Agenda Document Pack - Integration Joint Board - 20/10/2022
North Ayrshire Council · 20 October 2022
Back to Integration Joint Board — 20 October 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Integration Joint Board Meeting Thursday, 20 October 2022 at 10:00 Council Chambers, Cunninghame House, Irvine / Hybrid via Microsoft Teams Meeting Arrangements - Hybrid Meetings 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 Declarations of Interest Members are requested to give notice of any declarations of interest in respect of items of business on the Agenda. 2 Minutes/Action Note The accuracy of the Minutes of the meeting held on 22 September 2022 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). 3 Director's Report Submit report by Caroline Cameron, Director (NAHSCP) on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 1
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4 Woodland View Ward 7B Service Redesign Proposals and future models of Care Delivery Submit report by Caroline Cameron, Director (NAHSCP) seeking approval for service redesign proposals with delivery of new model of care at Woodland View and wider Community services which are in line with service demands and pressures, investment, national and local priorities (copy enclosed). 5 NAHSCP Workforce Plan 2022-25 Submit report by Scott Bryan, Interim Programme Manager – Strategic Planning on the Workforce Plan 2022-25 (copy enclosed). 6 Mental Welfare Commission Report - Authority to Discharge Submit report by David Thomson, Head of Service (Health and Community Care) on progress in relation to the action plan developed in response to the Mental Welfare Commission – Authority to Discharge Report (May 2021) (copy enclosed). 7 Unscheduled Care Update Submit report by Caroline Cameron, Director on the above (copy to follow). 8 Annual Delivery Plan Submit Annual Delivery Plan by Gillian Arnold, Head of Planning and Information for noting by Members (copy enclosed). 9 IJB Dates 2023 Submit report by Karen Andrews, Team Manager on the proposed timetable for meetings of the IJB and PAC for 2023 (copy enclosed). 10 Urgent Items Any other items which the Chair considers to be urgent. 2
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Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home, where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public seating areas will not be filmed. However, by entering the Council Chambers, using the press or public seating area or (by invitation) participating remotely in this meeting, you are consenting to being filmed and consenting to the use and storage of those images and sound recordings and any information pertaining to you contained in them for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. If you do not wish to participate in a recording, you should leave the meeting. This will constitute your revocation of consent. If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk. 3
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Integration Joint Board Sederunt Voting Members Bob Martin (Chair) North Ayrshire Council Cllr Margaret Johnson (Vice-Chair) NHS Ayrshire & Arran Cllr Timothy Billings North Ayrshire Council Adrian Carragher NHS Ayrshire and Arran Cllr Anthea Dickson North Ayrshire Council Christie Fisher NHS Ayrshire and Arran Marc Mazzucco NHS Ayrshire and Arran Cllr Louise McPhater North Ayrshire Council Professional Advisors Caroline Cameron Director Paul Doak Head of Service (HSCP Finance & Transformation)/ Section 95 Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Alistair Reid Lead Allied Health Professional Adviser Darren Fullarton Associate Nurse Director/IJB Lead Nurse Dr Louise Wilson GP Representative Janet Davies Lead Psychologist Stakeholder Representatives Terri Collins Staff Representative – NHS Ayrshire and Arran Louise McDaid Staff Representative – North Ayrshire/ Chair, North Coast Locality Forum Pamela Jardine Carers Representative Clive Shephard Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third Sector Representative Vacancy IJB Kilwinning Locality Forum (Chair) Vacancy IJB Garnock Valley Locality Forum (Chair) Louise Gibson IJB Irvine Locality Forum (Chair) 4
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 22 September 2022 at 10.00 a.m. involving participation by remote electronic means and physical attendance within the Council Chambers, Irvine. Present (Physical Participation) Voting Members Bob Martin, NHS Ayrshire and Arran (Chair) Councillor Margaret Johnson, North Ayrshire Council (Vice Chair) Councillor Timothy Billings Councillor Anthea Dickson, North Ayrshire Council 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 – North Ayrshire Stakeholder Representatives Louise McDaid, Staff Representative (North Ayrshire Council)/Chair, North Coast Locality Forum Pamela Jardine, Carers Representative Present (Remote Participation) Voting Members Adrian Carragher, NHS Ayrshire and Arran Christie Fisher, NHS Ayrshire and Arran Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Darren Fullarton, Associate Nurse Director/IJB Lead Nurse Stakeholder Representatives Louise Gibson, IJB Irvine Locality Forum (Chair) Vicki Yuill, Third Sector Representative In Attendance (Physical Participation) Alison Sutherland, Head of Service (Children, Families and Criminal Justice) Thelma Bowers, Head of Service (Mental Health) David Thomson, Head of Service (Health and Community Care) Peter McArthur, Senior Manager (Addictions) Raymond Lynch, Senior Manager (Legal Services) Craig Stewart, Committee Services Officer Angela Little, Committee Services Officer Agenda Item 2 5
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In Attendance (Remote Participation) Michelle Sutherland, Partnership Facilitator, HSCP Eleanor Currie, Principal Manager – Finance Apologies Councillor Louise McPhater, North Ayrshire Council Alistair Reid, Lead Allied Health Professional Adviser Aileen Craig, IJB Monitoring Officer 1. Apologies and Chair’s Remarks 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/Action Note The accuracy of the Minutes of the meeting held on 25 August 2022 were confirmed and the Minutes signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local Government (Scotland) Act 1973. 3.1 Matters Arising from the Action Note It was noted that matters arising from the action note were on track. Noted. 4. Chief Social Work Officer Annual Report 2021/22 Submitted report by the Chief Social Work Officer on the Annual Report required by the Scottish Government. The report set out at Appendix 1, highlights the range of Social Work activity throughout the year and places that in the context of the socioeconomic challenges faced locally. Members asked questions and were provided with further information in relation to:- • Recruitment of social workers, particularly given the current challenging financial landscape; • Mental health matters; and • Child protection arrangements. The Board agreed to note (a) the contents of the report and, in particular, the successes and challenges detailed therein; and (b) the skilled and compassionate interventions of our practitioners and managers. 5. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on developments within the North Ayrshire Health and Social Care Partnership. 6
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The report provided an update on the following areas:- • National developments that included the New mental health and well-being platform for employers, outlined in more detail in the reports; • Ayrshire wide developments that included Discharge Without Delay – 7 Minute Briefing and Child Health Report 2022; • North Ayrshire Developments that included ‘Near Me’ (a video calling service used by many health and public services) based at Kilwinning Library, Respite fund applications open for unpaid carers, Impact Arts opportunities for young people and a recent team-building day involving North Ayrshire Drug & Alcohol Recovery Service (NADARS) through a successful application to the Staff Well-being fund; and • An update on the Covid vaccination programme including a pause to the remaining asymptomatic testing in place for health and social care staff and in high risk settings and updated guidance in relation to the use of face masks in social care alongside the seasonal flu vaccination programme. Members asked questions and were provided with further information in relation to:- • The ‘Near Me’ service and whether it would be rolled out to other public libraries in North Ayrshire, following evaluation; and • The current testing arrangements for health and social care staff and whether the test kits were still suitable for any future strains of the Covid-19 virus that might emerge. Noted. 6. Annual Performance Report 2021-22 Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the key achievements during 2021-22 and the publication of the Annual Performance Report. The Annual Performance Report was set out at Appendix 1 to the report. Noted. 7. 2022-23 – Month 4 Financial Performance Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the IJB’s financial performance. Appendix A to the report provided the financial overview of the partnership position, with the full Transformation Plan for 2022/23 provided in Appendix B. Appendix C provided an overview of those service changes with financial Savings attached to them and the current BRAG status around the deliverability of each saving. Appendix D outlined the movement in the overall budget position for the Partnership following the initial approved budget. The local finance mobilisation plan submission was provided at Appendix E to the report with Appendix F showing the IJB reserves position in detail. The Board agreed to (a) note (i) the overall integrated financial performance report for the financial year 2022-23 and the current overall projected year-end underspend of £0.389m, (ii) the progress with delivery of agreed savings, (iii) the remaining financial risks for 2022-23, including the impact of remaining Covid-19 estimates and costs; and (b) approve the budget reductions which were detailed at paragraph 2.11 of the report. 8. Reserves Policy 7
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Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the updated Partnership reserves policy. The updated policy was set out at Appendix A to the report. The Board agreed to approve the updated reserves policy. 9. North Ayrshire Health and Social Care Partnership and Alcohol and Drug Partnership Implementing Medication Assisted Treatment – update report and Improvement Plan Submitted report by Peter McArthur, Senior Manager (Addictions), on the implementation of new Medication Assisted Treatment (MAT) Standards and requesting endorsement of the North Ayrshire MAT Improvement Plan. The MAT annual summary report 2021 to 2022; RAG Status - for MAT standards 1 to 5 - July 2022; North Ayrshire MAT Implementation Plan finalised draft - for endorsement & approval 080922; and Correspondence from Minister for Drugs Policy - MAT requirements and accountability 2022 was set out at Appendices 1 – 4 to the report, respectively. The Board agreed to (a) endorse the MAT Improvement Plan and (b) note the obligations placed on Chief Officers and Chief Executives in relation to governance and accountability. 10. Recovery & Renewal for Mental Health Submitted report by Thelma Bowers, Head of Mental Health, on the Scottish Government Programme of work for Mental Health Recovery & Renewal investment and service development in alignment with Scottish Government strategic priorities. Members asked questions and were provided with further information in relation to:- • Funding arrangements particularly involving the Third Sector. The Board agreed to (a) note the update on the programme of work for Mental Health Recovery and Renewal; (b) endorse and support the programme as set out in the report; and (c) that a seminar be arranged to give more information to Members in this area. 11. Whistleblowing Report – Quarter 1, April to 30 June 2022 Submitted report by Karen Callaghan, Corporate Governance Co-ordinator, in relation to whistleblowing concerns raised in Quarter 1 (April-30 June 2022). Noted. The meeting ended at 11.40 p.m. 8
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North Ayrshire Integration Joint Board – Action Note Updated following the meeting on 22 September 2022 No. Agenda Item Date of Meeting Action Status Officer 1. Mental Welfare Commission Report: Authority to Discharge 21/10/21 The Board agreed to (a) note the terms of the report; (b) approve the North Ayrshire Health and Social Care Partnership response to the recommendations; and (c) receive an update report to the IJB in 12 months in terms of progress with the recommendations of the Mental Welfare Commission report. Update by October 2022 David Thomson 2. Communities Mental Health & Wellbeing Fund 17/3/22 The Board agreed to (a) note the terms of the report; and (b) note that a report would be brought to a future meeting of the Board, for consideration, which would provide learning and an evaluation of what worked, and what did not, in respect of the Fund distribution process, etc. Update to a future Board (date: tbc) Vicki Yuill 3. Medium-Term Financial Outlook 17/3/22 The Board agreed to (a) note the Medium- Term Financial Outlook and the potential financial position in years 2 and 3; and (b) approve the setting up of a Workshop, at the appropriate time, in order to help and facilitate consideration of matters going forward once the funding position, by the Scottish Government, had become clearer. Agreed to Set up a Workshop, at the appropriate time, once funding position, by the SG, had become clearer. Update – IJB Development Workshop taking place on 22 September 2022. Paul Doak 9
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4. Unscheduled Care Performance 16/6/22 The Board agreed to (a) (b) receive a performance update at the next meeting in August and thereafter consider any further interventions required; and (c) Verbal update provided 25 August 2022 Caroline Cameron 5. Director’s Report 25/8/22 A future report to be provided to the IJB on suicides, drug and alcohol related deaths. Date tbc Caroline Cameron 6. The Promise in North Ayrshire: Update on Progress 25/8/22 The Board agreed to note (b) that a further progress report and action plan will be remitted to IJB following The Promise Conference to be held in November 2022. Date tbc Alison Sutherland 7. North Ayrshire HSCP and ADP Annual Performance Management Report – Alcohol and Drugs 25/8/22 A future report to IJB from the ADP giving a clearer understanding in terms of drug types which have contributed to drug death statistics. Date tbc Caroline Cameron/ Peter McArthur 8. Recovery & Renewal for Mental Health 22/9/22 The Board agreed that a seminar be arranged to give more information to Members in this area. Date tbc Caroline Cameron/ Thelma Bowers 10
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Integration Joint Board 20 October 2022 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 IRISR Independent Review of Inspection, Scrutiny and Regulation COSLA Convention of Scottish Local Authorities NCS National Care Service CSWO Chief Social Work Officer PEAR Prevention, Early Intervention and Recovery CLASP Community Led Action and Support Project 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. Agenda Item 3 11
