North Ayrshire HSCP Clinical and Care Governance
North Ayrshire Council · 19 September 2024
Back to Integration Joint Board — 19 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Integration Joint Board 19th September 2024 Subject : North Ayrshire HSCP Clinical and Care Governance Annual Report 2023-24 Purpose : This report is presented to IJB Members for :- • Awareness Recommendation : IJB Members are asked to note the contents of the Annual Report 2023-24 Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required √ 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms CAMHS Child & Adolescent Mental Health Services CCGG Clinical Care Governance Group HSCP Health and Social Care Partnership IJB Integration Joint Board NHS AA NHS Ayrshire and Arran MWC Mental Welfare Commission NA North Ayrshire 1. EXECUTIVE SUMMARY 1.1 North Ayrshire HSCP continues to have robust clinical and care governance arrangements in place to provide high quality care and support for the people in North Ayrshire. 1.2 This paper provides an update and overview of governance activity for the period August 2023 – August 2024 inclusive for consideration by the Integrated Joint Board (IJB). The Annual Report is attached at Appendix 1. 2. BACKGROUND As part of the integration of health and social care services, a National Clinical and Care Governance Framework was developed. Clinical and Care Governance is the system in which the HSCP’s are accountable for continuously improving quality and safeguarding high standards of care. The Partnership has developed Clinical and Care Governance arrangements in line with the commitments and requirements contained in the Integration Scheme.
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2.1 The Clinical and Care Governance Group (CCGG) provide assurance to the IJB that: • Quality of care, effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services • The planning and delivery of services take full account of the perspective of patients and service users • Unacceptable clinical and care practice will be detected and addressed The Terms of Reference for the CCGG are included as Appendix 2 of this report. The CCGG has a standing agenda that ensures routine consideration of: • Public Protection • Professional Updates • Heads of Service updates • Adverse Events • Complaints/Enquiries • Inspection Reports/Action Plans/SPSO • Workforce • Consultation and Safety Action Notices • Infection Control and Infection The CCGG has also had specific updates and assurance reports on: • Implementation of the Safe Staffing Bill • Responding to Substance Use on Mental Health Inpatient Wards • Evaluation and review of Front Door Service • Prisoner Early release Programme • Brighter Pathways programme board • Unaccompanied asylum seeking children and trafficked young people 2.2 Mental Welfare Commission The Mental Welfare Commission (MWC) for Scotland’s mission and purpose is to be a leading and independent voice in promoting a society where people with mental illness, learning disabilities, dementia and related conditions are treated fairly, have their rights respected, and have appropriate support to live the life of their choice. To achieve this mission and purpose the Commission have identified four strategic priorities: • To challenge and to promote change • Focus on the most vulnerable • Increase their impact • Improve their efficiency and effectiveness
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Between April 2023 and March 2024 mental health services across Ayrshire and Arran received 10 visits from the MWC (9 announced visits and 1 unannounced visit). • The MWC made 22 recommendations following all visits and received responses to all recommendations within 3 months of the report being published. • An assurance report providing details of all visits, recommendations and action plans and thematic reports was developed by the North Ayrshire CCG and presented to the NHS Ayrshire and Arran Healthcare Governance Group in July 2024. • Action plans on response to the MWC on the recommendations were submitted back to the MWC within 3 months and are reviewed and monitored through the Mental Health Clinical and Care Governance framework. • The insights, recommendations and positive acknowledgement of the delivery of high quality care provided by the MWC review and visit process is seen as positive by our organisation. • Any improvements identified provide the clinical site, senior management and staff teams with a clear focus, helping to prioritise areas of work which in turn provides the assurance required to evidence the continued delivery of high quality care. • A report detailing the MWC visits recommendations was submitted to the Healthcare Governance Committee in August 2024. 2.3 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. 3. PROPOSALS 3.1 Anticipated Outcomes Further meeting dates for the NA HSCP’S CCGG are planned for 2024/25, and future update reports will be provided to the Integration Joint Board. 3.2 Measuring Impact It is anticipated that through continuous quality improvement and enhanced reporting structures, the CCGG will ensure services are safe, effective, person-centred and responsive to the ongoing needs of the population.
