Agenda Document Pack - Integration Joint Board - 19/09/2024
North Ayrshire Council · 19 September 2024
Back to Integration Joint Board — 19 September 2024 and its agenda
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Integration Joint Board Meeting Thursday, 19 September 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 Minutes The accuracy of the Minutes of the meeting held on 22 August 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 North Ayrshire HSCP Clinical and Care Governance Annual Report 2023- 24 Submit report by Darren Fullarton, Lead Nurse/Associate Nurse Director on the North Ayrshire HSCP Clinical and Care Governance Annual Report 2023- 24 (copy enclosed). 5 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP) on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 6 North Ayrshire HSCP & ADP Annual Performance Management Report – Alcohol and Drugs Submit report by Peter McArthur, Alcohol and Drug Services on the annual performance information in relation to the partnership’s Alcohol and Drug services (copy enclosed). 1
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7 North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Submit report by Peter McArthur, Alcohol and Drug Services on the North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report (copy enclosed). 8 2024-25 – Month 4 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 4 (July) (copy enclosed) 9 Transformation Plan Progress Update Submit report by Lee Ballantyne, Senior Manager (Strategic Planning and Transformation) on the Transformation Plan Progress (copy enclosed). 10 Strategic Risk Register Submit report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the Strategic Risk Register (copy enclosed). 11 NHS Ayrshire and Arran Delivery Plan 2024 – 2025 Submit report for information on the NHS Ayrshire and Arran Delivery Plan 2024 – 2025 (copy enclosed). 12 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 will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest 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, 2
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substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk 3
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IJB Sederunt Voting Members Margaret Johnson (Chair) North Ayrshire Council Joyce White (Vice-Chair) NHS Ayrshire & Arran Cllr Tom Marshall North Ayrshire Council Cllr Anthea Dickson North Ayrshire Council Cllr Nairn McDonald North Ayrshire Council Jean Ford NHS Ayrshire & Arran Tom Hopkins NHS Ayrshire & Arran Marc Mazzucco 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 Lynne McNiven Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Terri Collins Staff Rep - NHS Ayrshire and Arran Lynda MacFarlane Staff Rep Vacancy Carers Representative Clive Shephard Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third Sector Representative 4
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 22 August 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 Councillor Nairn McDonald, 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 Sharon Hackney, Lead Allied Health Professional Stakeholder Representatives Hazel Brown, Third Sector Representative Linda McFarlane, Staff Representative Present (Remote Participation) Voting Members Jean Ford, NHS Ayrshire and Arran Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Wendy Van Riet, Director Psychological Services In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families and Justice) Kerry Logan, Head of Service (Health and Community Care) Eleanor Currie, Principal Manager, (Finance) Raymond Lynch, Senior Manager, (Legal Services) Lesley Higgins, Service Manager (Practice Standards) Ann Hotchkiss, Trauma Lead (Practice Standards) Lee Ballantyne, Senior Manager (Strategic Planning & Transformation) Karen Andrews, Team Manager (Governance) Craig Stewart, Committee Services Officer Hayley Clancy, Senior Committee Services Officer In Attendance (Remote Participation) Michelle Sutherland, Partnership Facilitator, HSCP Agenda Item 3 5
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William Lauder, (NHS Ayrshire and Arran) Apologies Darren Fullarton Iain Jamieson Thelma Bowers Vicki Yuill 1. Apologies for Absence Apologies for Absence were noted. 2. Declarations of Interest There were no 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. 3. Minutes The accuracy of the Minutes of the meeting held on 13 June 2024 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 4. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on the developments within the North Ayrshire Health and Social Care Partnership. Officers responded to members’ questions on various aspects of the report. Noted. 5. Annual Performance Report 2023-24 Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the achievements during 2023-24 and the publication of the Partnership’s Annual Performance Report, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 6. 2024-25 – Month 3 Financial Performance Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the Integration Joint Board’s financial performance as at month 3 (June). 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. Officers responded to members’ questions on various aspects of the report. The Board agreed to note (i) the overall integrated financial performance report for 6
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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 (ii) the progress with delivery of agreed savings, (iii) the actions being taken to progress financial recovery and a further recovery plan to be presented to IJB in September, (iv) the remaining financial risks for 2024-25; (b) approve the budget reductions set out at section 2.10 of the report; and (c) the Terms of Reference for the Finance Working Group set out at Appendix F to the report. 7. Accounts Commission: Integration Joint Board Finance and Performance Submitted 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, set out at Appendix 1 to the report. 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. Officers responded to members’ questions on various aspects of the report. Noted. 8. Delayed Discharge Performance Submitted report by Kerry Logan, Head of Service (Health and Community Care) on the performance in relation to Delayed Discharge and the Improvement Plans for North Ayrshire. The detailed submission outlining a summary of the current position, key challenges and specific actions and investment required for North Ayrshire to sustain and improved delayed discharge performance was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 9. Chief Social Work Officer Annual Report 2023-24 Submitted report by Scott Hunter, Chief Social Work Officer (NAHSCP) to present the annual Chief Social Work Officer report required by Scottish Government, which was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to note (a) the contents of the report, in particular the successes and challenges; (b) the skilled and compassionate interventions of our practitioners and managers; (c) the worsening financial context and associated impact on all ages within our community both in terms of wellbeing and risk; and (d) approve the annual report to be submitted to the Office of the Chief Social Work Adviser in Scottish Government. 10. North Ayrshire - Being Trauma Informed and Responsive Submitted report by Scott Hunter, Chief Social Work Officer (NAHSCP) on the ongoing work to develop our approach and response to trauma. The report highlights the 7
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specific pieces of work currently being progressed and the short medium and long- term plans to further build on the Trauma Informed approach across council services. Officers responded to members’ questions on various aspects of the report. Noted. 11. Whistleblowing Annual Report 2023-24 Submitted report by Karen Callaghan, Corporate Governance Co-ordinator, in relation to whistleblowing concerns raised in 2023-24. Noted. 12. Whistleblowing Report Quarter 1, April – 30 June 2024 Submitted report by Karen Callaghan, Corporate Governance Co-ordinator, in relation to whistleblowing concerns raised in Quarter 1 (April – 30 June 2024). Noted. The meeting ended at 12:35pm. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 8
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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. Agenda Item 4 9
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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 10
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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. 11
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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 12
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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. 13
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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 14
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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 15
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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). 16
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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 17
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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. 18
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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. 19
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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. 20
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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. 21
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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”. 22
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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. 23
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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. 24
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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. 25
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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 26
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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. 27
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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. 28
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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. 29
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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 30
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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 31
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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 32
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Integration Joint Board 19th September 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 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. The report will also provide COVID related information by exception. 3. CURRENT POSITION National Developments 3.1 Health, Social Care and Sports Committee – Pre Budget Scrutiny IJBs 2025/26 I attended the Health, Social Care and Sport Committee meeting on Tuesday 3rd September 2024 to give evidence on the Pre Budget Scrutiny process 25/26, which Agenda Item 5 33
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the Committee has decided to focus on IJB budgets. I was representing North Ayrshire HSCP and was accompanied by Pat Togher, Chief Officer representing Edinburgh City HSCP along with Sharon Wearing representing IJB CFOs’. The meeting was televised and can be view via the link below. https://www.scottishparliament.tv/meeting/health-social-care-and-sport-committee- september-3-2024 The focus of the Committee was on: • Financial Performance • Financial sustainability • Performance and designing for shifting the balance of care and • outcomes • Governance, leadership and culture • Data for planning and outcomes • Commissioning and procurement • The wider context: increasing demand, unpaid carers, the National • Care Service and workforce The Official Report of the above meeting is also available on the Parliament’s website and can be accessed by following this link: Health, Social Care and Sport Committee Official Report, 3 September 2024 3.2 Health, Social Care and Sport Committee – Post Legislative Scrutiny Report The Health, Social Care and Sport Committee have also published their report on its post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013: Phase 2 which can be accessed here: Post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013: Phase 2 (parliament.scot). The North Ayrshire SDS team will review and compare the findings with our own local actions and SDS review. 3.3 Scottish Child Abuse Inquiry – Phase 10 Investigations The Scottish Child Abuse Inquiry has announced a new case study, which will be referred to as phase 10 and will look at children’s homes run by local authorities, as well as homes run by voluntary providers and used by local authorities to place children. Phase 10 of SCAI’s investigations concerns the provision of residential care for children and young people in establishments run by local authorities. Investigations will also focus on establishments into which local authorities placed children in care. 34
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It is expected that public hearings will commence in the second half of 2025. This is a category of residential care which SCAI’s wide-ranging Terms of Reference require it to investigate. Investigation of this category has been ongoing throughout the life of the Inquiry, and many relevant statements have already been provided by a range of applicants. As part of the Inquiry’s preparatory work, SCAI regularly reviews the stages that all its investigations have reached and may, if necessary, add to its list of focused investigations. 3.4 Rethink Dementia Campaign The new 'Rethink Dementia' campaign, in partnership with COSLA was launched on 4th September 2024. The campaign encourages people to 'Rethink Dementia' as evidence shows social contact can help alleviate some symptoms commonly associated with dementia and help them stay well for longer. By maintaining contact with friends or loved ones living with a dementia diagnosis and doing the things we’ve always done with them, we can all make a difference. This important campaign was developed in collaboration with a National Lived Experience Panel and in response to insight that shows many people associate dementia primarily with its later stages. Also, there is a lack of understanding that it is a progressive disease and that in the earlier stages particularly, people can live independent, fulfilling lives. Rethink Dementia will run on TV, cinema, outdoor, press, digital and radio for five weeks. The campaign will target 30-60 years olds living in Scotland, however it is relevant to everyone - younger or older. 3.5 Home First – Supporting Patient Recovery at Home The Scottish Government shared the Home First Stakeholder Toolkit which has been developed to support patient discussions when an individual is returning home to recover. 35
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The research shared by the Scottish Government supports the best place for patients to recover is at home and this approach is designed to enable this while helping maintain a person’s independence. This 'Home First' approach is part of the overarching Right Care Right Place messaging which helps the public access the right care in the right place to ease the pressure on health services and improve patient outcomes. Our Communication Lead, Nicki Teager will push out the messages for this approach across the partnership and social media channels, as will our operational teams working within the hospitals and in the community. North Ayrshire Developments 3.6 Performance and Audit Committee Following the resignation of Councillor Timothy Billings as Vice Chair of the Performance and Audit Committee, Councillor Nairn McDonald has volunteered to undertake the role of Vice Chair. One vacancy remains on PAC and expressions of interest from IJB members to join the Committee are welcomed. 3.7 Unpaid Carers Roadshows North Ayrshire Carers Gateway and the NAHSCP Carers Team are holding a series of roadshows in the coming months, where they’ll be joined by service providers and professionals who will share information on benefits, fuel poverty, cost of living, training and education, health and wellbeing, community organisations and support groups. These can be booked online now for the following dates, or just drop in on the day: Tuesday September 17: Brodick Hall, Arran, 2pm to 6pm Wednesday 23 October: Kilwinning Community Sports Club, 2pm to 6pm Thursday 21 November: George Steven Centre, Kilbirnie, 1pm to 5pm 36
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3.8 Trindlemoss team to present at accessible story festival Staff and customers from Trindlemoss Day Opportunities attended a workshop at the Accessible Book & Story Festival, which took place on September 13 and 14 at the Scottish Storytelling Centre in Edinburgh. They attended the event to share their experiences of working with ShowWorks Theatre to produce a performance piece around the theme of ‘being and becoming’. The project was funded through Creative Scotland’s Participatory Arts and Mental Health Fund and The Baring Foundation, in partnership with the Mental Health Foundation. As part of this, they presented a short film about the work and leading a conversation about the partnerships that made it possible. A private local screening of the film was held on 10th September 2024 in the Harbour Arts Centre, Irvine. 3.9 Positive feedback for Ward 7A in report A recently published Mental Welfare Commission report on the Assessment and Treatment (A&T) Unit at Ward 7A, Woodland View Hospital, has provided very good feedback around leadership, therapeutic and caring relationships, and detailed person-centred care records at the facility. The unit provides access to specialist intensive multi-disciplinary A&T services for adults living in Ayrshire who have a learning disability and associated complex support/health needs. You can access the full report on the Mental Welfare Commission website. 3.10 Mental Health Unscheduled Care Assessment Hub – Official Opening The Mental Health Unscheduled Care Assessment Hub was officially launched on Friday 13th September 2024 with full operational opening from 5pm that day. The Mental Health Unscheduled Care Assessment Hub, based at Woodland View in Irvine, provides a patient-focused, therapeutic space to support the delivery of compassionate care to those individuals with acute mental illness who would be eligible to access an adult acute mental health bed for ongoing intensive assessment. Managed and coordinated by the Mental Health Unscheduled Care Service, the hub provides 24-hour access to mental health assessment and interventions. The service is delivered by experienced Mental Health Nurses within a therapeutic environment for a period of up to 72 hours, and will be able to accommodate up to five patients. 37
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The hub aims to: • Improve the patient journey through the Mental Health Unscheduled Care Service • Facilitate closer working and a smoother patient journey between community and inpatient services • Reduce the number of unscheduled admissions to acute inpatient mental health beds • Reduce the waiting time for planned acute admission • Reduce the number of initial assessments carried out on acute wards; releasing time for treatment • Provide training opportunities in assessment of mental illness for medics, nursing and other disciplines. The service underwent 3 'testing' phases (with a reduced bed base (2-3 beds) whilst awaiting necessary estate works. During these 'soft launch tests' the hub demonstrated its benefit with 75 individuals passing through the hub during that time. Of those 75 individuals :- • 21 required admission to hospital, meaning that less than 28% of patients admitted to the hub, went onto need an acute adult mental health bed. • The majority were discharged, and all within the maximum 72hr expectation. • 44% continued to be supported by the unscheduled care mental health teams following discharge. Providing the benefit of improvement and sustained patient journey • 16% were discharged back to existing care supports. • 12% were discharged without follow up. 3.11 Money Matters - Welfare rights advice in schools is expanding Money Matters has had a dedicated Welfare Rights Officer providing advice in North Ayrshire secondary schools since 2021. The service has been a huge success and has put more than £1m into the bank accounts of families during this time. The project is now expanding, with an additional two Welfare Rights Officers joining the team. This will enable the team to offer advice to all parents / carers with children in any education establishment, including early years, primary and secondary. The three Welfare Rights Officers will be split across the localities and referrals can be made direct to the officer by phone, email or the online ‘contact us’ form. 38
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3.12 NAHSCP Locality Planning process update The first cycle of the HSCP locality planning process has now been completed, after an initial period of engagement with the public in April 2024. The Locality Conversation events enabled us to hear from our communities on three key areas of health and social care: • Places and Spaces • Healthy Living • Services People were asked whether there were geographical aspects of their locality that impacted on their access to services, as well as whether they felt there were any services missing from their local area. We also asked what initiatives they thought brought the most benefit to positive community wellbeing, and whether they felt that any health and social care services needed improved or expanded. The themes that came out of these sessions will be used to identify issues within our localities and feed into other planning processes, such as our next Strategic Plan. To ensure that everyone living in North Ayrshire is able to have their say on health and social care services in their locality throughout the year a survey has been developed that will run until August 2025 that anyone is able to fill in. The survey will take around 5 to 10 minutes to complete and can be accessed online. The Strategic Planning and Equalities Team is also looking to do some targeted engagement with groups with shared characteristics (for example, LGBTQ+, disability, carer, gender, age, religion, ethnic minority) for both a revised Equalities Outcomes Plan and the NAHSCP locality planning process. The team is collating information on different existing groups across all North Ayrshire localities that they could potentially engage with this September. If you know of a group who may be interested in sharing their views on health and social care services, please contact hscp-engagementteam@north-ayrshire.gov.uk with the following details: • Name of group • Locality of group • Meeting time and place of group • Lead contact of group 39
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3.13 ‘Peace of Mind’ for North Ayrshire residents North Ayrshire residents will soon be able to access ‘Peace of Mind’, an innovative programme aimed at reducing social exclusion and isolation. Run by social enterprise Peace of Mind Services, the programme has been operating in Fife for the past 3 years and will now be coming to North Ayrshire through funding from the National Lottery. Since starting in Fife, there have been seven groups established across the region, supporting 50 individuals who were previously attending local day care centres. Those participating in the groups have taken part in a range of social activities including lawn bowling, arts and crafts, and visiting a range of Scottish cities and museums. A number of attendees have also gone on to find volunteering opportunities or even moved into paid employment. The team is already accepting referrals to the programme, which will formally launch in North Ayrshire on Tuesday 8 October at the TACT 25th anniversary celebrations at their offices in Saltcoats. Visit the Peace of Mind website to find out more about the programme or to refer. 3.14 Save the date: North Ayrshire Mental Health Arts Festival launch event The Scottish Mental Health Arts Festival will take place from Thursday 10 October to Sunday 27 October, with a theme this year of ‘In/Visible’. As part of the celebrations, there will be a wide range of fantastic events taking place in North Ayrshire throughout the whole of October that anyone can take part in, including a fantastic launch event at the Harbour Arts Centre in Irvine from 6pm to 8pm on Wednesday 9 October. Participants will have the opportunity to take part in some taster sessions and enjoy some live performers, guest speakers, art demonstrations and refreshments. Information on how to book tickets for this free event will be available in the new few weeks, as well as information on where to find details on the rest of this year’s events. 40
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3.15 NAHSCP Partnership Awards – Promoting Wellbeing Together Nominations for the NAHSCP Partnership Awards closed on 30th August 2024. At the closing date over 200 nominations had been received which is the highest number of applications received since the inception of the awards. Arrangements are now well underway for the Award Ceremony on 25th October 2024 at Redburn Community Centre, Irvine. 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] Appendices Nil 41
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Integration Joint Board 19 September 2024 Subject : North Ayrshire HSCP & ADP Annual Performance Management Report – Alcohol and Drugs Purpose : To present the annual performance information in relation to the partnership’s Alcohol and Drug services. This report is for :- • Awareness Recommendation : IJB are asked to note the content of the report. 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 HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 To present the annual performance report for North Ayrshire Health and Social Care Partnership (HSCP) for the period April 2023 to March 2024. 2. BACKGROUND 2.1 This annual report (please refer to Appendix 1) provides detailed information related to all alcohol and drug related performance management targets, standards and outcomes. 3. PROPOSALS 3.1 IJB are asked to note performance in relation to :- • Access to Treatment Waiting Times; • Alcohol Brief Interventions; • Naloxone supply; • Drug Related Deaths; • Training delivery • Finance; Agenda Item 6 43
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3.2 Anticipated Outcomes Assurance regarding all key performance management information. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources The Alcohol and Drug Partnership (ADP) works across agencies with a wide range of staff 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. 4.5 Risk Risk assessments are completed as and when required – Low risk grading with regard to the information contained within this report. 4.6 Community Wealth Building Improvements will increase community confidence in partnership approaches and raise awareness of the impact of alcohol and drugs and the work of the ADP to reduce drug related deaths. 4.7 Key Priorities Actions and improvements link directly with Ministerial Priorities to support the delivery of local strategic and operational plans across statutory and partner services and support wider actions to prevent drug related deaths in line with the National Mission. 5. CONSULTATION Service users, families and staff from across a variety of services have contributed to the achievement of targets, standards and outcomes Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services 01294 317840, peter.mcarthur@aapct.scot.nhs.uk 44
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Appendices • Appendix 1 North Ayrshire HSCP & ADP, Performance Management Report Alcohol and Drug information (1st April 2023 to 31st March 2024) 45
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1 NORTH AYRSHIRE HEALTH & SOCIAL CARE PARTNERSHIP (H&SCP) and the Alcohol & Drug Partnership (ADP) Performance Management Report Alcohol and Drug information 1st April 2023 to 31st March 2024 Prepared by: Denise Brown NHS Prevention and Service Support Team Peter McArthur North Ayrshire Alcohol & Drug Services 46
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2 North Ayrshire – Access to Services – Waiting Times April 2023 – March 2024 Alcohol • 90% of clients will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Drug • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery Target achieved Q1 Q2 Q3 Q4 100% 96% 97% 100% Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved Q1 Q2 Q3 Q4 99% 96% 97% 100% Target achieved Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved 47
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3 ALCOHOL BRIEF INTERVENTIONS (ABI) Ayrshire and Arran wide information Annual report: April 2023 – March 2024 Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in wider settings (as at 31/03/2024) – 1210 SUBSTANCE USE TREATMENT TARGET The Scottish Government have created a new ‘Substance Use Treatment Target’ to increase the number of individuals being supported in treatment. North Ayrshire has been set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. Baseline from Scottish Government Quarterly reporting – North Ayrshire North 01/04/2020 882 Target by March 2024 - an increase of 77 North 01/04/2020 959 Interventions were put in place across our community alcohol and drug recovery services to support the achievement of this target. Please note the monthly information supplied is unpublished and has been collected from local prescribing systems to monitor progress, however, we await an initial verified nationally published report. Increase from Baseline figure by 247 at the end of March 2024. This exceeded the target set. Now awaiting a new nationally set target for 2024 onwards. Quarterly period Target Actual Apr-Jun 22 891 898 Jul-Sep 22 900 940 Oct-Dec 22 910 974 Jan-Mar 23 920 1011 Apr-Jun 23 930 1051 Jul-Sep 23 940 1080 Oct-Dec 23 950 1103 Jan-Mar 24 959 1129 Total 2 Year Increase Figure 77 247 Target achieved Target achieved 48
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7 AYRSHIRE AND ARRAN DRUG RELATED DEATHS INFORMATION Annual summary report: 1st April 2023 – 31st March 2024 National Records for Scotland - Drug Related Deaths Please find information in the link below around the definition of drug related deaths and what deaths are excluded from this definition: https://www.nrscotland.gov.uk/files/statistics/drug- related-deaths/drd2016/html/drug-related-deaths-2016-annex-a.html The link below details the full report which details statistics of drug-related deaths in 2022 and earlier years, broken down by age, sex, substances implicated in the death, underlying cause of death and NHS Board and Council: https://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2022 Published confirmed deaths (Extracted from National Records of Scotland Drug Related Deaths in Scotland, 2021) Number of deaths confirmed (most recent published information) East North South Total 2018 29 38 15 82 2019 41 41 26 108 2020 36 39 31 106 2021 38 39 23 100 2022 30 37 15 82 2023 – No confirmed published data as yet (however when reviewing local unpublished information, a further decrease is expected for North Ayrshire) Number of NADARS reviews conducted for individuals identified as potentially suffering a drug related death Number of these reviews which identified learning or recommendations Number of reports submitted by other services which identified learning or recommendations In the last year, local learning identified from reviews were: • NADARS review robustness of processes around GP notification of discharge from their service. • Where clients have not been seen and have to be re-appointed the plan of next steps should be documented clearly within clients notes • The Ayrshire Risk Assessment Framework (ARAF) used to assess a client’s mental health must be updated to reflect any significant change in a client’s circumstance on all occasions • Where Next of Kin information is available it is important to ensure their details are complete and up to date and recorded on the Care Partner system. 47 4 3 0 52
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8 PREVENTION AND SERVICE SUPPORT TEAM Annual summary report: 1st April 2023 – 31st March 2024 Alcohol & Drug training and education sessions Calendar courses with 739 participants Ad-hoc training courses with 1723 participants 110 89 Bitesize sessions with 79 participants 29 Training Delivery The team continue to provide a wide range of education and training initiatives which focus on improving awareness, competence and knowledge of those affected by alcohol and drug use, and those working in the field. Due to the COVID-19 pandemic the team introduced virtual training, this continues to be offered as well as face to face training. PSST currently issue upcoming training courses on a quarterly basis. What did our participants say? “I really enjoyed the variety of delivery slides/videos/breakout rooms” “Interactive. Trainers very knowledgeable and happy to answer any questions” “Thoroughly enjoyed today. Very informative and I particularly liked the interactive part of the presentation” "Learning about BBV which was new to me. Training was really useful and informative. Trainers were great" "I really enjoyed the training. Being new to this line of work it was very informative and will help me my job role" "I enjoyed learning about the types of drugs and the stats in this session. The trainers’ knowledge of the same provides me with confidence to carry out my role effectively” 46 sessions delivered within Ward 5 Attended 13 stalls/events Ad-hoc training and health information events by locality area 38% 30% 8% 24% East North South Pan-Ayrshire Alcohol Brief Interventions Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in priority settings (as at 31/03/2024) – 1210 Follow our social media pages to keep up to date with our activities in the Prevention and Service Support Team Prevention and Service Support Team – NHS Ayrshire and Arran @PSST_NHSaaa 53