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3. CURRENT POSITION National Developments 3.1 Creating Hope Together : Scotland’s Suicide Prevention Strategy 2022-32 The Scottish Government launched the Creating Hope Together : Scotland’s new Suicide Prevention Strategy and Action Plan on 29th September 2022. The Strategy sets out an ambitious plan for Scotland to implement the first stage of the 10 year strategy and includes four long term outcomes. To achieve the vision within the strategy these outcomes must be delivered to affect change across society, services, communities, and individual experiences. The action plan identifies which areas will continue to be focussed on and identify new areas of future work to support delivery of the outcomes. The actions are built around 6 action areas and a workplan will be developed to detail which level the actions will be delivered, e.g., national, local, regional (or a combination), lead partners, resourcing and timescales. Finalisation and publication of the outcomes framework will include key indicators to measure progress in delivering the plan. A copy of the strategy is available through the attached link 3.2 Launch – National Conversation for New Dementia Strategy The Scottish Government launched their “National Conversation” for the New Dementia Strategy on 29th September 2022. The aim of the ‘National Conversation’, informed by a short discussion paper, is to meaningfully capture the experiences of people living with or caring for someone with dementia and to enable them to develop a new Strategy that covers all aspects of life for someone living with dementia. It will run from 29th September until 5th December, and can be responded to via Citizen Space. To enable people to respond how they choose, they will also be open to receiving video and audio clips and will also hold a series of online conversations on the Strategy, and will work with partners to facilitate face-to-face discussions in the coming months. For further information, please get in touch at dementiapolicy@gov.scot. 12
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3.3 National Care Service Forum The first National Care Service Forum took place in Perth on Monday 3 October and was well attended by people online and in person. The keynote speaker at the event was Kevin Stewart MSP, Minister for Mental Wellbeing and Social Care, and with input from Humza Yousaf MSP, Cabinet Secretary for Health and Social Care, and Angela Constance MSP, Minister for Drugs Policy. The forum provided an opportunity for stakeholders, people who access social care, the social care workforce, carers and unpaid carers to share their thoughts about the National Care Service. Group discussion took place around a number of questions and Scottish Government undertook to ensure that the information gathered at the event would be used to help inform the co-design of the NCS. The forum will become an annual event. 3.4 Independent Review of Inspection, Scrutiny and Regulation of Social Care in Scotland On 21st September 2022, Kevin Stewart, Minister for Mental Wellbeing and Social Care announced the commission of an Independent Review of Inspection, Scrutiny and Regulation (IRISR) across social care support services. Dame Sue Bruce has been appointed as Chair of the IRISR, supported by Stuart Currie as Vice Chair. The IRISR will :- (a) explore how regulation and inspection of social care services and partners who contribute to care and wellbeing can be effectively supported to improve outcomes and experiences for the people of Scotland; (b) ensure regulation, scrutiny and inspection of social care arrangements have a basis in human rights and; (c) ensure appropriate scrutiny of all aspects of the National Care Service (NCS). Two advisory panels will be appointed to strengthen and assist the IRISR by providing specialist advice to the Chair, and to inform any recommendations that may be made regarding social care regulation, inspection and scrutiny. The review will include a call for evidence and include a programme of stakeholder engagement in the coming months to ensure input from a wide range of voices, including those seldom heard, to help support the review process. Dame Sue Bruce has been asked to report back to Ministers by June 2023. 13
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3.5 Inquiry : Health Inequalities in Scotland The Scottish Parliament’s Health, Social Care and Sport Committee published a report of the findings of its recent inquiry into health inequalities in Scotland. The inquiry explored evidence on the fundamental causes of health inequalities and heard a range of evidence from policy-makers across a wide spectrum of policy areas. The report sets out areas for future action at local authority, Scottish Government and UK Government levels and highlights areas where further action is required. A copy of the report can be accessed through this link. 3.6 Health and Social Care : Winter Resilience Overview 2022-2023 On 4th October 2022, the Cabinet Secretary of Health and Social Care published the annual progress update on the NHS Recovery Plan 2021-2026 which set out a joint set of 8 priorities, agreed with COSLA designed to prepare for winter. A copy of the Winter Resilience Overview document can be found through this link. Ayrshire Wide Developments 3.7 Staff Wellbeing Centre, Ayrshire Central Hospital During the covid pandemic, staff wellbeing areas were set up across sites within NHS Ayrshire & Arran using existing clinical and training areas that had temporarily closed due to the pandemic. These areas became safe havens for staff and served not only as somewhere for staff to rest and reflect, but also as places to access to a range of well-being services at a time when stress and anxiety was heightened and emotional, physical and mental support was vital. NHS Ayrshire & Arran wants to ensure staff continue to have these essential spaces to enhance their emotional, physical and psychological well-being going forward, with newly refurbished centres currently in development at University Hospitals Ayr and Crosshouse and Ayrshire Central Hospital, which will give staff improved access to rest areas separate from the public. The Staff Well-being Centres are accessible to all clinical and non-clinical staff from across our entire health and social care system, with the vision of providing a sanctuary for them to be able to stop, reflect and reconnect with themselves. The centre has rest areas with comfortable seating, along with 2 consulting rooms. Staff are welcome to take their breaks in the centre as it will be open in line with the dining room’s operating hours. The first of the new Staff Well-being Centres was officially opened at Ayrshire Central Hospital on 29 September 2022. The centre makes up part of the existing building for the Gallery Dining Room and is a place for all health and social care staff to take a much-needed pause and relax. The official opening was marked with a ribbon cutting 14
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by the Chief Executive, Claire Burden, and Chair of Ayrshire and Arran NHS Board, Lesley Bowie. 3.8 Caring for Ayrshire Events The Caring for Ayrshire Informing and Engagement Programme will recommence during November 2022 starting with three formal launch events in the following areas; • East Ayrshire – 15 November 2022, Take a Bow, Kilmarnock KA3 7PH 10- 12noon • North Ayrshire – 21 November 2022, Fullarton ConneXions, Irvine KA12 8PE 10-12noon • South Ayrshire – 24 November 2022, Ayr Town Hall, Ayr KA7 1JX 1430-1630 These events provide an opportunity to restart the Caring for Ayrshire conversation and provide an update on progress and next steps. North Ayrshire Developments 3.9 Social Work Leadership Event The partnership hosted it’s first Social Work Leadership Event on Friday 30th September 2022 attended by over 60 participants. The event was hosted by Scott Hunter, CSWO and included presentations from Dr Martin Kettle from Glasgow Caledonian University on Professional Identity which looked at how to strengthen the professional identity of Social Works unique contribution in the context of integrated working. A presentation from Colin Turbett from Common Weal on Community Social Work and the opportunities this presents for North Ayrshire and a presentation from Stuart Muirhead from IRISS on the factors required for effective innovation in Social Work Services. Participants also heard from 2 local managers on examples of successful service development within family support and mental health services. 3.10 Our Community Space Sessions A new community project launched in the Garnock Valley earlier this summer is proving to be a huge success. ‘Our Community Space’ sessions run monthly in three Garnock Valley Towns, offering residents a chance to enjoy a chat and meet new people, explore ways to improve their mental and physical well-being and find out what’s going on in their communities. The main aim of the drop-in sessions is to reduce social isolation and loneliness, providing a welcoming and informal atmosphere where people can come together to enjoy the company. 15
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Local organisations and services have also been attending to share valuable information and advice, with representatives from NAC’s Housing service, NAHSCP’s Money Matters team, the Lennox Partnership, the Scottish Fire Service’s Home Safety team, CLASP (Community Led Action & Support Project) and NHS Ayrshire & Arran’s Musculoskeletal Pain team having been among the guests to attend so far. Staff from Turning Point Scotland’s Prevention, Early Intervention and Recovery (PEAR) Service have also been delivering Naloxone training as part of the project. Naloxone is a life-saving medication that can rapidly reverse an opioid overdose. 3.11 Foxgrove Art and Therapeutic Design Newsletter Foxgrove will provide the first medium secure adolescent inpatient service for young people in Scotland and is a key strand of the Scottish Government’s Mental Health Strategy 2017-2027. The purpose-built facility, which is currently under construction within the grounds of Ayrshire Central Hospital in Irvine, will ensure that children can be cared for closer to home and will receive appropriate care, treatment, therapies, security and on-going education. The latest Foxgrove Art and Therapeutic Design Newsletter has now been published, containing information on the inspiration behind the feature wall design at the heart of the building. 3.12 Unpaid Carers Update Two new staff been appointed to the Carers Team to commence work to examine service approaches to identifying and supporting all carers. These appointments also allow the softer front door approach to begin with carers completing a self-referral, proportionate assessment and low-level resource release. The communications and guidance for this are being developed with plans to commence in November. A Prior Interest Notice (PIN) for retender of the Carer information and Support service has been issued to engage a strategic partner to support the design and delivery of our carer services. Pan Ayrshire plans to meet duties under Section 28 Carer Involvement in Hospital Discharge are underway with support from Health Improvement Scotland. This involves two new staff, a referral process and signposting function agreed thus far. Improvement work with NAC Education to increase the identification of young carers and offer of Young Carer Statements is underway with YC Co-ordinators assigned across schools, awareness sessions beginning 11th October and a review of guidance and resources to support YC’s and staff. 16
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3.13 SDS Learning Review The SDS Learning Review Board is well established with the fourth meeting scheduled at the end of October. This is chaired by Scott Hunter, Chief Social Work Officer, and the membership is representative of local and national partners. The overarching aim of the review is to bring forward a range of recommendations and best practice to strengthen our mainstream model of service delivery across all services in Children & Families and Health & Community Care. Early agreements have been reached to consider best practice community social work approaches and delivery. The branching projects have been agreed and are being populated and will commence November 22 – April 23. The scope of these is: A) Policy & Procedure B) Social Work Practice & Systems C) Intake & Review Systems COVID Update 3.14 Social Care Staff Support Fund The Social Care Staff Support Fund was due to end on 30th September 2022. The Scottish Government and COSLA have agreed to extend the fund to 31 March 2023. This fund is available for social care staff who are absent from work due to having COVID19, or self isolating in line with public health guidance, and will remain in place to support and encourage infection prevention and control in social care settings. Further guidance and eligibility criteria on the funding can be found here. 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 17
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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 18
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Integration Joint Board 20th October 2022 Subject : Woodland View Ward 7B Service Redesign Proposals and future models of Care Delivery Purpose : To inform and seek IJB approval for service redesign proposals with delivery of new model of care at Woodland View and wider Community services which are in line with service demands and pressures, investment, national and local priorities. Recommendation : IJB to endorse the option appraisal recommendations and approve proposal for use of Ward 7B as a 72-hour Unscheduled Care Unit, delivery of an alternative outreach rehabilitation model from Warrix Avenue and future planning for delivery of a CAMHS Assessment Hub 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 X Glossary of Terms AMH Adult Mental Health AUCS Ayrshire Unscheduled Care Service (AUCS) CAMHS Child and Adolescent Mental Health Service CMHT Community Mental Health Team EMH Elderly Mental Health ECT Electro Convulsive Therapy ED Emergency Department HSCP Health and Social Care Parternship IPCU Intensive Psychiatric Care Unit MHANP Mental Health Advanced Nurse Practitioner UHA University Hospital Ayr UHC University Hospital Crosshouse 1. EXECUTIVE SUMMARY 1.1 As a requirement of Covid contingencies, mental health inpatient rehabilitation services were reconfigured – this has led to the development of an enhanced outreach Agenda Item 4 19