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4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk Governance contributes to risk management and risk mitigation activities. 4.6 Community Wealth Building None 4.7 Key Priorities As part of the integration of Health and social care services, a National Clinical and Care Governance Framework was developed. Clinical and Care Governance is the system in which the Health and Social Care Partnership are accountable for continuously improving quality and safeguarding high standards of care. 4.4 Equality/Socio-Economic None 5. CONSULTATION None Caroline Cameron, Director For further information please contact Darren Fullarton, Lead Nurse/Associate Nurse Director Appendix 1 – NAHSCP Clinical and Care Governance Annual Report 2023-24 Appendix 2 – Clinical and Care Governance Group Terms of Reference
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1 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Health and Care Governance Annual Assurance Report 2023-2024 1.0 Introduction As part of the integration of Health and Social Care services, a National Clinical and Care Governance Framework was developed. Clinical and Care Governance is the system in which the Health and Social Care Partnership are accountable for continuously improving quality and safeguarding high standards of care. The North Ayrshire Health and Social Care Partnership (HSCP) has developed Clinical and Care Governance arrangements in line with the commitments and requirements contained in the Integration Scheme. The role and function of the North Ayrshire Clinical and Care Governance Group (CCG) is built upon strong partnership and collaboration and North Ayrshire HSCP continue to provide robust arrangements for the clinical and care governance of partnership services and wider relevant provision to deliver on statutory, policy and professional requirements and the achievement of partnership quality ambitions. The Health and Care Governance Group is a standing group of the IJB. It is a requirement to submit a biannual report on the activity of the Clinical and Care Governance group within the Partnership to the IJB and an annual report to the Healthcare Governance Committee. The North Ayrshire Health and Social Care Partnership Annual Performance Report (2023-2024) and the Chief Social Work Officer Report 2023-2024 provide detail of how North Ayrshire HSCP 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 and Local measures . This paper contains an update on Clinical and Care Governance activity and should be read in conjunction with these reports. 2.0 Key Messages • The North Ayrshire HSCP continues to have robust clinical and care governance arrangements in place to provide high quality care and support for the people in North Ayrshire. • The partnership continues to face financial challenges in delivering and improving service within the available budget.
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2 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • The partnership continues to strengthen its approach to engaging with our local communities to ensure that the design and delivery of service is done in collaboration with those that use the service. • The partnership continues to support the health and wellbeing of its workforce. • The partnership has received positive feedback and learning from independent visits and inspection. 3.0 Clinical and Care Governance Group The North Ayrshire Clinical and Care Governance group has met on 5 occasions since August 2023 and the meeting was adjourned on 3 occasions as the group was not quorate. The next NA CCGG is scheduled for 11th September 2024. The CCGG has a standing agenda that ensures routine consideration of: • Public Protection • Professional Updates • Heads of Service updates • Adverse Events • Complaints/Enquiries • Inspection Reports/Action Plans/SPSO • Workforce • Consultation and Safety Action Notices • Infection Control and Infection The CCGG has also received specific updates and assurance reports on: • Implementation of the Safe Staffing Bill • Responding to Substance Use on Mental Health Inpatient Wards • Evaluation and review of Front Door Service • Prisoner Early release Programme • Brighter Pathways programme board • Unaccompanied asylum seeking children and trafficked young people
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3 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Engagement • A new method for carrying out local planning 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. • 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. Care Opinion 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. Over the last year, 43 stories were received for North Ayrshire on Care Opinion. This is an increase of 33 stories published since 22-23. Governance Framework North Ayrshire IJB NHS Healthcare Governance Committee Performance and Audit Committee North Ayrshire Clinical and Care Governance Group Social Work Governance Group Community Care Governance Group Children’s and Criminal Justice Governance Group Mental Health, Addiction and Learning Disabilities Clinical Governance and Development Group Local Service Governance Groups Local Service Governance Groups Local Service Governance Groups
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4 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together The partnership continues to promote Care Opinion across all services to encourage service users to feedback on the service they have received. It is hoped with more activity the Partnership can report on more detailed feedback and stories shared. Compliments Over the last year the Partnership have received 74 compliments, 50 of which were received for Health and Community Care. 13 compliments received for Children and Families and 8 for Mental Health & Learning Disabilities Service. Support Services received 3 over the course of the year, which includes 1 for Finance & Transformation and 2 for Business Support. Overall, there has been an increase of 34 compliments received from the previous year Complaints In total, 219 informal and formal (Stage 1 and 2) complaints were received over the year. This includes both NAC and NHS. This is a decrease of 16 complaints received from the previous year. For NHS, 13 out of 87 completed complaints (15%) were upheld or partially upheld, with the other 85% either not upheld, or resolved at stage 1 (informally).