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9 Ayrshire College Alcohol and Drug Liaison Officer 98 workshops were held with 1138 students 37 1-1 supports with students 6 staff supports 9 health events with an estimated 765 contacts 1 training session delivered for 12 information hub staff Naloxone 99 staff completed the Naloxone Learnpro Minimum of 57* lives saved in the community *lives saved across Ayrshire and Arran as reported on the Shared Addiction Management System (SAMS). Many saves go unsupported. 6 Train the trainer sessions delivered 39 Naloxone awareness sessions delivered 113 203 267 401 0 50 100 150 200 250 300 350 400 450 2020 2021 2022 2023 Naloxone supplied by PSST Service Support Service Support facilitate service development activity which supports the implementation and delivery of the quality improvement agenda for Alcohol and Drug Services which meets national, local and strategic objectives. 22 Audit and evaluation activity 8 Guidelines reviewed and updated Get our NHS Ayrshire and Arran Alcohol and Drug App Download the NHS Ayrshire & Arran app from your Apple or Android app store. Then search for Alcohol and Drugs. 32 Drug and Alcohol groups supported Support to implementation of MAT standards and reporting Development of NADARS Roles and responsibilities directory Gathering, collating and presenting client satisfaction and client stories ABI Heat Standard recording and reporting Support to START and RADAR service Support to local Adverse Incident review processes and reporting 54
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10 INFORMATION MANAGEMENT AND TECHNOLOGY (IM&T) Annual summary report: 1st April 2023 – 31st March 2024 The Information Management and Technology Team are responsible for the development, training and monitoring of the Shared Addiction Management System (SAMS) and the training and monitoring of Drug and Alcohol Information system (DAISy). These systems are used to record drug and alcohol information, which enables the team to provide national and local reports. SAMS updates 3 sections within SAMS were updated New MAT 9 Mental Health added to SAMS SAMS updated to use Active Directory Login New Substitute Prescribing Application went live Training, e-learning and support E-learning • Completion of a new Alcohol Detox module • New Substitute Prescribing read-only module released • Updated ABI module Training • 68 individuals received SAMS training • 34 individuals received DAISy training • 2 Naloxone training sessions delivered to new organisations Support Approximately 50 SAMS/ DAISy support calls per month IM&T are also responsible for the collation and reporting of Drug Related Deaths and the completion of the National Drug Death database. Drug related death reporting Reporting • Quarterly reports including ASPIRE report, (29 individual performance reports), Naloxone quarterly reports, Scottish Governance reports, ADP reports and local performance and planning reports • Development of reports and audits for MAT standards and submission of MAT 1 – 10 numerical data • Monthly reports including 10 current OST reports, MAT Target Report, SAMS Data Quality Reports and Psychological Therapy Waiting Times • Weekly DAISy quality data checks for Waiting Times, Assessments and Reviews for all Alcohol and Drug services • Monthly substitute prescribing audit • Drug related death report • Development of report for new residential rehab dataset • Approximately 10 – 15 ad hoc report requests per month 55
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11 IMPLEMENTATION OF MAT STANDARDS ACROSS NORTH AYRSHIRE Annual summary report 2023 - 24 In April 2021, the Scottish Government introduced 10 new Medication Assisted Treatment (MAT) Standards for implementation by Alcohol and Drug Services. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality1. , New approaches were required within North Ayrshire to support rapid access to MAT: • A local test of change was carried out to evaluate the new model of care to establish effectiveness prior to roll out • An Improvement Implementation Plan was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government; • Quarterly updates on MAT developments were submitted to the national MAT support Team – MIST; • An explicit delivery plan was put in place for delivering trauma informed practice; • Guidelines and clinical & care pathways of support were put in place to ensure consistency and to support the staff to deliver the interventions. Results/outcomes (2023/24) • Improvement in the waiting time from referral to commencement of appropriate Opiate Substitution Therapy medication - 75% of individuals were offered a first MAT assessment on the same day as engagement with the service • 100% of individuals were supported to make an informed choice on MAT medication and the appropriate dose • 75% of notified high risk events to the multi-agency assessment team for assertive outreach were contacted on the same day • 85% of individuals were retained in service for more than 6 months • Over 90 individuals have shared care support with Primary Care • 100% of individuals received a mental health assessment • 100% of individuals were offered BBV testing, Harm Reduction interventions and a physical health assessment • Improvement in satisfaction and experience of clients. A RAGB self-assessment was completed and evidence (numerical, experiential and process information) was submitted to the MIST team for analysis and benchmarking. The table below highlights a very positive final RAGB score for the implementation of MAT standards 1 - 10 across North Ayrshire with improvement and progress across all 10 standards. 56
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12 RESIDENTIAL REHABILITATION EXPANSION Access to residential rehabilitation across Ayrshire and Arran – Ward 5, Woodland View. Ward 5 has 10 beds for residential care: Seamless pathways of support are in place with the local community team supporting individuals before, during and after their placement (extra support in place for NA residents e.g. in addition to ongoing NADARS support, everyone is also provided with daily follow up support from the P.E.A.R service for the first week following discharge). During 2023/24 Access to additional local residential rehabilitation - Harper House The NA H&SCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022. It is located in Saltcoats and is a Care Inspectorate registered service, funded by the Scottish Government – it offers specialist support for the ‘whole family to recover from the harms of problematic drug and alcohol use’. Their family- focused programme of interventions is ‘designed to benefit each member of the family and the family unit as a whole’. Referrals are accepted from across Scotland, with enhanced local access available for residents of North Ayrshire. These pathways continue to be improved with a local oversight group meeting regularly to support the identification and suitability of families. In 2023/24 NADARS supported 7 applications into Harper House with 5 starting the programme. The 2 families who were not suitable at that time have had continued involvement from community services as appropriate. Access to External Residential Rehabilitation (ERR) Individuals wishing to access external residential rehabilitation support can do so via NADARS who will support the development of a care plan, identify a residential rehabilitation provider, seek funding and then support individuals into, through and after their external residential rehabilitation placement. In 2023/24, 55 referrals were received for ERR. Following assessment, 22 individuals were suitable for ERR and funding was approved (33 individuals felt not ready or declined the ERR intervention at that time and were offered alternative community supports). • 21 individuals commenced ERR (with one individual declining admission at their start date) 5 5 Detoxification Rehabilitation 138 individuals (NA = 94) 74 individuals (NA =45) Detoxification support Rehabilitation support 57
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13 FINANCIAL INFORMATION ADP 23-24 Forecast Spend Ministerial Priorities Sum of Agreed Projects Community based treatment and recovery services for adults £1,122,568.30 Other £107,995.54 Other Projects £1,030.90 Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) £209,179.50 Alcohol and drug services specifically for children and young people £100,343.47 Recovery community initiatives £135,699.00 Services for Families affected by alcohol & Drug use £126,637.91 Additional National Mission uplift £218,035.22 MAT Standards £364,225.04 Residential Rehab £164,252.28 Whole family Approach framework £141,366.26 Residential Support £41,609.04 Grand Total £2,732,942.45 Community based treatment and recovery services for adults 41% Other 4% Other Projects 0% Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) 8%Alcohol and drug services specifically for children and young people 4% Recovery community initiatives 5% Services for Families affected by alcohol & Drug use 5% Additional National Mission uplift 8% MAT Standards 13% Residential Rehab 6% Whole family Approach framework 5% Residential Support 1% Community based treatment and recovery services for adults Other Other Projects Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) Alcohol and drug services specifically for children and young people Recovery community initiatives 58
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14 Additional funding streams Ministerial Priorities Sum of Agreed Projects Other Projects £ 1,030.90 Additional National Mission uplift £ 218,035.22 MAT Standards £ 364,225.04 Residential Rehab £ 164,252.28 Whole family Approach framework £ 141,366.26 Grand Total £ 888,909.70 The ADP has accumulated a reserve balance due to underspends in previous financial years. • Plans are in place to utilise the reserves and they are committed in future years. Other Projects 0% Additional National Mission uplift 25% MAT Standards 41% Residential Rehab 18% Whole family Approach framework 16% Other Projects Additional National Mission uplift MAT Standards Residential Rehab Whole family Approach framework 59
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Integration Joint Board 19 September 2024 Subject : North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Purpose : To present the annual report in relation to the continued implementation of the Medication Assisted Treatment Standards. This report is for :- • Awareness Recommendation : IJB are asked to note the content of the report. 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 Medication Assisted Treatment MAT HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 To present the 2023 to 2024 annual report regarding the continued implementation of the Medication Assisted Treatment (MAT) Standards. 2. BACKGROUND 2.1 This annual report (please refer to Appendix 1) provides detailed information relating to implementation of the MAT Standards, achievements, outcomes and priorities for the year ahead. 3. PROPOSALS 3.1 IJB are asked to note information in relation to :- • Effects of change; • Intervention Outcomes; • Client experience; • Developments and future priorities; Agenda Item 7 61
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• Benchmarking and RAG ratings; • Improvements and progress 3.2 Anticipated Outcomes Assurance regarding positive progress in the delivery of MAT Standards across all 10 Standards. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. More detailed outcomes and positive impact measures are evidenced via regular reporting to the Scottish Government. 4. IMPLICATIONS 4.1 Financial There is a risk of being unable to sustain implementation of MAT Standard 7 (Primary Care) unless recurring funding can be identified (currently the ADP has provided non- recurring funding to implement a new model of care which will be evaluated over the next 2 years). 4.2 Human Resources The implementation of the MAT Standards involves a wide range of staff across a variety of partner organisations 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. 4.5 Risk Risk assessments are completed. There is a Low risk grading with regard to full implementation of 9 of the 10 Standards. There is a Medium risk grading with regard to the full implementation of MAT Standard 7 (Primary Care) due to the absence of recurring funding. 4.6 Community Wealth Building Improvements will increase community confidence in partnership approaches and raise awareness of the impact of alcohol and drugs and the work of the ADP & HSCP to reduce drug related deaths. 62
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4.7 Key Priorities Actions and improvements link directly with Ministerial Priorities to support the delivery of local strategic and operational plans across statutory and partner services and support wider actions to prevent drug related deaths in line with the National Mission. 5. CONSULTATION Service users, families and staff from across a variety of services have contributed to the achievement of MAT delivery. Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services. 01294 317840, peter.mcarthur@aapct.scot.nhs.uk Appendices • Appendix 1 Medication Assisted Treatment – Annual Report 63
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IMPLEMENTING MEDICATION ASSISTED TREATMENT (MAT) NORTH AYRSHIRE DRUG AND ALCOHOL RECOVERY SERVICE (NADARS) Reporting period: 1st April 2023 - 31st March 2024 Quality issue: In 2022, there were 1,051 drug related deaths registered in Scotland, 279 deaths fewer than 2021. Although this is the lowest number of deaths since 2017, there were 3.7 times as many deaths in 2022 compared with 2000. Ayrshire and Arran continues to have the second highest death rate at 28.1per 100,000 population. Evidence suggests quick access to treatment is crucial and being in treatment can be a protective factor for majority of individuals. The Scottish Drug Deaths Taskforce (SDDTF) has prioritised the introduction of the MAT standards to help reduce the number of drug related deaths. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality. Aim: To have no barriers to accessing treatment and care that supports an individual’s recovery. This project focussed specifically on improving access to appropriate Medication Assisted Treatment (MAT) within the North Ayrshire Drug & Alcohol Recovery Service (NADARS) in order to prevent deaths, reduce harms and promote recovery opportunities. Effects of change during 202324: • Improvement in the waiting time from point of referral to commencement of appropriate Opiate Substitution Therapy (OST) medication - average time from assessment to prescribed medication 0 days. • Increased choice in OST medications • Improvement in satisfaction and experience of clients. • All individuals received a mental health assessment and support as required. • All individuals were offered Blood Borne Virus (BBV) testing, Harm Reduction interventions, physical health assessment and referred on for further support where required. • All individuals had the opportunity to access Recovery Development Worker's with lived experience to provide person centred recovery support. • All individuals had the opportunity of family involvement. • All individuals were offered housing, advocacy support and were referred for social care support where appropriate. Tests of change: Cycle 1: Implement and Test the MAT clinic pathway on a Monday and a Thursday in one locality (Three Towns). Cycle 2: Secure funding to recruit staff to support the implementation of the full model. Cycle 3: Refine project charter to facilitate full model Cycle 4: Expand service to 5 days per week across 6 localities of North Ayrshire (NA). (Test of change is complete and now working towards sustaining full model during 2024/25) 0 1 2 3 4 5 Average number of days referral to prescription 0 1 2 3 4 5 6 7 8 9 10 Average number of days from assessment to prescription Median = 3 days Median = 0 days 64
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IMPLEMENTING MEDICATION ASSISTED TREATMENT 565 REFERRALS BY GENDER FEMALES MALES 188 377 (33%) (67%) REFERRALS BY GENDER & AGE GROUP 0 50 100 150 200 0 - 24 25 - 34 35 - 44 45 - 54 55+ COMMENCED SAME DAY/NEXT DAY (where clinically safe and appropriate) 97% of clients commenced MAT on same day or next day from assessment INTERVENTIONS OFFERED AT POINT OF MAT DELIVERY 100% of clients were offered Mental Health Support and Harm Reduction interventions BBV testing, IEP and Sexual Health 350 individuals chose this pathway of MAT related support. The reasons given for not commencing the pathway were: • clients went to prison • not ready to commence MAT but continued to receive support from the wider service NALOXONE AND OVERDOSE AWARENESS 100% 72%* of clients were of clients were supplied offered Naloxone with Naloxone or already had a kit *The remaining 28% declined* CLIENT SATISFACTION Of clients rated their initial waiting time either “excellent” or “very good” 79% 81% Of clients rated the communication from NADARS either “excellent” or “very good” Of clients who were able to commence medication at their initial appointment stated that there were no delays in getting their prescription 95% 95% Of clients felt that they were given sufficient information to make an informed choice on their treatment options 95% Of clients felt that the NADARS worker explained all the care and treatment options in a way that they understood 81% Of clients rated the overall service either “excellent” or “very good” OPIOID SUBSTITUTION THERAPY (OST) MEDICATIONS PRESCRIBED FOLLOWING ASSESSMENT 63% 32% 5% Methadone Espranor/ Buvidal Suboxone This evidences increased patient choice of OST 65
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IMPLEMENTING MEDICATION ASSISTED TREATMENT Developments during 2023/24: • Quarterly reports have been submitted to the Scottish Government evidencing progression across each of the 10 standards from the previous year. • An explicit delivery plan was put in place for delivering trauma informed practice • LOPs, SOPs, guidelines and clinical & care pathways of support were reviewed & updated • MAT availability was increased at Caley court and expanded to 5 days per week. MAT is now available across all 6 localities with immediate support available to all from Caley Court alongside remote (low threshold) access in more rural areas including the islands. • Over 90 individuals currently have ‘shared care’ support with Primary Care colleagues. • A workforce training plan is in place to ensure all staff offering MAT & OST can provide the core harm reduction services at the same time and place as MAT delivery • A robust 7 wide reaching experiential process was implemented by the NA ADP, to capture, analyse and utilise feedback from clients, families and staff to inform service improvement • Appropriate recording information systems were updated to collect and analyse data • In the absence of additional national being able to be accessed, the NA ADP committed non-recurring funding to implement initial MAT 7 (Primary Care) developments at pace. • A new staff guidance document was approved for implementation to provide an ‘interface protocol’ as to how secondary care mental health services & alcohol & drug services can better support individuals with co-occurring mental health and alcohol and/or drug use. Priorities for 2024/25 • Sustained implementation of all 10 MAT standards • Following formal submission of experiential data, we will conduct a local analysis to identify themes for further improvement. • Based on national feedback/approval we will update the NA MAT 7 model & explore options to secure additional funding to deliver, in full by next year, a revised NA implementation plan • Work underway, with all ADP partners, to scope out requirements and system change to support MAT delivery for individuals using Stimulants and Benzodiazepines; • Engage with service users, families and staff to evaluate and learn from the recently implemented MAT 9 related multi-agency ‘operational interface protocol’ to better support individuals presenting with co-occurring mental health and alcohol and/or drug use • For MAT 6&10 a key development/priority is to continue to increase access to psychological interventions and therapies through staff training and ongoing support. INFORMATION AND FEEDBACK 565 referrals were received between 1st April 2023 and 31st March 2024 350 clients commenced MAT support (the others declined service, required preparatory support or disengaged from service) 97% of clients commenced MAT on the same day or next day from assessment (where clinically appropriate and safe) 99% of clients commenced MAT within 1 week Reasons for timescales over 7 days include initial non- attendance with follow up in place Detailed numerical data on referrals, timescales, interventions etc was submitted to MIST in April 2024, which is now being analysed to identify good practice and learning. 66
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IMPLEMENTING MEDICATION ASSISTED TREATMENT EXPERIENTIAL FEEDBACK • To gather feedback and data in a consistent and impartial way, the ADP adopted a multidisciplinary approach by identifying a mixture of service staff and individuals with Lived & Living Experience (LLE) to gather experiential feedback from service users, families/carers of people on MAT, and staff delivering the service. • Individuals identified to carry out the interviews attended a 3-session training course delivered by MIST (national MAT Implementation Support Team). • A mixed methods approach was applied to gather data e.g. 1-1 interviews, smaller engagement events. • The ADP Support Team collated, analysed, and themed the data for submission to MIST (with full involvement of the Experiential Engagement Team and people with LLE). The feedback received was mainly positive and demonstrates the ease of access, increased choice of medications and no barriers to the overall support received. “Everything got dealt with at my initial appointment. Services are totally different now in comparison to years ago so there is nothing I could suggest that would've made it better” “I definitely felt involved in my options. I mind the lassie discussed all available options I could choose from and I think it was Espranor she recommended for me, due to it having a blocker effect, so if I used on top of it there would be no effects. I decided to go for methadone though and my choice was respected.” MIST BENCHMARKING 2024 – SCORING TRACKER Over the last year there has been improvement and progress across all 10 standards 67
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Integration Joint Board 19th September 2024 Subject : 2024-25 – Month 4 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at Month 4 (July). 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 £6.697m, reduced to £2.995m through already identified financial recovery actions; (b) notes the progress with delivery of agreed savings; (c) approves the actions which are being taken to progress financial recovery and that a further recovery plan will be presented to the next IJB; (d) notes the Care at Home recovery actions detailed at Appendix F (d) notes the remaining financial risks for 2024-25; and (e) approves the budget reductions which are detailed at paragraph 2.10 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 Agenda Item 8 69
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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 July, 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 £6.697m (2.1%) for 2024-25, reduced to £2.995m 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: Split TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth4 £6.697m £0.857m £5.840m Less Financial Recovery Plan Projections £3.702m £0.369m £3.333m Residual Risk £2.995m £0.488m £2.507m 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 Whilst the overall projected outturn position has not significantly changed, there are material movements within services, the main movements in the overall projected position and recovery plan are summarised below: Improvement: • Children’s residential places £0.352m Deterioration: • Care Home places £0.063m • LD placements £0.320m 1.5 The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making available interim funds. NHS Ayrshire and Arran and North Ayrshire Council are not in a financial position to make interim funds readily available, therefore it is imperative that the IJB 70
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continues to support the process of development of the Financial Recovery Plan and the actions required to work towards financial balance by the year-end. 1.6 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. 1.7 The Scottish Government have recently announced the 2024/25 funding for the Mental Health Outcome bundle which estimates a 4.5% reduction from 2023/24. Formal confirmation of the funding allocation has not yet been received, but this would equate to £0.450m and the service are currently working through the implications of this reduction. 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 4 At month 4 against the full-year budget of £321.083m there is a projected year-end overspend of £6.697m (2.1%). The Integration Scheme outlines that there is an 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 £5.840m in social care services and a projected overspend of £0.857m 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. Appendix G provides information on the costs of bank and agency staff as requested at the August IJB. 71
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2.3 Health and Community Care Services Against the full-year budget of £90.116m there is a projected overspend of £6.049m (6.7%) (£0.062m adverse movement) and the main variances are: a) Care home placements - the budgeted number of permanent placements was 765 and at month 4 there were 789 placements. The projected overspend is £0.614m (£0.063m adverse) on permanent placements and respite placements are projected to be online (£0.023m adverse movement). A plan is in place to manage down the number of permanent placements to reach the target, however this is challenging due to the need to minimise delayed discharge from hospital and to continue to support those in critical and substantial need in the community. 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 (now all in house) is projected to be £3.254m overspent (no movement). 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 – 4 is skewed because of the transfer of the purchased service at different points so this will be reviewed and refined in month 6 when there will be more representative data. c) Physical Disability Services – projected overspend of £0.682m (£0.030m adverse) split as follows: £1.007m over in residential placements, £0.027m over in direct payments and £0.352m under in community care packages. d) Integrated Island Services is projected to overspend by £0.752m. The most significant variance is a projected overspend at Montrose House of £0.561m which relates to the net overspend on agency staff (i.e. net of underspend on employee costs). e) Specialist Rehab wards – projected overspend of £0.126m (£0.009m favourable) (Redburn ward £0.152m overspend and Douglas Grant £0.026m 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 £0.762m (£0.003m favourable) due to use of supplementary staffing. 72
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2.4 Mental Health Services Against the full-year budget of £107.531m there is a projected overspend of £1.069m (1%) (adverse movement of £0.478m) 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 £0.916m (£0.320m adverse movement) across community care packages, direct payments and residential placements. • Community Mental Health services are projected to underspend by £0.411m (£0.011m favourable) which is mainly due to a projected underspend of £0.541m in community packages and overspends in residential placements of £0.093m and direct payments of £0.055m. 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 £0.106m (£0.035m adverse) 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 £0.658m overspent (£0.137m adverse movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.442m (£0.058m adverse) 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 £0.679m (£0.048m favourable movement) 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, 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 73
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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 £0.538m (£0.011m adverse movement). 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 £0.415m (£0.004m adverse) 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 £0.585m (£0.099m adverse) due to increased demand and cost of medicines. Innovation Fund – projected underspend of £0.112m (no change) 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 2.5 Children and Justice Services Children’s Services Against the full-year budget of £44.045m there is a projected overspend of £1.134m (2.6%) (£0.449m favourable movement) pre earmarking and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £1.369m (£0.352m favourable movement). The main areas within this are noted below: 74
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• Following budget investment of £4m the children’s residential placements are overspent by £1.539m based on 33 placements at month 4 and assumes a reduction to 32 places by month 6. This demonstrates a reduction of 5 places since the start of the financial year. 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 £0.728m underspent (£0.027m favourable movement). • Children with disabilities – there is a net projected overspend of £0.256m (£0.132m adverse movement) 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. • Employee costs – are projected to overspend by £0.216m, largely due to overspends in the children’s houses. b) Head of Service – is projected to underspend by £0.524m (£0.053m favourable movement). 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 23-24 and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children, which is projected to over-recover by £0.819m and which covers costs incurred across a number of C&F service areas. 75
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c) C&F Health Team – is projected to overspend by £0.246m (£0.015m favourable) 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 £0.012m 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 £1.293m (£0.068m adverse) and the main areas of underspend are: • There is projected slippage on the LD and MH transition funding of £0.661m 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 £0.296m 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 1.818m Over/(Under) Achievement 0.500m 0.296m 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 2024-25 indicate a reduction in the turnover being projected, which reflects a more 76
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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 4 £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. Reductions Requiring Approval: Ref Description Amount (£000) 1 Post to medical records (37) 77
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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 4 the MH lead partnership is projected to overspend by £0.658m (£0.215m NRAC share for East and £0.188m for South). South HSCP (month 3 info) – 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. East HSCP - projected underspend of £0.208m (£0.176m favourable movement) in total (of which £0.077m will be allocated to North). The main variances are: Allied Health Professions (Lead Partnership) There is a projected underspend of £0.431m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings in Physiotherapy / MSK and Podiatry services and is partially offset by increased Orthotics costs. Primary Care and Out of Hours Services (Lead Partnership) There is a small projected overspend of £0.023m on the Primary Care Lead Partnership budget and additional costs in Out of Hours services £0.371m, with work ongoing to mitigate increased costs as far as possible over the course of the 2024/25 financial year and going forward, as well as additional Primary Care contracting and support costs £0.024m. These additional costs are largely offset by a projected underspend in Dental services totalling £0.219m, where staffing numbers are running at less than establishment. Recruitment over the remainder of the financial year has the potential to impact further on the projected outturn position at month 4. In addition, there is a small saving on Primary Medical Services costs £0.152m. Prison and Police Healthcare (Lead Partnership) The £0.043m projected underspend at month 4 is largely due reduced staffing costs. 78
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Other Services (Lead Partnership) The £0.243m projected overspend is due to increased Area Wide Evening Services costs, mainly due to additional staffing costs including high use of bank staff, which will require to be addressed going forward. 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 £432.3m. The directorate overspent by £11.2 million after 4 months. This was caused by overspends on agency medical and nursing staff, together with drug expenditure including the New Medicines Fund, equipment and supplies. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland. 156 additional unfunded beds remained open across both main hospital sites during July. There is a material underlying deficit caused by: • Unachieved efficiency savings • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are 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. 79
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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 announcements by Scottish Government in relation to public sector finances and in-year spending reductions will 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. • 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. 80
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• 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. Non- recurring funding has been provided to meet costs associated with this but it is unclear whether this will be sufficient. These risks will continue to be monitored during 2024-25. 2.13 RESERVES The IJB reserves position is summarised in the table below. 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 Anticipated Drawdown (0.357) (3.379) (1.202) (4.938) Balance – 31 March 2025 - - 0.572 0.572 The £1.774m HSCP earmarked reserve relates to the Service Redesign and Change Fund; of this total only £0.096m currently 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. Further detail on the reserves is given in Appendix D. 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, work has continued to develop the financial recovery plan and identify further targets for financial improvements. The current plan is outlined in full at Appendix E. 81
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There has been progress towards some of the targets, and these are already reflected in the current projected outturn of £6.697m 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. A summary of the Care at Home plan is included at Appendix F. 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. • Restrictions on all but essential overtime working. • 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. 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. Meetings have now been scheduled to the end of the year and the first meeting took place on 9th September. 82