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model from Warrix Avenue that has released the Ward 7B physical ward environment for other purposes and the staffing budget for this area to be reallocated to support this new model. 1.2 Through an option appraisal, a proposal has been developed to re-open Ward 7B as a Nurse Led 72 Hour Assessment Unit with an expected impact of reducing Adult Mental Health (AMH) Acute beds. This freed bed capacity could be consolidated in one AMH acute bedroom wing to potentially become a self-contained unit for a Child and Adolescent Mental Health Service (CAMHS) Assessment/Support Hub. Ward 7A can also retain the additional space ‘borrowed’ from Ward 7B. 1.3 These proposals for new unscheduled care services are not reliant on the funding associated with previous Ward 7B staffing provision. Existing staffing resource has been redirected to sustain the enhancement to Warrix Avenue to continue to develop/provide their outreach model and remaining financial resource will be utilised to address pressures across inpatient services including Woodland View page-holder capacity, Electro Convulsive Therapy (ECT) staffing, Intensive Psychiatric Care Unit (IPCU) supplementary staffing avoidance and patient flow within Elderly Mental Health (EMH) inpatient services. 2. BACKGROUND 2.1 Ward 7B Availability As part of the response to the Coronavirus pandemic, the use of Warrix Avenue and Ward 7C (Forensic Rehabilitation) was optimised to allow a ward (7B) to be vacated as a contingency as a Covid ‘Red Zone‘ ward. This change later also facilitated the opportunity of the vacated ward to allow for a number of ward decants from 2020 until late 2021 to support Fire Damper/Fire Stop works across Woodland View. On the completion of this programme, it was agreed to invite pan-Ayrshire bids for alternative use of this valuable resource. 2.2 Staffing Resource and Funding Key to being able to keep Ward 7B vacated from its original purpose has been the development of the Warrix Avenue model. To allow for this reduction in beds at Wards 7B/7C a new model has been developed at Warrix Avenue - providing intensive outreach support to individuals for up to one year in their own homes (pan Ayrshire) – typically for those who have passed through Warrix Avenue as part of their rehabilitation programme, but also to individuals who may be referred direct from all adult community services or AMH acute for direct support. This new model also eases some of the pressure on pressured Community Mental Health Teams (CMHTs) with a very phased transition of persons with complex needs. 20
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Staff displaced by the restructuring of rehabilitation services as a Covid contingency temporarily supported Warrix Avenue as this model was developed and funding released from Ward 7B requires to be vired to substantively support the required increased staffing resource to sustain this model and allow Ward 7B to remain vacated. 3. PROPOSALS 3.1 Nurse Led 72 Hour Unscheduled Care Unit Approval be given for the six beds and associated public spaces within Ward 7B not utilised as additional space for Ward 7A (4 bedrooms) to be utilised to provide a nurse led Unscheduled Care service. 3.2 CAMHS Assessment/Support Hub Approval be given to further explore the anticipated released resource within AMH Acute to be redeveloped to provide a CAMHS Assessment/Support Hub. The anticipated function would be to provide inpatient care for young people aged 12-18 years for crisis admissions, mealtime support (Eating Disorders) and complex neurodevelopmental assessments. 3.3 Impact/Anticipated Outcomes Nurse Led 72-hour Assessment Unit • Reducing need for Adult AMH Acute beds • Reducing length of stay through very focused assessment on admission with clear decision point within 72 hours of admission • Improved patient care experience, simpler pathway and removing risk of multiple assessments and waits within busy emergency departments • Releasing time from ambulance and police services accompanying persons requiring psychiatric assessment to Emergency Departments (EDs) • Reduce need for sole practitioner assessments, pressure for these assessing staff and benefit of joint assessments • Benefit of wider support from Woodland View in case of distressed or agitated persons • Maximise use of condition appropriate environment at Woodland View – better for service user and families • 24/7 hub for unscheduled care including crisis and Mental Health Advanced Nurse Practitioners (MHANP) services with links to NHS 24 overnight, Ayrshire Unscheduled Care Service (AUCS) and out of hours social work. • Bringing together numerous unscheduled functions (one stop shop) to ensure seamless care / rapid transition. • Video assessment room for ‘Attend Anywhere’ assessment to support remote urgent psychiatric assessment 21
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• Reduce workload for AMH Acute staff group in terms of reduced number of admissions CAMHS Assessment/Support Hub • Would allow for a significant number of young persons requiring inpatient assessment, short term care to remain in Ayrshire and Arran • Would reduce burden/expectation of pressured paediatric services within University Hospital Crosshouse (UHC) currently asked to support young persons requiring a place of safety during psychiatric crisis • Reduce requirement for a young person to be admitted to an AMH Acute ward • Address increasing concern as to accessibility of Skye House due to service changes/limitations set by NHS Greater Glasgow & Clyde and identifies a local solution • Meets with Caring for Ayrshire ambitions and would lead to better care experience and maintaining connections with families • Whilst Nurse Led 72-hour assessment becomes operational and impact is assessed, allows time for this model to be further considered including required physical changes to released AMH Acute environment, staffing model required and proposed pathways to see if would be viable • Increase likelihood of recruiting and retaining staff with commitment to development of service model having specific NHS Ayrshire and Arran CAMHS inpatient provision • Would test aim/ambition to develop a new build bespoke unit for CAMHS in longer term • Maximises use of valuable Woodland View estate and support that can be offered from wider staff group 4. IMPLICATIONS 4.1 Financial Staffing for the Nurse Led 72-hour assessment unit will be delivered from within existing funded Unscheduled Care staff group. Monies for Ward 7B running costs, domestic, meals, portering etc will be met within previous funded services. Physical works – bid has been included within Mental Health Infrastructure requests for one off spend for preparatory works to make small number of changes to make Ward 7B fit for new proposed use. Costs of required works are awaited. The Warrix Avenue outreach model will require to be vired and funded from the existing Ward 7B rehabilitation service budget to substantively support the required increased staffing resource to sustain this model and allow Ward 7B to remain vacated. There has also been other reinvestment in cost pressure areas at Woodland 22
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View including ECT delivery and Ward 8 staffing model to address resource required for enhanced observations. There is further financial modelling work underway to fully develop the CAMHS assessment hub proposal which is predicated on the successful delivery of the 72- hour Mental Health Unscheduled Care Unit. 4.2 Human Resources Remaining previous Ward 7B staff group have gone through organisational change process and been matched in to posts at Woodland View or Warrix Avenue (assumed uplift to Warrix Avenue to offer outreach model). There would be no-one remaining in redeployment situation if uplift to Warrix Avenue is agreed. 4.3 Legal None. 4.4 Equality/Socio-Economic Both proposals allow for persons experiencing mental disorder/distress opportunity to have urgent condition specific assessment/support in an appropriate environment within their own Board area – the right service, at the right time by appropriate competent staff. 4.5 Risk Overall If funding changes for augmentation to Warrix Avenue staffing are not agreed, then this model of rehabilitation is not sustainable and Adult Acute service will become increasingly occupied by persons not requiring that level of care and be unable to accept admissions of those requiring that care as a result – High risk of adverse event in community. Ward 7B would therefore need to be retained for its original function and the space afforded to Ward 7A to be reclaimed. As alluded to in the paper, the remaining staffing budget from current Ward 7B would be utilised to address a number of service pressures across inpatient services including supporting page holder function at Woodland View, supporting development of ECT Team, addressing reliance on supplementary staff within our Intensive Psychiatric Care Unit and further progressing test of change work around facilitating earlier discharge from Elderly Mental Health inpatient setting. Cumulatively, not progressing with these requested changes would have significant impact financially and clinically across inpatient services. Nurse Led Unscheduled Care and CAMHS Hub proposal. There are currently care pathways for both these client groups – based in community and Emergency Departments. 23
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The need for urgent decisions to be made around need for inpatient admission within pressured circumstances (and in case of EDs inappropriate environments) can lead to decision for admission to be made when, if time could be afforded for de-escalation and longer assessment, there could frequently be opportunity to identify alternative support in community setting when there is increased confidence situation has de- escalated and there has been time for community supports to be mobilised/engaged. High risk - avoidable admission being agreed in need to make decision in pressured situation. Medium risk – adverse event - harm to self or others of person in ED setting engaging in act of deliberate self-harm more possible within that environment or person exhibiting stress/distress behaviours assaulting staff. High risk – adverse outcome of assessment due to lone practitioner assessment/decision making that could be mitigated through joint assessment. Being admitted to adult acute inpatient care can lead to a lengthy inpatient stay whilst all assessments are completed, time until consultant review and the risks of being in a busy adult inpatient ward. High risk – lengthier inpatient stay than is required. Currently for young persons, the admission pathway would preferably be to Skye House via our Service Level Agreement meaning care out with Ayrshire and Arran and High risk of challenge for families to keep in contact, increasing young person’s isolation and medium risk for services in liaising with the Skye House care team. High risk – admission to Adult Acute bed due to lack of availability at Skye House or young person remaining in Paediatric care setting, increased opportunity of adverse event due to risk to self/others of being in a non-age/condition specific environment. 4.6 Community Wealth Building Progressing proposed changes should allow for significant part of monies being spent out-of-area care for CAMHS persons to be spent instead within Ayrshire and Arran. When supplementary staff are required, this can often require to be escalated to agency level for shifts to be filled and such staff often reside out with Ayrshire. Use of released Ward 7B staff budget for other purposes will lead to a number of new substantive posts within our service. If agreed enablement works for Ward 7B and to scope required works for CAMHS development should lead to opportunity for Ayrshire based companies/businesses both in design and physical work changes. 24
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4.7 Key Priorities As described throughout the paper progression of these proposals align with North Ayrshire Council and North Ayrshire Health and Social Care Partnership (North HSCP) Strategic ambitions of • Tacking and reducing inequalities • Improving individual and family wellbeing • Prevention and early intervention • Bringing services together • Improving mental health and wellbeing As well as according with the Caring for Ayrshire ambitions of Ayrshire residents receiving the right care, locally and by staff with appropriate skills to do so. 5. CONSULTATION A pan-Ayrshire approach has been maintained throughout this process from asking for ideas/bids for alternative usage of Ward 7B to inclusion on the option appraisal panel to finalise preferred bid for future use of Ward 7B. Papers around these proposals have already been presented to the Partnership Senior Management team (PSMT) and NHS Ayrshire and Arran Corporate Management Team, approval was given by these groups to submit to Integrated Joint Board for final approval. Copies of papers have also been provided for sharing/discussion at South and East HSCP equivalent groups and Strategic Planning and Operational Group. Caroline Cameron, Director William Lauder, General Manager Ayrshire Central Hospital William.Lauder@aapct.scot.nhs.uk 01294 323489 25
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North Ayrshire Integration Joint Board 20th October 2022 Subject : NAHSCP Workforce Plan 2022-25 Purpose : • Approval • Discussion Recommendation : IJB to note the content of the Workforce Plan 2022-25 IJB to approve Workforce Plan for publication by 31st October 2022 and subsequent implementation. 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 NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integration Joint Board SPF Staff Partnership Forum PSMT Partnership Senior Management Team HR Human Resource FTE Full Time Equivalent 1. EXECUTIVE SUMMARY 1.1 All Health and Social Care Partnerships are obligated to produced three-year Workforce Plans. Following a period of development, the Workforce Plan for NAHSCP for the period to March 2025 is now ready for publication and implementation. 1.2 All plans must be published by 31st October 2022. 1.3 The plan sets out the key challenges facing the HSCP workforce in North Ayrshire, and a vision for how our services and workforce will change over the short and medium term. 1.4 An initial draft plan was submitted to Scottish Government at the end of July 2022. This plan was to be reviewed by Scottish Government Officers, with feedback on Workforce Plans to be returned by the end of August 2022. The draft plan was reported to IJB in August. Agenda Item 5 27
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1.5 At the time of report submission, no feedback from the Scottish Government has been received by NAHSCP. 2. BACKGROUND 2.1 The Scottish Government published its National Workforce Strategy for Health and Social Care in Scotland in March this year. This strategy sets out the Governments intentions for growing the health and social care workforce across Scotland and achieving its vision of: o ‘a sustainable, skilled workforce with attractive career choices where all are respected and valued for the work they do.’ Following this publication, guidance was provided to HSCPs to support them in the development of their individual Workforce Plans. In short summary, the guidance proposed that HSCPs should reflect current Workforce profiles and future implications and develop a workforce plan focused on the Scottish Governments five pillars. 2.2 The guidance provided by Scottish Government indicated IJBs should seek to achieve the following: • Provide an overview of the current workforce, including key challenges and risks • Provide a reflection of the local workforce implications over the short and medium term. This includes, looking at workforce priorities over the short-term (next 12 months), considering medium-term workforce development over the medium-term (three years) and consider the establishment gap between the current and future workforce. • A workforce action plan built around the five pillars of workforce planning, Plan, Attract, Train, Employ, Nurture. The pillars should be used as a framework to detail the actions which organisations will take to recruit and train staff in sufficient numbers to deliver the future workforce. 2.3 An initial draft workforce plan was submitted to Scottish Government at the end of July 2022, keeping within identified timescales. It was indicated that draft plans would be reviewed by Scottish Government Officers and feedback provided back to partnerships by the end of August 2022. At the time of submitting this paper, no feedback from the Scottish Government has been received. 3. PROPOSALS 3.1 In developing the Partnership’s Workforce Plan, we have sought to follow the guidance set out by the Scottish Government. 28