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5 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Elected Member Enquiries For NAC, 364 Elected Member enquiries were completed over the period: an increase of 31 from last year. This figure also includes enquiries received via NHS route (40 over course of year). Q4 had the lowest percentage completed on time. During this period, it was noted there was a high number of complex enquiries received. Note, 79% were completed within a further 5 working days. Workforce • 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. • 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. • The partnership has provided assurance reports to the Healthcare Staffing Programme Board on how it is meeting the requirements of Health and Care (Staffing) (Scotland) Bill 2019. • The partnership is working with its workforce and with partners to take forward the Agenda for Change Pay reform: Reduced working week Protected Learning Time Band 5 nurse review
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6 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Quality Improvement • The Scottish Patient Safety Programme – Mental Health (SPSP MH) is a national initiative which launched in 2008 that aims to support and improve the safety and reliability of health and social care and reduce harm when care is delivered. • In April 2022, NHS Ayrshire and Arran (NHSAA) became part of the Healthcare Improvement Scotland (HIS) Collaborative Improvement Programme which concluded in August 2023 and focussed on the following: the implementation of the ‘From Observation to Intervention’ national guidance reducing the incidence of restraint, whilst improving this experience for staff and patients reducing episodes of seclusion, whilst improving this experience for staff and patients. • Whilst there is no requirement to submit data nationally for SPSP as the collaborative has now ended, there continues to be a focus on data and analysis and future reports will be provided using the existing data system, Business Objects. There is a monthly mental health data surveillance meeting to ensure wards experiencing signals in their data in relation to falls, falls with harm, violence and aggression, self-harm and restraint are highlighted and offered support where required. • Excellence in Care (EiC) is a national approach which aims to ensure people have confidence they will receive a consistent standard of high-quality of care no matter where they receive treatment in NHS Scotland. EiC programme ensures that all NHS boards have consistent, robust processes and systems for measuring, assuring, and reporting on the quality of care and practice. • EiC programme provides assurance of quality of care in accordance to the Health and Care (Staffing) (Scotland) Act 2019, through the application of the EIC Framework and assurance measures scrutiny. • Progress within EiC includes revision and testing of a bespoke MH Care Assurance tool, this tool has been devised by the MH Senior Nursing Team to provide assurance of high quality of care and is being tested prior to implementation. Falls Risk Assessment tool and care planning is under-review to ensure that clinical teams have reliable processes to identify and mitigate risk of falls. A proposal has been submitted both nationally and locally to undertake research to develop a mental health specific risk assessment tool. • NHS Ayrshire and Arran submit EiC assurance data on a monthly basis to Public Health Scotland. Nationally agreed measures are extracted and submitted from Business Objects, DATIX, QMPLE and SSTS.
