings. These reports are then shared with Boards via the INWO monthly Bulletin and published on the INWO website. Locally these reports are reviewed when published to benchmark our processes and to identify if there are areas where we can learn and improve our local practice to ensure best practice. Published INWO recommendations in Q1: INWO recommendations: Ensure that the investigation takes full account of the information being shared by the person who raised the concern. o In NHS AA investigators meet the complainant to discuss the concerns, ensuring the main concerns are understood and agreed prior to undertaking a whistleblowing investigation. Terms of Reference (ToR) are agreed by the complainant and investigator for all WB investigations. While we have a process in place, it is recognised this needs firmed up to ensure the ToR is in place and agreed with the complainant and returned to the Corporate Governance Coordinator. This is being done in the majority of cases. Ensure those involved in the whistleblowing process are provided information on how and where to access support. o At all stages of NHS AA Whistleblowing process information on accessing support, across the organisation, is provided verbally and in email and 310
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4 of 5 letter correspondence with those involved in the process. It is also provide to anyone who contacts the Speak Up mailbox seeking advice. No other recommendation were relevant to NHS AA. 2.3.7 Quality Procedures for raising concerns should provide good-quality outcomes through a thorough but proportionate investigation. The approach to handling whistleblowing concerns ensures that learning and improvement is progressed for upheld whistleblowing concerns and are shared across all relevant services. 2.3.8 Workforce The Standards support our ambition for an open and honest organisational culture where staff have the confidence to speak up and all voices are heard. This is focused through our organisational Values of ‘Caring, Safe and Respectful’ and promoting a culture of psychological safety. 2.3.9 Financial There is no financial impact. 2.3.10 Risk assessment/management If staff do not have confidence in the fairness of the procedures through which their concerns are raised, or do not feel assured that concerns raised will be acted upon, there is a risk that they will not raise valid concerns about quality, safety or malpractice. The opportunity to investigate and address these concerns will have been lost, with potentially adverse impact on quality, safety and effectiveness of services. There is also a wider risk to organisational integrity and reputation, if staff do not believe they will be listened to and do not feel senior leaders in NHS Ayrshire & Arran are fulfilling the organisation’s Values of ‘Caring, Safe and Respectful’ and promoting a culture of Psychological Safety. 2.3.11 Equality and diversity, including health inequalities A local Equality Impact Assessment (EQIA) for the Standards is in place and published on our public facing web. This assesses the impact of the Whistleblowing Standards on staff and those who provide services on behalf of the NHS with protected characteristics. 2.3.12 Other impacts • Best value: Governance and accountability and Performance management. The delivery of an effective process for whistleblowing concerns will support the Board’s commitment to safe, effective and person-centred care. Effective handling of concerns supports the delivery of the Healthcare Quality Strategy. • Compliance with Corporate Objectives - Create compassionate partnerships between patients, their families and those delivering health and care services which respect individual needs and values; and result in the people using our services having a positive experience of care to get the outcome they expect. 2.3.13 Communication, involvement, engagement and consultation There is no requirement for formal engagement with external stakeholders in relation to the formulation of this paper. There has been wide communication of the Standards across the organisation. 311
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5 of 5 2.3.14 Route to the meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • Whistleblowing Oversight Group on 11 July 2024 • Staff Governance Committee on 1 August 2024. 2.4 Recommendation The NHS Board Members are asked to discuss the paper for Quarter 1 (April – 30 June 2024). 312