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3.1.2 The plan identifies five local workforce priorities. The priorities help support a clearer workforce planning vision and form the basis of workforce action planning. o Understanding our workforce (PLAN) o Promoting our organisation (ATTRACT) o Investing in our people (TRAIN) o Building our Workforce (EMPLOY) o Growing our people (NURTURE) The priorities are mapped directly to the Scottish Government’s workforce planning pillars. 3.1.3 Building on current workforce data and management feedback, the plan sets out the key workforce challenges facing the partnership. These include: • Vacancy levels and challenges of recruitment • Staff turnover • High levels of staff absence • A lack of appropriately trained/qualified workers across the health and social care sector • A predominately older workforce, with many close to age of retirement 3.1.4 The plan offers a view of the future workforce, identifying Social Work and Nursing projections over the next 3 years. In addition, where available, the plan includes our aspirations for our future workforce. Following management feedback, a profile of future required roles by service area over the next three years is provided. However, the plan underlines that these future requirements are aspirational, as it is unclear if future financial resources will allow all identified posts to be realised. 3.1.5 In complementing the future required workforce, the plan also provides an overview of key service developments planned over the short and medium term. Many of these proposals aim to reduce demand on health and social care service and reduce pressure on the partnership’s workforce. 3.1.6 A workforce action plan has been produced and will be structured in line with the local priorities as set out in paragraph 3.1.2. Further information on the outcomes of the plan is available in section 3.2 below. 3.2 Anticipated Outcomes Overall, the plan aims to help ensure that North Ayrshire HSCP is seen as great place to work and build a career. The plan will set out our commitment to growing and retaining our people by offering clear career pathway information for all staff, to encourage them to develop a life-long career with North HSCP. In implementing this plan, we anticipate the identified workforce priorities to be realised over the next three years. 29
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Understanding our workforce (PLAN) In progressing this priority, we will seek to improve the workforce planning functions across the partnership, supporting teams at all levels to think more about workforce planning matters. We will seek to improve the access to workforce intelligence to help embed effective workforce planning. Promoting our organisation (ATTRACT) Our goal against this priority is to deliver a clear message that North Ayrshire HSCP is a great employer that offers real job satisfaction and development opportunities. Investing in our people (TRAIN) This priority will provide effective training and upskilling opportunities for our workforce. Actions will cover supporting staff to access formal health and social care qualifications and degrees, as well as additional training opportunities. Building our Workforce (EMPLOY) We will improve our recruitment processes, making applying for jobs in the partnership more accessible, and will promote the benefits of working in the HSCP. In addition, we will work closely with NAC and NHS colleagues to improve how we share and promote our employment opportunities, ensuring our vacancies are shared widely on multiple platforms and advertised through a variety of methods. Growing our people (NURTURE) This priority seeks to support members of staff in their daily roles, as well as further their development and career progression. Actions here will deliver wellbeing supports to staff members, ensuring they are supported to continue fulfilling their roles. In addition, further actions will also be implemented to support the ongoing development of staff by providing guidance on succession planning and creation of career pathway guidance for all staff. 3.3 Measuring Impact The Workforce plan is supported by a Workforce Action Plan, that will set out key actions to help further develop our workforce and support the development and wellbeing of staff. This action plan is structured around the Partnership’s identified workforce priorities. These in turn map directly to the Scottish Government’s five pillars of workforce planning. Progress against actions in the Workforce Plan will be monitored regularly and be subject to the HSCPs performance review processes. 30
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4. IMPLICATIONS 4.1 Financial The Workforce plan is aligned to the Partnership’s Medium-Term Financial Outlook (MTFO). It has been recognised that the ability to meet the aspirational aspects of the workforce plan, for example increases in the size of the workforce are likely to be impacted by the Partnership’s financial situation in the coming years. 4.2 Human Resources The Workforce plan will have significant implications for Human Resource as we seek to better understand our workforce, and implement actions to support its development, particularly in relation to growing the workforce, investing in developing staff, and supporting staff wellbeing. 4.3 Legal In publishing this plan, the Integration Joint Board are complying with the legal obligation to produce a new Workforce plan within set timescales. 4.4 Equality/Socio-Economic An Equality Impact Assessment will be completed on the Workforce Plan prior to publication to ensure our intentions do not discriminate or adversely impact on any protected group. 4.5 Risk Risk identified suggests that failure to adequately support workforce development – including failure to recruit or retain appropriate staff - will result in inadequate staffing levels. In turn this will negatively impact on the quantity and quality of care provision to local residents. 4.6 Community Wealth Building Aspects of Community Wealth Building will be recognised through effective commissioning of local third and independent sector organisations in the delivery of health and social care services. By commissioning additional services from within the North Ayrshire social care market, we can effectively invest back into local communities. 4.7 Key Priorities Further development of the workforce will assist the partnership in working towards all five strategic priorities. It also directly contributes to the priority of ‘Develop and Support our Workforce’. 5. CONSULTATION In development of this workforce plan, engagement has been undertaken across all partnership service areas. This has included the distribution and analysis of a Workforce Planning Survey completed by Service Managers and ongoing discussions with service leads. Engagement has also been undertaken with providers from local Third and Independent Sector organisations with a focus on delivering services that support Health and Social Care. The draft plan was presented to IJB in August for further comment and feedback, which has been incorporated in the final version of the plan. 31
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The Plan has been presented to Partnership Senior Management Team, and was the subject for discussion and feedback at the Extended Senior Management Team meeting in September. The Plan was also presented to the Strategic Planning Group on 18th October 2022. Caroline Cameron, Director For further information please contact Scott Bryan, Interim Programme Manager - Strategic Planning, (sbryan@north-ayrshire.gov.uk) Appendices Appendix 1 – NAHSCP Draft Workforce Plan 2022-25 32
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2022 Workforce Plan 2022-25 FINAL DRAFT NORTH AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP NORTH AYRSHIRE Health & Social Care Partnership 33
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1 Governance Review Group / Development Date Comments 1st Draft submitted to Scottish Government Workforce Planning Office 02/08/2022 Initial submission. Comments due back by end August 2022 Partnership Senior Management Team (PSMT) 04/08/2022 Broad endorsement of approach, with offers of support to develop plan going forward. Highlighted data gaps to be considered. North Ayrshire Integration Joint Board 25/08/2022 Draft presented to IJB for discussion and feedback. Comments provided have been considered and included in later draft. Feedback received from Scottish Government Workforce Planning Office 11/10/2022 Extended Partnership Senior Management Team Meeting (EPSMT) 07/09/2022 Feedback collected from HSCP Leaders and Senior Managers on the draft plan and suggested actions for inclusion. Staff Partnership Forum 27/09/2022 Meeting Cancelled Strategic Planning Group 18/10/2022 Integration Joint Board 20/10/2022 Version Control Detail Version Date Changes 1st Draft submitted to Scottish Government Workforce Planning Office V2 02/08/2022 Initial submission. Comments due back by end August 2022 Changes following Scottish Government submission V3 03/08/2022 Inclusion of NHS protected characteristic data. Version updated post EPSMT V4 03/10/2022 Inclusion of additional actions and reference to service developments. Additional Workforce Data Included 34
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2 Contents 1. Introduction .................................................................................................................................... 3 2. Workforce Plan Summary ............................................................................................................... 4 3. North Ayrshire Health and Social Care Partnership ...................................................................... 8 4. Policy Drivers .................................................................................................................................. 9 5. Our Workforce Priorities .............................................................................................................. 12 6. Our Workforce Now ..................................................................................................................... 13 7. Workforce Challenges .................................................................................................................. 19 8. Workforce Projections and Future Requirements ........................................................................ 26 9. Our Workforce in 12 Months ........................................................................................................ 29 10. Our Workforce in 3 Years.......................................................................................................... 33 11. Third and Independent sector workforce ................................................................................ 36 12. Supporting Wellbeing ............................................................................................................... 41 13. Our Workforce Action Plan ...................................................................................................... 43 14. Appendices ................................................................................................................................ 50 Appendix A - NAHSCP .................................................................................................................... 51 Appendix B - Aligning and Defining our priorities ......................................................................... 53 Appendix C Workforce Planning Approaches ............................................................................... 55 Appendix D - Policy Drivers ........................................................................................................... 56 Appendix E - Additional Workforce Requirements ....................................................................... 60 35
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3 1. Introduction In recent years, North Ayrshire Health and Social Care Partnership has endeavoured to meet the unique challenges presented to us through the Covid-19 Pandemic. All NAHSCP staff, including frontline care workers, administrative support staff, and senior leaders, have had to quickly adapt to new ways of working, often in very challenging circumstances. Through the pandemic, we truly learned how determined and hard-working our workforce is, and how vital it is to ensure our on-going recovery from Covid-19. Now more than ever the importance and value of our workforce is prominent, their support in our Covid-19 recovery is and ability to meet the growing demand for health and social care services in North Ayrshire are critical. Further, we are also mindful of the wider economic and workforce challenges that are a result of other national and global factors. This focus on our staff is recognised in our new Strategic Commissioning Plan (2022-30) with ‘Developing and Supporting our Workforce’ being included as one of our five strategic priorities. This plan sets out our ambitions for our workforce, how we intended to shape our services to ensure we provide the best health and social care to local people in need in line with our strategic, operational, and financial plans. We expect, through implementation of this plan, the HSCP workforce is ready to meet the future health and social care needs of local people, and a career with NAHSCP in health and social care is celebrated for the value it brings to the lives of local people. How we developed this plan This plan is the product of many months of development, involving review of relevant national and local policies and publications, engagement with HR and workforce planning colleagues, consultation with HSCP leaders and senior managers and with local Third and Independent Sector organisations. To help guide and inform the development of the local plan, a working group was established that includes Strategic Planning Leads, Human Resource officers, Workforce information analysts, Partnership Planning Managers, and TSI representation. Engagement has also taken place with other key stakeholders, including HSCP professional leads, Learning and Development leads, and Union representatives. The NAHSCP Workforce plan is strongly influenced by the Scottish Government’s National Workforce Plan for Health and Social Care Service. We have created a local set of five workforce priorities, based on the Government’s five pillars of workforce planning. Workforce statistics have been provided for both Local Authority and NHS contracted staff and presented to provide an overview of the current Health and Social Care Workforce in North Ayrshire. This information provides key insights into the challenges facing the local workforce. To help identify our future workforce, we surveyed managers and senior leads across our service areas and local Third and Independent Sector organisations. The feedback received helped us to identify local workforce challenges as well as the aspirations over the short (12 to 18 month) and medium (3 year) term. 36