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7 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • Measure submission percentage for all active measures has increased. However, national reporting of Stress and Distress Behavioural Assessment within SDU clinical areas has been unachievable due to capacity issues within Business Intelligence. • Monthly scrutiny of all EiC data compliance is undertaken to ensure concerns are escalated to Senior Charge Nurses and Clinical Nurse Managers. Quality Improvement Capacity • Within Mental Health Services there is a focus on increasing QI capacity and capability through a number of learning opportunities. • To date: 24 Mental Health staff have completed the Ayrshire and Arran Improvement Foundation Skills (AAIFS) 4 staff having completed a national qualification Scottish Improvement Leadership (ScIL). However, 2 have moved onto other roles. 1 member of staff is currently completing ScIL in alignment with EiC • The Quality Improvement and Innovation Group (QI and I) has also witnessed an increased attendance of staff to share their improvement ideas, feedback on tests of change and identify where QI support and education can be offered. • The introduction of this collaborative QI team (Partnership and Caring for Ayrshire) and Senior Nurse Model has helped to establish a streamlined, consistent and improved approach to the co-ordination and delivery of QI support across Mental Health Services with a view to achieving the desired increased capacity and capability. • The QI and I group are currently looking at whole service projects that can impact the patient journey experience. Risk and Risk Management • North Ayrshire HSCP AERG meets on a fortnightly basis and the MH AERG (Pan- Ayrshire AERG) meets on a weekly basis and are guided as per the NHS Ayrshire and Arran Adverse Event Policy. • Both Adverse Event Review Groups are committed to creating a culture that promotes the delivery of the highest possible standard of care to all patients/service users, with an open learning and improvement culture. The group has oversight, and manages, all escalated adverse events and complaints linked to adverse events that occur within the service. • The group ensures there is an effective and robust review of adverse events which identifies any contributory factors and/or root causes whilst taking cognisance of findings from previous adverse events to identify gaps and weaknesses in the agreed actions.
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8 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • An annual AERG Assurance report is submitted to the Risk and Resilience Steering Group. • The Risk Management Team generate a quarterly activity report on Adverse Events. Datix reports • Recent report from the risk management team shows that the number of Datix reports in Q1 (2024/5) was 675. • The number of Datix reports in this period with a consequence score of 4 or 5 was 35. Local Management Team Reports • The total number of LMTRs commissioned in North Ayrshire in 2023/24 was 5. This is a decrease from 20 in 2022/3 and 27 in 2021/22. Significant Adverse Event Reviews • Since 2019 NHS Ayrshire and Arran has commissioned 277 SAERs across all parts of the organisation with Mental Health Services accounting for 45% of all SAERs. • Commissioning of SAERS within Mental Health Services has been consistently high since 2019. • Since 2019 there have been 126 SAERs commissioned within Mental Health Service across Ayrshire with an average of 2 SAERs per month during this period. North Ayrshire = 84 East Ayrshire = 35 South Ayrshire = 27 • In the past 12 months 19 SAERS have been commissioned in North Ayrshire. • The three community mental health teams are the areas where the majority of SAERs are commissioned with North Ayrshire CMHT almost double the number of East and South. The overall majority of SAERs are commissioned for community services, with the majority of SAERs commissioned following suicide. • There are currently 104 staff who have received Root Cause Analysis Training across Mental Health, Addiction and Learning Disability Services.
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9 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • HIS Guidelines state that an SAER should be commissioned and completed within 90 days. The average longest time in a given year to complete a SAER has reduced from 531 to 204 days and the average length of time has reduced from 313 to 185 over the past 4 years. • Overall there has been a positive trend in the time that it takes to undertake a SAER within Mental Health, however more capacity is required if we are continue with this trend. • The activity on undertaking Significant Adverse Event reviews has increased steadily over the past 10 years. This is welcome evidence of an ongoing commitment by the organisation to learn when things do not go well, however, the impact on capacity of senior staff across to undertake these complex and challenging reviews cannot be underestimated. Infection Prevention and Control • Infection Prevention Control is a standing agenda item for the Clinical and Care Governance Group and its subgroups • Directorate reports on IPC activity is submitted to the Prevention and Control of Infection Committee for scrutiny and assurance. • Regular IPC audit activity within the partnership is reported within the Clinical and Care Governance framework for review, monitoring and action. 4.0 Service Report 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. North Ayrshire HSCP has lead responsibility for Mental Health Services (including psychology, CAMHS, Learning Disability assessment and treatment), Child Services (including child immunisation and infant feeding). East HSCP has lead responsibility for primary care and urgent care services. Primary care refers to the four independent contractors (General Practitioners, Community Pharmacists, Optometrists and General Dental Practitioners) who provide the first point of contact for the Ayrshire and Arran population. South Ayrshire HSCP 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 the FNP.