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• 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: Split TOTAL Health/NHS AA Social Care/NAC Projected Overspend @ mth4 £6.697m £0.857m £5.840m Less Financial Recovery Plan Projections £3.702m £0.369m £3.333m Residual Risk £2.995m £0.488m £2.507m 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. 83
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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 £6.697m (2.1%). 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 £2.995m 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. 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. 84
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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]- 85
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PUBLIC INFORMATION 2024-25 Budget Monitoring Report–Objective Summary as at 31st July 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 £'000 £'000 COMMUNITY CARE AND HEALTH 71,300 76,257 4,957 18,816 19,908 1,092 90,116 96,165 6,049 5,987 62 : Locality Services 30,392 31,227 835 5,366 5,410 44 35,758 36,637 879 795 84 : Community Care Service Delivery 36,732 40,208 3,476 0 36,732 40,208 3,476 3,447 29 : Rehabilitation and Reablement 2,099 2,116 17 0 2,099 2,116 17 35 (18) : Long Term Conditions 987 997 10 9,459 10,373 914 10,446 11,370 924 927 (3) : Community Link Workers 358 358 0 0 0 0 358 358 0 1 (1) : Integrated Island Services 732 1,351 619 3,991 4,125 134 4,723 5,476 753 782 (29) MENTAL HEALTH SERVICES 34,339 34,858 519 73,192 73,742 550 107,531 108,600 1,069 591 478 : Learning Disabilities 25,723 26,640 917 556 555 (1) 26,279 27,195 916 596 320 : Community Mental Health 6,575 6,165 (410) 1,739 1,738 (1) 8,314 7,903 (411) (400) (11) : Addictions 2,041 2,053 12 1,899 1,899 0 3,940 3,952 12 15 (3) : HBCCC 0 0 0 353 247 (106) 353 247 (106) (141) 35 : Lead Partnership Mental Health NHS Area Wide 0 0 0 68,645 69,303 658 68,645 69,303 658 521 137 CHILDREN & JUSTICE SERVICES 39,130 40,018 888 4,915 5,161 246 44,045 45,179 1,134 1,583 (449) : Irvine, Kilwinning and Three Towns 3,054 3,086 32 0 0 0 3,054 3,086 32 25 7 : Garnock Valley, North Coast and Arran 3,206 3,249 43 0 0 0 3,206 3,249 43 40 3 :Intervention Services 1,716 1,715 (1) 0 0 0 1,716 1,715 (1) 7 (8) : Care Experienced Children & Young people 27,185 28,554 1,369 0 0 0 27,185 28,554 1,369 1,721 (352) : Head of Service - Children & Families 1,082 558 (524) 0 0 0 1,082 558 (524) (471) (53) : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 0 0 : C&F Health Team 415 384 (31) 4,203 4,449 246 4,618 4,833 215 261 (46) : Lead Partnership NHS Children's Services 0 0 0 712 712 0 712 712 0 0 0 CHIEF SOCIAL WORK OFFICER 1,561 1,573 12 0 0 0 1,561 1,573 12 (62) 74 PRIMARY CARE 0 0 0 53,109 53,109 0 53,109 53,109 0 (42) 42 ALLIED HEALTH PROFESSIONALS 0 10,306 10,306 0 10,306 10,306 0 0 0 MANAGEMENT AND SUPPORT COSTS 9,038 8,500 (538) 4,407 3,652 (755) 13,445 12,152 (1,293) (1,361) 68 FINANCIAL INCLUSION 970 972 2 0 0 0 970 972 2 (13) 15 OUTTURN ON A MANAGED BASIS 156,338 162,178 5,840 164,745 165,878 1,133 321,083 328,056 6,973 6,683 290 Over/ (Under) Spend Variance at Period 3 Movement in variance from Period 3 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget 86
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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 £'000 £'000 Return Hosted Over/Underspends East 0 0 0 0 (215) (215) 0 (215) (215) (171) (44) Return Hosted Over/Underspends South 0 0 0 0 (188) (188) 0 (188) (188) (149) (39) Receive Hosted Over/Underspends South 0 0 0 0 204 204 0 204 204 204 0 Receive Hosted Over/Underspends East 0 0 0 0 (77) (77) 0 (77) (77) (12) (65) OUTTURN ON AN IJB BASIS 156,338 162,178 5,840 164,745 165,602 857 321,083 327,780 6,697 6,555 142 Over/ (Under) Spend Variance at Period 3 Movement in variance from Period 3 Partnership Budget - Objective Summary 2024/25 Budget Council Health TOTAL 87
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PUBLIC INFORMATION 2024-25 Savings Tracker Appendix B Social Care: Description Deliverability Status at budget setting Deliverability Status at Month 4 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 88
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 4 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 89
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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 0.002 Social Care Budget Reported at Month 3 156.338 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 90
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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 Reduction to the Working Week (mth 2 - 4) 4 0.105 Post to medical records 4 (0.037) HD107: breast Feeding project funds 4 0.056 BBV 4 0.280 Anticipated budgets assumed in the report but not yet allocated 4 2.045 Health Budget Reported at Month 4 164.745 TOTAL COMBINED BUDGET 321.083 91
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PUBLIC INFORMATION 24-25 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2024 2024-25 Anticipated Draw Downs Projected Balance at 31 March 2025 : Alcohol & Drug Partnership 641 (641) 0 : Mental Health Action 15 57 (57) 0 : Service Redesign / Challenge Fund 1,774 (1,202) 572 : Community Living Change Fund 377 (377) 0 : Family Wellbeing Fund 1,313 (1,313) 0 : Wellbeing Fund 50 (50) 0 : Breast Feeding Network 26 (26) 0 : MH Recovery and Renewal 546 (546) 0 : Buvidal 23 (23) 0 : Brooksby 5 (5) 0 : Cossette Funding 4 (4) 0 : Expansion of Primary Care Estates 55 (55) 0 : GP Premises Improvements - tranches 1 and 2 63 (63) 0 : Mental Health Wellbeing in Primary Care 81 (81) 0 : Dental Practice Improvement 29 (29) 0 :Appropriate Adult Scheme 2 (2) 0 :Adult Tier 3 Weight Management Service 19 (19) 0 : Phlebotomy 22 (22) 0 : LD Health Checks 66 (66) 0 Total Earmarked 5,153 (4,581) 572 Unallocated General Fund 357 (357) 0 General Fund 5,510 (4,938) 572 Earmarked Funds 92
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E FINANCIAL RECOVERY PLAN £m £m £m Projected Overspend at Month 4 6.697 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) (0.086) (0.614) June IJB Reduce CAH capacity/delay recruitment/in- house efficiencies (0.850) 0.000 (0.850) June IJB Community Wards - reduce supplementary staffing and review bed capacity (0.500) (0.247) (0.253) 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 (0.106) (0.106) 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%) (0.314) (0.198) (0.116) Children and Families Reduce children's external placements - early reduction from Brighter Pathways work (0.500) (0.500) 0.000 June IJB Additional target re-residential placements (0.500) (0.229) (0.271) August IJB Additional target re-residential placements (0.225) 0.000 (0.225) September IJB Reduce investment in C&F social work via service redesign fund (0.300) 0.000 (0.300) September 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 Review of earmarked reserves (0.216) 0.000 (0.216) September IJB Target Achieved Outstanding (5.068) (1.366) (3.702) Remaining projected overspend 2.995 93
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PUBLIC INFORMATION Appendix F - Care at Home Recovery Plan 1. Situation The overspend on Care at Home is reflective of an increase in the overall capacity and complexity of need within the service, alongside a rise in service costs, as we strive to meet the growing level of demand in our communities and to support hospital discharge(s). The Care at Home Service in North Ayrshire has seen a 50% increase in the number of annual care visits in the last 4 years. Below summarises the budget and spend position for Care at Home Services since 2019. The Care at Home budget has increased significantly since 2019-20 with an overall increase of £9.8m over that period, however most of this increase is directly related to pay inflation with the only additional funding for additional capacity being £3.4m to support with winter pressures. The Care at Home budget has been relatively static in real terms against a backdrop of a significant increase in demand. The Care at Home service has a budget of £30.061m for 24/25. This is inclusive of Care at Home services delivered via SDS Option 2 and 3. Currently this is projecting an overspend of £3.255m for 2024/25 financial year. As part of the overall Financial Recovery Plan for the IJB there is a requirement for a reduction in current spend in-year, with a move to working towards delivering services within budget thereafter. A £1m savings target was identified for the Care at Home service to deliver in 2024-25. 94
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PUBLIC INFORMATION 2. Background Self-Directed Support is the way that care and support is delivered in Scotland, providing people with options, choice and control. From 2019 to 2023, the landscape for Care at Home delivery in North Ayrshire has been very fragile with 5 Care at Home providers exiting the market for the provision of care in an unplanned basis. In July 2024 the delivery of Care at Home supports in North Ayrshire, via Self Directed Support Option 3, moved to a fully inhouse model. This change in the way care is delivered was reflective of a number of factors including quality and the safe delivery of care and support. Currently there are over 2,000 people in receipt of care and support via Care at Home, with 92% receiving services through the Partnership’s inhouse Care at Home service. The Partnership utilises eligibility criteria to deploy its available resources, with priority given to those adults with the greatest need. Care at Home supports are provided across the 4 mainland localities in North Ayrshire, and on the islands of Arran and Cumbrae. Since 2020, to date, there has been a 40% increase in the planned hours of care delivered by the inhouse Care at Home service, with a 50% increase in the individual number of care visits provided over this same period. Staffing levels for the Partnership’s inhouse Care at Home service have also increased over this same period by 50% from 653 contracted staff in 2020 to 981 in August 2024. Whilst the growth in the Partnership’s Care at Home service is evident, demand for Care at Home supports has risen by around 30% from pre pandemic levels. Whilst there is robust application of criteria to access services, and use of initiatives such as reablement designed to only provide shorter term supports and to reduce levels of dependency, social work and service delivery teams report significant changes in the complexity of need required in supporting people in the community. This is demonstrated by the Job Evaluation and regrading of the Partnership’s Care at Home Assistant role in 2023, which reflected the change in the role and the skills required to provide more complex and intensive community Care at Home supports. Unfortunately, Health and Community Care teams continue to manage a significant waiting list for community and hospital referrals which is a result of aforementioned increase in referral activity and complexity of need. Given the waiting list for supports, and levels of unmet need, a priority of need is applied to those who are waiting supports – this prioritises people with care needs associated with end-of-life care, public protection and hospital discharges. Levels of unmet need can fluctuate and are influenced by peaks in demand. Below illustrates the priority of need framework used by Care at Home services to prioritise demand, unmet need and waiting lists from the Community and Hospital: 95
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PUBLIC INFORMATION Positively, community unmet need has reduced since December 2023 when 193 people in the community were awaiting a new package of care, with 166 waiting as at August 2024. Levels of delayed discharge associated with Care at Home had shown signs of improvement earlier in 2024, however this improvement wasn’t sustained and as at reporting in August 2024, 24 people were a delayed discharge awaiting a package of care. Overall, 76% of unmet need for care at home is for people waiting in the community for care. The Partnership also provides a Community Alarm and Telecare service to over 4,000 people across Ayrshire. The alarm service generates around 450k activations on an annual basis with requests for support directed to identified contacts and, where appropriate, to the Partnership’s responder service who provide approximately 6,000 physical responses to North Ayrshire service users on a monthly basis. The Community Alarm and Telecare service is in the process of transitioning from analogue to digital technology. 3. Plan As part of the financial recovery plan, targeted savings for the remainder of the financial year 2004-25, have been identified from the Care at Home service. The vast majority of the service cost is workforce and any reduction in workforce will inevitably result in reduced service capacity. The required service changes include a reduction in the inhouse workforce (circa 1,062 weekly hours), reduction in Self Directed Support (Option 2) spend and actions related to the management of spend and approval of additional staffing costs linked to vacancies and sickness absence. It is proposed that workforce changes will be achieved by natural turnover and a targeted recruitment freeze, alongside careful future targeted recruitment activity to maintain safe care delivery. 96
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PUBLIC INFORMATION The planned reduction is estimated to deliver an in-year 2024-25 reduction of £0.850m against an original target of £1m, this is deemed to be the maximum reduction which can safely be delivered in-year. The reduction in Care at Home workforce will result in an overall reduction in Care at Home capacity within the service. Whilst efforts will be made to minimise the impact of this and to manage any resultant risks and challenges. A summary of these is provided below: Risks/Impacts • Reduction in capacity will reduce the volume of Care at Home supports which the Partnership can provide and may result in longer waiting times to receive care • A disproportionate impact on people awaiting services in the community as we continue to prioritise urgent referrals and hospital discharge • Reduction in capacity may result in increased delays in people being able to access Care at Home supports, both from the community and to support hospital discharge - approximate increase to the waiting list(s) combined of 56 people (3%) however this may vary dependent on hours/care requirements • Impact on other people and services – for example length of stay in hospital, access to community rehab beds, requirement for access to long term care settings • Increased reliance on informal supports and carers • The service may be less flexible/responsive to critical care requests • Seasonal/Winter responsiveness • Greater risk of workforce pressures • There will not be the same level of capacity to absorb and respond to any potential future unplanned care provider market issues Whilst the above outlines the potential impact of this change and reduction in care capacity, the below are a range of management mitigations either in place or proposed to reduce this and to manage risk. Mitigations • Continue to follow the existing priority of need framework which ensures those most in need of the service will be prioritised • Weekly unmet need oversight and assurance group, which includes arrangements for how service users are contacted whilst they wait • Recruitment to 6-month reablement lead to re-establish and promote reablement service provision • Reablement Service Access pilot expansion • Consider wider ‘access to service’ opportunities for demand management • Care Monitoring System review to maximise efficiency in existing service delivery • Programme of Care at Home reviews for existing users 97
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PUBLIC INFORMATION • Scaling up use of technology and Community Alarm/Telecare • Closely monitor absence and vacancy levels on a weekly basis • Continue to recruit to casual workforce to promote and develop contingency options • Refresh service wellbeing at work strategy to minimise staff absence levels through sickness • Protect and promote the Community Alarm and Telecare Service, particularly to those service users awaiting a service 98
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PUBLIC INFORMATION Bank and Agency Costs to Month 4 Appendix G 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) TOTAL AAC074 NORTH CORE SLT ADULT 5,412 5,412 AAC403 WARD 1 WOODLANDS VIEW 25,510 137,942 163,452 AAC406 WARD 2 WOODLANDS VIEW 15,759 93,103 108,861 AAC410 ACH REDBURN REHAB WARD NRS 1,587 39,712 41,299 AAC412 ACH DOUGLAS GRANT REHAB WD NRS 6,446 33,955 40,400 AAD401 WARD 3 WOODLANDS VIEW NURSING 17,386 117,487 447 135,320 AAD402 WARD 4 WOODLANDS VIEW NURSING 21,871 101,551 185 123,607 AAH047 NEW CLONBEITH NURSING(JURA) 51,193 34,734 85,927 AAH415 WVIEW THE GLEN ECT 1,611 1,611 AAH417 WVIEW WARD 10 ACUTE MH NRS 22,585 31,444 54,029 AAH423 WVIEW WARD 8 ACUTE MH NRS 10,300 303,301 251 313,852 AAH460 WARD 5 WOODLANDS VIEW 5,940 9,978 15,919 AAH466 WVIEW WARD 7B REHAB MH NRS 2,103 2,103 AAH492 NEW DUNURE NURSING(CLONBEITH) 17,669 56,237 73,905 AAT001 TRINDLEMOSS 26,773 46,783 73,556 AAW047 ARRAN HOSPITAL NURSING 11,398 16,007 5,717 33,122 ACN004 PACKAGE OF CARE (P) - CY 10,198 10,198 ACN012 PACKAGE OF CARE (P) - AMG 18,187 18,187 ACN013 PACKAGE OF CARE (P) - LMO 3,368 3,368 ACP003 NC POC TEAM 3 966 966 ACA412 CAMHS UNSCHEDULED CARE 1,703 1,703 ACF002 EARLY YRS-C/F TEAM 2 290 290 ACN047 ARRAN DN 235 235 ADN000 THREE TOWNS DN 4,284 161 4,446 ADN033 IRVINE DN 9,597 9,597 ADN042 NORTH WEST COAST DN 235 99 334 ADN075 GARNOCK VALLEY DN 38,464 38,464 ADN080 NORTH DN TEAM LEADERS 3,360 3,360 ALA047 LADY MARGARET NURSING 5,935 2,012 7,947 AMA408 PREVENTION + SERVICES SPT TEAM 1,481 1,481 AML102 MH UNPACS (PRIVATE) 0 0 AML146 LD HEALTH CHECKS 51,594 51,594 AML392 NORTH CLDT 157 157 AML402 LDS MANAGEMENT 2,129 2,129 AML500 MHS INPATIENT MGT 13,137 13,137 AMN412 CMHT NURSING-NORTH AYRSHIRE 6,609 6,609 AMN415 WVIEW WARD 7C FORENSIC REHAB N 1,950 45,193 47,143 AMN419 DAY ACTIVITIES TEAM 227 227 AMN425 INTENSIVE COMMUNITY NURSING TEAM 8,845 8,845 AMN431 ADULT MENTAL HEALTH LIASION TEAM 2,295 2,295 AMN433 PCMHT NORTH 1,663 1,663 AMN446 WVIEW WARD 6 LOW SECURE NRS 27,425 79,182 106,607 AMN454 WARRIX AVE 6,071 7,342 13,413 AMN468 ACTION 15 - ADULT LIAISON 2,951 2,951 ANU632 ICFN - COMMUNITY PHLEBOTOMY 5,860 5,860 AWV438 WVIEW WARD 7A LD A+T NRS 5,532 211,353 250 217,136 AXC407 WVIEW WARD 9 ACUTE MH NRS 16,258 54,635 70,894 AXC418 WVIEW WARD 11 ACUTE MH NRS 35,370 129,107 257 164,734 TOTAL 477,553 1,603,525 5,878 1,391 2,088,346 2) SOCIAL CARE Agency Cost Montrose House 252,121 Acm - Irvine 1,188 Mh Acm 15,895 Ld Acm 7,826 TOTAL 277,030 Bank Agency 99
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Integration Joint Board 19th September, 2024 Subject : Transformation Plan Progress Update Purpose : This update is for awareness and to assure IJB of progress. Recommendation : The IJB should note the progress 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 HSCP Health and Social Care Partnership IJB Integration Joint Board PID Project Initiation Document 1. EXECUTIVE SUMMARY 1.1 The North Ayrshire HSCP Transformation Plan 2024-27 is an ambitious programme of change consisting of a range of improvement and reform 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. 1.2 This report highlights key activity and general updates on progress made in the six months since approval. 2. BACKGROUND 2.1 The Plan was approved by IJB in March 2024. Since that time the financial outlook has deteriorated, and the need for transformation and the redesign of services has become more urgent and more important to the long-term sustainability of the functions for which we are responsible. 2.2 Since approval in March the Transformation Board has updated their Terms of Reference and approach, and many new projects have been initiated across every area of the partnership. Agenda Item 9 101
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Key Activity 2.3 In April the Transformation Board agreed governance and approach, including Terms of Reference, format of meetings, and project management methodology (including template documents). It was agreed that each meeting would have a ‘Focus On’ a specific area of the Transformation Plan, but with space on the agenda for raising Risks, Issues, Requests, or Successes from any area of the plan, particularly where a time-critical decision is required. 2.4 May had a ‘Focus On Transformation’ and the board was updated on Workforce Planning, and agreed to the development of a HSCP Digital and Data Plan. Also in May, two members of the transformation team were successful in achieving a fully funded place on Cohort 23 of NES' Digital Health and Care Leadership Programme (DLP). This programme supports Scotland's Digital Health and Care Strategy and Delivery Plan and aims to: maximise the potential of digital solutions to benefit people; and, to support participants to develop the strategic leadership skills required to influence the use of digital solutions in health and social care delivery. 2.5 June ‘Focus on Adult Health and Community Care’ had seven new projects being initiated in that area, and an additional project request approved. June also saw the first Ayrshire-wide Innovation Network Event with over 80 attendees and presenters from across Scotland sharing examples of innovation to support transformation of health and social care services across Ayrshire. 2.6 August ‘Focus on Mental Health and Learning Disabilities’ had eight new projects initiated. 2.7 The second Ayrshire-wide Innovation Event took place on 10th September and had a range of examples of innovation and transformation, including an overview of a new companion robotic device from the National Robotarium, as part of an early intervention and prevention model of care. Later in September the Transformation Board will have a ‘Focus on’ Children, Families and Justice. 2.8 Coming up: October is a ‘Focus on Transformation’ again, including the Workforce Plan 2 Year Report, and the new Digital and Data Plan. November will ‘Focus on Partnership-wide Projects’. 102
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Service Updates 2.9 Adult Health and Community Care • The Anam Cara refurbishment project, completed and Anam Cara re-opened on 18 March 2024. • The Alarm Receiving Centre project concluded, with a new supplier appointed and contract commencing on 1 May 2024. • The Care at Home Review concluded in June 2024 with the successful transfer for SDS Option 3 supports to inhouse Service Delivery. • The packages of Care Project has concluded the initial analysis and review stage. This will now move to an options appraisal with a draft report setting these out, and detailing service risks and challenges. • The Analogue to Digital project continues with 85% of digital alarms installed across North Ayrshire. National timescales associated with the Analogue to Digital transition have now been extended with the phase out of analogue lines not expected to complete until 2026/27. The project has a final stage for completion and this is expected to conclude mid-2025. The project has secured additional funding to offset inflationary rises and costs of digital technology. • The Blue Badge Scheme Review is on track, with refreshed processes leading to significant streamlining. • The Community Rehab Project has started, with a draft PID and initial workshop completed, and the PID is expected to be approved and endorsed by the end of October 2024. A Community Rehab Programme Board has been established and will oversee the progress of the project and associated workstreams. • The Enhanced Intermediate Care Team review is advancing with four subgroups established to consider specific service areas, and the work of this will also link into the community rehab project. • The Palliative and End of Life Care Group has established and a project PID due to be submitted for endorsement. The group will take forward agreed Caring for Ayrshire outputs. • The Technology First Project has held its initial meeting and a staff questionnaire has been issued to help focus the scope of works. Ongoing scoping continues and a technology hub is being explored. 103
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• The Day Service Review has identified £100,000 in savings for the current financial year and is now focusing on securing £200,000 per annum budget savings from year two onwards. The Review work is ongoing and will ensure engagement with key stakeholders as part of the process. • The Delayed Discharge and Winter Preparedness Project continues, with a recent workshop to review and refresh the action plan. The group will agree a plan for winter 2024/25 and implement an oversight group to monitor the progress of this. • The Arran Single Point of Contact project is delayed due to pending IT infrastructure upgrades at Arran War Memorial Hospital. However, the initial setup for Netcall is being reviewed prior to sign off. A testing and training period will follow before a 'go live' date is agreed. • Home First Strategy has experienced delays due to capacity issues within the staffing resource. The strategy is now unlikely to meet its November 2024 deadline, and a report will be submitted to the Transformation Board outlining the issues and identifying mitigation actions. 2.10 Children, Families and Justice • Brighter Pathways Board set up and meeting regularly. Terms of Reference and PID are agreed. All workstreams have commenced except for Children’s Houses- Model of Care (Scheduled for 18th September). Crisis Support & Early Intervention Service mapping has taken place with a view of identifying any gaps in service provision, with the view of developing solutions (where possible). New UASC Policy has been developed. New Supported Carer Policy agreed. An update will be provided to Transformation Board in September. • Neuro Developmental Supports (this is a lifespan focus not just Children’s) is progressing well: workstreams have commenced and a new strategic group launched (chaired by Caroline Cameron). This has oversight of a Neurodevelopment implementation group for both Children and Adults building on the work of the two extreme teams. A business case is being developed with a full options appraisal for a preferred solution for a diagnostic service and the investment required. This will include options for a preferred model, workforce and digital solutions. • The work to review the North Ayrshire Justice Court team is underway and we’re currently collating data from the Service to assist with developing an Options Appraisal Paper. • The Transport Provision PID is in development, will be taken to Transformation Board in September. 104
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2.11 Mental Health and Learning Disabilities • MAT Standards have continued to be rolled out and North Ayrshire received green and provisional green (where evidence did not reach 12 months of data) from the MAT Implementation Support Team (MIST) in their benchmarking report. • Adult Community Mental Health Nursing team has begun to use TrakCare for all appointments again which allows for more visibility of service user appointments across the system and better data collection. • Scottish Government has awarded North Ayrshire HSCP funding for 2024/25 to start an Early Intervention in Psychosis service. • The Intensive Support Service for Learning Disabilities has launched with Nursing, Occupational Therapy and a Nurse Support Worker. While there have been challenges with recruiting, the service has been supporting individuals experiencing delayed discharge within Ward 7A, and those living in the community but at risk of placement breakdown. Along with supporting individuals with interventions, linkage to their community, and connection with third sector partners such as TACT and Neighbourhood Networks, the team has also been supporting carers and staff teams. It has seen a variety of positive outcomes, including successful engagement with individuals who did not previously engage with services. • A review of the Adult Community Mental Health Service is underway. Data and research is being gathered to inform the project group of the current state and best practices from around the world. Staff engagement is due to start Monday, 9 September with Service User engagement scheduled to begin shortly thereafter. The project is on track to deliver recommendations by early 2025. • The Community Wellbeing services are being looked at through a cross-functional project bringing together Mental Health & Learning Disabilities and Health and Community Care. This project will take a particular look at the commissioned service provision across the partnership, come up with recommendations for savings of £100,000 and look at how best to structure Wellbeing services for an efficient, integrated and inclusive approach. The PID for this project is scheduled to go to the Transformation Board Meeting on Monday, 9 September. • Work continues for the Digital Programme with more Mental Health Services making a coordinated transition onto TrakCare patient management system. Concurrently, a review of the entire digital landscape for Mental Health services across Ayrshire and Arran is underway with a report of work required to achieve the aims of the national strategy is expected to be complete by October 2024. 105
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• A draft PID has been developed for the Implementation of the National Specification of the Care and Treatment of Eating Disorders which is expected to deliver improvements to the Community Eating Disorders service. • As part of the Extreme Team implementation plan to improve support for people with disabilities throughout their life course, two engagement sessions have taken place with relevant teams with a further two sessions planned in the coming months. A dedicated Service Manager post has been recruited with the appointee due to begin on 28 October with two Senior Practitioner posts expected to follow thereafter. This will build stability within the teams and support any changes to practice that may be necessary. • Review of Out of Area placements has been ongoing via the Learning Disability Social Work team. • As part of the models of care work at Woodland View, a Project Initiation Document has been drafted with a view to developing a business case for an Alcohol Related Brain Damage service. This is following a prolonged pilot process to gather demand data. A workshop has also taken place with a number of relevant stakeholders to help with the business planning process. • An initial scoping and information gathering meeting has taken place to address overspends in Woodland View, a PID is being developed to outline how best to go about this project. • Recruitment and retention of staff in Ward 7A (assessment and treatment ward for clients with Learning Disabilities) has been increasingly difficult. We are currently looking at contingencies to mitigate the immediate circumstances and work will progress in the near future to further explore the best model of care for the needs of the client group. • While the MAT Standards Implementation is predominantly complete, the implementation of MAT Standard 7 involving the right to receive this service in Primary Care settings does not currently have recurring funding. By the end of 2025/26 financial year the funding allocated to getting this service started will run out and no permanent funding stream has currently been identified. 2.12 Partnership Wide • The Carers Gateway North Ayrshire Service is now embedded with full recruitment and outreach model operating across all localities and school clusters offering support on carers doorsteps and in community spaces. Development of carer information and self-help continues on the Carers Gateway website and with Bridgit – online digital resource. Short breaks fund has opened with 53 applications in the month of July. Engagement with carers on Arran has been a great success as was the inaugural Carers Conference in June where 120 carers 106
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and professionals came together. Locality roadshows are set for Arran, Kilwinning and Garnock Valley. The Gateway are soon to recruit a Carer Support Role (Health) covering community hospital and primary care settings to support carers at the point of hospital discharge and will begin Carers Champions Board training and preparation in October to replace the longstanding HSCP Carers Advisory Group. NAHSCP Carers Team will also be submitting a proposal to Council to commit to the Young Carers Covenant to continue to support change and equal futures for young carers. • The implementation of the agreed recommendations from the SDS learning review are ongoing in partnership with Horizons Research. We are currently drafting the ethics of care framework, have produced a draft Public Value Proposition and accompanying set of ‘Anchors’ to guide staff. The front face of an SDS website is being designed and populated, NAHSCP SDS Policy being drafted and change stories being gathered to tell the story of SDS in a different or more relatable way. Three SDS sessions have been offered to HSCP Team Management staff to consider what change, control and flexibility looks in their service with the final session scheduled for 27th September. • The Front Door Review has been underway since January 2024 and is making good progress, with consideration now being given to key design features of any alternative model of provision. The review is on track with recommendations due in December. • The development of the Digital & Data Plan is also well underway with a staff survey of current digital experience, and a Landscape Review both now complete. The Plan is due to go to Transformation Board in October. • The 2 year report for the current workforce plan 2022-2025 is being developed and will be published later this year. This will report the progress of delivering the workforce plan and identify any actions that may need to carry over into the next plan. The Workforce Plan for 2025-2028 will begin with the evaluation of the current plan, and incorporate information from the census and labour market forecasting data to identify the future health and care needs of North Ayrshire. Work to develop the new strategy will begin early next year. • The implementation of our new information recording system for social care, Eclipse, is progressing. The development of all service defined recording processes is almost complete and the focus of works is now transitioning to the preparation of essential statutory, strategic, and management reporting in advance of launch. A ‘go live’ date is to be agreed very soon and that will provide a renewed focus for the staffing group using the new system in support of the training to be delivered. 107