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4 2. Workforce Plan Summary The health and social care landscape across Scotland is changing. In North Ayrshire we are seeing demand for support increasing across all age groups and service areas. To effectively meet this demand and support local people to live safe, health and active lives, we must ensure the social care workforce is appropriately prepared. Our Current Workforce As of April 2022, the North Ayrshire Health and Social Care Partnership had a workforce of 3,622 people, with a compliment of 3,059 Full Time Equivalent (FTE) posts. Of this, 1,869 people (52%) were employed by North Ayrshire Council (NAC), and 1,783 (48%) employed by NHS Ayrshire and Arran. The HSCP workforce is predominately female, with 85% of staff being made up of women. The Chart below shows the age breakdown of all partnership staff. Of note, is that 43% of the workforce is made up of people over the age of 50. More details on the partnership’s workforce, including breakdown by service, employment type, absence and turnover and protected characteristic profiles can be found in section 6. Workforce Projections and Future Requirements Section 8 provides further information on the future workforce of NAHSCP. Building on historical staffing data, we have projected the change in our Social Work and Nursing Workforce over the next three years. As the table below indicates, both the Social Work and NHS Nursing workforce are expected to grow over the three years of this plan. Staffing Group 2021 Workforce (FTE) 2025 Projected Workforce (FTE) Social Work 191.3 212.3 Social Work Assistants 76.8 86.8 Nurse 1011 1112 While increases are expected across most service areas for both Social Work and Nursing posts, trend data has highlighted challenges in Mental Health Nursing. This service area has seen a decrease in its workforce over the past few years. Number have fallen from 614 (FTE) Nurses in 2018, to 567.6 (FTE) in 2022. Forecast suggest this number to decrease to 532.8 (FTE) by 2025 Section 8, also provides information on future roles required by service area. Feedback from HSCP management identified a number of key roles that will be required over the next three 9 106 249 373 406 444 474 625 556 303 77 <20 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 + NAHSCP Age Breakdown 37
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5 years to ensure services can deliver effective care and help improve the health and wellbeing of service users and local people. However, it is stated that both workforce projections and the identified future roles are aspirational and will be subject to the financial resources available to the HSCP. Key workforce challenges An overview of the key workforce challenges facing the Partnership can be found in section 7. While the key focus is on challenges with North Ayrshire, it is mindful of the wider social and economic challenges that are being experienced across the Country. This section also reflects some of the key demographic and health and social care challenges that are increasing demands for local health and social care services. This includes the rising older population, the high levels of poverty and deprivation in North Ayrshire, and a rising demand in mental health services. From a service perspective, the key challenges identified include: ▪ Widespread challenges in recruiting to vacant posts, experienced across all service and professional areas ▪ Staff retention – likely as a result of the high level of vacancies and competition across the health and social care market. ▪ A lack of appropriately trained/qualified workers – particularly for professional roles (e.g. shortage of trained Mental Health Officers) ▪ High levels of staff absence, exacerbated by the high pressure of working through the pandemic ▪ High levels of staff turnover in specific services ▪ A high proportion of older workers heading towards retirement age Workforce priorities Our local workforce priorities are identified in section 5. Building on the five pillars outlined on the National Workforce Strategy for Health and Social Care, we identified five local priorities that also reflects the workforce planning approaches by our parent organisations. Our five priorities for Workforce Planning are: These priorities have been used in producing our local workforce action plan. Priority 1. Understanding our Workforce Actions aligned to this priority will seek to improve workforce planning functions to demands and needs on our services. Actions will look at improving provision of and access to Understanding our Workforce (Plan) Promoting our Organisation (Attract) Investing in our people (Train) Building our Workforce (Employ) Growing our people (Nurture) 38
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6 workforce intelligence information to support effective planning and embed effective workforce planning processes. Priority 2. Promoting our Organisation Our goal against this priority is to deliver a clear message that North Ayrshire HSCP is a great employer that offers real job satisfaction and development opportunities. Actions will focus on promoting career development in health and social care and promoting the benefits of working with the HSCP. Priority 3. Investing in our People Actions identified against this priority will seek to provide effective training and upskilling opportunities for our workforce. Actions will cover supporting staff to access formal health and social care qualifications and degrees, as well as additional training opportunities. Priority 4. Building our Workforce In recognising the current challenges in recruitment in the HSCP, actions aligned to this priority will seek to improve our recruitment processes. Building on the actions identified in previous priorities, we will promote the benefits of working in the HSCP through our recruitment processes. In addition, we will work closely with NAC and NHS colleagues to improve how we share and promote our employment opportunities, ensuring our vacancies are shared widely on multiple platforms and advertised through a variety of methods. Priority 5. Growing our People Actions aligned to this priority will seek to support members of staff in their daily roles, as well as further their development and career progression. Actions here will deliver wellbeing supports to staff members, ensuring they are supported to continue fulfilling their roles. Actions will also be implemented to support the ongoing development of staff by providing guidance on succession planning and creation of career pathway guidance for all staff. Workforce of the Third and Independent Sector We recognise that many health and social care support services are provided through Third and Independent sector organisations. As such, we engaged with representatives across North Ayrshire to identify the workforce challenges facing the sector and their aspirations over the next three years. In total, 26 Third or Independent sector organisations that deliver health and social care services across North Ayrshire responded to a local workforce survey. More detail on the feedback provided can be found in Section 11. Some of the key challenges facing the sector include: 39
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7 • Recruitment and retention, with organisations reflecting the high level of competition in the social care market and a general inability to pay the same rates workers can expect in statutory services. • Staff training and development, with training being limited to only statutory requirements and challenges over accessing training subsidies. • Delivery of rural care packages, with many services delivered in the more rural parts of North Ayrshire unable to pay worker travel costs. • Access to ongoing funding, with many funding streams only awarded for one year, making long-term planning difficult in the sector. Over the course of the life of this plan, aspirations in the sector are to be supported to be able to provide more sustainable services and care to the people of North Ayrshire. The sector hopes to deliver more person-centred care services, working closer with families and carers to deliver better care services and support for local people across North Ayrshire. Actions within the action plan identify need to work closer with the third and independent sector and improving processes for how local organisations can access funding and be commissioned by the HSCP. Staff Wellbeing We recognise the importance of maintaining the positive wellbeing of our workforce. If wellbeing in the workforce is low, it presents a real risk to individuals themselves, their colleagues and the people they support. As such, it is essential that we recognise the factors that can lead to low wellbeing and support staff to remain rested, healthy and able to carry out their roles. Section 12 of this plan identifies the key factors that can impact the wellbeing of HSCP staff. These include: • Concerns over health and safety in the workforce, particularly in relation to Covid-19 • Lack of peer support that has been lost during the pandemic, with many staff feeling isolated • Impact of long-term absences on individuals and colleagues • High workload levels To support staff wellbeing a number of initiatives and supports have been put into place, including: • Staff wellbeing support hubs • Provision of safe spaces for staff members • Informal team social interactions during the day, ‘team blethers’ • Wellbeing grants available to all staff 40
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8 3. North Ayrshire Health and Social Care Partnership North Ayrshire Health and Social Care Partnership (the Partnership) provides locality-based health and social care services for people throughout their life: from birth through childhood, teenage years, adulthood and end of life. Our service areas and key partners include: • Delivery Services o Children, Families and Justice Services o Adult Health and Community Care Services o Mental Health, Addictions and Learning Disability Services • Support Services o Business Support Services o Finance and Transformation • Key Partners o Citizens of North Ayrshire o North Ayrshire Third Sector Interface o Independent Sector o Wider Community Planning Partners (Ayrshire Justice Partnership, Scottish Fire and Rescue, Police Scotland) More information on the range of services delivered by North Ayrshire Health and Social Care Partnership can be found in Appendix A. 41
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9 4. Policy Drivers The plan had been developed in alignment and recognition of a number national and local strategic and operational plans and strategies. Highlighted below are several relevant local and national policy drivers that have influenced the development of this workforce plan. Further information and details in relation to these policies and strategies can be found in Appendix D. Local Strategies Caring Together – NAHSCP Strategic Commissioning Plan 2022-30 Published in April 2022, the Partnership’s Strategic Plan sets out our commitment to achieving our vision that, “People who live in North Ayrshire are able to have a safe, health and active life”. To help achieve this vision, we have identified five strategic: Caring Together represents the first time that a strategic priority around the development of our staff has been identified for action. The priority to, ‘Develop and Support our Workforce’ reflects the HSCPs recognition of the value our staff have on ensuring we can achieve our vision. Our workforce is one of our most valuable assets and it is essential that it is developed appropriately to meet the health and social care needs of local people. We will endeavour to ensure that our workforce is fully supported to undertake their roles while also offering clear career pathways for those who wish to develop further and progress within the Partnership. Primary Care Improvement Plan – ‘Ambitious for Ayrshire’ Ambitious for Ayrshire was initiated following the implementation of the Scottish General Medical Services Contract in 2018. This contract changes how local GP and Medical practices operate, with a change in the role of GPs. Instead of being predominately GP led, medical practices are moving towards multi-disciplinary team models, where each practice will have a range of medical professionals available. The development of multi-disciplinary teams across the Primary Care sector will mean a greater diversity in the skill set of staff. However, this also brings the challenge of ensuring appropriate supply is available to ensure MDTs can operate at capacity. The Promise The Partnership will work closely with our national and local partners as we help to deliver ‘The Promise’ for Children, Young People and Families. The Promise seeks to improve the experience of all children, young people and their families if they require additional support, creating a more compassionate care system for young people and families. Enable Communities Develop and Support our Workforce Provide Early and Effective Support Improve Mental and Physical Health and Wellbeing Tackle Inequalities 42
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10 The implementation of The Promise will have a significant impact on the Children and Families Workforce. The Promise Plan for 2021-24 can be accessed here: https://thepromise.scot/plan-21-24-pdf-spread.pdf Scottish Living Wage As a large local employer, it is essential that people who work for the partnership receive a fair wage that affords them a decent standard of living. To support this approach, the Partnership is dedicated to ensuring each of our employees receive the ‘Real Living Wage’. This wage is independently calculated by the Resolution Foundation, who undertake regular analysis on the cost of living (including, housing costs, childcare, food costs and transport). In November 2021, the Real Living Wage was increased to £10.90. This has been implemented by North Ayrshire Council and will be received, as a minimum hourly rate, by all NAC contracted Partnership employees. Conversations are currently ongoing regarding implementation for NHS staff and it is anticipated these will be concluded soon. The Real Living Wage goes beyond the National Living Wage and the National Minimum Wage. By providing the living wage, we help to tackle local poverty and inequalities and ensure all partnership employees are valued for the work they do. National Strategies National Workforce Plan for Health and Social Care The National Workforce Plan for Health and Social Care was published in early 2022 and set out the Scottish Government’s vision for Scotland’s health and social care workforce. The vision is that Scotland has: “A sustainable, skilled workforce with attractive career choices and fair work where all are respected and valued for the work they do.” In setting out its approach, the national strategy sets out three key ambitions for the health and social care workforce, which is to support its ‘Recovery’ from the impact of the Covid 19 pandemic, support the ‘Growth’ of a sustainable workforce, and ‘transform’ how our health and social care services operate. To support the future development of the national health and social care workforce, the Scottish Government has identified five national pillars for action. These are: PLAN – ATTRACT - TRAIN - EMPLOY - NURTURE It is advised that these five pillars are employed by health and social care organisations across Scotland in the development of their own workforce plans. Development of a National Care Service Following the publication of the Independent Review of Adult Social Care (2021) the Scottish Government has agreed to progress legislation to develop a National Care Service. The Scottish Government will continue to develop legislation and prepare for the creation of this 43