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10 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Adult Services The Chief Social Work Officer (CSWO) for North Ayrshire IJB presented their annual report (2023/24) to the North Ayrshire IJB and North Ayrshire Council’s Cabinet meetings during August 2024. The Chief Social Work Officer is a statutory appointment whose functions cover all social work and social care services. The CSWO oversees the discharge of the council’s statutory social work duties, ensure the provision of effective professional and objective advice to elected members and officers and ensure effective and safe provision of social work services. The North Ayrshire Care Home Oversight and the Care at Home Oversight Groups continue to meet regularly. These groups continue to fulfil key governance activity in relation to the Social Care sector and are an invaluable way to bring together a range of professionals to share information, intelligence and support. These groups have worked closely in the year past to manage high risk situations. Community Care/Services 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. 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 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”.
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11 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together 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. • 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. Community Nursing • The Community Nursing review, which took place late 2021/early 2022, reviewed the community nursing care models being delivered across Ayrshire and Arran with the aim to develop care models which meets the needs of the changing demographics. This review covered 24 hour/7 day per week community nursing services. • Through the Pan Ayrshire Community Nursing Governance Group we have been progressing the work identified through the four main recommendations of the review: new models of care; workforce planning and workforce competence; IT and Digital; and governance. • A Community Nursing Transformation update was presented to the North IJB in May 2024.
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12 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Mental Health, Addiction and Learning Disability Services Mental Health Services • 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 2023. 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. • A pilot of the Mental Health Hub was successfully undertaken earlier in 2024. The MH Hub is a 72 hour mental health assessment hub based within Woodland View Hospital staffed by mental health nurses from the Intensive Community Psychiatric Nurse team and the Mental Health Advanced Nurse Practitioner Team. The Hub provides patients an opportunity to have immediate support and assessment for up to 72 hours. • 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. Community Mental Health Services • Demand and Capacity within Adult Community Mental Health Service has been challenging over the previous years. Demand continues to rise, with on average a new referral received every 40 minutes (increased from one every hour from the previous year). A ongoing unprecedented demand for neurodevelopmental conditions continues to rise at a rapid rate. • There has been no increase in investment directed at Community Mental Health Services, with limited funding associated with Mental Health Recovery and Renewal being ring-fenced for specific areas, such as CAMHS, Psychological Therapies, Primary and Forensic Care (Action 15). Identified monies for Mental Health and Wellbeing in Primary care, has also failed to be released from Scottish Government. • ‘Core’ mental health staffing has been challenging with staff moving to more attractive and boundary services. Leaving not only a gap in establishments (across every MDT member; psychiatry, psychology, occupational therapy, and nursing) but a further knowledge gap of knowledge, skills and experience. The NA HSCP Workforce Plan provides further detail on ambitions for workforce over next 12 months and 3 years.
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13 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • Workforce tools demonstrate that current establishments (even if at full establishment) are insufficient to meet demand, and that the service is already operating at a significant risk. This risk has been highlighted within the Organisational Risk Register in the previous year. The gap between demand and capacity continues to grow year on year. • The service are undertaking a transformative programme of work to consider the service ability moving forward, and in review of the National specification for Secondary Care Mental Health Services. North Ayrshire Drug and Alcohol Service • A report from North Ayrshire Drug and Alcohol Recovery Service (NADARS) and North Ayrshire Alcohol and Drug Partnership (NAADP) to the North Ayrshire IJB has highlighted some of the positive work being undertaken to prevent drug and alcohol related deaths locally. • 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 training • 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. 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. • 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. • The Learning Disability service continues to experience workforce pressures across a number of its elements, in particular Trindlemoss House. • A new post – Senior Nurse Learning Disabilities was supported to build on current professional nurse support within Learning Disabilities. This post will support the ongoing activity around professional nursing practice and development.