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3. PROPOSALS 3.1 It is proposed that IJB note the progress to date. 3.2 Anticipated Outcomes Informing IJB and the people of North Ayrshire on the progress of the Transformation Plan, and also providing assurance of the governance arrangements and that the Transformation Board has appropriate oversight. 3.3 Measuring Impact Stakeholders are assured of progress. 4. IMPLICATIONS 4.1 Financial A number of the transformation projects will deliver financial savings once they are fully operational; financial targets are being finalised as part of the budget development for 2025/26 and will be reflected in the Medium-Term Financial Outlook. 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. 108
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5. CONSULTATION Consultation has taken place with Planning Managers in the Transformation Team, and with the Transformation Board. Lee Ballantyne, Senior Manager (Strategic Planning and Transformation), LeeBallantyne@north-ayrshire.gov.uk Appendices • Transformation Plan • Transformation Board Terms of Reference 109
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Children, Families and Justice Services √ √ Develop Throughcare and Aftercare Policy with Housing providers Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ Grow and nurture and increase Foster placements and supported carers - recruitment, policy and support Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ Develop pathway to Residential School Placements with Education Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ √ Reconfigure Model of Care in Children's Houses Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ √ Early intervention and crisis/intensive support pathways Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ √ Strategic Needs Assessment/Data/Workforce Plan, Initiate, Monitor Monitor, Close by Mar 26 x √ √ √ Best Practice Models and research Plan, Initiate, Monitor Monitor, Close by Mar 26 x Transport provision √ √ Transfer children's transport provision to the HSCP and reconfigure how service is provided moving away from single journey taxi provision Plan, Initiate, Monitor, Close by end 24 x x CF&J SMT North Ayrshire Justice court team √ Carry out a review of the current delivery model at Kilmarnock Sheriff Court. Plan, Initiate, Monitor, Close by end 24 x x CF&J SMT Family Support - Early Intervention and Crisis Approaches √ √ √ √ In line with Whole Family Wellbeing Funding and investment in Early Intervention Teams review approach to crisis response (eg Rosemount and Whole Family Wellbeing Service) Plan, Initiate, Monitor Monitor, Close by Mar 26 x CF&J SMT Neurodevelopmental Supports - Children √ √ √ √ √ Implement the Neuro Specification for Children and Young People Plan, Initiate, Monitor Monitor Monitor, Close North Ayrshire Lifespan Neurodevelopment strategy group Re-modelling Children's Care Options Strategic Priorities Brighter Pathways Programme Board Project Profiling Primary Project Governance Route 110
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route Mental Health and Learning Disabilities √ √ √ √ Continued programme of review of inpatient models of care with a focus on promotion and expansion of community rehabilation models of care for mental health, building on learning from Warrix Avenue.This will include development of business cases for ARBD (Alcohol Related Brain Damage), CAMHS tier 4, forensic provision, community based forensic rehabilitation, EMH phase 3 ACH site (Caring for Ayrshire) Monitor, Close x x Income generation for national highly specailist service gap in forensic services to other boards - Low secure & forensic rehabilitation Plan Monitor, Close x Income generation for national specialist inpatient services gap (IPCU) bed to other Boards Plan Monitor, Close x Review and extend programme of inpatient income generation SLA's including AMH services to other boards. Plan, Initiate, Monitor Monitor, Close x √ √ √ Workforce redesign in alignment with new models of carel Plan, Initiate, Monitor, Close x x √ Review high cost placements including UNPACS Plan TBC (based on Plan) TBC (based on Plan) MAT Standards √ √ √ √ √ Set up the systems required to report on Medical Assisted Treatment standards for Addictions and roll out the 10 standards across NA. The programme will be run on a pan ayrshire basis led by NA. Includes dual diagnosis pathway development. Monitor, Close x x North Ayrhsire MAT implementation group & Pan Ayrshire MAT oversight group √ √ √ √ √ Building on the business case development for MH Primary Care and investment in SW and MHO capacity in Mental Health Community Services undertake a review of CMHT/Primary Care MH service configuration, access criteria, pathways and capacity. Ties in with meeting Adult Secondary Mental Health Services Quality Standards Plan, Initiate, Monitor, Close x x √ √ √ √ √ Launch a pilot Early intervention in first episode psychosis service - revisit business case, bid for national funding Initiate, Monitor, Close (if funded) x x √ √ √ √ √ Review community recovery and rehab service provision across 3rd sector, Recovery College, Acorn, mental health in primary care and community link workers. Plan, Initiate, Monitor, Close x x √ √ √ √ √ Launch the LD Intensive Support Team and monitor progress of assessments of out of area placements. A dynamic register should be developed and maintained which will feed into national data. Monitor Monitor, Close x √ √ √ √ √ Review provision Acute Assessment model (Ward 7A) based at Woodland View alongside community models and in alignment with IST service Plan, Initiate Monitor, Close x √ √ √ √ √ Implement recommendations from Extreme Team - Supporting People with Learning Disabilities through the whole life course Monitor Monitor Monitor, Close Community Mental Health Services and Primary Care Mental Health services Extended Pan Ayrshire SMT/SMT, MH governance group and Pan Ayrshire Strategy Leadership group North Ayrshire Mental health & wellbeing group (to be established), Core standards group & Pan Ayrshire Leadership strategy group North Ayrshire complex care group, LD Transformation board & Pan Ayrshire leadership strategy group Woodland View - Models of Care Complex Care/ Coming Home 111
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route √ √ √ √ √ Review the service delivery and workforce model for Trindlemoss complex care service Plan, Initiate, Monitor, Close x x √ √ Review service delivery model at Trindlemoss Supported Accommodation Plan, Initiate, Monitor, Close x x √ √ √ √ √ Implement TEC/Responder Service, piloting at Trindlemoss base Plan, Initiate, Monitor, Close x x √ √ √ √ √ Complex Care Accommodation Requirements: Research and recommend options for effectively meeting the housing needs of complex care users in North Ayrshire. (added 19/6/24) Plan, Initiate, Monitor, Close x x √ √ √ √ Engage in and influence West of Scotland CAMHS pathways and service developments Plan, Initiate, Monitor Monitor Monitor √ √ √ √ Reconfigure West Road as the Ayrshire and Arran CAMHS/CEDS Centre for specialist assessments Monitor and Close by Sep 24 x x √ √ √ √ √ Implement National Eating Disorders strategy and delivery plan Plan, Initiate Monitor Monitor, Close Digital Transformation √ √ √ √ √ Delivery of a programme of Digital Transformation including development of a business case for wider MH services in alignment with national strategy, Implementation of Trakcare Patient Management System in Community Services and pilot phase 1 of Strata health SPOC, triage and decision making approcahes. Monitor, Close x x Pan-Ayrshire MH Digital Transformation Group MH Unscheduled Care √ √ √ √ Open and monitor impact of Adult Mental Health Assessment Hub (Ward 7B) in Woodland View Monitor Monitor, Close x ESMT/SMT MH governance & Pan Ayrshire Leadership strategy group Neurodevelopmental Supports - Adults √ √ √ √ √ Through the Extreme Team implement pathways of support for Adults seeking neurodevelopment service support and diagnosis Plan, Initiate, Monitor Monitor Monitor, Close North Ayrshire Lifespan Neurodevelopment strategy group reporting to CSSP and Pan Ayrshire Leadership strategy group Psychiatry Review √ √ Review of service workforce model and leadership structures Plan, Initiate, Monitor, Close x x MH Governance, Professional leadership group, ESMT/SMT & Pan Ayrshire ;leadership strategy group LD/MH social supports √ √ √ √ Review low level social support provided to LD/MH service users in alignment with the wellbeing model review to reduce variance and implement an equitable approach Plan SMT & LD transformation board CAMHS North Ayrshire complex care group, LD Transformation board & Pan Ayrshire leadership strategy group CAMHS Governance group, MH governance & Pan Ayrshire Strategy leadership group Complex Care/ Coming Home 112
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route √ √ √ √ √ Suicide Prevention - "Creating Hope Together" Monitor Monitor Monitor √ √ √ √ √ Dementia Strategy - "Everyone's Story" Plan, Initiate, Monitor Monitor Monitor √ √ √ √ √ Mental Health and Wellbeing Strategy Plan, Initiate Monitor Monitor √ √ √ √ √ Self-harm Strategy Plan, Initiate Monitor Monitor √ √ √ √ √ Psychological Therapies specification & standards Plan, Initiate Monitor Monitor √ √ √ √ √ Adult Secondary Mental Health Services Quality Standards Monitor Monitor Monitor √ √ √ √ √ Barron Review - Forensic Mental Health Services Monitor Monitor Monitor ESMT/SMT, MH governance, North Ayrshire MH & Wellbeing strategy group & Pan Ayrshire leadership strategy group Scottish Government Strategy - Local Implementation 113
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route Health and Community Care Systems & Technology √ Explore and identify all available technology options and implement systems to identify and enhance the use of technology as first point of provision for accessing formal supports. x Plan, Initiate, Monitor, Close Evaluate H&CC SMT √ √ Analogue to Digital: Phased project to manage access to Community Alarm and Telecare services during the analogue to digital telephony transition. Monitor and Close by March 25 x x Analogue to Digital Project Board √ √ Review and streamline processes within the Blue Badge team. Monitor and Close by March 25 x x Transformation Board √ √ Review provision of Community Alarm and Telecare call monitoring service. CLOSED (SUCCESSFUL) Close by June 24 x x Analogue to Digital Project Board √ √ CM2000: Review workforce scheduling and monitoring of service delivery system. (MOVED TO PW) Close by June 24 x x Transformation Board √ √ √ Care packages: Programme of waiting list and existing community package reviews - targeting lower packages of care to consider alternatives, reablement approaches and need in line with eligibility criteria for support. Monitor and Close by March 25 x x H&CC SMT √ √ Implement the reconfiguration of Care at Home service delivery from June 2024, as agreed by IJB in March 2023. Review required to minimise additional costs when transferring service. Monitor, Close by July 24 x x CaH Steering / Oversight Group √ √ Take forward Pan Ayrshire programme of work following the Palliative/EOL Business Case, agreed PID in June 2023 and National Strategy due later in 2024. Reframing and reconfiguring existing service provision, including hospice care, within existing resources. Plan, Initiate, Monitor Monitor, Close x P/EOL Group √ √ Review and improve the Dementia Support and Respite models of care. (to follow Day Services Review below) Plan, Initiate, Monitor Monitor, Close x H&CC SMT TBC √ √ Evaluate recent Day Services Review and current Day Services models both on the mainland and the islands of Cumbrae and Arran. This should incorporate learning from recent pilots with focus on blended approach inlcuding outreach opportunities. Plan, Initiate, Monitor Monitor, Close x H&CC SMT TBC √ Explore current packages of care model and consider future sustainable delivery. [CLOSED WITH NO RECOMMENDATIONS] Plan, Initiate, Monitor, Close by end of 24 x x H&CC SMT √ √ Home first Strategy Plan, Initiate, Monitor, Close by March 25 x x H&CC SMT √ √ Delayed Discharge and Winter Preparedness Improvement Plan with a focus on Care at Home Capacity, Adults with Incapacity and Discharge to Assess. Monitor and Close by March 25 x x H&CC SMT Arran Integrated Services model √ √ √ Continue to work towards an Integrated Hub on Arran building on the frailty work and developing a single point of contact for all health and social care services. Initial Agreement has been redrafted. Close (or change) x x n/a Unscheduled Care Improvement Programme Models of Care 114
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route Primary Care MDTs - GP Premises √ √ √ Implement HSCP MDTs across each of the localities to support GP practices and HSCP service coordinate care for those with the most complex needs. Address premises capacity issues initially in Frew Terrace, Oxenward and Beith. Monitor Monitor, Close by end of 25 x H&CC SMT √ √ Review of the Enhanced Intermediate Care Service Plan, Initiate, Monitor Monitor, Close x Community Rehab PB √ √ Review of community rehab provision incorporating the range of community rehab services and how these better link together. Plan, Initate, Monitor, Close by end Mar 25 x x Community Rehab PB √ √ Community wards: Review current inpatient ward functions and rehab models. Plan, Initiate, Monitor, Close by end of 24 x x Community Rehab PB √ √ Policy review for access to and criteria for Aids and Adaptations, linking with Housing Review. Plan, Initate, Monitor, Close by end Mar 25 x x Community Rehab PB √ √ Review of podiatry service provision with a specific focus on reducing waiting lists including eligibility criteria. Plan, Initiate, Monitor Monitor, Close x TBC √ √ Review of OT service provision with a specific focus on reducing waiting lists including eligibility criteria. Plan, Initiate, Monitor Monitor, Close x TBC √ √ Review of speech and language therapy service provision with a specific focus on reducing waiting lists including eligibility criteria. Monitor, Close x x TBC √ √ Moving and Handling: Building on investment in Castleview training centre for social care staff - improve quality of risk assessment process, support to frontline staff, support with moving and handling aids and consider provision to wider services (including providers and Carers) Plan, Initiate, Monitor Monitor, Close by end of 25 x Community Rehab PB Community AHP Provision Community Rehab Models 115
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Service Area Project Description/Workstream Enable Communities Develop and support workforce Early and Effective Support Mental and Physical Health and Wellbeing Tackle Inequalities 2024/25 2025/26 2026/27 Strategic Priorities Project Profiling Primary Project Governance Route Partnership Wide Self Directed Support (SDS) Review √ √ √ Engage with all stakeholders to look at how we encourage a more innovative and person centred approach to SDS. Implement the next phase of work from the Learning Review. Initiate, Monitor Close April 25 x SWGB/PSMT Carers Strategy and Service √ √ √ √ Implement the Carers Strategy agreed at IJB in August 2023 together with new enhanced model of support from Unity. Plan TBC, based on plan TBC Direct to IJB Implementation of Eclipse information system √ Implementation of new information recording system for social care to replace Care First. This will include development of new protocols and transfer of data from current system to the new one. Monitor, Close Evaluation x Eclipse Project Board Front Door Review √ √ √ √ Commence a review of the HSCP front door first point of contact across services including duty systems. Scope to include first point of public contact, to maximise capacity and mitigate current risk. 12 month review 6 month to implement recommendation s x Accessing Health and Social Care Services Learning Review Board √ Update and further develop workforce plans to ensure the partnership has the right skills, roles, and number of people, now and in the future, including developing learning pathways, upskilling and reskilling opprtunities, and other strategies to improve recruitment and retention. Workforce Plan 2 year update by Oct 24 New workforce plan Oct 2025 x F&T SMT √ Develop approaches and explore options to provide alternative supports to workforce to address and support a reduction in staff absence levels, for example additional Occupational Health capacity or support. Workforce Plan 2 year update by Oct 24 New workforce plan Oct 2025 x F&T SMT Digital & Data Plan: Phase 1 √ √ √ √ √ Develop and implement a NAHSCP Digital & Data Plan, aligned to national digital and data strategies. - fully articulating the digital & data requirements of a cohesively integrated value-based health and social care service - generating a baseline of digital capability / maturity - identifying barriers and opportunities for improvement - embedding digital & data across all teams and functions - creating a data-driven culture that supports innovation Initial Plan developed with recommended next steps TBC TBC F&T SMT Leadership structures √ Review leadership structures across the Partnership Plan, Initiate, Monitor,Close x x PSMT CM2000 √ √ Review workforce scheduling and monitoring of service delivery system (currently CM2000 - contract ends Mar 25 ) Plan, Initiate, Monitor,Close by Dec 24 x x PSMT Eligibility Criteria √ √ √ √ Consider whole-scale review of service eligibility criteria including policy and procedure used within services to ensure - resources are targeted to those most in need and an equitable approach to providing support and managing waits. Plan TBC TBC PSMT Workforce Planning 116
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NORTH AYRSHIRE Health and Social Care Partnership Transformation Board Terms of Reference 2024-2027 1 Introduction 1.1 Transformation is defined as making best use of available resources to transform products and services to achieve better outcomes and experiences. It is a deliberate planned process that sets out to achieve our high aspirations of health equity, improved social circumstances, and long-term sustainability for the people of North Ayrshire. It delivers measurable improvement by fundamentally changing how care is delivered, what staff do (changing both the types of roles, and the capabilities, required in the future), as well as the role of communities and individuals. 1.2 Our high aspirations are set out in our Strategic Plan where we have defined five strategic priorities to enable us to achieve our vision for people of North Ayrshire to have a safe, healthy, and active life: • enabling communities • developing and supporting our workforce • providing early and effective support • improving mental and physical health and wellbeing • tackle inequalities The measurable improvement and fundamental change required to achieve our high aspirations will be underpinned by: • a deliberate and planned process – Transformation Plan • understanding the types of roles, and the capabilities, required in the future – Workforce Plan • better use of digital, and specifically data, to inform decision-making and measure impact – Digital & Data Plan 1.3 The Transformation Plan is an ambitious programme of change consisting of a range of improvement projects each aiming to advance value-based and data-driven products and services, to contribute to the long-term sustainability of health and care in North Ayrshire. 1.4 The Transformation Plan will be overseen by a programme board who will oversee the development and implementation of the plan and provide assurance to the Integrated Joint Board (IJB). 1.5 The programme board will be known as the Transformation Board. 117
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2 Purpose & Remit 2.1 The purpose and remit of the Transformation Board is to: • ensure the Transformation Plan is aligned to our strategic priorities and aims to deliver measurable improvement. • oversee the delivery of the Transformation Plan through effective programme monitoring. • provide whole system oversight, and to monitor associated risks and benefits, to ensure health equity, improved social circumstances, and long-term sustainability, are prioritised. • support system wide change management where required. • ensure any proposed change is safe, and is compliant with current legislation and/or relevant policy directive (e.g. Equality Impact Assessments) 3 Membership 3.1 The Transformation Board shall comprise the following core members: • Director (Chair) • Chief Finance and Transformation Officer • Heads of Service • Chief Social Work Officer • Senior Manager (Strategic Planning and Transformation) • Principal Manager (Business Support) • Principal Manager (Finance) And the following optional members: • Planning Managers • Team Manager (Information Systems and Performance) • Associate Nurse Director • Senior Manager (Allied Health Professionals) • Director of Psychological Services • Senior Manager (Contracts and Commissioning) 4 Attendance 4.1 Members are permitted (and encouraged) to nominate a deputy to attend meetings in their absence. 4.2 Additional members may be co-opted as required. 5 Quorum 5.1 The meeting shall be quorate when the Chair, or nominated deputy, is present together with 50% of the representatives of the membership. 118
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6 Meetings 6.1 The Board will meet monthly and will be chaired by the NAHSCP Director. 6.2 The Chair may at any time convene additional meetings of the Transformation Board 7 Duties 7.1 The Transformation Board will work within existing governance structures to: • provide assurance to IJB on effectiveness of the Transformation Board and progress of the Transformation Plan. • both inform, and be informed, by the Strategic Planning Group. • contribute to the development and implementation of an appropriate Digital & Data Plan to ensure transformation is value-based, data-driven, and has measurable impact. • ensure appropriate alignment with Workforce Planning. • ensure effective communication across the Health and Social Care Partnership to champion transformation, and support system wide change where required. 7.2 Members are responsible for assuring the development of robust project plans, aligned to the strategic priorities, with measurable outcomes, clear actions, milestones, timescales, roles and responsibilities, and a defined approach for managing risks and benefits. (Monitoring of individual projects is by Service SMT or dedicated/nominated Project Board, reporting back to the Transformation Board only by exception.) 7.2 Members may be required to lead areas of work in support of the transformation programme and will be responsible for ensuring that allocated areas of work are progressed. 7.3 Members are responsible for ensuring that they accurately reflect the views of the those they represent, and to provide regular updates on the progress of the Transformation Plan to relevant stakeholders. 8 Administration of Meetings 8.1 Appropriate administrative support for the Transformation Board will be arranged by the HSCP Finance & Transformation Team. 8.2 Action notes will be circulated in draft form to members and considered at the subsequent meeting for agreement. This information will be shared at each IJB via the Directors report. 8.3 The agenda and supporting papers will be sent to members at least five working days before the date of the meeting. 9 Authority 9.1 The service representatives and members of the Transformation Board have authority in line with that delegated to them in the scheme of delegation, however the Transformation Board does not have decision making authority and will therefore make recommendations to IJB or PSMT for decisions. 119
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10. Reporting 10.1 The Transformation Board will provide regular reports to the Integrated Joint Board to ensure effective governance arrangements. The Senior Manager (Strategic Planning and Transformation) will draft reports on behalf of the Transformation Board. 10.2 The Senior Manager (Strategic Planning and Transformation), responsible for the day-to- day management of the programme, will ensure the Transformation Board is kept appropriately informed and has the information required to oversee the delivery of the Transformation Plan. Once robust project plans are in place updates are by exception. 10.3 The Planning Managers, and/or Service Leads, responsible for the day-to-day management of individual projects, will ensure the Senior Manager (Strategic Planning and Transformation) and Service SMT (and/or Project Board) is kept appropriately informed and has the information required to oversee the delivery of the projects. 10.4 The Board will be supported by a robust and consistent HSCP approach to project and programme management, supported by Planning Managers. 120
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Integration Joint Board 19 September 2024 Subject : Strategic Risk Register Purpose : To present the updated IJB Strategic Risk Register for consideration and approval. Recommendation : To approve the updated IJB Strategic Risk Register 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 IJB Integrated Joint Board NHS National Health Service PAC Performance Audit Committee PSMT Partnership Senior Management Team 1. EXECUTIVE SUMMARY 1.1 This report provides an update on the strategic risk register, to help ensure the IJB are proactive in identifying and managing the risks to the successful delivery of our Strategic Plan. 2. BACKGROUND 2.1 A Strategic Risk Register is a requirement of the Clinical and Care Governance Framework and as part of our Risk Management Strategy, which was last approved by the IJB in March 2023. 2.2 The review focussed on updating previous risks and identifying new risks. There is one new risk which has been escalated from the operational risk register on the recommendation of the PSMT: SRR14 Asylum Arrivals - there is a growing risk to health, primary care and social care sustainability, as the numbers of adult asylum seekers dispersed by the Home Office grows, the number of unaccompanied children and young people asylum seekers and trafficked young people grows. Agenda Item 10 121
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The remaining previous risks have been updated to reflect any additional mitigating action and reassessed on that basis. Most of the risk remained at the same score but one risk increased in score and two risks reduced score: Increased score: • SRR01 Financial Sustainability – the gross risk increased from 15 to 25 which reflects the overspend position in 2023/24, reduction in available reserves and the projected 2024/25 outturn. Reduction in score: • SRR10 Covid residual risk reduced from 15 to 12 as the risk is around the funding of covid related costs, as the Covid funding ceases in 2023-24, rather than the remobilisation of services. It is recommended that SRR10 is removed from the strategic risk register as the residual risks around workforce and demand are now incorporated in other risks 2.3 The actions required to manage and control the risks have been identified and they will be subject to ongoing monitoring and review by the PSMT with an update to be reported to the Performance and Audit Committee. 2.4 There are 11 risks noted on the Strategic Risk Register, with a number of these graded as high risk. While there are a number of controls and mitigations in place there may be further actions required to reduce the risks further in line with the level of risk tolerance. The current Strategic Risk Register is included as Appendix A. The risks are summarised below: Ref Title Gross Risk (score pending further controls) 2023 Residual Risk (score after further controls) 2023 Gross Risk (score pending further controls) 2024 Residual Risk (score after further controls) 2024 SRR01 Financial Sustainability 15 High 12 High 25 Very High 12 High SRR02 Infrastructure (ICT Integration) 12 High 9 Moderate 12 High 9 Moderate SRR05 Transformational Change Programme 9 Moderate 6 Moderate 9 Moderate 6 Moderate SRR06 Governance 9 Moderate 3 Low 9 Moderate 3 Low SRR07 Demography and Inequality Pressures 16 High 12 High 16 High 12 High SRR08 Workforce 12 High 9 Moderate 12 High 9 Moderate SRR09 Local Impact of Scottish Government Policies 16 High 12 High 16 High 12 High SRR11 National Care Service 15 High 15 High 15 High 15 High 122
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SRR12 Clinical and Care Governance 9 Moderate 9 Moderate 9 Moderate 9 Moderate SRR13 Provider Failure (commissioned services) 12 High 12 High 12 High 12 High SRR14 Asylum Arrivals n/a n/a 12 High 12 High 2.5 The scoring of the risks is based the severity of the risk multiplied by the likelihood of it happening. The background to this is given in the extract of the approved risk management strategy in Appendix B. 2.6 The operational risks of the partnership are regularly reviewed and considered at service management meetings. The Clincial and Care Governance Group is responsible for the oversight of operational risks within the partnership. The Group consider any High or Very High risks (as defined by the approved risk management strategy) and if required esalate these to the Partnership Senior Management Team (PSMT) for consideration for inclusion on the Strategic Risk Register. 3. PROPOSALS 3.1 It is proposed to: • approve the risk register detailed in Appendix A including the action required to manage, mitigate and control the risks. • Approve the removal SRR10 Covid from the Strategic Risk Register. 3.2 Anticipated Outcomes Risk management is an integral part of governance and it is essential that the IJB has assurance that risks are identified and managed appropriately to ensure the safe and sustainable delivery of services. 3.3 Measuring Impact The risk register will be monitored with the individual risk owners being responsible for keeping the register up to date under the overview of the Principal Manager – Finance. It is recommended that risk assessments be reviewed on an annual basis as a minimum. PAC will monitor the register to ensure the actions required to manage and control the risk are being progressed, with updates provided to the IJB and PAC at least annually. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk 123
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The report falls in line with the agreed risk appetite statement which is low-risk appetite in respect to adherence to compliance duties. 4.6 Community Wealth Building None. 4.7 Key Priorities Appropriate and effective risk management practice will deliver better outcomes for the people of North Ayrshire, protecting the health, safety and wellbeing of everyone who engages with the IJB or for maximising opportunity, delivering innovation and best value, and increasing performance. 5. CONSULTATION 5.1 The strategic risks have been reviewed and agreed by the PSMT. For more information please contact: Paul Doak, Head of Finance and Transformation at pdoak@north-ayrshire.gov.uk or Eleanor Currie, Principal Manager – Finance at eleanorcurrie@north-ayrshire.gov.uk 124
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Appendix A Strategic Risk Register Glossary of Terms Term Definition Term Definition NAHSCP North Ayrshire Health and Social Care Partnership ARG Allocation of Resources Group SAHSCP South Ayrshire Health and Social Care Partnership ICT Information and Computer Technology EAHSCP East Ayrshire Health and Social Care Partnership MDTs Multi-Disciplinary Teams NHS/ NHS AAA NHS Ayrshire & Arran EKSF Electronic Knowledge and Skills Framework MTFP Medium Term Financial Plan TURAS Training Management System CRES Cash Releasing Efficiency Savings SPOG Strategic Planning Officers Group LD Learning Disability ICF Integrated Care Fund IJB Integrated Joint Board RMP Records Management Plan PSMT Partnership Senior Management Team CPAG Child Poverty Action Group NAC North Ayrshire Council 125
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Appendix B Extract from the Risk Strategy on Risk Scoring 126
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SEVERITY CONSEQUENCE MATRIX - Description and definition of the CONSEQUENCE / IMPACT of the risk should it occur (these are a guide) Severity “Domains” 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme Objectives and projects Barely noticeable reduction in scope / quality / schedule Minor reduction in scope / quality / schedule Reduction in scope or quality, project objectives or schedule. Significant reduction in ability to meet project objectives or schedule. Inability to meet project objectives, reputation of the organisation seriously damaged and failure to appropriately manage finances. Injury (physical and psychological) to patients/staff. Adverse event leading to minor injury not requiring first aid. Minor injury or illness, first-aid treatment needed. No staff absence required. Significant injury requiring medical treatment and/or counselling. Major injuries or long- term incapacity/ disability (loss of limb), requiring medical treatment and/or counselling. Incident leading to death or major permanent incapacity. Patient experience / outcome Reduced quality of patient experience / clinical outcome not directly related to delivery of clinical care. Unsatisfactory patient experience / clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience / clinical outcome, short term effects – expect recovery < 1Wk Unsatisfactory patient experience / clinical outcome, long term effects - expect recovery > 1Wk Unsatisfactory patient experience / clinical outcome continued ongoing long-term effects. 127
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Complaints / claims Locally resolved complaint Justified complaint peripheral to clinical care Below excess claim. Justified complaint involving lack of appropriate care. Claim above excess level. Multiple justified complaints. Multiple claims or single major claims. Staffing and competence Short term low staffing level (< 1 day), where there is no disruption to patient care. Ongoing low staffing level results in minor reduction in quality of patient care Minor error due to ineffective training / implementation of training. Late delivery of key objective / service due to lack of staff. Moderate error due to ineffective training / implementation of training. Ongoing problems with staffing levels Uncertain delivery of key objective / service due to lack of staff. Major error due to ineffective training / implementation of training. Non delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training / implementation of training. Service / business interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care. Some disruption in service with unacceptable impact on patient care. Temporary loss of ability to provide service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked. Permanent loss of core service or facility. Disruption to facility leading to significant “knock on” effect. Financial Negligible organisational financial loss (£< 1k). Minor organisational financial loss (£1- 10k). Significant organisational financial loss (£10-100k). Major organisational financial loss (£100k- 1m). Severe organisational financial loss (£>1m). Inspection / assessment / audit Small number of recommendations which focus on minor quality improvement issues. Minor recommendations made which can be addressed by low level of management action. Challenging recommendations but can be addressed with appropriate action plan. Enforcement Action. Low rating. Critical report. Prosecution. Zero Rating. Severely critical report. 128