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11 new national service, which is expected to be implemented by the end of the current parliamentary period in 2026. The move to a National Care Service will have a significant impact on the Health and Social Care Workforce. As of October 2022, the full details of what service delegated to IJBs will be transferred to the NCS is unclear. There is concern that the close integrated and partnership working relationships formed under IJBs may be at risk as the NCS is created. Integrated teams may be separated as Council employed social work and social care staff are transferred to the new national body, with health contracted colleagues remaining with the NHS. As the legislation and plans develop, North Ayrshire IJB and HSCP will continue to engage and provide constructive feedback to ensure the wellbeing of staff and people who access our services is maintained. 44
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12 5. Our Workforce Priorities As identified, there are many key policy drivers informing the NAHSCP workforce plan. As an integrated partnership, it is important that we offer a blended approach to workforce planning, ensuring that the methods used by our parent bodies, and national organisations are reflected. More information on the approaches used by our parent bodies can be found in Appendix C. To support this, we have developed a set of local workforce planning priorities to help shape and guide our approach to workforce planning. These priorities were developed through a mapping exercise with other local and national approaches. In delivering our workforce plan, we will work towards the following priorities. A definition of each of these priorities and how they align to our parental bodies can be found in Appendix B. 4. Building our Workforce (Employ) We recruit the right people, using a variety of methods and approaches. 5. Growing our People (Nurture) We support career development, building knowledge and experience. We maintain the positive wellbeing of staff 3. Investing in our People (Train) Our staff have access to the training and development they need to ensure they have the right skills for their roles. 1. Understanding our Workforce (Plan) We make full use of our workforce data to help plan for the future. 2. Promoting our Organisation (Attract) NAHSCP is viewed as an excellent organisation and considered a great place to work. 45
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13 6. Our Workforce Now A snapshot of the HSCP workforce was collected on 1st April 2022. Information provided has been aggregated for both the North Ayrshire Council and NHS Ayrshire and Arran Workforce. As at April 2022, North Ayrshire Health and Social Care Partnership had a total workforce of 3,622 people (FTE 3059) across all our delivery areas. In terms of headcount, 52% (1869) of our Workforce are contracted by North Ayrshire Council, with the remaining 48% (1753) contracted by NHS Ayrshire and Arran. In terms of FTE, 49.5% (1514) are NAC contracted, with 50.5% (1544) NHS A&A contracted. Most of our workforce, 86.4%, are under a permanent employment contract, with only 13.4% of staff under temporary conditions. Overall, 51.9% of staff are employed full-time, with 48.1% working part-time. There is a greater proportion of part-time workers contracted by NAC (55.2%), compared with NHS A&A (40.6%) Workforce by service area The chart below shows our workforce by our key service areas. As demonstrated, Health and Community care is the largest service in terms of workforce, accounting for approximately 45% of NAHSCP. The Health and Community Care workforce also accounts for the highest proportion of part- time staff, with 89% of staff under a part-time contract. 372 529 689 289 142 1217 224 160 Children, Families and Justice Health and Community Care Mental Health, Learning Disability and Addictions Management and Support WORKFORCE BY CONTRACT TYPE (HEADCOUNT) Full time Part time 462 1367 846 382 Children, Families and Justice Health and Community Care Mental Health, Learning Disability and Addictions Management and Support NAHSCP Workforce by service area (FTE) 46
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14 Workforce profile The chart to the right provides and overview of the age and sex profile. of the NAHSCP workforce. As is demonstrated the workforce of NAHSCP is predominately female. In addition, the workforce also has a high number of older employees of 50 plus. Workforce by Sex As indicated above, the NAHSCP workforce is predominately female, with women accounting for 85% (3,074) of all employees. A breakdown by contract type highlights that 52% of the female workforce are part-time. This compares to only 26% for males. Workforce by Age Again, as indicated, NAHSCP has an aging workforce. As demonstrated in the chart below, there are high volumes of staff in older age brackets. Overall, 43.1% of the NAHSCP workforce are 50 years old or over. This presents a particular risk due to staff retirement ages. NHS employees are eligible to retire at 55, and currently 20.1% of the NHS contracted staff in NAHSCP fall in this age bracket. The minimum retirement age for NAC employees in the local government pension scheme is 60 years, currently there are 13.2% of NAC contracted staff in this age bracket. 1 12 28 54 49 70 73 104 96 49 12 8 94 221 319 357 374 401 521 460 254 65 <20 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 + NAHSCP Workforce by Age and Sex Female Male Male 15% Female 85% NAHSCP Workforce by Sex 0 100 200 300 400 500 600 700 <20 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 + North HSCP Age Profile NAC NHS Total 47
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15 Workforce Equality Information In addition to collecting information on gender and age, the Partnership also produces workforce statistics on other protected characteristics. Providing information on protected characteristics is voluntary by members of staff. As such, the information often contains data gaps. Disability Of the 1,869 NAC this information was reported on, 67 (4%) identified as living with some form of disability. The types of disability are not disclosed. In addition, information was not available for a further 24% of staff members (452). For the NHS Workforce, 19 (1%) of staff reported as living with a disability or long-term condition. 844 members of staff (47%) did not disclose this information. Ethnicity Of the 1,869 NAC employees this information was reported on, the majority of the workforce identify as ‘White Scottish’ (1,320, 70.63%). A further 421 staff members (22.53%) have not provided any ethnicity information. The chart below shows the ethnicity of all other staff members. 3 3 3 2 1 4 2 1 6 5 3 5 90 African (Scottish or British) Asian - Chinese (Scottish or… Asian - Indian (Scottish or British) Asian - Other Asian - Pakistani (Scottish or… Mixed or Multiple Other Other - Arab (Scottish or British) White - Other White - Polish White Eastern European White Irish White Other British African Asian Mixed Other White HSCP (NAC) Workforce by Ethnicity Yes 4% Not disclosed 24% % NAC workforce with a disability Yes 1% Not Disclosed 47% % NHS Workforce with a disability 48
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16 The NHS workforce has similar profile to the NAC. Overall, 73.76% (1,324) of NHS employed staff identified their ethnicity as ‘White Scottish’. A further 17.16% (3080 of staff did not disclose an ethnicity. The reported ethnicities of the remaining 9% of staff is highlighted below. Religion and Belief In terms of reporting on religion and belief, over 60.4% (1,129) of the NAC workforce did not disclose any information in relation to this characteristic. 21.6% (404) of the workforce identified as having No religion. The chart below shows the identified religion of all other staff members Within the NHS Workforce, the majority of staff (682, 37.99%) identified as having No religion or belief. 22.34% of staff (401) identified as members of the Church of Scotland. A further 22.17% of staff (398) chose not to disclose this information. All responses by percent of the NHS workforce is highlighted in the chart below. 1 7 3 4 5 3 24 21 95 Chinese, Chinese Scottish or Chinese British Indian, Indian Scottish or Indian British Pakistani, Pakistani Scottish or Pakistani British Other Mixed or Multiple Ethnic Group Other Ethnic Group Irish Other Other British Asian Mixed Other White HSCP (NHS) Workforce by Ethnicity 60.4% 21.6% 9.7% 5.4% 2.0% 0.4% 0.2% 0.1% 0.1% 0.1% Not disclosed No Religion Church of Scotland Roman Catholic Other Christian Other Religion/ Belief Humanist Buddist Muslim Pagan Percent NAC Workforce by Religion 37.99% 22.34% 22.17% 10.25% 5.68% 0.89% 0.28% 0.22% 0.17% No Religion Church of Scotland Not disclosed Roman Catholic Christian - Other Other Hindu Muslim Buddhist Percent NHS Workforce by Religion or Belief 49
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17 Staff Absence NAC and NHS Ayrshire and Arran use different methodologies to reports staff absence with NHS reporting a percentage figure, and the Local Authority report Average Working Days Lost. Both Local Authority and NHS reported increased absence figures in 2021/22 compared with the previous year with NHS returning a rate of 5.35% absence (up 0.83%), and Local Authority at 15.29 Workdays Lost per Employee (up 3.82 workdays). All main service areas, without exception, reported an increase in sickness absence in 2021/22. In both years, it appears the greatest reason for absence was related to Anxiety, stress, depression, or other psychiatric illness. The second most common reason has been identified as Musculoskeletal problems. The charts below show the absence levels by parent organisation and service area. 1.42 1.77 4.64 5.17 2.71 2.72 5.09 6.24 Business Support North (Dir) Children's Health / Care & Justice Services North (Dir) Community Health & Care Services North (Dir) Lead Partnership North (Dir) NHS Absence Rates (Percentage) 2020/21 2021/22 10.82 12.56 3.35 19.94 14.21 17.34 7.28 20.64 Child, Families&Justice Health & Community Care HSCP Finance & Transform Mental Health NAC Absence Rate (Avg Days Lost) 2020/21 2021/22 50
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18 Staff Turnover The Employee Turnover rate for 2021/22 is 8.5%, an overall increase, compared with the previous year, of more than 40%. Figures indicate that whilst employee turnover has increased across both NHS and Council settings, numbers of employees leaving are significantly higher within the Local Authority in each of the last 3 years, with most recent 187 leavers (NAC) compared to 118 (NHS), in 2021/22. As the chart above indicates, and the chart below underlines, the staff turnover rate in North HSCP has increased in 2021-22. It is likely that the turnover rate in 2020-21 was lower due to the pandemic, making the 2019-20 information a more meaningful comparator. Even so, turnover in 2021-22, is still higher than in 2019-20. The high absence rates highlighted in information above have been identified as a challenge by senior leaders in the Partnership and are discussed in later sections. 101 99 118 167 108 187 268 207 305 2019-20 2020-21 2021-22 Volume of leavers by service year NHS NAC TOTAL 6.1% 5.8% 6.8% 9.8% 6.1% 10.1% 8.0% 6.0% 8.5% 2019-20 2020-21 2021-22 HSCP Turnover Rate NHS NAC Combined Avg 51
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19 7. Workforce Challenges The Health and Social Care Workforce currently faces several challenges. In each case, the identified challenges can impact on the Partnership’s ability to deliver safe and effective health and social care services. In addition, some of the wider global challenges identified may negatively impact the overall health and wellbeing of the local population, driving demand for more health and social care services. Some of the key risks to our workforce are set out below. Global and National Challenges Following the negative impact of the COVID-19 pandemic and its subsequent restrictions, it appears that overall the Scottish economy is in recovery. Employment levels in Scotland are exceeding those recorded in 2019, and rates of unemployment and economic inactivity are also lower. However, the Scottish workforce is still subject to many challenges: • Cost of living crisis: Due to rising inflation, increases in the cost of living are placing additional pressures on individuals and families. In 2022 Scotland has rising levels of employment, coupled with real wage increases. However, wages are being exceeded by inflation, meaning employees are becoming worse off. • Recruitment challenges: Despite high levels of employment, there are still a high volume of vacant posts across Scotland as employers struggle to recruit new staff. This is particularly noticeable in the Health and Care Sector. • Staff retention: Due to workforce supply issues, there appears to be increased levels of competition between employers; to secure suitable staff. Including improved wages or ‘golden hello’ incentives. In summary, despite high levels of employment, there remains a high level of vacancies across many key sectors in Scotland. Due to the cost-of-living crisis, worker pay is effectively decreasing, as such employees are likely to be more open to moving to better paying work. This means employers are finding it more difficult to recruit and retain staff, and therefore negatively impacting on service delivery. Demographics of North Ayrshire In addition to wider social and economic challenges, and the direct challenges facing our local workforce, the changing demographic profile of North Ayrshire also presents a particular challenge. Local information suggests that the changing local population and high levels of poverty and deprivation indicate a growing demand for health and social care services in the long term. Most information projections suggest that the population of North Ayrshire is changing. As such, the health and social care workforce must adapt to ensure it continues to meet the demands of local health and care need. Overall, the total population of North Ayrshire continues to decrease, and is expected to shrink by 3.9% between 2018 and 2030, falling to 129,987. 52