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14 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together A new model of delivery for Annual Health Checks for people with a learning disability has been underway. As of August 2024 within North Ayrshire we have provided 286 health checks. Children and Adolescent Mental Health Service (CAMHS) • 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 (Integration Joint Boards) between March and May 2023. • 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. • CAMHS in Ayrshire Referral to Treatment is currently the best performing 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. 0 500 Number of Health Checks Offered Number of Health Checks Completed 418 286 North 06/08/24
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15 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Psychology • Psychological Services remain close to the LDP 90% RTT standard (87.8% in June 2024), but pressures of referrals have impacted upon our ability to meet this threshold. Our overall aggregate score is adversely impacted by three services in particular (Neuropsychology, Community Paediatrics and CAMHS Psychology) and we are focusing effort upon supporting these services in order to address waiting times. Recruitment to vacancies to psychology posts has become easier because availability of workforce has increased. Unfortunately, the reason for this is a reduction in available funding from SG across Scotland. Recruitment to longstanding vacancies in the service will help improve the RTT over the next year. • Over the last year we have been able to establish our new leadership structure, with a new Director of Psychological services starting in December 2023 and a full complement of the 4 Heads of Specialty posts. • Psychological services has a new established clinical governance structure with two new Clinical governance groups which have started in June 2024. The Psychological Therapies and Interventions CGG chaired by the Director of Psychological services is supporting the implementation of the National specification for the Delivery of Psychological Therapies and Interventions (SG Sept 2023). • Significant work has been undertaken to ensure that Psychological Services have the structure and procedures in place to facilitate the requirements of the Safe Staffing Act across all Psychological Specialties. • There remains a substantial focus on improvement of data quality and reporting. Psychological Services is working closely with data analysts and digital systems leads in order to ensure that we have data required for service improvement. Children’s Services 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 • Care experienced youth groups • Awareness raising and training Children and Families Health Team continues to operate a Governance and Development Group to provide oversight for governance related activity within the service, as well as a forum for discussing and ratifying any new service developments. Membership is made up of representatives from all Children and Families Health teams, as well as the senior leadership team.
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16 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together The Group reports to the Associate Nurse Director Children and Young People’s Governance Group and to the Clinical Care Governance Group. Health Visiting • All children under 5 years and their families continue to have access to the Universal Health Visiting Pathway in North Ayrshire, with a minimum of 11 visits being offered until the child commences school. • We continue to experience difficulties improving data related to developmental concerns: we have seen a decrease in children with no developmental concerns at the various assessment points in the health visitor timeline. This is mirrored nationally and has led to the Scottish Government to establish an Early Years transformational change programme to look at this issue through a quality improvement lens. Locally, we are looking at ways to address this. • 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 2022/23 was released late in 2023 and showed a very positive picture for North Ayrshire: 76.7% of P1 children were of a healthy weight. The highest % since 2008/09. 12.7% of P1 children were at risk of overweight. The lowest % since 2005/06. 9.7% of P1 children were at risk of obesity. The lowest % since 2008/09. School Nursing • In line with CEL 16, NHS Boards have a duty to offer health assessments to all looked after children and young people. For under 5s, this is done by the Health Visitor and for school-aged children, school nurses have this responsibility. During 2023/ 24 there was a significant focus by the team in ensuring that a robust notification and assessment process was in place. The output of this has been that 78% of children eligible for an initial health assessment took up the offer and were subsequently supported with their health and wellbeing. This is an increase on the previous year. • The school nursing service continues to experience challenges in our ability to fully implement all 10 priority pathways set out by the Scottish Government. As such, the service was placed on the operational risk register during 2023/24 and various control measures have been implemented to manage the risk. A number of Standard Operating Procedures have been drafted to ensure practice consistency across the team and with the intention of freeing up some capacity. • 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. Children’s Immunisations • The Children’s Immunisation Team continues to deliver a high quality 2-5 year programme in North Ayrshire and school-based immunisation programme across Ayrshire.
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17 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • The seasonal flu campaign for children and young people remains on the operational risk register in respect of risks around recruitment of staff. Despite these challenges, overall rates for seasonal flu vaccination were higher in North Ayrshire’s children compared to the national average. Work to continually improve these figures continues into 2024 planning. Perinatal Wellbeing Team • Due to the expansion of the team, support to expectant and new mums for low level mental health concerns is now available across North Ayrshire. A budget realignment has allowed the fixed term Band 6 Perinatal Mental Health Nurse post to be made permanent, meaning that all three nurses will be permanently funded – a much needed support for the team. • 119 new requests for assistance were received by the team during 2023/24, a 14.3% increase on 2022/23, with each full-time nurse holding a caseload of between 25 and 30 at any one time. Infant Feeding Team • 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. Early Years’ Support Team • The team provides support the Health Visitors and Family Nurses in North Ayrshire by offering early and preventative help to families on a range of issues. • In 2022/23, 1684 Requests for Assistance from Health Visitors or Family Nurses were made for families in North Ayrshire with a child under 5. Of these, 48% stayed within the service, supported by the Early Years’ Support Team, an increase of 5% on the previous year, and reflecting the benefits of the integrated early years model we have in North Ayrshire. Refugee Support Team • Nursing team supporting the health assessments for Ukrainian Displaced People (UDP), asylum seekers (including Unaccompanied Asylum Seekers) and refugees created in May 2023 as part of North Ayrshire’s wider Resettlement Team.