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Adverse publicity / reputation No media coverage, little effect on staff morale. Local Media – short term. Minor effect on staff morale / public attitudes. Local Media – long term. Impact on staff morale and public perception of the organisation. National Media (< 3 days). Public confidence in the organisation undermined. Usage of services affected. National Media (> 3 days). MP / MSP Concern (Questions in Parliament). Organisational / Personal Security, and Equipment Damage, loss, theft (£< 1k). Damage, loss, theft (£1-10k). Damage, loss, theft (£10-100k). Damage, loss, theft (£100k-1m). Damage, loss, theft (£>1m). 1 Remote 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Probability Will only occur in exceptional circumstances. Unlikely to occur but definite potential exists. Reasonable chance of occurring – has happened before on occasions. Likely to occur – strong possibility. The event will occur in most circumstances. 129
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Risk Rating LIKELIHOOD SEVERITY 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme 5 Almost Certain 5 10 15 20 25 4 Likely 4 8 12 16 20 3 Possible 3 6 9 12 15 2 Unlikely 2 4 6 8 10 1 Remote 1 2 3 4 5 130
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North Ayrshire Integration Joint Board Strategic Risk Register - September 2024 Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Score Severity Probability Score Rating Proposed New Control Measures Previous Score Severity Probability Score Rating Risk Tolerance / Appetite SRR01 Financial Sustainability - financial failure from demand for services outstripping the available budget, as a result of the level of delegated resource to the IJB from partners not being sufficient to deliver on strategic objectives. Overall risk of budget not being aligned to delivering financial balance whilst delivering on strategic outcomes. This may lead to service user assessed needs being unmet, inability to deliver on the Strategic Plan, with a reduction in performance, progress not being made with national targets, reputational damage to the IJB and partner bodies and the requirement to implement service changes that are not in line with the strategic objectives. There was a significant overspend in 23/24 meaning that free reserves of only £0.4m remain moving into 24/25. Head of Finance and Transformation * IJB actively monitors the partnership financial position. * Regular updates are provided to the Council and NHS. * A Chief Finance and Transformation Officer is in place within the HSCP to support delivery of transformation at scale and pace. * A Medium-Term Financial Outlook will be refreshed for 2025-28 and reported to IJB in Autumn 2024. * Transformation Board overseeing the programme of service re-design with an agreed Transformation Plan for 2024-27. * Integrated approach to managing totality of NHS and LA resources delegated to the IJB. * Robust processes for monitoring the monthly financial position ensuring financial projections can inform any corrective action. * Financial returns are submitted to the Scottish Government on a regular basis. * Previous financial settlements have seen both partners meet the SG settlement conditions with any additional resources passed to the IJB. * Focus on accuracy of data used to inform financial projections alongside regular review of waiting lists and approval processes. 15 5 5 25 Very High * Continue to actively managing the demand for services using professional judgement to determine when care is provided. * Establishment of a Budget Working Group to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. * Strengthen 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. * Review of expenditure authorisation levels across the Partnership and escalate specific decisions to senior officers. * Staff communication in relation to discretionary/non-essential spend. * Review of temporary posts and robust vacancy management/approval. * Strengthen across services the existing approval and prioritisation approaches for new care requests, which will be approved in line with resource availability. * Review of future year savings or transformation programmes to identify scope for acceleration. 12 4 3 12 High Treat SRR02 Infrastructure - ICT System Integration and Property - lack of an integrated IT system to meet the needs of NAHSCP leading to non-robust and inefficient information recording and sharing resulting in inefficient business models, duplication of effort, inaccurate or lack of data on service demand and delivery and risk to service users, patients and staff. Head of Finance and Transformation * Some pockets of agile and remote working have been implemented and work continues to roll these initiatives out to improve efficiency. * Access to systems can be requested to allow NHS-Partnership staff access to NAC systems, and NAC-Partnership staff access of NHS systems. * Work has progressed to reduce the number of MH ancillary recording systems and consolidate data on centralised systems. * Working from home has accelerated the use of technology with more business being conducted via MS Teams. * HSCP systems and performance team supporting work across the partnership and progressing developments and issues with systems * Defining the new system set up for replacing CareFirst. * Work continues on the removal of a number of NHS Access databases. * Implementation of Trakcare functionality within Adult Community Mental Health Services to manage patient clinics across all three Partnerships. * Ensure that there are local arrangements in place to manage local risk. * NHSAAA are undertaking a review of all MS Access databases in use for removal to centralised systems. * MH Digital Transformation board established * MH digital business case being developed to address future planning needs. * Digital pilot for CYP neurodevelopment transformation with Strata Health. * Optimising existing estate to address complex care needs. 12 4 3 12 High * Develop NAHSCP Digital & Data Strategy * Develop strategic direction with NHSAAA, EAHSCP and SAHSCP. * Replacement of the current social care system will include consideration of functionality which will support health service data requirements * A pan-Ayrshire initial meeting took place with NHS in Jan 2023 to agree that the use of the NHS Orion platform for data integration would be of benefit to partnerships teams - a scoping exercise is now underway by NHS IT to review how this platform works in practice within Glasgow for implementing locally - NHS have provided the 2024 development roadmap for an Integrated Care Record - NHS networks investigating how to improve connectivity to social work employees from Ayrshire Central Hospital 9 3 3 9 Moderate Tolerate SRR05 Transformational Change Programme - failure to deliver transformational change impacting on financial sustainability, effectiveness of service delivery alongside negative impact on individual's outcomes through a failure to modernise services to meet current and future demands. Head of Finance and Transformation * Newly appointed Senior Manager to lead the delivery of the Transformation Plan. * NAHSCP Transformation Board for oversight of programme development and delivery. * Reporting to NAHSCP Integration Joint Board, NHSAA Performance Governance Committee which has oversight on behalf of the NHS Board and NAC Extended Leadership Team. * Pan Ayrshire SPOG, NHSAA, NAC Scrutiny Groups & Staff Partnership Forum review and professionally challenge business plans *Scheduled meetings with Planning Managers to ensure effective communication throughout the change process on a 6 weekly basis. * Cross fertilisation and knowledge transfer of Planning Managers. * Development of Transformation Board risk register to manage risks associated with Programme change strands. * Alignment of service change/transformation plans to Strategic Plan priorities * Delivery Plans developed for each programme which identifies specific requirements for the successful delivery of each area, triggers exception reports to report when plans are not on track 9 3 3 9 Moderate * Raising awareness of Programme within the three parent organisations (including elected members and board members) via established reporting arrangements * SPOG review of business cases prior to formal submission to corporate parents to highlight negative aspects * Development of Workforce Plan, and Digital and Data Strategy, to ensure alignment with transformed products and services. 6 3 2 6 Moderate Treat SRR06 Governance - IJB governance arrangements are not conducive to effective working and decision making, Leading to a lack of confidence in the IJB and reputational damage. Failure to comply with governance requirements such as Freedom of Information, Complaints and other regulations laid down within the Public Bodies (Scotland) Act. This could lead to a breach of specific regulations resulting in enforcement action from governing bodies, adverse public reaction and/or prosecution. Governance Officer * Appropriate arrangements in place for representation at the IJB and sub-committees * Integration Scheme, Strategic Plan, Standing Orders and Code of Conduct in place. * Policies and procedures developed and in place for each function including Complaints, FOIs/Adverse Events for both HSCP and IJB. * Operational Governance / Delivery groups in place to ensure appropriate action planning and monitoring including Performance and Audit Committee, Clinical and Care Governance Group, Adverse Events Review Group, Health and Safety Groups and the Staff Partnership Forum. * IJB receives 6 monthly updates on Clinical and Care Governance activity including details of adverse events; significant case review; complaints. This update includes details of outcomes and lessons learned. The Adverse Event Review Group now includes a fortnightly update for all AERs across the North HSCP. *Approved a Risk Management Strategy, Strategic Risk Register and risk appetite statement. *Health and Care Governance Framework in place 9 3 3 9 Moderate * Development of IJB member induction programme was paused during pandemic but has now been finalised and sessions have taken place. All new members provided with introductory dicussions and induction materials. * Address representation gaps on IJB including Carers * HSCP reviewing resourcing and capacity for demand to undertake SAERs. Proposal to enhance process with training and reviewing capacity across the three HSCPs. * Pan Ayrshire Review of Integration Schemes underway during 2024. * support from IJB monitoring officer re code of conduct and roles and responsiblities of members 3 3 1 3 Low Treat Gross Risk Residual Risk 131
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North Ayrshire Integration Joint Board Strategic Risk Register - September 2024 Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Score Severity Probability Score Rating Proposed New Control Measures Previous Score Severity Probability Score Rating Risk Tolerance / Appetite Gross Risk Residual Risk SRR07 Demography and Inequality Pressures - failure to adequately plan for and respond to changes in our population profile and in the levels of poverty in North Ayrshire will result in more people experiencing higher levels of physical and mental ill health, resulting in increasing demand on services, an inability of services to provide adequate care and negative impact on health and wellbeing. This includes the impact of the war in Ukraine, refugees, unaccompanied asylum seeking children and care experienced young people who may face inequality. Chief Officer * Through delivery of the strategic plan the IJB sets out actions to tackle inequality through its Partnership Pledge and across all five of the strategic priorities. * HSCP services work to address inequalities, for example our Money Matters service work with vulnerable families, providing them with benefits advice and helping to maximise household incomes. * The Partnership will continue to work closely with partners to deliver the Fair for All pledges and progress the Fairer Food agenda. * Demography increases are factored into budget planning to ensure the resource requirements are understood and funding is identified to meet needs * The Change Programme and previous Challenge Fund Projects are focused on early intervention and prevention approaches stemming the impact of future demography increases. * Equalities Impact Assessments considered as part of IJB decision making processes * Expand Community Link Workers service to assist individuals to understand the full range of formal and informal community based services available to them * Our Justice services offer greater levels of support to those with experience of the Justice system, providing offenders with employment and wellbeing support, and reducing the likelihood of reoffending. * We provide welfare training to staff across the HSCP, including NHS, NAC and Third Sector Staff, helping to better inform our workforce of the impact of inequalities. * Refresh of MH Ayrshire conversation priorities, locality forum/engagement sessions and LD strategy refresh * Workforce plan will underline need to meet future demand resulting from population change 16 4 4 16 High Our Strategic Plan 'Caring Together' 2022-30, again underlines the HSCPs commitment to addressing local inequalities by retaining Tackling Inequalities as a key priority. We will Raise the profile of the impact of inequalities with our communities, staff, service users and volunteers through implementation of the strategic plan to ensure they have a firm understanding of inequalities and its impact on health and wellbeing. New Demographic Measures * The HSCP will respond to new demographic data from the Census as reports are released over the coming year, and ensure these are considered within current workstreams and workforce planning. - We will improve our processes around Social Care Assessment to ensure there are no delays or waiting lists for people who require an assessment or review of their need. - Through our extended response service for those over 65+ at home, we respond mental health crises faster and are able to reduce the number of Mental Health hospital admissions. - On Arran, the development of an integrated hub will allow for the provision of more effective 24/7 care, supporting people with complex care needs to remain at home. - Part of the Caring for Ayrshire programme will review the North Ayrshire primary care estate to ensure it is fit for purpose to meet the health and care needs of local people now and in the future. - Ensure we provide effective advice, respite options and financial support to carers, including older carers, to ensure they are supported to continue in their caring role. 12 3 4 12 High Treat * Strategic plan has key focus on providing early and effective support to help people remain as healthy as possible for as long as possible. * We will also continue to undertake Equality Impact Assessments on all new policy or service proposals, ensuring we ass the impact of any proposals on identified protected groups. Further, the EIA process included assessment of how proposals meet the Fairer Scotland Duty. * Our commissioning and procurement process adopt ethical approaches, ensuring all commissioned services do not discriminate against any particular groups and provide real actionable community benefits * Involvement in NAC Ukrainian Taskforce, Ayrshire Taskforce and Refugee Taskforce which meets regularly to share information and allow for appropriate planning. * By implementing new ways of working in Trindlemoss, people with a learning disability will have greater opportunities to develop skills and access meaningful paid employment Inequalities Measures * The independent advocacy strategic plan 2022-26 was approved in November 2023 and aims to empower people to make their own, informed, decisions, and engage with people who may not communicate in traditional ways. *The HSCP Equality Outcomes Plan 2022-25 was approved by Board in Marh 2023 and sets out how the organisation plans to improve outcomes, particularly for people with complex care needs, refugees and new Scots, children and families, and people with learning disabilities. * Embedding Money Matters staff in nine GP practices and seven local schools in North Ayrshire’s more deprived areas, to improve access to financial advice and income maximisation services for local families. - Increase the number of employability mentors in Justice Services, to support those with experience of the justice service into meaningful employment or training opportunities and to help divert away from criminal behaviours. - Implement the National Health Visiting Pathway, supporting children in their early years and reducing the number of children with developmental concerns in the early stages. - Working closely with Housing colleagues to ensure formerly looked after young people can access a positive and stable housing destination. - In our Drug and Alcohol Services, we are implementing actions to reduce the number of local drug and alcohol related harms and deaths. This includes implementing the national MAT (Medicated Assisted Treatment) standards and increasing the number of ABIs (Alcohol Brief Interventions) delivered across North Ayrshire. - Through the Caring for Ayrshire programme, we set out a phased approach to improve local primary care premises (GP Practices and Health Centres). This will improve overall professional capacity within GP practices for Multi-Disciplinary Teams, ensuring the right support is available for local people with health concerns. SRR08 Workforce - failure to recruit and retain and plan workforce requirements effectively leading to an insufficient workforce (number of staff, key roles and competency levels), resulting in a reduction in capacity to safely and effectively care for local people and a negative impact on service user and patient's needs being met Chief Officer * Collaborative recruitment in A&A for areas including ICT, Primary Care Implementation plan, Mental Health and Clinical Leadership * A new workforce Plan for 2022-2025 was approved in October 2022 which aims to address the changing needs due to demographic changes, and challenges with recruitment and the workforce * Engagement with local secondary schools to expand the range of work experience and modern apprentice options that are available to promote a career in care. * Engagement with Ayrshire College to refine and expand the range of options available for students to experience service delivery in North Ayrshire. * Conduct exit interviews with all staff to understand reasons for leaving, using this intelligence to inform plans to improve working conditions and role satisfaction * Work with local providers to understand the pressures they face and support them, supporting the implementation of the Scottish Living Wage and fair work agenda * Early identification of vacancies and timeous submission of recruitment paperwork to the vacancy scrutiny group * Managed risks to recruiting on a permanent basis rather than relying on temp recurring funding, through creative use of funding and alignment with other service needs/alternatives Locality based recruitment events are held on a weekly basis, hosted by the Care at Home service. These are a key mechanism to grow the workforce and meet the ongoing workforce needs for service delivery of Care at Home Services. * A new Learning and Development Strategy was published for 2023-2028, outlining how we will ensure a trained and supported workforce * Workforce service plans being reviewed developed in alignment with national and local strategy with service redesign to optimise existing workforce capacity and address demand . This is across all areas starting with high priority risks. 12 4 3 12 High The 2022-2025 workforce plan contains numerous actions to address workforce challenges, including: * HR and Service leads meet and will continue to meet on a quarterly basis to update, review and amend work force plan in accordance with service demands and future planning requirements in mind. * * Engage with education colleagues (LA, FE and HE) to support the promotion of the wide range of courses and careers available in Health and Social Care in North Ayrshire HSCP * Locality based recruitment events are held on a weekly basis, hosted by the Care at Home service. These are a key mechanism to grow the workforce and meet the ongoing workforce needs for service delivery of Care at Home Services. * * Work had begun on a draft Succession Planning/ Guidance tool for the HSCP. This guidance would encourage managers and senior leaders to offer development opportunities to help gain essential experience that would help them develop into future leaders. * * Work is ongoing to develop a ‘career pathway’ guidance for all staff, to highlight possible career progression routes for the NAHSCP workforce. * The iMatter staff experience survey and What Matters to You? Engagement continues, to ensure senior managers are able to get feedback from employees about what is important to them in the workplace. 9 3 3 9 Moderate Treat 132
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North Ayrshire Integration Joint Board Strategic Risk Register - September 2024 Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Score Severity Probability Score Rating Proposed New Control Measures Previous Score Severity Probability Score Rating Risk Tolerance / Appetite Gross Risk Residual Risk SRR09 Local Impact of Scottish Government Policies: risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on strategic objectives, including funding to deliver on the same. Examples include the Promise, the Living Wage, Free Personal Care, Mental Health Recovery and Renewal, Creating Hope Together and Neurodevelopmental specifications and other future policy developments including the National Care Service. The impact being the inability to deliver on these alongside strategic plan commitments and objectives and the impact of funding for new policy and legislative commitments. Chief Officer * Horizon scanning for policy developments through partners, professional networks including links with Scottish Government policy teams * Regular liaison with Scottish Government and COSLA senior officers * Attendance at the national Chief Officer network. * Responses to consultations on potential implementation of new policy areas * Early impact assessments locally for national policies, including operational and financial service impact * Financial modelling to respond to requests for information to support full funding * Fully brief IJB members and wider partners on policy implications for the IJB to gather support and awareness of any implementation issues or concerns 16 4 4 16 High * Promote and develop pan-Ayrshire approaches to impact assessment of policy implementation * Reinforce the role of Elected Members and IJB members to influence Scottish Government decision making through political routes * consider local implementation alongside available resources to ensure the IJB are aware of developments which are not fully funded and able to make informed decisions * pause recruitment and investment in new service areas until funding position is confirmed 12 4 3 12 High Treat SRR11 National Care Service - Development of the National Care Service leading to uncertainty about the future delivery of services by the IJB resulting in an impact on the current services and staff. Chief Officer * Providing a full response to the Scottish Government Consultations, including scrunity at parliamentary committees of the amendments to the Bill at Stage 2 * Participating in national engagement events organised by Scottish Government * Keeping up to date with and seeking to influence developments via national professional networks * Continue the current transformation programme to continue to deliver the improvements intended to be achieved by integration of health and social care. 15 3 5 15 High * Push for more information where there were significant gaps in the draft legislation, e.g. services included, goverance arrangements, role of National Care Board, escalation and accountability frameworks * Continue seeking to influence developments via national professional networks. * consideration of a local communications plan and approach to manage expectations re implementation and service delivery 15 3 5 15 High Treat SRR12 Clinical and Care Governance: Failure to have an appropriate framework in place leading to an adverse impact on the culture resulting in a reduction in the quality of the delivery of the highest quality of care and support is understood. Chief Social Work Officer and Associate Nursing Director *continuous review of arrangements for Clinical and Care Governance are essential for the delivery of statutory, policy and professional requirements and the achievement of our quality ambitions. *ongoing review of established structures and processes to assure Integration Joint Boards, Health Boards and Local Authorities *empowering clinical and care staff to contribute to the improvement of quality *making sure that there is a strong voice of the people and communities who use our services. * ensure that professional leadership develops good governance for each of the following components: culture, systems, practices, performance, vision and leadership. * delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams, and between health and social care professionals and managers 9 3 3 9 Moderate * Continue to review and develop the governance framework. 9 3 3 9 Moderate Tolerate SRR13 Provider Failure (commissioned services) There is an ongoing risk of social care supplier failure due to staffing and recruitment challenges and the financial viability of care providers. Particuarly across community based support and also in residential settings including care homes. Supplier failure leads to risk to service users, potential for withdrawl of care and discruption to care plans. Senior Managers * Reviewed and monitored via CAHOG and CHOG where intelligence and early warning signs are shared across agencies including the Care Inspectorate; * Enhanced Contract management in place with monitoring tools; * Monthly or quarterly management meetings with companies if required; * Formal support measures including quality of care monitoring; * Financial background checks; * National COSLA involvement; * Moratoria (voluntary or compulsory) in place where risk to service users is considered identified. 12 3 4 12 High * Continue with current governance, mitigation and control measures. * Ongoing engagement with current Community Support Providers. * Where possible scope opportunities for additional providers to support capacity/contingency plans. * Ongoing engagement with current Community Support providers. * Where possible scope opportunities for additional providers to support capacity/contingency plans. * Promote 'open book' approach with providers re financial position; * Ensure services have business continuity plans to minimise impact on service users. 12 3 4 12 High Treat SRR14 (new) Asylum Arrivals - there is a growing risk to health, primary care and social care sustainability, as the numbers of adult asylum seekers dispersed by the Home Office grows, the number of unaccompanied children and young people asylum seekers and trafficked young people grows. Head of Service - Children & Justice Services * North Ayrshire Refugee taskforce led by NAC Housing, attended by Home Office and MEARs dispersal agents, * Agreed targets with COSLA for Mears and resettlemt schemes - new MOD scheme has not yet set targets. *HSCP Asylum Seeker, refugee and Ukrainian Arrival Taskforce * Standing item at bi-monthly PSMT *HSCP Refugee Support Team established to provide initial assessment and screening of all new arrivals. Funding is for one Staff Nurse post. Team has recently taken on assessments of UASC from the school nursing service and discussions about health support to trafficked young people are ongoing *NHSAA Public Health continues to screen and treat TB and blood borne virus issues, n/a 3 4 12 High *Continue governance approaches * Finance team continues to map impact on childrens houses from unaccompanied asylum seekers and trafficked young people, * NHSAA Public Health continues to scrren and treat TB and blood borne virus issues, *HSCP Refugee Support Team continues to screen all new arrivals including UASC linking with Public Health, social work, and other services as required ** Impact statements provided to Home Office and MEARs about on-going stresses on primary care, HSCP Health and Social Care in specific towns and villages as agreed targets likely to be exceeded, * NAC 'buy-back' of 40 ex-council housing scheme to 31 March 2024 to provide more stable accomodation and reduce risks on homelessness services. n/a 3 4 12 High Treat 133
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1 NHS Ayrshire and Arran Delivery Plan 2024 – 2025 Agenda Item 11 135
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2 Contents 1. Introduction ....................................................................................................................... 3 2. Primary and Community Care ........................................................................................... 4 3. Urgent and Unscheduled Care .......................................................................................... 6 4. Mental Health .................................................................................................................... 8 5. Planned Care .................................................................................................................. 11 6. Cancer Care .................................................................................................................... 13 7. Health Inequalities and Population Health ...................................................................... 15 8. Women and Children’s Health ........................................................................................ 20 9. Workforce ........................................................................................................................ 22 10. Digital Services Innovation Adoption ............................................................................... 25 11. Climate ............................................................................................................................ 27 136
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3 1. Introduction The Caring for Ayrshire Vision provides a set of principles and associated care settings that describe how health and care services could, in the future, be provided to our communities. This high level vision is driven by the need to rebalance health and care so that it is less acute focussed and there is a stronger emphasis on delivering care in a variety of alternative and more locally based settings. As Caring for Ayrshire is a longer term vision, it will take a number of years to fully deliver and will require significant service change aligned to investment in infrastructure. In moving towards realising that longer term vision, there are a range of shorter term challenges that the Board faces, particularly around service and financial sustainability, in relation to a range of services. There is a need to consider alternative delivery models that address these challenges whilst aligning service delivery to the wider Caring for Ayrshire vision – effectively building a set of shorter term actions. Our Triumvirates, led by a clinical lead, a managerial lead and a nursing lead, have commenced work to develop proposals to address these shorter term challenges. The work of the Triumvirates has been initially focussed around 5 key service areas: Emergency Care including Accident and Emergency Medical Specialties Emergency General Surgery Critical Care Woman and Children Services These proposals consider the site impact, particularly in relation to University Hospital Crosshouse (UHC) and University Hospital Ayr (UHA) whilst also considering opportunities to shift services out of acute settings. As such, there has been involvement from site managers, digital colleagues and estates and facilities personnel. In addition, and in support of the Triumvirate work, 5 patient pathways are being analysed to show in practice how the Caring for Ayrshire vision will translate into future whole system service provision, shaped in a way that delivers the required rebalancing and identifies key changes required to achieve this. The 5 patient pathways that are being explored are Respiratory, Frailty, Rehabilitation, Diabetes and Palliative Care. Whilst working towards our vision, we continue to work collaboratively with our health and social care partners and our wider community planning partners to improve planning and investment in our communities, to optimise population health not only through better provision of health and care services but through wider economic benefit, regeneration and growth in our communities. As we move towards an increasingly integrated approach to service delivery, there will be more emphasis on workforce collaboration and skills transfer. By concentrating our resources in multi-disciplinary teams operating across the health and care system, we can ensure that safe, effective, person-centred and sustainable services are delivered through a workforce that has the right skills and competencies and is able to achieve the best possible outcomes for our communities. There is a requirement to deliver a sustainable health and care service within the envelope of funding available. The financial context for NHS Ayrshire and Arran is extremely challenging with a significant budgetary gap of £56M forecast for 2024/25. The Board will continue to scope 137