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20 Within this falling population, we see a growing older people population. By 2025, those 65+ will account for 25% of the population, and almost 27% by 2030. This correlates with a shrinking younger (0-15) and working age (16-64) population. In addition, there will be a more significant growth in those over 75 years. From 2018 to 2030, the 65-74 age group is forecast to increase by 12% (from 17,093 in 2018 to 19,207 in 2030). However, over the same period, the population who are 75 or over will increase 30% (12,981 in 2018 to 16,905 in 2030). Considering the complexity of health concerns increase as we age, the increase in older people population implies a greater demand on Health and social care services in the future. For example, it is likely that both the Care at Home and District Nursing Service workforce will need to increase to meet greater demands of people require health and social care support in their own homes and communities. North Ayrshire continues to have areas of high deprivation contributing to social and health inequalities across the population. The most recently published Scottish Index of Multiple Deprivation figures suggest as much as 41% of North Ayrshire’s population live within areas that are considered among the most deprived areas in Scotland. In addition, information published by the charity EndPovertyNow also suggests that more than 1 in 4 children (28.3%) in North Ayrshire live in poverty. Health & Care Strategic Needs Assessment Since 2012, the life expectancy for both men and women in North Ayrshire has seen a decrease. In the reporting period 2012/14, life expectancy in North Ayrshire was 80.8 years 19% 18% 18% 17% 59% 57% 55% 53% 22% 23% 25% 27% 2018 2022 2025 2030 Population Structure by Age Group 65+ 18 - 64 0 - 17 17093 19207 12981 16905 2018 2019 2020 2021 2022 2023 2025 2024 2026 2027 2028 2029 2030 Projected trend of 65 to 74 and 75 plus population 65 - 74 75 + 53
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21 for women and 76.1 years for men. In 2018/20, this has dropped to 80.1 years for women, and 75.3 years for men. However, Healthy life expectancy for men in North Ayrshire has increased in recent years. However, we see a decreasing trend for women. In the latest time period available (2018-2020 3-year aggregate), the average healthy life expectancy in North Ayrshire was 58.5 years for men and 56.3 years for women in 2017-2019. Currently, 27% of local people are living with a Long-Term Condition (LTC) which could include Arthritis, Asthma, Diabetes, or COPD). Projected prevalence up to 2025/26 shows there is to be a gradual increase in the population living with an LTC. Long-term conditions are more common in older age groups, with the proportion of people living with one or more LTC increasing with age. By 2026, only 2 in every 10 people in North Ayrshire under the age of 65 will have a long- term condition. For those 85 and over, 8.2 in every 10 people will live with an LTC. Further, the proportion of people living with more than one long-term condition (multi- morbidity) increases with age, with approximately 15% of over 65s with multi-morbidities, compared with less than 5% of under 65s for 3 LTCs. There is also strong evidence for a rise in the prevalence of those affected by poor mental health. For example, in North Ayrshire, the percentage of local people being prescribed medication for Anxiety, Depression or Psychosis increased each year, and was reported at 22% in 2020. This is higher than the Scottish average. Service Challenges In developing this plan, a survey was completed by senior managers and service leads. This survey afforded managers the opportunity to specify the key challenges facing their services. Some of the key challenges experienced are detailed below. Overall, the key workforce challenges that where highlighted across all services included: o Recruitment difficulties - despite high levels of job vacancies o Staff retention – as a possible result of the high level of competition in the job market at present. o Lack of appropriately qualified/experienced staff – particularly for more enhanced/professional roles o High levels of staff absence o High levels of potential retirements, resulting in a loss of workforce experience Children, Families and Justice Services Overall, the Children, Families and Justice Service is managing with all essential business requirements. However, there remains a considerable amount of pressure on the service due to high levels of vacancies and staff absence. The service is also reporting high volumes of staff preparing for absence to undergo medical procedures that were delayed due to Covid- 19 restrictions. 54
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22 The service recognises the challenge of recruitment for Social Workers across locality teams and in Service Access. This is also being compounded with an increase in service referrals, meaning that demand on the service is greater than current capacity. In our early years’ service, and number of additional challenges have been identified, including high retiral levels. The service also has an aging workforce that brings with it the risk of further retirals and increased chance of periods of ill health. The service is already experiencing the impact of long-term absence on caseloads. In addition to recruitment challenges for both clinical positions and seasonal roles, the service is seeing an increase in staff wishing to move to part-time working for better work/life balance. Health and Community Care Across our Health and Community Care services, we are experiencing challenges of recruitment and high levels of turn-over, particularly in our Care at Home Service. Care at Home traditionally has high levels of vacancies but are now finding it harder to recruit to and retain staff. This is attributed to both retirement due to ill health or opportunities in other job sectors. The role of Care at Home worker is often viewed negatively. In our Long-term conditions service, we are seeing low level of applications for Registered General Nurses (RGN), with number of applications having fallen over the past 4 years. There are also low numbers of Registered Mental Health Nurses (RMN) applying for community posts, presenting an on-going challenge. The service is also noting challenges in recruiting Senior Charge Nurses and Clinical Team Leaders, which could indicate a lack of experienced leaders in teams. The absence levels, mostly as a result of Covid-19, have continued to provide challenges to the service. There continues to be recruitment challenges for Adult Social Workers, highlighting a low number of applicants for vacant posts, issues of retention and ongoing staff absence levels. Island Services on Arran currently have a high level of vacancies in Care at Home and Montrose House Care Home, with additional vacancies in primary care posts, including GPs, nursing and physiotherapy. Arran faces additional demands to recruitment due to it being an island, these include housing costs, cost of living on the island and a reliable ferry service for an effective commute. Allied Health Professional services identify ongoing support to other services as a current challenge. Following support to other services during the pandemic, the service is now facing the challenge of returning to normal service delivery in providing moderate AHP consultations to local people. This is further exacerbated by a public perception that all services should be back to ‘normal’. The service also reports low levels of administration support, requiring professionals and clinicians to be redirected to undertake admin functions. These challenges are in the face of rising demand for the AHP service from both the community and primary care services. 55
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23 In our Primary Care services, a number of challenges have been identified: o Mental Health Practitioners - the service has not been able to recruit to the island of Arran and remote sessions are now being delivered. The service is under pressure as there is currently no in-built resilience cover and the service has requested additional posts via new Primary Care Mental Health monies. The team are challenged by a lack of space in some GP practices and some staff deliver sessions remotely. o Community Link Workers - the growth in digital supports requires the digital navigator post to be made permanent and it is hoped that new Primary Care Mental Health monies can support this ambition. The team are challenged by a lack of space in some GP practices and some staff deliver sessions remotely. o Pharmacotherapy - the service has not been able to recruit to the island of Arran and the island team is exploring the expansion of skills across technical grades with GP training support. There is a lack of resilience in the team and team is exploring a 10% growth across teams. There is a limit of senior pharmacotherapy staff across Scotland and the Ayrshire team have very successfully skill mixed. The team are challenged by a lack of space in some GP practices and some deliver sessions remotely. o MSK physiotherapists - The service is currently under pressure as there is no built-in absence resource and a lack of availability of senior MSK professionals to recruit due to marketplace shortages across Scotland. The service is currently exploring skill mix to build a wider career path in primary care. o CATC the service continues to refine and develop its clinical specification to enhance the interventions and patients supports available. The team are challenged by a lack of space in GP practices and work continues to resolve this issue. All of the service above requires the support of GPs to ensure clinical training, supervision and support. Due to a lack of GPs across the Ayrshire system, this can be a challenge. However, Ayrshire & Arran are now exploring a 'Primary care Training Academy' to support this training need. Mental Health, Learning Disability and Addictions As in other service areas, there are significant challenges facing our Mental Health, Learning Disability and Addictions Service. As Lead Partner for Mental Health Services across the Ayrshire and Arran Health board areas, many challenges faced by the service also impact in the two other partnership areas in Ayrshire. The Community Mental Health Team (CMHT) have not seen the same levels of investment as other services in recent years (for example unscheduled care and perinatal mental health services). This has led to a significant gap in service demand and capacity. While reviewing the current CMHT workforce, it has been identified that there are gaps in both staff volume and experience. With the expected retirement of a number of CMHT staff in the near future, the skill/experience level in the service will significantly shift. With high levels of inexperienced staff, the service has the challenge of skills development. North Ayrshire Drug and Alcohol Recovery Service (NADARS) identified the challenges of both recruitment to vacant posts and the retention of staff members. It was highlighted that there 56
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24 is a high level of competition in the market at present, making recruitment additionally challenging. In addition, due to recent changes in pension legislation, more experienced staff are now considering retirement at some point in the future. In Psychological Services (Pan-Ayrshire Service), there are challenges in recruiting to specific priority posts, including Child (CAMHS and neurodevelopmental) and Adult Mental Health in the Community. In the past year, SG has provided additional dedicated funding to all Boards to increase specialist Psychology provision to clear long waits and support Boards to achieve the waiting times standard by March 2023. 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 and an increase in staff movement between Boards as high numbers of new posts are being developed. The greatest challenge in Psychological Services has been recruiting to the established larger services of CAMHS and AMH Community as staff have opportunities to take posts in smaller, new, developed specialist services. In AHP services several challenges have been identified. As in other areas, recruitment to specialist posts is proving challenging. As a result, staff are spread thinly across the large geographic area of Ayrshire and Arran. In addition, the current cost of fuel is an additional concern for members of staff. The service is also impacted by high levels of staff absence and special leave. This is also in conjunction with an increase in demand for AHP services with inward migration to Ayrshire causing particular difficulties. Concern was also raised by the service over adequate investment/ provision of training and development opportunities. Management and Support Services NAHSCP has several support services, working to ensure our operational delivery services can carry out their functions effectively. These are covered across our Business Support and Finance and Transformation services. In our Business Support Services, we are experiencing a high level of staff turnover as employees move onto more promoted posts in other areas, particularly to other council services. Further, while additional staffing funding is often proved to operational service areas across the HSCP, Business Administration is often overlooked. Our Money Matters service also reports recruitment difficulties for experienced welfare rights and income advisor posts. Across AHP and Independent Living Services, there is a lack of appropriate administration support, meaning clinical and professional staff often have to undertake admin tasks, leading to a detrimental impact on workloads. 57
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25 Financial Context North Ayrshire IJB agreed its Medium-Term Financial Outlook (MTFO) covering the period from 2022-2025 in March 2022. This is a critical part of the strategic planning process as it sets out the resources which the Partnership expects to have available to deliver services. It assists with ensuring that these resources are aligned to the strategic priorities as well as with annual financial planning. The financial context for the public sector remains extremely challenging and so it is vital that our strategic ambitions are set against the financial resources which are anticipated to be available. The MTFO looks at the economy, the fiscal outlook and the resource spending outlook in the context of national policies and demand pressures and local priorities. It projects the financial gap which will need to be addressed through service transformation and financial savings to deliver the services which will help us achieve our strategic priorities. The Scottish Government has published a one-year budget for 2022-23 and so the financial position for 2023-24 and 2024-25 is projected through three different scenarios – best, medium, and worst case. The Government published it’s Resource Spending Review in Summer 2022; whilst this is not a detailed budget it will facilitate future refresh of the MTFO. 58
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26 8. Workforce Projections and Future Requirements For the purposes of this plan, a long-term analysis of staffing trends was undertaken. This analysis also offered workforce projections over the medium term. NAC – Social Work Workforce For North Ayrshire Council staff, information was provided on the Social Work and Social Work Assistant Workforce. Data provided covered the long-term period from 2008 to 2021. Based on workforce analysis, the 3-year average workforce change was identified as 15.7 FTE posts for Social Workers and 7.5 FTE posts for Social Work Assistants. Applying these figures to the most recent workforce information, we are able to offer a projection of the local workforce. For Social Workers, based on the 2021 workforce of 191.3 (FTE), this will increase to 212.4 (FTE) by 2025. Likewise for, Social Work Assistants, we project the workforce to consist of 86.8 (FTE) by 2025, based on the 2021 workforce of 76.8 (FTE). Projections by broad service area are identified in the chart below. 212.3 86.8 0 50 100 150 200 250 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2024 2025 SW and SWA Workforce Trend and Projections All SW All SWA SW (proj) SWA (proj) 0 20 40 60 80 100 120 Children Adults Justice Generic Children Adults Justice Generic Social Workers Social Work Assistants SW and SWA FTE projections 2019 2020 2021 2024 2025 59