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18 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together • Since the creation of the team and up until March 2024: 162 health assessments were carried out with adults and 99 health assessments with children Migrant screenings for Tuberculosis and blood borne viruses, as well as immunisation schedules were undertaken with 76% of the new arrivals. • During 2023/24, the team temporarily took on responsibility for Unaccompanied Asylum Seeker Children (UASC) and spontaneous arrivals/ trafficked children to free up capacity in the school nursing service. • Funding for this team ends in March 2025. 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. Children’s Care Placements – Brighter Pathways • The HSCP have embarked on a programme of work to address the current challenges associated with resources and accommodation for looked after and care experienced young people. A Programme Manager has been appointed and will work alongside a Planning Manager and Senior Management, to deliver and support the transformational change over the next two years. A Programme Board has been established and chaired by the Chief Social Work Officer with membership from key stakeholders and Corporate Parents, to provide strategic leadership and governance to support the workstreams and allocate resources where required. • The work of the Brighter Pathways programme board will be closely aligned with The Promise development plan and the work of the Corporate Parenting Steering Group which is responsible for overseeing the six Corporate Parenting duties and each corporate parent upholds the rights and safeguard the wellbeing of Care Experienced people. There is a collective responsibility, ownership and commitment across services and agencies to develop solutions to our challenges, and shared goal of achieving the best possible outcomes for care experienced young people in North Ayrshire. The transformational change and service developments will be delivered through establishing focussed workstreams on the following areas: 1. Housing and Throughcare 2. Fostering and Kinship 3. Education including Residential School Placements 4. Internal Children’s Houses – Model of Care 5. Early Intervention and Crisis/Intensive Support Pathways
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19 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together 6. Strategic Needs Assessment/Data/Workforce 7. Best Practice Models and Research 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 Mental Welfare Commission (MWC) for Scotland’s mission and purpose is to be a leading and independent voice in promoting a society where people with mental illness, learning disabilities, dementia and related conditions are treated fairly, have their rights respected, and have appropriate support to live the life of their choice. To achieve this mission and purpose the Commission have identified four strategic priorities: • To challenge and to promote change • Focus on the most vulnerable • Increase their impact • Improve their efficiency and effectiveness • Between April 2023 and March 2024 mental health services across Ayrshire and Arran received 10 visits from the MWC (9 announced visits and 1 unannounced visit). The MWC made 22 recommendations following all visits and received responses to all recommendations within 3 months of the report being published. An assurance report providing details of all visits, recommendations and action plans and thematic reports was developed by the North Ayrshire CCG and presented to the NHS Ayrshire and Arran Healthcare Governance Group in July 2024. Action plans on response to the MWC on the recommendations were submitted back to the MWC within 3 months and are reviewed and monitored through the Mental Health Clinical and Care Governance framework. The insights, recommendations and positive acknowledgement of the delivery of high quality care provided by the MWC review and visit process is seen as positive by our organisation. Any improvements identified provide the clinical site, senior management and staff teams with a clear focus, helping to prioritise areas of work which in turn
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20 | P a g e NORTH AYRSHIRE Health and Social Care Partnership Delivering care together provides the assurance required to evidence the continued delivery of high quality care. A report detailing the MWC visits recommendations was submitted to the Healthcare Governance Committee in August 2024. 5.0 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. CAROLINE CAMERON DIRECTOR DARREN FULLARTON ASSOCIATE NURSE DIRECTOR/LEAD NURSE