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4 out cash releasing savings through service efficiencies, however the route to achieving financial balance will require significant service reform and realignment over the next 2 – 5 years. This reform work has already commenced through our Triumvirate work and is inline with our Caring for Ayrshire vision. Establishing a sustainable financial recovery plan, as we work through this post Covid era, asks that NHS Ayrshire and Arran meets a scale of financial efficiency that far exceeds customary CRES expectations. However, it is acknowledged that the sustainable and longer term recovery of the deficit is crucial. NHS Ayrshire and Arran recognise that Realistic Medicine is essential to delivering a sustainable health and care system for the future and as such this will be at the heart of all the recovery and service improvements which are being progressed. NHS Ayrshire and Arran will ensure our actions align to the national action plan which was published in September to deliver Value Based Health and Care. Delivery of these actions will ensure better outcomes and experiences for the people we care for, through the equitable, sustainable, appropriate and transparent use of available resources. Throughout 2024/25 and beyond we will continue work to increase awareness of Realistic Medicine across the organisation. A Realistic Medicine Steering Group has been established with key stakeholders from across acute services, pharmacy, mental health, palliative care, nursing, estates, primary and urgent care, recognising that everyone regardless of their role, can help build a more equitable and sustainable health and care system. These areas of focus translate into 3 key priority areas of work over the next 5 years: Financial Sustainability delivered through improvements in system response and delivery to urgent and emergency care; Development of a Commissioning Plan for unscheduled care and accompanying transformation plan; and Through the CfA priorities, work with public, system partners and clinical leads throughout the system, about how streamlining service provision is realised through partnership working and enabling change and service improvement through the resources, localities, systems and services we have. 2. Primary and Community Care A programme for annual review of General Medical Services (GMS) Contracts will be developed by the primary care team to review practice operating models, quality indicators (including chronic disease management) and identify any improvement work. This programme of work will enhance oversight of core service delivery by the Board and help to identify early, any issues or additional support that practices may require to sustain service delivery. A deep dive review into understanding all our GP Practices across Ayrshire and Arran is being undertaken, which will help inform the current status, challenges and opportunities within General Practice. This also includes the impact of various programmes of work that have been in development and rolled out over 2023/24. The outcome of the review will provide a clearer understanding of how GP Practices are currently operating at an HSCP level. The review will highlight potential barriers for progress or other areas requiring more targeted actions to allow the Primary Care Management Team to work closely with General Practice teams. The actions identified from this extensive review will be taken forward over the next 12-24 months supported by HSCP Clinical Directors, GP Stakeholders and Cluster Leads. 138
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5 An ongoing review programme for General Practice Enhanced Services which commenced summer 2023 will ensure the enhanced services in place remain current and fit for purpose in line with NHS Quality Ambitions and national and local drivers for change. The Programme will provide governance and assurance these are being delivered in accordance with the agreed specification, ensuring they meet the needs of the population and are sustainable. This review also provides opportunity to further enhance what is in place within primary and community care in its widest sense to support patients closer to home with specialist input where required for areas such as diabetes and respiratory services. Infrastructure planning for Primary Care Services commenced in October 2023 along with the three Ayrshire HSCPs, aligned to Caring for Ayrshire, to look at greater cluster level models of care. This included engaging with each GP Practice, with 100% return rate, to understand their premises and service delivery models, along with community facilities to identify our areas of greatest challenge as well as opportunity for future models of care. It is anticipated this will progress over the next three years aligned to the organisation’s short/medium/long term plans. NHS Ayrshire and Arran were successful in a recent bid to be a Primary Care Improvement Phased Investment Programme Demonstrator site to work with NHS Health Improvement Scotland (HIS) to demonstrate what a model of full implementation of the MDT (focussing on CTAC and Pharmacotherapy teams) can look like in General Practice. This is a 12-18 month programme which will be nationally funded and delivered by a local programme team with local governance arrangements. Data will be collected which will be used to model full national implementation of priority areas of the GMS 2018 Contract. Development work will also continue alongside this to further embed MDT teams into practice through the GMS Contract which would continue in tandem with the focussed work on Pharmacotherapy and CTAC. A recent audit indicated that 72% of CTAC activity was undertaken by CTAC staff and 28% undertaken by GP practice staff. In order to provide full task transfer, to include additional resilience, there is a requirement to increase the workforce as well as further review the skill mix of total workforce. Progressing as a demonstrator site will allow a robust service across every GP Practice including resilience models. A key component of the CTAC role includes chronic disease monitoring and early detection of key cardiovascular risk factor conditions. This will further support each GP Practice to manage these conditions. The Diabetes in Dalmellington Pilot has documented an increase in uptake of eye screening, foot screening, and overall engagement with health services. It has highlighted the potential that can be released through collaborative and respectful relationships across the wider system, by successfully delivering a care and self-management support model within a community hall setting. Over the next three years the learning from this pilot will be used to inform the programme design and implementation of a community-based model for the prevention and self-management support for other long-term diseases, within Dalmellington and if feasible other priority areas across NHS Ayrshire and Arran, demonstrating the ability and value of NHS, local authority, and third sector agency collaboration in this way. Delivered by Ayrshire Urgent Care Service (AUCS), delivery of primary urgent care during the out of hours (OOH) period is a robust well embedded service within NHS Ayrshire and Arran. The team continue to utilise and maximise any opportunity to further review and enhance the service linked to activity and patient outcome data. AUCS continues to test new models of delivery using Advanced Nurse Practitioner models and wider MDT services (e.g. District Nursing, Social Work Services, Emergency Mental Health Crisis Team, and Advanced Paramedics). 139
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6 Non-emergency patient transport is available to General Practice and patients who call NHS 24 and for patients meeting a specific criteria to allow transport to an identified healthcare setting for continuing care and treatment. This was fully embedded early 2023 and continues through business as usual arrangements. Dental service reform is underway which will allow understanding of the future delivery model for dental services in Ayrshire and Arran to provide sustainable access to person centred NHS oral health services closer to home. It will also allow the opportunity to understand patient need to ensure our services are in the right place to deliver care wrapped around individuals. This aligns to the NHS Ayrshire and Arran Caring for Ayrshire vision aimed to design a fully integrated system wide approach to ensure our services are in the right place at the right time in the right place. Reform will also allow the service to set out a framework for governance and oversight by the NHS Board and the three Ayrshire Integration Joint Boards. The outputs of the review will help inform the specific actions and priorities we take forward over the coming years aligned to the work ongoing at national level to understand the future strategic direction of dental services. The Uveitis/Juvenile Idiopathic Arthritis Service (JIA) development has recently been signed off by the Ophthalmology Service and work is now progressing to implementation and roll-out. This service will be provided in local Community Optometry practices instead of being referred to Ophthalmology. Further discussions are required between primary care and Ophthalmology on the planned roll out of a Community Glaucoma service (NESGAT) due to a low number of accredited practitioners in Ayrshire and Arran. This may impact on viability and resilience of the service to enable roll out in the next year. A number of stable glaucoma patients continue to have their reviews carried out at locally accredited Optometry practices through shared care arrangements. 3. Urgent and Unscheduled Care There has been an ongoing programme of work in place across Ayrshire and Arran to support patient outcomes and improve performance, however, it is recognised that this has not been at the pace and scale required. The priorities for 2024/25 will be informed by our understanding of our system data and we will continue to utilise and develop our whole system model tool, to predict, with a reasonable level of accuracy, the number of occupied beds required in our hospital sites. This approach has also been used to develop further 6-month projections, which have allowed us to test various scenarios and inform our short-to-medium-term action planning. The utilisation of the whole system model and its accompanying projections is an important step towards effective resource allocation and management within the acute hospital sites. By providing an informed forecast of future demand, site teams are supported to optimise resource allocation more effectively and to proactively respond to potential challenges arising from increased levels of demand, thereby helping to ensure continued quality of care. In addition to local data and modelling, CfSD data outputs have further reinforced our understanding that the key area of focus for Ayrshire and Arran should be around reducing the number of patients with a length of stay of over 14 days and increasing the number of patients in a short stay pathway. Utilising the local and national data, the key areas of focus for Unscheduled Care for 2024/25: 140
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7 Development of Commissioning Plan and subsequent plan to redistribute unscheduled care provision: Reduction in number of patients with a length of stay over 14 days; and Increase in number of patients on a short stay pathway. To support the Unscheduled Care pathways we will continue work on providing alternatives to front door attendance and admissions and increasing virtual capacity. The introduction of new pathways through Redesign of Urgent Care (RUC) programme delivered by the Ayrshire Urgent Care Service (AUCS) has helped to attract and retain the current workforce to sustain clinical rotas for the 24/7 urgent care service in NHS Ayrshire and Arran. The Flow Navigation Centre (FNC) provides rapid early triage and clinical assessment of patients to identify the most appropriate pathway for their care aiming to keep people closer to home wherever possible and avoid an acute attendance. In December 2023 an Urgent Care test of change (ToC) within AUCS was developed, working alongside General Practice to support local practices with home visits between the hours of 3:30pm and 5:30pm. This was developed recognising the impact on General Practice when patients present to the practice late in the afternoon with an urgent care need requiring a house visit, and the requirement to ensure there is sufficient workforce in place to respond to this on a daily basis. To ensure safe delivery of the ToC, it is being rolled out on a phased basis at cluster level to ensure activity is monitored and evaluated. So far, feedback has been positive from general practice and early reports highlight this has allowed clinicians within practice to focus on planned appointments or patient engagement without concerns that they will be required to attend a last minute house call. The ToC will continue to be monitored and evaluated with a plan to extend wider across Ayrshire early 2024/25 with a view to developing the model further to include face to face appointments. This will be aligned to the vision of creating a 24/7 seamless urgent care pathway with general practice and AUCS working together. Scoping is underway for a pathway from AUCS to the Musculoskeletal (MSK) service which would encourage timely care, better patient flow, and reduced demand in Primary Care, Emergency Department and Minor Injury Unit (MIU). Currently AUCS are required to refer the patient back to their own GP Practice if the clinician believes they need follow up at the MSK service. Early intervention would help to promote better patient outcomes, reduced number of appointments and more efficient use of resources, preventing duplication and delay for patients. A test of change will be implemented as part of the scoping exercise and evaluated to inform future service models. NHS Ayrshire and Arran continue to create additional H@H capacity to enable the provision of care closer to home and structured around the person’s needs provided by multi-disciplinary teams. We recognise that there are many occasions where a hospital admission is not necessary and in these instances, delivering care at home or in a community setting, is to the benefit of patients. There is significant evidence that initiatives that reduce hospital activity, such as admission avoidance pathways and supporting people to manage their own care, have the potential to improve patient experience and overall health outcomes. Qualitative evidence demonstrates that patient’s value being in the comfort and familiarity of their own home, whilst reducing disruption to daily routines. NHS Ayrshire and Arran have introduced a new H@H Paediatric service, the first in Scotland. Phase 1 of this service provides Antibiotic Therapy (IVAB) to infants, children and young people in the community. This service avoids the need for patients to be admitted to hospital and also expedites early discharge home. The trajectory is that 2 acute beds will be 141
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8 saved per month due to avoided admissions. Within 2024/25 we will expand our service delivery model to include care at home for children with other care needs. NHS Ayrshire and Arran, compared to other parts of Scotland, has the third highest admission rate due to COPD of all Scottish NHS Boards. The establishment, and subsequent expansion of Rapid Respiratory Response (RRR) Services will support the safe management of patients with COPD in the community. The service is designed to safely and effectively provide rapid access to treatment for patients with an acute exacerbation in their COPD, which may result in presenting to healthcare services on an urgent or unscheduled basis. A data informed approach has been taken to explore how the service can make best use of collaborative pathways across primary and secondary care services and expand into all three HSCPs. Further review of skill mix and evaluation of the RRR service is being undertaken to inform future staffing model. 4. Mental Health Scottish Government published the new Mental Health and Wellbeing Strategy in 2023 which sets out the longer-term commitment to improve the mental health and wellbeing of everyone in Scotland. The Strategy describes what a highly effective and well-functioning mental health system should look like, covering all levels of need, including the needs of people with severe and enduring mental health conditions, along with maintaining good mental wellbeing, and community support. Locally we will take a life-course approach to understanding mental health and will endeavour to develop a programme of work, with partners, over the coming year to identify and align actions in Ayrshire and Arran to the national delivery plans. During 2024/25 Public Health teams will collaborate with Mental Health teams to develop a matrix model of working for a life course approach to mental health and develop an understanding of the demographics of the local population to allow for better decision making and allocation of resources. However, challenges with the mental health environment continue to create challenges around clinical space, new facilities have been identified but progress has been delayed due to availability of funding streams. As in other service areas, there are significant workforce challenges facing Mental Health services. The Community Mental Health Team (CMHT) have not seen the same levels of investment as other Mental Health services in recent years. This has led to a significant gap in service demand and capacity. Recognising recruitment challenges for qualified Mental Health workers (with many posts expected to take up to a year to fill), the service will consider new advanced/enhanced roles and different ways of working. In CAMHS, recruitment challenges are particularly around Psychiatry, Nursing and Psychology. The service will continue to look at the skill mix required for the service, based on these challenges recruit more Allied Health Professionals (AHP’s) and look at innovative ways to encourage Psychiatrists to work in Ayrshire. Psychological Services are also experiencing challenges in recruiting to specific priority posts, including Child and Adult Mental Health in the Community. Although training places are increasing year on year, there is currently an insufficient specialist workforce to fill all vacant posts across Scotland so there is currently a competitive workforce context. Inpatient and Forensic Services Within the Mental Health Inpatient Service key priorities for 2024/25 will be to improve patient flow, reduce the average length of stay and number/duration of delayed discharges. 142
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9 To support these improvements and deliver a more coherent system of forensic mental health services, we will work to: Improve referral pathways and increase expectation of ‘pace’/throughput; Implement more robust bed projection processes; Continue to develop relationships with the West of Scotland Forensic Network, being part of wider bed capacity solutions; Review persons subject to UNPACs placement and repatriate locally as clinically appropriate; Develop a centralised Data Dashboard to provide robust data on service performance against key measures to inform service delivery and improvement; and Work on developing Band 4 Assistant Practitioner role to address ongoing workforce deficit for Band 5 staff and enhance service delivery, reducing supplementary staffing spend. Child and Adolescent Mental Health Service (CAMHS) Within Ayrshire and Arran, CAMHS services are provided by 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. This is provided through three distinct teams to ensure that children and young people are on the correct pathway at a much earlier stage: Specialist Community CAMHS (SCAMHS), CAMHS Urgent Assessment and Intensive Treatment (CUAIT) and Neurodiverse CAMHS (N-CAMHS). Whilst transforming and developing our services we will continue to learn from children, young people, families and Carers with ‘Lived Experience’ of the service and are currently working to gain feedback through KIDSCREEN which is a health related quality of life questionnaire for children, young people and their parents. Within 2024/25 CAMHS will continue to work towards the waiting time targets set out in the CAMHS NHS Scotland National Service Specification. Already CAMHS has met the 4-week first appointment response time in alignment with the national specification through a redesign of the service and implementation of the three pathways and by fully implementing the revised service access criteria of accepting only those referrals where there are underlying mental health needs in alignment with the national specification. This has enabled meaningful redirection of referrals to wider whole system supports and services to more appropriately meet the needs of children and young people who do not have an underlying mental health condition. Focus is now on providing interventions and treatments, where required and agreed with children, young people and families/carers, as soon as possible, and no later than 18 weeks from first referral, with the median experienced wait for treatment being no longer than 12 weeks. Commissioning of external providers will continue through 2024/25, to enable children and young people, to continue to be seen timeously. In addition, we will work with our IT systems and through a programme of wider transformation linked to the Mental Health Digital Transformation Board, will endeavour to develop effective data collection systems that provide robust data and reports to inform service improvement, redesign and monitoring of performance. This will also prepare the service for reporting on delivery of the forthcoming Mental Health Standards. 143
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10 Psychological Therapies The latest published data for quarter ending December 2023 indicates that compliance for Psychological Therapies (91.1%) remains higher than the Scotland average. Developments over the next 12 months will address the requirements and standards dictated by the Psychological Therapies Service Specification with a specific program of work, linked to Scottish Government timescales, for implementation. This will be led by the Senior Psychology Leadership team and will involve cross discipline and specialty engagement to ensure adequate outcomes. Within this framework, governance and availability of psychological interventions will be enhanced via establishment of dedicated clinical governance routes to augment the established Psychological Interventions Training Group and to augment or replace local clinical governance pathways. Patient centred areas of focus will continue to address issues of longest waits, matched- stepped care within services for children and young people, neurodevelopmental service provision (both Children and Adults) and whole board alignment to the updated Matrix Treatment Recommendation for Psychological Therapies (2023) and the implementation of the National Specification for the delivery of Psychological Therapies and Interventions (Scottish Government, September 2023). This will sit alongside continued work in ensuring a Trauma informed approach is embedded within all directorates of the organisation. Working with partners in acute/ neuro services to increase workforce capacity of the psychological therapy provision is a key objective. We will consider further investment in the Enhanced Psychological Practitioner training programme, with Partnership support, dependent upon outcomes from current cohort of trainees. We will await any national funding provision for the establishment of Early Intervention in Psychosis services. Risks over the same period are linked to temporary funding streams. Cessation and/or delay of these streams of funding risks a significant impact on core mental health services. The lack of allocation to Primary Care funding also adversely impacts on demands upon secondary care and our ability to meet waiting times targets. Implementation of the National Specifications relating to children and young people with neurodevelopmental conditions, and the Community Wellbeing Framework for Children and Young people, are considered important to specialist secondary mental health services being able to meet waiting times targets. These specifications sit outside specialist mental health, but any failure will directly affect the pressures upon our service. Recent work within the area of Adult Neurodevelopmental has concluded, with outcomes presented to Chief Officers in February 2024. It is expected that this will necessitate specific, additional funding requests to meet the increasing demand for neurodevelopmental condition assessment and treatment. Community Mental Health Community Mental Health Teams (CMHTs) across Ayrshire and Arran continue to experience a steady increase in referrals, not just associated with, but significantly impacted by an unprecedented increase in neurodiversity referrals. The CMHTs have not yet had any additional investment to support with this increase and consideration as to how we continue to meet this demand continues to be explored, with the service looking at innovative ways to maximise the current workforce. The Pan-Ayrshire Duty Service is one such change that has proved effective in providing some staffing resource release back to the CMHTs. However, more work requires to be undertaken on the support/ training and development needs of our workforce. Having identified a significant shortfall in required establishments, work still needs to be done to ensure that the right people are being cared for at the right time and wider considerations are 144
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11 undertaken for those that don’t require the support and treatment of a community mental health team at that time. Primary Mental Health Pathways to support the impact on community mental health teams have been explored and implemented where possible within primary care, such as the introduction of Mental Health Practitioners within GP practices. However, these posts have been funded non-recurringly and we await confirmation of Mental Health and Wellbeing in Primary Care service monies to support this pathway on a recurring basis. We have developed plans for years 2, 3, and beyond for mental health and wellbeing in primary care, and are currently working towards sign off via the three Integrated Joint Boards (North, South and East). Should funding become available these plans will be ready to enact to support us to: Deliver a coherent system of forensic mental health services, addressing issues raised by the independent review into such services; Improve support and develop the Mental Health workforce; and Improve the mental health built environment and patient safety. Part of the challenge for mental health services has been appropriate accommodation and space to deliver care. Whilst we have launched our specialist perinatal mental health service and maternity neonatal psychology team within the past 2 years, we have faced challenge to formally launch our infant mental health team. Despite staff now being in post, the ability to provide assessment, care and treatment has been difficult due to a lack of access to child and family friendly clinical space. The Mental Health Unscheduled Care Service has seen significant redesign and rebranding over the past few years, with the unscheduled care mental health service provision available directly within our communities and hospital sites, with agreed pathways from NHS 24, Scottish Ambulance and Police Scotland. The final deliverable is to provide a mental health unscheduled care assessment hub, akin to our combined assessment units at University Hospital’s Ayr and Crosshouse; that provides (for those that need it) a safe, appropriate and timely compassionate response. Supporting individuals for up to 72 hours, to identify and facilitate the appropriate care, assessment treatment and/ or follow up appropriate for them. Following some time delay works are now progressing with a formal launch date expected in early 2024/25. 5. Planned Care Through 2024/25 we will endeavour to improve delivery of planned care services through reduction in waiting list backlogs and waiting times, as well as modernising and improving quality of services for patients. Recognising that patients are waiting longer for surgery, we have had Active Clinical Surveillance clinics in place since March 2023 to Support Patients to Wait Well. This is currently in place for patients who have been waiting longer than three months for general, orthopaedic and gynaecology surgery. Patients are invited to attend an initial in-person appointment with a Perioperative Care Coordinator who triages them to prioritise who is most in need and provide information and signposting to allow the patient to better prepare for their surgery, or to ‘wait well’. To ensure we are able to continue to schedule planned care appointments during times of peak system pressure, we have embedded a ‘hospital within a hospital’ approach. An area of 14 145
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12 beds within University Hospital Ayr (UHA) has been formally protected in order that elective orthopaedic surgery can continue, albeit at a reduced capacity, during times of peak pressure. Similarly 4 beds are protected for planned care gynaecology at University Hospital Crosshouse (UHC), and at times of pressure these beds can also support continuation of breast surgery. Following on from work undertaken over the previous two years, the work in 2024/25 will have focus on the following areas: Analysing and understanding the changing service demand. Robust DCAQ analysis of TTG in 2023/24 has provided a better understanding of the service demand and gaps within the surgical areas. A similar level of detailed analysis of outpatient demands and capacity will be completed. Productivity and efficiency opportunities. We will continue to deliver close monitoring and management of operating theatre capacity using both published theatre utilisation data and locally developed measures of operating theatre fallow time. Where possible and affordable within the funding envelope, we will seek opportunities to address those capacity constraints such as through innovative recruitment and international recruitment approaches, as well as through capacity opportunities in the upcoming National Treatment Centres and mutual aid opportunities. We will establish a renewed focus on daycase rates through the theatre governance group and other directorate discussions. We will fully roll out the Allocate system for medical staff job planning and in parallel will endeavour to develop an ongoing measure of the delivered clinical capacity in order to ensure optimum productivity. We will ensure that our waiting lists are up to date with an ongoing in-house programme of outpatient waiting list validation, and through bi-annual validation of the IP/DC waiting list through the established National Elective Coordination Unit (NECU) process. Modernisation Our clinical teams will be supported to further roll out modern practice opportunities such as Activity Clinical Referral Triage (ACRT) and Patient Initiated Review (PIR). We will work with colleagues in CfSD and PHS to develop more robust data measures in order to demonstrate further progress in roll out of these practices. We will continue to engage with the work of the CfSD Speciality Delivery Groups, and ensure that best practice opportunities are promoted within the services. We will develop an action plan in order to support implementation of the new NHS Scotland Waiting Times Guidance, and will roll this out with a supporting suite of updated policies, standard operating procedures and training. Investment Significant recurring investment of Access funding has already been targeted at orthopaedics, endoscopy and CT scanning services, and the impact of this is very clear. Through 2024/25 a further £0.5m will be invested in areas where analysis during 2023/24 has identified the greatest gaps and waiting times risks; this being part of a progressive approach to investing in sustainable solutions to delivering planned care capacity for the future. Analysis has also demonstrated that current capacity, even with the available access funding, is insufficient to clear the pandemic backlogs in addition to managing the ongoing demands. A 3-year investment proposal generating significant further capacity will be finalised, ready for implementation should additional access funding become available through the year. 146
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13 The key priorities for 2024/25 below are dependent on availability of workforce, clinical space and funding: Diagnostics - Endoscopy Introduce Transnasal Endoscopy (TNE) service at UHA Introduce qFiT analysis at NHSAA lab Develop plan for introduction of double qFiT Update Endoscopy DCAQ following recent service changes Diagnostics - Imaging Progress training of 2 X trainee Ultrasonographers Utilisation of Locums Continuation of a second MRI mobile scanner Treatment Time Guarantee (TTG) Remobilise all Inpatient and Day case operating theatres Mon-Fri daytimes Scope further 2 UHA operating theatres functioning routinely as extended days Work to reduce operating theatre fallow time Work to increase cataract productivity Increase theatre productivity through improved theatre list scheduling Outpatients Introduce new vetting and clinic delivery model in Diabetes and Endocrinology and re- evaluate DCAQ Establish medium term mutual aid for Diabetes Establish SLA for sleep pathway Implement Digital Dermatology Focus on Neurology, Gastroenterology and Diabetes and Endocrinology Scope further specialties to adopt PIR Carryout Insourcing and Waiting List Initiatives Audiology Within the Audiology Service much of the next 5 years will be directed by the findings from the Independent National Audiology Review. The Review has delivered 55 recommendations that Audiology Service is required to work towards meeting to ensure that the Service is safe, effective and meeting the needs of the local population. This will be done through the development of both local and national conversations and work. Of the 26 Board recommendations, within NHS Ayrshire and Arran 19 are either complete or being progressed, the remaining 7 have at present not been started. There are sustained challenges around recruitment which creates a dependency on the use of high cost locums which is at risk due to budget constraints. 6. Cancer Care A new Cancer Strategy for Scotland 2023-33 was launched with the strategic intent to improve cancer survival and provide excellent, equitably accessible care. The 10-year vision for our health service is that more cancers are prevented, and our compassionate and consistent cancer service provides excellent treatment and support throughout the cancer journey, and 147
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14 improves outcomes and survival for people with cancer. We are focusing on improving cancer outcomes through better prevention and diagnosis. We continue to strive for earlier diagnosis as we know this is critical to improving outcomes and survival. As well as being able to provide more curative treatment, we also recognise the importance of treatments to extend life and the provision of holistic palliative care. All of these aims must be underpinned by the principles of person-centred care and an understanding of what matters to every individual with cancer. Cancer has remained a priority for NHS Ayrshire and Arran and a wealth of work has been progressed and/or underway to redesign cancer services, embed new ways of managing cancer pathways and increase service resilience in line with the National Cancer Plan and Framework for Effective Cancer Management. While the 31 day cancer waiting times standard (CWT) has been consistently met (from decision to treat to first treatment), the 62 day standard remains challenged (from urgent suspicion of cancer (USC) referral to first treatment). Through 2023/24 we continued to implement the Framework for Effective Cancer Management and demonstrated some notable improvement in performance against the 62-day UCS referral to treatment standard. We will continue to be guided by the Framework through 2024/25 with an ambition to deliver yet further improvement. The main priority pathways for further improvement continue to be the colorectal, breast and urology pathways. Our analysis clearly demonstrates that reducing diagnostic delays will have the single biggest impact. As such the main areas for action are reducing pathology and endoscopy delays, and also reducing times to imaging investigations. Since there is significant overlap between this aspect of the cancer plan and the planned care plan, the specific actions for both are included together in the Planned Care section. Over the last 3 years NHS Ayrshire and Arran has been one of three NHS Boards which participated in a trial of Rapid Cancer Diagnostic Services (RCDS). We will continue our established GP Direct Access to CT pathway which also picks up cancer at an early stage with a cancer yield of around 19%. We will await the outcome of the University of Strathclyde project evaluation before finalising any further plans in this regard. We will embed both the national optimal lung and optimal head and neck pathways, subject to adequate resource being secured, to meet the timescales in these new pathways, and aim to detect, diagnose and treat cancers at a much earlier stage. Public messaging around screening and seeking early GP contact about concerning symptoms is key, but also leads to increased referrals. We will embed ACRT and robust re-grading of UCS referrals as per guidance to enable us to manage sustained increase in UCS referrals as we know that cancer conversion rate from UCS referrals is between 2-8% across the tumour types. The introduction of robot assisted surgery (RAS) in NHS Ayrshire and Arran will ensure that residents of Ayrshire have access to the most modern cancer surgery available. We will fully embed RAS in 2024/25 with training of 4 more surgeons, taking the total RAS team to 8. This will also enable the commencement of RAS prostatectomy in NHS Ayrshire and Arran which will reduce waiting times for treatment and is also expected to benefit the wider West of Scotland population by reducing the demand on the NHS Greater Glasgow and Clyde prostatectomy service. This will also help with early capacity planning for any future prostate cancer screening programme which may be developed. We will continue to build on the robustness of our cancer performance governance structure, ensuring clinical and managerial leadership at senior level. This enables a focus on improving both cancer waiting times as well as QPI performance. This will be supported by monthly meetings with the tumour specific clinical leads, where discussion is focussed on QPI 148
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15 performance, challenges, successes and completion of any action plan. We will continue to contribute to the governance of QPI performance by WoSCAN through the Regional Cancer Oversight Group. There is significant concern around oncology capacity and workforce which is being looked at nationally through the Scottish Cancer Network and more recently, a WoSCAN working group to look at challenges in the four West of Scotland Boards. In Ayrshire we have increased non- medical prescribing to well above target levels (70% for some tumour types against a target of 40%) and we continue to be able to recruit from experienced nurse and pharmacy cohorts to ensure we have adequate resource to manage increasing demand. Demand is increasing by at least 10% per year with the approval of new drugs and the success of current SACT regimes and immunotherapy, which means our on-treatment population is increasing, in particular breast and haematological cancers, with new drugs being approved regularly for most other tumour types. In 2024/25 we will complete a review of the physical estate for Tier 2 and Tier 3 SACT in order to plan for anticipated increases in demand in coming years, and will develop a plan for future development, subject to funding. The single point of contact for cancer patients is their Advanced Cancer Nurse Specialist (ACNS) and there are ACNS for all main tumour types. All patients are holistically assessed by their ACNS. Holistic needs assessment using the cancer concerns checklist/care plans is utilised within multiple services. Patients are provided with information specific to their needs and preferences. Patients are given an information and support directory at diagnosis which includes information on counselling services, Macmillan Move More, Healthy and Active Rehab Programme, Macmillan Money Matters, Support Groups. Services are sign-posted, or the patient is referred to the service as required, including those mentioned above including AHP services and buddy support services. A ‘Macmillan Improving the Cancer Journey’ project is underway, where patients will be referred for holistic assessment in the future and they will refer on appropriately for social/psychological support with ACNS focusing on other clinical care/support requirements and referrals. 7. Health Inequalities and Population Health NHS Ayrshire and Arran are committed to providing an environment in which diversity is valued and encouraged, and to ensuring patients, carers, families and staff are treated with dignity and respect, no matter their protected characteristics. We strive to provide the best care and treatment we can, within the resources available to us, while ensuring everyone working in the NHS has the right training and skills for their job within a safe and clean environment. As an Equal Opportunities employer we strive to have staff with the right skills to deliver equitable and quality services. NHS Ayrshire and Arran’s Mainstreaming Report sets out our commitment to ensuring the ever- changing demography and multiple identities of our population are person-centred and that our core function of providing health care and prevention of ill-health for all meets the needs of those who access it. It aims to inform our service users, their carer’s, visitors, staff and partner organisations how we as an organisation work towards ensuring that equalities is being mainstreamed into the functions and activities of our organisation. NHS Ayrshire and Arran’s approach to continuous improvement and embedding of equalities into our functions continues through visible leadership, organisational commitment and staff training amongst other initiatives. 149
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16 As a Board, we are fully committed to continually improving the ways in which we engage with people. Our engagement strategy to support and develop engagement with stakeholders across all protected characteristics underpins the progression of strategies and service reform. Equality and inclusivity underpin our engagement approaches. We have an important role to play in supporting and encouraging people to get involved as active partners in their own care or through engagement in wider discussions about health and care services. By ensuring that all engagement activity is appropriately impact assessed from the outset, we can identify any potential barriers for people to participate and take appropriate steps to mitigate or minimise those impacts. Like all public sector organisations, NHS Ayrshire and Arran is required to assess the impact of all its policies, services and functions on equality. This means that we must try to predict what will happen to different groups of people affected by our work, and then make changes to our plans so that any possibility of a negative impact is reduced or eliminated. To do this NHS Ayrshire and Arran uses a procedure called Equality Impact Assessment (EQIA). A good EQIA has to focus on key questions and actions is much more likely to achieve a worthwhile assessment and lead to identifying realistic actions. The Equality Impact Assessment process helps us to develop policies that focus on positive outcomes and solutions, identify what is working well, in addition to what needs improving, encourage greater openness and involvement in policy making and service delivery, develop good practice, demonstrate leadership on equality of service delivery and help to avoid claims of unlawful discrimination. The impact of poverty is well documented and experiencing poverty can have multiple and lasting ill effects on outcomes and opportunities across the life course. In line with the national practice model, Getting It Right for Every Child (GIRFEC), and the United Nations Convention on the Rights of the Child (UNCRC), poverty should be viewed as a threat to children’s health and wellbeing which has the potential to impact their adult outcomes and which health services and Local Authorities have a duty to protect children from. Causes are likely to be multifactorial, and tackling inequalities will require action across many fronts, including reducing structural inequalities and addressing barriers to equitable care. In 2019/20 across Scotland, North and East Ayrshire had the 2nd and 4th highest and South Ayrshire had the 11th highest percentage of children living in relative poverty, with 27.9%, 27.3% and 24.8% respectively, which are all in excess of the Scottish average. Wide and transformational action is required to meet the 2030 statutory income targets ‘less than 10% children in relative poverty by 2030’. The work NHS Ayrshire and Arran is doing around child poverty is closely linked with the new Employability Steering Group and the new Community Wealth Building/Anchor Organisation Programme Board. The child poverty work brings together colleagues from a range of disciplines and departments. For example colleagues in both paediatrics and midwifery have recognised the key role they play and are considering how they can best support families who are struggling financially, for example looking at how to increase the uptake of the Young Patient Family Fund and participating in a workshop that informs staff how to refer families into financial inclusion services. By helping address the key drivers of poverty through our services, the NHS are not only helping our patients, but have the potential to improve the quality of patient care more broadly, and help staff feel empowered that they can provide support to patients at this challenging time of the cost of living crisis. Public Health are the lead for child poverty within NHS Ayrshire and Arran, working with local authority partners, to reduce and prevent child poverty whilst also mitigating its impacts through Local Child Poverty Action Reports (LCPARs). Each year Public Health produce an annual Tackling Child Poverty paper for the NHS Board along with an NHS action plan to 150
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17 tackle child poverty, reporting on key actions and deliverables. The NHS Plan includes actions to collaborate with local authorities to deliver joint LCPARs, ensuring statutory duties are met. NHS Ayrshire and Arran is supporting the development of healthy places which improve population health and reduce inequalities whilst tackling the climate emergency, through our role as an active partner in key place and planning related activities undertaken by the NHS, local authorities, and community planning partnerships. This work is informed by the 5 Place and Wellbeing Outcomes and focuses on public health input, using local data, published evidence, and tools such as Health Impact Assessment, to key planning processes by partners (such as the drafting of Local Development Plans, major industrial developments, and new travel/transport infrastructure) and to the utilisation of NHS estates for green health activities. NHS Ayrshire and Arran has produced a three-year screening inequalities strategy which focuses on cross-cutting actions to reduce inequalities in access and uptake of screening programmes. Three areas of focus are Breast Screening, Bowel Screening and Cervical Screening. Ayrshire and Arran encompasses an expansive geographical area and we recognise travel to be a barrier to breast screening uptake, and work continues to analyse uptake data and allocate assistance and funding for travel to breast screening locations. In addition, it is known that prisoners are more likely, than their age-matched peers in the general population, to develop chronic diseases like bowel cancer. Inequalities in bowel screening uptake are especially evident in this population. A number of targeted screening education initiatives continue to be implemented within this setting. Also a monthly clinic has been developed to provide increased access for individuals who experience significant barriers to cervical screening, e.g. experienced previous trauma and those with physical disabilities. NHS Ayrshire and Arran work across a number of priorities, two of which have the greatest impact on the burden of disease, smoking cessation and weight management. Within both of these programmes the focus is on inequalities sensitive practice. The Tobacco Strategy with actions relates to cessation, prevention and protection. The cessation service (Quit your Way) operates within a variety of settings aiming to target geographically deprived areas alongside population groups such as college students, pregnant women, prisoners etc. This specialist service works alongside the Community Pharmacy Service to deliver the best support to smokers. More recently this has also involved working with those who vape, to stop. The Weight Management Strategy has been endorsed by all three Community Planning Partnerships. Delivery of both child healthy weight interventions (by our Jumpstart team) and adult weight management is available across a variety of settings e.g. primary care, leisure services, local football clubs etc. NHS Ayrshire and Arran are the planning partner for health, with NHS Ayrshire and Arran Chief Executive and Public Health as members of all three Community Planning Board’s within Ayrshire. This ensures we work together with our partners, and with the local community, to plan for, resource and provide or secure the provision of services which improve local outcomes across Ayrshire and Arran with a view to reducing inequalities. We deliver effective community planning by understanding local communities, needs, circumstances and opportunities which are then used to identify local priorities. This understanding is built on the information, knowledge and evidence from community planning partners, as well as from the views of local people and drives public service reform. As community planning partners we work together to improve local services and to ensure that they meet the needs of local people, especially those who need the services most. 151
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18 Alcohol and Drug Services NHS Ayrshire and Arran work with partners to support the National Mission on Drugs to reduce drug related deaths and improve lives. Priority areas include the implementation of MAT Standards, delivery of the treatment target and increasing access to residential rehabilitation. Services will prioritise the delivery of the Medication Assisted Treatment (MAT) standards by implementing their local improvement plans with the support of the national MAT support team (MIST). Whilst reviewing and improving MAT access through established community alcohol and drug services, the additional focus over the next 3 years will be on implementing actions to support MAT access through wider settings e.g. primary care, prison and police custody. A specific challenge in implementing and embedding MAT within primary care is the absence of recurring funding. Discussions continue with colleagues across primary care, finance, the Health Board, Health and Social Care Partnerships (HSCP’s) and Alcohol and Drug Partnerships (ADP’s) to highlight the funding challenges and explore ways to continue to resource this work. Services will continue to offer an ‘open’ referral process and be flexible in their approach to meet the ongoing national ‘Access to treatment’ waiting time’s standards. The promotion of Alcohol Brief Interventions (ABI’s) will continue across core and wider settings to ensure this national standard continues to be met. We will work with our partners to implement additional measures to reduce both drug and alcohol related deaths. Increased support will be available to individuals following a Non-Fatal Overdose (NFO), local ADP drug related death prevention strategies will be implemented, improved pathways of support will be available to better support individuals with co-occurring mental health and drug and/or alcohol use (with updated guidance being available for staff) and Naloxone related training and supply will be prioritised. In March 2022, the Minister for Drug Policy set a new ‘substance use’ treatment target to increase the numbers of individuals accessing treatment support by April 2024. Pathways and processes are in place to offer quick access to treatment including having an ‘open’ referral system and supporting more individuals into treatment via MAT interventions. In terms of a future target, post April 2024, services are awaiting new information whilst advice has been sought from the Minister. Individuals from across Ayrshire and Arran will continue to be supported, as required, to access local hospital based detoxification and rehabilitation support via Ward 5, Irvine. Families will be prioritised for support via access to the national family support facility (Harper House) based in North Ayrshire, who provide safe, structured support for the whole family to address their problematic drug and/or alcohol use, improve their mental health and quality of life. Individuals will also be supported to access external residential rehabilitation, however, due to expected demand the challenge will be securing sufficient funding from local ADP’s who have been provided with a set amount of funding for this purpose. Services will continue to work with ADP partners to highlight challenges and opportunities for further development and funding. Custody Healthcare In 2020/21, the Scottish Government commissioned research to provide a comprehensive, national assessment of needs in the prison population in relation to four domains of health: physical health, mental health, social care and substance use. Locally the recommendations in the Health Needs Assessment have been developed into a SMART action plan that involves all relevant stakeholders so that the information and learning from the assessment leads to tangible and measurable actions that result in improved health and wellbeing outcomes for those in the care of the prison. 152
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19 The Independent Review of the Response to Deaths in Prison Custody was published by Scottish Government in 2021. The purpose of the review was to make recommendations for improvement to ensure appropriate and transparent arrangements for the immediate response to deaths in prison custody. One recommendation was for Leaders of national oversight bodies to work together with families to support the development of a single framework on preventing deaths in custody. A standard national process (Toolkit) for both NHS and SPS staff to use on best practice responses following a death in prison has been developed. Executive Lead for prisons healthcare and those in custody is the Head of Service Children’s Health Care and Justice Services/Chief Social Work Officer, East Ayrshire Health and Social Care Partnership and is a member of the Executive Leads Network. Those in the care of the prison or police custody are more likely to be affected by a mental health issue and have higher rates of substance misuse. Medium term plans include the development of models that deliver enhanced early identification and intervention to reduce harm and achieve improved outcomes with increased treatment choice also, evidence based assessment of progress on delivery of MAT standards 1-10 by April 2025. Priority actions for 2024/25: Implementation of Medication Assisted Treatment (MAT) standards working with the national MIST (MAT implementation Support Team) team on how these can be delivered in a prison setting. Work is taking place across the prison estate with MIST on the MAT implementation plan. Evidence of progress with MAT 3 -5 with learning from test for change; Contribute to the work of the National Prison Care Network and SPS and implement locally the recommendations of the Independent Review of the Responses to Deaths in Prison Custody. Complete plan for Confirmation of Death training. All staff to complete online modules with follow up practical support sessions to be arranged; Work with National Prison Care Network to support national work on the change ideas developed for the Target Operating Model (TOM) and development of priorities for local actions. Engagement session with National Prison Care network and completion of TOM baseline document; and Complete test of change and share learning on prison admission process which aligns with TOM and implement and share learning on changes in the skill mix in the mental health team which aligns with TOM. Anchor Organisation NHS Ayrshire and Arran’s Anchor / Community Wealth Building (CWB) Strategy 2023-26 sets out plans to deliver on the anchor organisation ambitions alongside our anchor partners in the Ayrshire Community Wealth Building Commission and in support of the Ayrshire Regional Economic Strategy and the Ayrshire Growth Deal. The strategy sets out the Board’s ambition to support creation of a fair local wellbeing economy which enhances local wealth, reduces poverty and inequality through investing and spending locally, creating fair and meaningful employment, designing and managing our buildings, land and assets to maximise local and community benefits and reduce our environmental impact. Tackling Ayrshire’s social and economic inequalities will not be easy. Poverty rates in Ayrshire and Arran are higher than the Scottish average, Ayrshire’s workforce has fewer qualifications, and it is forecast to experience less economic growth and greater reductions in workforce in the short and medium-term. Given these stark economic inequalities, if Ayrshire’s health inequalities are to be reduced strategies must tackle the ‘fundamental causes’ driving inequality. 153
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20 This requires a joined-up approach, bringing together local partners to tackle inequality and to maintain a long-term vision of developing a local Ayrshire wellbeing economy. Our Anchor/CWB programme is governed by the Community Wealth Building/NHS as an Anchor Organisation Programme Board which meets quarterly. Our Anchor/CWB Programme focuses on the 5 standard pillars of Community Wealth Building and a sixth pillar Climate Change with Community Wealth Building leads appointed for each pillar. The Community Wealth Building/NHS as an Anchor Organisation Programme Board will continue to progress workstreams set out in our Anchor/CWB Strategy 2023-2026 and to deliver actions set out in the accompanying plans with a central focus on the three key pillars of Workforce, Procurement and Land and Assets. Priority actions for 2024/25: Develop a bespoke package of interventions for NHS Ayrshire and Arran to progress those currently far from employment and economically inactive closer to the labour market; Progress towards NHS Ayrshire and Arran Accreditation for Living Wage, Equally Safe at work, Menopause Friendly Workplace and Young Persons Guarantee; Progress Employability programme of students into employment with NHS Ayrshire and Arran by developing guidance for line managers; Further develop NHS Ayrshire and Arran community engagement process for Land and Property community asset transfer including notification to public of any land and property surplus to NHS requirement; Draft, approve and publish NHS Ayrshire and Arran land access guidance; Develop NHS Ayrshire and Arran greenspace strategy; and Promotion of NHSScotland Community Benefit Gateway) to Ayrshire third sector to encourage community benefit request registration. 8. Women and Children’s Health NHS Ayrshire and Arran continue to deliver on recommendations from the Best Start Policy to ensure women have a positive experience of maternity and neonatal care which takes account of their individual needs and preferences. It is important that all women, their babies, their partners and their families are aware of the support and choices that are available to them in order that they can be partners in care and achieve the best outcomes for them and their family. Of the 76 Best Start recommendations, 35 are progressed at a national level, 24 have been embedded into practice with a further 11 on track for delivery by 2026. We require support to progress a further 6 recommendations, with key challenges around lack of recurring funding for midwifery care, lack of community estate to deliver care in community settings, a rise in morbidity for the care model and continuity of carer in the high risk intrapartum period. One final year of non-recurring funding for Best start is being made available within 2024/25 and will impact on delivering the continuity of care model within current budgets, this issue exists for all Health Boards. There is a national review of the continuity of carer model and sustainability of service delivery. Locally we will look to carry out a review of accommodation for community midwives to deliver care. In addition, we will look to develop a Gynaecology Outpatient Procedure Unit for patients requiring clinical interventions, which may have previously required a theatre session and 154
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21 subsequent in-patient stay. This will be developed within current estate in Ayrshire Maternity Unit. We will look at expansion of direct access to Paediatric Assessment Unit (PAU) for GP referrals, negating any unnecessary time spent in Emergency Department for triage, unless clinically required. Developing measurable outcomes will evidence compliance on ED attendances after GP referral and 4-hour compliance from attendance at PAU to discharge or admission. The universal child health reviews are core to the Universal Health Visiting Pathway. The reviews provide an opportunity to work with parents to assess children's wellbeing, provide age appropriate health promotion advice, build parenting capacity, identify needs for support, and facilitate early access to effective interventions. This includes the requirement for all eligible families to be offered child health reviews at 13-15 months, 27-30 months and 4-5 years. In Ayrshire and Arran, all core assessment visits are being completed by a Health Visitor for all children. There have been significant staffing challenges due to vacancies, long term absence and maternity leave but this is beginning to resolve. However, vacancies continue to be part of the national picture due to the Higher Education establishments reviewing and changing their Health Visiting course programmes. Women’s Health Plan NHS Ayrshire and Arran is committed to contributing to the outcomes outlined in the National Women’s Health Plan for Scotland which underpins actions to improve women’s health inequalities by raising awareness around women’s health, improving access to health care and reducing inequalities in health outcomes for girls and women, both for sex-specific conditions and in women’s general health. Action to achieve this across Ayrshire and Arran requires cross departmental and multi-agency support and action. The two leading directorates for the strategic vision and delivery of this are Women and Children’s Services and Public Health. In 2023, work to explore the health needs of vulnerable women and girls commenced with a multi-professional workshop session. A recommendation from that session was to establish a single women’s health steering group, with multiagency representation to drive forward work under the guise of the Women’s Health Plan and will be progressed as a priority within 2024/25. The ultimate aim of the women’s health plan is to improve the general health and wellbeing of all women and girls, whilst reducing health related inequalities. The underpinning tenants of Realistic Medicine and Value Based Health and Care will be integral to delivering meaningful change and improvement for the population of Ayrshire and Arran. Throughout 2024/25 priorities will be to scope and deliver against the NHS Ayrshire and Arran Women’s Health Action Plan with currently identified priorities including Pre-conception care, cardiac care and general population awareness of women’s health issues. We will continue to monitor and implement the national Menopause and Menstrual Health Policy within NHS Ayrshire and Arran and improve the support provided to our staff. It is recognised that there are nationally significant challenges for patients accessing gynaecological appointments and laparoscopic surgery for the diagnosis and treatment of endometriosis. NHS Ayrshire and Arran recognise the challenges in providing access to endometriosis care and surgery and the associated risks and recognise that endometriosis is a progressive disease and the current wait times increase the risk of the disease becoming more complex, requiring more costly and specialist care. Currently women with Endometriosis are seen in general Gynaecology outpatient clinics by any Gynaecology Consultant as we do not have dedicated clinics. Any patients who require care by consultants with specialist skills in treating endometriosis are 155
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22 referred to the Endometriosis Centre in Glasgow. A review of endometriosis care delivered in NHS Ayrshire and Arran, aligned to the Women’s Health Plan, will be carried out in 2024/25. 9. Workforce We will continue to deliver upon the actions set out in our Workforce Plan 2022-2025 (Appendix 1) during 2024 which are linked to the national Workforce Strategy. Fundamental to this will be ensuring stability in our workforce supply and capacity, particularly for registrant staff groups. As set out in our Workforce Plan we have a corporate risk in relation to clinical registrant supply, and, having taken cognition of work and parallels with the implementation of the Health and Care Staffing Act and seeking to provide more granular risk detail, by job families encompassed by the Act, below this overarching ‘parent’ risk. Supporting our extant Workforce Plan are our Employability Strategy and recently approved Recruitment Plan (covering a 3 year period), the latter in particular being a material lever in seeking to mitigate our risk in terms of registrant supply. Following on from our successful newly qualified nurses and Clinical Development Fellows recruitment programmes that have been in place for several years we are expanding this approach to AHPs. The underpinning principle of our Recruitment Plan is ensuring the efficiency and effectiveness of our recruitment processes, as improvements in this will positively impact on our rates of supplemental staffing usage and overall staffing capacity. Whilst we are acutely aware of the requirement to ensure efficiency of administrative and support roles in their widest sense across the organisation this needs to be finely balanced to ensure there is no detriment to clinical workforce capacity i.e. reducing administrative capacity and effectively ‘shifting’ this activity to clinical colleagues to absorb - we must ensure that our clinical colleagues have optimal clinical capacity. Scoping, assessing and utilising technology to best effect will be instrumental in considering efficiencies for administrative and support services and this will take time to achieve. Employability and our Anchor ambitions provide us with the potential to utilise wider local labour market routes for mutual benefit. We will continue to utilise international recruitment as a supply lever for registrant staff and will also seek to make better use of supply routes arising from employability and armed forces to ensure we are maximising and exhausting all potential supply routes for staff to join, and develop their career, with NHS Ayrshire and Arran. The Nursing and Midwifery Workforce Group, led by the Deputy Director of Nursing and Midwifery, actively consider age profiles of their respective workforces and make plans for addressing this in collaboration with HR. Acute Services have implemented the introduction of International Nurses to Acute Clinical Areas, Working with Yeovil as pipeline to increase International Nursing recruitment. All Newly Qualified Nurse Graduates within NHS Ayrshire are offered a post with good links between HEIs and the organisation with both internal and external recruitment events. Routine application of Nursing and Midwifery Workforce and Workload tools to assess the nursing position and wider use of workforce / workload tools, across wider clinical cohorts and settings (Acute and Community), in compliance with the Health and Care (Staffing) (Scotland) Act are in place. However, there are multiple nursing workforce gaps across NHS Scotland. NHS Ayrshire and Arran is not alone in looking to address these issues and learning from and collaboration with colleagues across NHS Scotland will be necessary. There are multiple key challenges faced including; supply vs demand mismatch, skills gaps post pandemic, maintaining learning and development opportunities and retention of senior nurses. In order to solve these complex problems it will be necessary to reframe the problem. A nursing workforce 156
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23 strategy will be developed in conjunction with culture work within the nursing workforce to ensure values are aligned. Having an international recruitment programme allows us to access a much larger pool of potential nursing candidates than UK domestic recruitment alone. There is an ongoing need for these posts to support a robust transition into NHS Ayrshire and Arran. Since February 2023, a total of 21 Internationally Educated Nurses (IENs) have been recruited and started work in NHS Ayrshire and Arran, filling vacancies in Medical, Surgical, Trauma and Orthopaedics, ED/CAU, Theatres and ICU. We seek to reduce AHP vacancies and turnover, and ensure best use of resource available. We are doing this through a number of approaches – international recruitment, agreement to test a block recruitment approach with newly qualified AHPs, and planned review to maximise experience and support retention including review of learning and development resources and approach, establishment of workforce transformation groups and continued improvements in access to professional supervision. Finally, we are also exploring expanding existing nurse bank to include AHPs, with early success of inclusion of pre-registered AHP students as AHP support workers, and seeking to expand to include AHP registrants NHS Ayrshire and Arran introduced their first cohort of Trainee Assistant Practitioners in Acute Services in April 2023. The programme has supported HCSWs to attend Ayrshire College one day per week to undertake a Professional Development Award (PDA) at SCQF Level 8. This programme will conclude April 2024 where it is anticipated 19 Assistant Practitioners will graduate and become Band 4 Assistant Practitioners. Cohort 2 is planned to commence in September 2024 to the wider organisation. In December 2022, Scottish Government published ‘The Infection Prevention Workforce: Strategic Plan 2022-2024’. This workforce plan focussed on building the capacity and capability for Antimicrobial Stewardship (AMS), Health Protection (with relevance to IPC) and the Infection Prevention and Control (IPC) workforce in all health and care settings, and set out a range of actions for Boards. In early 2023 a review of the NHS Ayrshire and Arran Infection Prevention and Control (IPC) Service was commissioned by the Executive Nurse Director. This review set out a range of recommendations and options for workforce transformation of the IPC Team, incorporating changes to team structure, roles and ways of working. Key deliverables for this year focusing on stabilising the workforce, building senior expert clinical leadership within the team and strengthening epidemiology and data support. Specifically, the recruitment of a specialist director, recruitment to vacancies, and establishment of a data analyst post. Staff churn within the service provides opportunities for change in 2024/25, though the financial position provides a challenge to progressing these at the scale and pace which could be considered. An additional challenge is a number of post-holders are in interim positions due to the nature of the funding previously identified to support implementation of their roles. There is also uncertainty regarding future funding for several aspects of the service provision, for example to care homes, which makes the situation even more challenging. As the Infection Control Doctor role is presently vacant, this puts added pressure on senior nursing decision- makers within the IPCT. The implementation of the AfC pay negotiation workstreams – Band 5 nurse review, reduction in the working week and protected learning time - will have a material organisational impact on available workforce capacity (in terms of required resource for application of the Band 5 review process, and for the other streams the overall AfC staffing cohort capacity level) and associated expenditure the extent of which is not fully known at this stage. 157
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24 We continue to closely monitor our sickness absence rates and seek to positively address this with our Promoting Attendance Team working in collaboration with managers across service to ensure absence is managed in accordance with the NHS Scotland Attendance Management Policy. Long term absence constitutes the highest component of our organisational sickness absence and we continue to have a distinct focus upon management of long term absence in response to this. NHS Ayrshire and Arran consistently performs at a rate below the NHSScotland average and is within the top 4 territorial Boards with the lowest sickness absence rates across NHSScotland – we will continue to deliver our promoting attendance actions and associated staff health and wellbeing activity to support a maintained reduction in our level of sickness absence. During 2023/24 our sickness absence levels have tracked above our pre- pandemic 2019/20 profile, however we are acutely aware our staff, as per the general population, will be impacted by the referral and treatment backlogs across the range of NHS services which were and continue to be a needful result of the NHSScotland response to the pandemic. This will have a clear correlation to staff sickness absence levels and will do so for the foreseeable future, as will the demographic and wider socio-economic drivers that impact on our general population. There is, of course, a direct correlation with sickness absence and the demand / usage of supplemental staffing and we will seek to minimise supplemental staffing usage as far as practicably possible and where there is a requirement for use ensure this is the most cost effective option. We will also continue to manage and review other factors which impact on overall workforce spend, including continued annual review of pay protection, redeployment and non-compliant medical rotas, in addition to our ongoing scrutiny of supplemental staffing usage which has seen a significant reduction in non-framework nurse agency usage during 2023/24. In relation to the rescinding of non-framework Agency use, NHS Ayrshire and Arran are currently compliant with the DL issued by Scottish Government (SG) and are set to implement the requirements of the new updated DL around the use of all agency HCA by 1st April 2024. To support reductions in medical locum spend, the Best Medical Workforce Strategy will be fully implemented through the development of a strategic medical workforce plan. This will be accomplished by undertaking an analysis of workforce trends and historical additional medical spend to right size the medical workforce in NHS Ayrshire and Arran. This will be governed via the Monthly Medical Spend group reporting to the Financial Improvement and Scrutiny Group. During 2024/25 we will aim to: Develop and implement a strategic medical workforce plan for each sub-specialty within NHS Ayrshire and Arran (2024-2030) draft plan developed by November 2024; Reduce additional medical spend by £1m in 2024/25 academic year (August 2024/25); Develop and implement governance processes for medical workforce planning within NHS Ayrshire and Arran by February 2024; Develop and implement governance processes for authorisation of medical workforce spend (including agency, locum, resident on call, additional duty hours and Glasgow bank) within NHS Ayrshire and Arran by February 2024; and Minimise additional banding supplements paid to junior doctors (supplement paid for working more than 40 hrs/wk or core hrs Mon – Fri are before 7am or after 7 pm). NHS Ayrshire and Arran are preparing for the implementation of the Health and Care (Staffing) (Scotland) Act 2019 which seeks to facilitate high quality care, and improved outcomes for people using services in both health and care by helping to ensure appropriate staffing. The overarching ambition of the legislation is to ensure that at all times, suitably qualified and competent individuals, from such a range of professional disciplines as necessary, are working in such numbers as are appropriate for the health, wellbeing and safety of patients, and the provision of high-quality health care. NHS Ayrshire and Arran’s Health and Care Staffing Bill 158
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25 Programme Board has now been established and commenced a regular schedule of meetings. Chaired by the Nurse Director, and with multi professional representation, the Programme Board seeks to direct and coordinate the activity required to enable local readiness for enactment of the legislation. 10. Digital Services Innovation Adoption NHS Ayrshire and Arran Digital and Data Strategy 2023 - 2025 “Digital Excellent in Healthcare, a platform for change” sets out how we are going to develop and deliver on ambitions for a unified digital infrastructure that will ensure we are digitally fit to network with health and social care partners, as well as with national networks. This technical platform for integration will help us maximise opportunities for seamless health and care support, when and where it is needed. Our digital strategy is system wide and includes an Ayrshire and Arran wide commitment to deliver a single electronic patient record. Capital investment has been weighted to progressing the delivery of our digital strategy as we believe it to be a core enabler in reforming the way the Health Board can deliver best care as close to the patient as possible. Digital reform will enable new ways of working within our clinical and non-clinical settings by reducing both duplication and clinical risks, in addition to supporting our workforce to deliver health and care services closer to home. Optimising the use of digital and data technologies in the design and delivery of health and care services for enhanced patient access is key for improved safety as patients are mapped throughout their entire journey and provide single patient records for all disciplines which means continuity of care is delivered. This in turn will transform our live patient care with insightful, accurate and up to date data; provide live bed management tools and improve collaboration and data sharing across the entire system, making the Board future ready for the National Care Service. The outcomes will support delivery of our current reform programmes, including integrated care record and distributed working. Ayrshire and Arran are realising and maximising the benefits of the M365 platform. We are also part of the current stage of the federation project which sees us and 2 of our local authorities being able to collaborate and communicate on Teams without guest access. The third Local Authority have still to introduce M365 platforms. Our Developers are at an early stage looking at the Power Platform and how this can be utilised as opposed to paying for new digital solutions. The first of these developments is a Desk Booking app to support the local Distributed Working Programme. As applications become end of life, or their contracts are due to expire, alternative options are being considered which utilise the M365 platform, providing return on investment and cost savings against the current suppliers. Ayrshire and Arran are providing Developers and Project Managers as part of a new development matrix to assist in the further development of MDTs per speciality via the Teams environment for all cancer types. These MDTs aim to enable more efficient working and facilitate, through a uniform approach, cross speciality and cross region working. NHS Ayrshire and Arran overall compliance status against the Refreshed Public Sector Cyber Resilience Framework - NIS audited areas has risen by 19% in the last 12 months compared to a 2% increase in the previous 12 months. Key points highlighted by the auditor include most notable improvements in supplier management, risk management; improvements in all areas except one area which was already complete; and Digital Champions Network and digital training for non-executive Directors selected as examples of good practice. Focus continues in areas identified by 2022 audit to ensure continued improvement. The new evidence template 159
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26 has been adopted and the self-assessment tool is being utilised to ensure compliance progresses in 2024. The Health Board has been engaged with the Cyber Centre of Excellence since its inception and has close working relationships with members of the centre which help support incident response, monitoring and reporting. Digital Skills are high on our agenda and are featured throughout our local Digital Strategy. The organisation has also created a role in the form of a ‘Digital Skills Champion’ to support the work of the strategy and execute some of the associated actions which form part of this, particularly around the Digital Skills of our staff. We have built an excellent Digital Champions Network which continues to grow monthly and our approach to this has seen keen interest from other boards. We have completed a Digital Skills survey and resources are being researched and planning is underway on how this can be executed to ensure that all staff have access to enhance their digital skills and that they are also aware that they have a duty to ensure they are equipped for the digital world not only as our staff members but also as citizens and therefore patients of Ayrshire and Arran. NHS Ayrshire and Arran have in place a governance process for Accelerated National Innovation Adoption (ANIA) projects involving digital solutions. The purpose of this governance process is to improve our approach to digital innovation. This process outlines our approach around decision making and oversight as we go forward, ensuring that all ANIA digital initiatives are fully aligned with our priorities both local and national. A representative from Digital Services attends all meetings of the local Centre for Sustainable Delivery (CfSD) team. All projects being discussed by the CfSD team which contain new Digital systems or have potential for a Digital solution will be subject to the completion of a Pre Scoping Checklist (PSCL) by the appropriate clinician, supported where necessary by Digital Services resource. The PSCL will then be submitted to the Digital Services Programme Board for initial assessment. Requests will be reviewed to ensure they are aligned to the local digital strategy and the national health and social care digital strategy, meet the infrastructure standards (ensuring that any additional infrastructure requirements are captured and costed) can be resourced from both Digital Services and the affected service(s) and appropriate timescales set. ANIA projects will also be subject to the production of a Business Case by the appropriate service and supported by Digital Services. The Business Case will outline the benefits of the proposal and details of costs and any available funding if identified. Full option appraisal of alternative or existing solutions shall also form part of the Business Case. Upon approval by the appropriate Programme Board, the Business Case will be aligned with an accompanying SBAR and submitted to the Strategic Digital Delivery Group for final approval. Significant projects and those requiring funding will be submitted to Corporate Management Team for further discussion and decision at the appropriate level. By following the above process the following benefits will be delivered: Ensure effective use of available resources to deliver best value; Co-ordinate initiatives to identify overlap and synergies; Ensure informed decision-making; and Avoid duplication and silo-based thinking. A Strategic Digital Delivery Group (SDDG), has been formed to oversee the strategic decision making and implementation of the Ayrshire and Arran Digital Strategy. This includes the delivery of key actions, transformation of organisational processes, benefits realisation, and approval of new digital projects. Chaired by the Chief Executive, the group comprises senior stakeholders from within the organisation. The responsibilities of the SDDG are to provide strategic direction to the delivery of Digital Services throughout the NHS Board including close workings with the three Health and Social Care Partnerships. 160
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27 Key Priorities for 2024/25: Implementation of digital systems which support Hospital at Home, virtual capacity and Telecare and progress initiatives to increase uptake in the use of Near ME in specific acute outpatient clinics; Roll out of the new Child Health System; Support primary care practices to implement GP IT by providing both Project Manager and Digital Facilitator support to drive forward the implementation of Vision 3 to a single cohort of GP Practices, whilst planning for the first EMIS migrations in 2025; Align with the national cloud first strategies to provide resilient access to systems, flexible approaches to our data and storage requirements and increased security of systems by sourcing alternative shared data centre, server and storage facilities; and Implementation of the National e-Rostering Solution across NHS Ayrshire and Arran for all substantive clinical staff and Ayrshire and Arran rotation of Junior Doctors by taking on board learning from pilot site and approaching the next approved sites for implementation. 11. Climate NHS Ayrshire and Arran’s “Climate Change and Sustainability Strategy 2021-2032" sets out the framework for the board's pathway to climate change mitigation and adaptation. The strategy outlines our sustainable development to be undertaken across all areas in the organisation and will prompt action plans for each work-stream to improve our environmental sustainability. A series of key deliverable commitments have been identified against priority areas. NHS Ayrshire and Arran will aim to: Reduce Greenhouse Gas emissions (eg Nitrous Oxide, Inhaler Propellant etc) in line with local, regional and national requirements by focussing on the completion of key initiatives. This will be overseen by the green theatre programme team, electric vehicle transition project group, transport, pharmacy leads and primary care prescribing groups; Adapt to the impact of climate change, enhancing the resilience of healthcare assets through the initial development of Climate Change Risk Assessment and Adaptation Plan (CCRAs). The priority of future actions/ work streams will be determined based on overall risk; Achieve waste targets set out within current policy and progress deliverables and benefits related to the Circular Economy through the extension of existing sustainable development practices driven by the procurement scrutiny group; Decarbonise our fleet emissions (2025 for cars / light commercial vehicles and 2032 for heavy vehicles at latest) in line with local, regional and national requirements by focussing on the key initiatives. This programme of investment will be led by the Electric Vehicle Transition Project Team; Meet the requirements contained within the current policy “A Policy for NHS Scotland on the Climate Emergency and Sustainable Development: and Reduce its overall environmental impact through the adoption of sustainable actions in line with local, regional and national requirements by focussing on the completion of key initiatives. This will be overseen by the Green Theatre Programme team. This aim will be supported by learning from the National Green Theatre Programme. 161
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28 Progress achieved within the above priority areas will be monitored through existing internal governance within the organisation and reported as appropriate. 162
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Appendix 1 NHS Ayrshire & Arran Workforce Plan 2022-2025 – Action Plan Monitoring (6 monthly) Action ref Nat. strategy theme Action (Lead Director) & Lead Officer(s) RAG status Progress People Strategy Theme – Attract: Our ambition is to improve the supply of registrant clinical staff thus reducing our reliance on supplemental staffing solutions and ensuring we provide safe, effective, high quality services. A1 Attract Deliver upon our international recruitment plan for registrant staff in 2022/23 and refine this for subsequent years so there is an established supply (HRD) Assistant HRD – CES International Recruitment Lead Green Rolling programme of ongoing AHP and nursing recruitment on three monthly phases. A2 Attract Make improvements to our marketing for recruitment to ensure we stand out as an employer of choice in a crowded market (HRD) Assistant HRD - CES Recruitment Services Manager Green Recruitment plan agreed by CMT on 31/10 and branding is a key aspect of this. Work has commenced in collaboration with Digital Engagement Team. A3 Plan Seek to reduce our use of high cost nursing agency in line with our stabilising our system targets (Director of Nursing) Chief Nurses CNMs Green A significant amount of work has been progressed in line with DL(2023) to reduce the use of non-framework premium agencies. This was implemented in June 2023 and we have been able to demonstrate a greater than 90% reduction in NFA use. This has been achieved by promoting block bookings for bank and framework agency staff and this approach continues. A4 Plan Use the most cost effective supplemental staffing solutions such as bank, excess part time hours and overtime (Director of Nursing) Chief Nurses CNMs Green See progress for A3 above. A5 Employ Continue to encourage staff to join our banks including building on practice during the pandemic of encouraging students to join (Director of Nursing) Chief Nurse – EIC & PD Staff Bank Manager Green Students offered Band 3 on Nurse Bank when 1st year completed to encourage recruitment to bank. Moved to continuous recruitment for all internal appointments including student nurses. 10/04/23 All 2nd and 3rd year Student Nurses have been offered a Band 3 Healthcare Assistant post on the Nurse Bank Planning for 2023 intake is underway. A6 Attract Where supply allows we will seek to recruit to our latent vacancies for consultant medical staff however given the length of time some of these posts have been vacant, and ongoing national (Director of Acute Services) Site Directors GMs CDs AMDs Red Pressure areas: Acute medicine (Ayr), General Medicine (both sites), Pathology (pan-Ayrshire service), Anaesthetics, ICM and General Surgery (Ayr) Challenged position at UHA site within medical specialties with only 5 substantive consultant posts currently filled 163
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30 supply issues, we may need to redesign services accordingly Adverts out for locum consultants in acute medicine at UHA site utilising recruitment agency Pathology recruitment ongoing and hope to be able to recruit from this year’s CCT cohort Recruitment drive planned for medical specialties from April – August utilising the 16.8 WTE salaries. The aim would be for a pan-Ayrshire approach to recruitment. ICM review under way to explore options as unable to recruit despite multiple recruitment rounds. Specialist role advertised for ICM to attract senior tier Specialist role being explored for multiple specialties including dermatology and haematology A7 Plan Deliver on our vision for Best Medical Workforce (Medical Director) Clinical Lead for Service Development Green CDF/CTF Recruitment The reputation of our CTF and CDF programmes continue to be positive with 100% of respondents (exit interviews Aug 2023) stating they would recommend the programme to a friend. Fill rate for funded CDF posts in August 2023 was 100% and the Board was able to backfill all NES gaps except for three (x 1 Biggart and x 2 Emergency medicine). Recruitment was limited by the number of IMGs that can be safely supported at a time in departments. There have been two resignations from the programme for February 2024; one doctor has gained ST4 training number at national recruitment and another has resigned as they ‘time out’ for surgical applications. Neither is a concern and we will re-advertise these posts in November. There is one maternity leave gap in the CTF programme and the post is in the process of being re-advertised. MTI programme The MTI programme was relaunched within the Board in August 2023. It had been suspended for 2022/23 academic year due to the need for the Board to fund IMY3 programme via NES. The Board has successfully recruited x 2 MTIs for Ayr Hospital (Respiratory and Rheumatology) who have joined. A further MTI has been employed within gastroenterology at UHC for January 2024 start and the Board continues to engage with RCPE. A further two are required within GIM at Ayr Hospital to backfill trainees rotating out in February. 164
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31 Specialists The AMD group fully supports implementation of the Specialist grade wthin the Board. It is a way to help with both recruitment and retention of senior medical staff. ICM have recruited one specialist and Emergency Medicine has recruited x 2 so far. There are funding barriers to creating these posts which will have to be worked through over the coming months. Leadership Programme The new Clinical Leadership Development programme has launched with two sessions delivered so far. The next session is planned for 7 December. The programme covers clinical governance, job planning, difficult conversations and other topics that medical leaders require training on. New Consultant programme ongoing and evaluates well. The Board will be welcoming back a senior CDF as a rural GP fellow in February 2024. A8 Employ Continue our annual process of block recruiting all newly qualified nurses from the Ayrshire campus of the University of West of Scotland to funded nurse vacancies (across all branches) (Nurse Director) Chief Nurse – EIC & PD Recruitment Services Manager Green The Annual Newly Qualified Nurse recruitment for 2023 intake has now concluded. NQPs were offered Band 4 posts whilst waiting on NMC Pins. An after Action Review took place in October 2023 and planning for 2024 annual recruitment will commence in December 2023. Initial planning with UWS began in November 2023 A9 Train Deliver the NMAHP workforce strategy which facilitates education and leadership and career pathways at all levels, enable clinically led reform of new models of care, contributes to Magnet status and supports new role development (Nurse Director) Green The NMAHP strategy launched of 17th April. 4 working group led by ANDs have been developed and each has a working Driver Diagram. Each group now has dedicated Project support to support timelines and outcomes. Two NMAHP Learning Events are planned for November 2023 based on Transformational Leadership, Exemplary Professional Practice, Structural Empowerment and New Knowledge and Innovation. An update was presented to the Workforce Planning Implementation Group on 28/08/2023 and Board Meeting on 14/08/2023. A10 Plan Complete the Healthcare Improvement Scotland self-assessment template of preparedness for the Health & Care staffing which will become effective on (Nurse Director) Interim Deputy Nurse Director N&M Workforce Staffing Lead Green This is in progress and has been tested with a few nursing families. Feedback has been shared with HSP team at HIS. Our role was to test this rather than to complete it. This action will be ongoing. Requirement is to make sure every service is 165
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32 1st April 2024 and work with all job families ensure readiness aware of Bill and the components of this. Board self- assessment template now complete and first return submitted. A11 Plan Deliver our planned programme of running the suite of nursing & midwifery workforce and workload planning tools which will inform workforce demand and financial planning (Nurse Director) N&M Workforce Staffing Lead Green These were run in June 2022 for Acute Services and an established programme is in place for rollout. 10/04/23 Robust programme is being finalised for the 2023 running of the nursing and midwifery workforce and workload tools. The Gantt chart showing our intended delivery plan is attached. Responses are awaited from MH, EACH, ACH & WV wards 1&2. Discussion with Deputy ND planned for 10th April to consider Crosshouse Adult in-patient and EDEM. Suggestion is to avoid the ‘red block’ dates to allow capacity to train and support. 20/11/23 – Speciality Specific Workload Tools have been run throughout the year 2023 as per Gantt Chart (included below) with outcomes transposed into Reporting Templates and disseminated appropriately 22/6/23 Biggart & Girvan (Adult in-patient) 5/6/23 District Nurses, HV’s and School Nurses (1st National Run) 12/6/23 Maternity & Gynae wards 19/6/23 Crosshouse acute (Adult in-patient) & Adult Mental Health acute (MH tool) 3/7/23 Crosshouse A&E (EDEM Emergency Department Emergency Medicine) plus CCSN (Community Children & Specialist Nurses) (1st National Run) 17/7/23 Rehab/Forensic (MH tool) 24/7/23 ACH & WV rehab (Adult in-patient) 14/8/23 Ayr acute (Adult in-patient) 21/8/23 Burnock (Adult in-patient) & Marchburn (MH tool) 28/8/23 Ayr A&E (EDEM Emergency Department Emergency Medicine) 4/9/23 District Nurses, HV’s and School Nurses (2nd National Run) 25/9/23 CCSN (Community Children & Specialist Nurses) (2nd National Run) 16/10/23 CNS (Clinical Nurse Specialists) (1st National Run) Pending- 22/1/24 CNS (Clinical Nurse Specialists) (2nd National Run) 166
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33 Moving forward we need to plan our runs for the year 2024, as part of the Health & Care (Staffing) Act is our duty to run each Speciality Specific Workload tool for at least 2 weeks each year. A12 Plan Establish a multi-disciplinary Health & Care Staffing Board (Nurse Director) Complete Health & Care Staffing Programme Board now established and first meeting took place on 09/03/23 A13 Attract Undertake phased recruitment to fulfil the staffing levels associated with the Ayrshire National Treatment Centre as agreed and monitored monthly by Scottish Government (Director of Acute Services) General Manager - NTC Recruitment Services Manager Amber Awaiting submission of FBC to Board and SG CIG for approval. Workforce template agreed by SG NTC programme. As at 7th November, awaiting confirmation from SG to submit FBC. A14 Plan Appoint a Workforce Planning Advisor to assist in developing workforce plans and assessing workforce demand associated with delivering Caring for Ayrshire ambition (HR Director) Workforce Modernisation Manager N/A – action changed We have refocused our priority onto the availability of workforce intelligence in a service format via Power BI as being more assistive to organisational workforce planning as opposed to a Workforce Planning Advisor role which we were unsuccessful in attracting candidates to previously. A15 Employ Support the employment of Armed Forces leavers and veterans (HR Director) Assistant HRD - CES Recruitment Services Manager Green NHS Ayrshire and Arran has been awarded Gold Employer Recognition. We have a standing advert on the Force Families Jobs website. We are engaging in the NES hosted Supporting Armed Forces Employment (SAFE) programme to offer tangible support to ensuring we can gain more people from the AF community in joining our WF on a WoS regional basis. People Strategy Theme – Retain: Our ambition is to introduce both new and complementary roles and support the development and career progression of our staff enabling them to achieve their full potential R1 Plan Manage our workforce numbers to ensure we operate within our funded financial establishment (Director of Finance) Director of Acute Services Red Funded financial establishment for 22/23 was bolstered by non-recurring money for Covid which will not be there in 23/24. Triumvirates in Acute will have a key role in managing workforce numbers. Each acute hospital has wards open which have no budget and require to be staffed (often using agency) therefore will not be achievable until close the unfunded wards. R2 Plan Undertake scoping and mapping of all current specialist, advanced and consultant nursing, midwifery and allied health profession roles and identify where is potential for expansion in line with our recovery and strategic planning intent (Nurse Director) Amber 07/02/2023 – Engagement exercise has been completed with specialist nurses and AHPs, the results of which are to be included in an SBAR. The next phase is a survey to identify areas of advanced practice. Further work is required in terms of a short life working group to identify and take forward the actions. 167
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34 21/11/23 As part of the CNS (Clinical Nurse Specialists) National Runs, Paper 8 - Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland, the descriptors for Band 6 and above held within this paper were used to identify CNS’s throughout NHSAA in preparation for running the Speciality Specific Workload Tool National Run which commenced on the 16th of October with a 2nd run due on the 22nd of January 2024. 163 CNS’s were identified with 153 invited to run the 1st national run (10 abstained due to LTS or ‘New in Post’) 142 completed successfully. 27/11/2023 We have recently initiated a SLWG looking at transforming roles for AHPs in Ayrshire, with a view to taking a more strategic approach moving forwards. R3 Train Introduce new Medical Associate Profession roles in our Acute settings ensuring these are embedded with requisite governance and support mechanisms (Director of Acute Services) Site Directors GMs AMDs Green Registration of MAPs following national timetable with GMC. We have successfully recruited 3 WTE Anaesthetic Associates, aligned with NTC development, who are undertaking training. Recruited to surgical practitioner post within UHA. R4 Train Work collaboratively on a West of Scotland regional basis to introduce Physician Associate Roles and plan where these will be deployed within Ayrshire (HR Director) Amber WoS MAPS Steering Group has recently convened to provide direction to the roll out of MAPS roles in a co-ordinated way across the region. Initial steps have been development of generic job descriptions for MAPs roles to ensure grading consistency across the region. There is also close alignment with the national MAPs programme at NES. R5 Employ Undertake the review of Band 2 nursing roles as per the national directive (HR Director) Assistant HRD - CES HR Manager – Policy & JE Amber Review of Band 2/3 HCSWs underway. Substantive staff almost complete, with very small proportion remaining as B2. Bank staff exercise still in process. R6 Plan Develop plans for introducing Band 4 roles within the nursing workforce (Nurse Director) Chief Nurse – EIC & PD Recruitment Services Manager Green 28 were recruited to a Trainee Assistant practitioners commenced in Acute on 24/04/23 however only 23 commenced the programme due to a number of reasons, mostly financial. They begin a day release at Ayrshire College to complete a PDA on Thursday 27th April. This programme will conclude at the end of March 2024. 19 currently remain on the programme. Evaluation has been carried out during this programme and a final evaluation will be presented in May 2024 with Cohort 2 commencing in August 2024. 168