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27 NHS - Nursing Workforce Further information provided also highlighted the numbers of nursing staff employed with the Health and Social Care Partnership over the past few years. In 2022, 1,128 (FTE) nursing staff were working across the Partnership. While historical information for the nursing and midwifery workforce is limited (only being available since 2018), we have provided basic forecasts calculations up to 2025. This was carried out by taking an average of the annual workforce variance across the previous five years of data and using that average figure to calculate a forward projection. Using this method, we anticipate the nursing workforce to increase by approximately 29 FTE nurses each year. Information on the nursing workforce was also provided broken down to service area level. While the overall demand for nurses has increased over recent years, we are seeing a decrease in the number of nurses within the Mental Health Service. Considering the prevalence of Mental Health concerns, and demand on service, this trend presents a particular challenge for the Partnership, as while the number of MH nurses decreases, the prevalence of complex mental health concerns is increasing. Future Requirements In addition to the professional workforce projections outlined above, we also engaged with HSCP Senior Management to identify the future additional workforce required for each 914 911 1027 1011 1028 10561056 1084 1112 800 900 1000 1100 1200 2018 2019 2020 2021 2022 2023 2024 2025 Nursing and Midwifery (FTE) Projections Actual Projected 0.0 80.3 220.1 614.0 2.1 83.0 225.5 600.1 4.7 88.6 318.5 614.8 5.7 89.1 330.5 585.9 4.5 94.0 361.6 567.6 5.6 97.4 397.0 556.0 6.7 100.8 432.4 544.4 7.8 104.2 467.8 532.8 0 100 200 300 400 500 600 700 Business Support North (Dir) Children's Health / Care & Justice Services North (Dir) Community Health & Care Services North (Dir) Mental Health - Lead Partnership North (Dir) NURSING AND MIDWIFERY FTE PROJECTIONS 2018 2019 2020 2021 2022 2023 2024 2025 60
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28 service team. It should be highlighted that these are aspirational requirements that managers have identified to be able to effectively deliver future health and social care services, however, it is unclear at present if these requirements can be effectively resourced. Summary charts highlighting the required workforce are set out below. All figures are Full Time Equivalent (FTE). The detailed requirements can be found at Appendix E. Note, that for some services, medium term workforce requirements are yet to be identified and are subject to both internal and external review factors, such as the AHP National Rehabilitation Commission. 1 2 2 1 3 2 1 3 5 4 4 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8 Grade 4 Grade 7 Other Officers (Grade not known) Mental Health Practitioners Health and Community Care - Additional Workforce Requirements 2023 2025 13 0.8 2 5 5 16 15.5 2 4 6 5 1 2 5 7 4 2 Band 4 Band 6 Band 7 Grade 10 Grade 7 Other Officers Social Work Assistants Social Worker Students Team Managers Children, Families and Justice - Additional Workforce Requirements 2023 2025 8 2 4.5 21.8 2 4.6 Band 3 Band 4 Band 5 Band 6 Band 7 Other posts AHP - Additional Workforce Requirements 2023 1 1 1 8 0.6 2 25 2 2 1 1 1 1 1 1 B4/5 Assistant Psychologists Band 7 Band 8 MH Nurses Occupational Therapists Prescribing Pharmacists Psychological Therapists Social Workers Specialist GP prescribers Staff Nurse Ward 5 (Nurse or AHP) Service Manager Band 3 OT Assistant Mental Health Service - Additional Workforce Requirements 2023 2025 61
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29 9. Our Workforce in 12 Months To support our on-going recovery from COVID it is essential that our workforce has the appropriate capacity and skill set to continue to deliver effective health and social care services to the people of North Ayrshire. Over the next 12 months, we will seek to address many of the immediate and pressing challenges on our workforce while also implementing procedures to improve our overall approaches to workforce planning. As restrictions ease and confidence increases, we will expect to see a full role out of Agile working for staff across the partnership. This will mean much of our workforce will have a flexible approach to their work location, with more people expected to return to office-based working while still balancing working from home. In summary, over the next 12 months we will seek to build greater capacity across all our services. This will include continuing to develop an experienced and skilled workforce, ensuring we attract motivated and skilled staff to the HSCP and ensure the experience held within our organisation is maintained and passed on. To do this we will develop clear pathway for skills development. We will have developed a Succession Plan approach for our workforce, to ensure we are identifying future leaders and supporting them with appropriate skills development and opportunities. In addition to Succession Planning, we will provide clear career pathways to support all staff members and effective career route plan. To support both career development pathways and succession planning, our leadership will consider the overall management structure of the HSCP to ensure there are clear manageable career steps for progression. How the workforce of each of our services will look in 12 months is highlighted below. Children, Families and Justice Services Overall, in Children, Families and Justice Services, we will seek to build our workforce and processes to ensure delivery of the Promise. This will include further developments in: o Early help and intervention approaches o Whole Family Wellbeing o Co-located, multi-disciplinary team working o Supporting local families address poverty o Child protection procedures (Signs of Safety and Safer and Together) o Trauma informed practice To support these developments the service will need a full complement of staff within existing resources plus further lead posts in areas such as Trauma informed work, additional social workers and social work assistants (across each NA locality) to reduce caseloads. This will also require additional more team managers to provide leadership and oversight. In our Early Years’ Service, the increased complexity and vulnerabilities in families has been noted following the Pandemic. This means an additional amount of time is now required to support families and children in the early years. As such, additional capacity is required across 62
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30 a range of early years teams to improve service delivery, reduce waiting lists and reduce dependency on costly bank staff approaches to plug workforce gaps. The service will seek to enhance capacity across the following services: o Health Visiting o Children’s immunisations o School Nursing Staff o Support worker capacity for school age children o Peri-natal mental health services o Creation of a ‘Dad’, support worker The service will also develop a workforce development programme to support the retention of a staff, support staff to develop additional skills and experience that would support their career development within the Partnership. In our Justice Services we will seek to enhance our Making a Difference Programme to improve engagement with Service Users and supporting community sustainability. This development would see the team allocated additional Project Workers and Social Work Assistants. Health and Community Care To support our developments in primary care, over the next 12 months we hope to see the successful transfer of PCIF services (including CTAC, Pharmacotherapy and MSK Physiotherapy) to the HSCP. This help ensure primary care services are at appropriate capacity and resilient to demand. To support the effective delivery of primary care services, we would also seek to enhance the following capacity in local GP practices: o Mental Health Practitioners o Community Link Workers (digital navigator) o Occupational Therapists Recognising the shortage of local GPs to oversee and support those within the multi- disciplinary Teams, the service – along with NHS Ayrshire and Arran – are exploring the potential for a ‘Primary Care Training Academy’ to support training need. In Community Care Assessment and Review, the newly appointed posts created from additional Scottish Government Funding will be used to help to reduce waiting times for social care assessments. In our Care at Home Services, we will continue our recruitment drives, succeeding in recruiting to all community care positions. This will be further supported by a review of the Care at Home assistant role profile. We will roll out our new models of day services for older people in North Ayrshire. To support improvements in our registered services, we will consolidate recent inspection reports, and work with local providers to deliver improvement plans. 63
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31 In our Island Services, we will complete he work on an integrated hub for Arran including a workforce plan that will be developed to support the new model of care we will deliver in the hub which will include modelling of future demand based on an home first model utilising overnight care on Arran (which we don't currently provide). By completing the project plan and business case for the hub we will look at a single 24/7 rota for our bed-based services. In our Long-Term Conditions service, we will consider the best approaches for the District Nurse weekend workforce, to ensure safe and efficient staffing levels. We will continue to increase our community district nursing resource in order to develop pathways and new models of care. In the ward environment, we aim to increase the number of Band 3 HCWS as part of band 2 review. We will also develop dedicated CNM support for community services. The service will also build in 22.5% contingency within community nursing, to support Annual Leave, Sickness Absence and study leave. Mental Health, Learning Disability and Addictions In North Ayrshire, Drug and Alcohol Recovery Services will respond to both local and national priorities including delivering on the Medicated Assisted Treatment Standards, non-fatal overdose, developments in Housing First approaches, and enhanced Dual Diagnosis support. The workforce will adopt a hybrid approach to working, including at home, base and community venues. The NADARS workforce will be fully flexible and adaptable to changing priorities. The service will also be supported by a robust Information Management and Technology (IM&T) in place to support them The Community Mental Health Team (CMHT) will develop the appropriate capacity to meet growing local demand. It is anticipated that a portion of demand on the CMHT will be addressed through the effective resourcing of Mental Health supports in primary care MDTs across North Ayrshire. Despite this positive development, on review of current caseloads, current capacity within the team will still not meet growing demand for service. As such, additional capacity is required. In 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 Psychological Therapies, the service will recruit to established vacancies and utilise all new dedicated Scottish Government funding. Recruitment to these posts will help to reduce waiting lists across mental health services, particularly in areas with the longest waits, such as CAMHS, Community Paediatrics and AMH Community. The service will use new Scottish Government funding to expand Psychology services in established clinical areas where there is recognised unmet need (for example, Addictions, Older Adults, Acute services). The service will seek to increase the capacity of the senior Psychology Leads team to ensure appropriate leadership of our expanding service, including, Perinatal, Infant MH, Eating Disorders, In-patient, Children and Young People Medium Secure/Foxgrove, provision to Acute - ICU/post-Covid. 64
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32 Allied Health Professionals Our AHP service will seek to enhance the support it provides across all service areas. Over the next twelve months, the services priority will be to recruit to vacant posts, and to work with partners across the system to maximise the capacity and impact of AHPs. We will seek to improve access to those services where waiting times are currently most challenging, and to resume any services that remain paused post pandemic, and still have relevance in our new context. We will continue to make greatest use of additional funding opportunities. We will progress work to ensure efficient pathways and processes, to maximise registrant time and capacity. We will continue work to better understand how the current AHP workforce aligns to the delivery of safe, quality care. The service will continue to place focus on staff wellbeing and development, with increased focus on ensuring all AHP staff have access to regular supervision Management and Support Services While embracing our new ways of working, our Business Support Services will consolidate our support services to ensure a more consistent approach to service provision across all partnership services. In addition, Business Support will also develop and implement a Personal At-Risk Distribution System (PARD). This system will improve our workforce’s ability to identify and respond to the most vulnerable local people in the event of local or national emergencies. A review of the function of Moving and Handling/CALM Team will also be undertaken to increase capacity to better support training to frontline staff members. In our Finance Section, we will require to monitor the workload demand of the Financial Intervention Team. While there are currently no plans to increase staff numbers, this may be reviewed in caseload increases to a point where there is a potential risk to service users and families in terms of not being able to access services. Due to the current profile of the Finance Section, in terms of team members close to retirement age, the section would seek to benefit from a succession planning approach. Across AHP Services and Multi-Disciplinary Teams, we will seek to enhance administrative support capacity to services. This will include, generic administration support, IT system support and production of monthly management reports. This support will free the capacity of service managers and team leads to focus on clinical duties and leadership. 65
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33 10. Our Workforce in 3 Years By 2025 we anticipate our North Ayrshire Workforce to have developed appropriately to face the local health and social care demands of local people. Our teams will be appropriately staffed and resourced and have a clear understanding of their purpose. North Ayrshire HSCP will be recognised as a great place to work, as we demonstrate our commitment to investing in our people, enhancing their skills, and supporting them to build long and meaningful careers within the Partnership. We will continue to prioritise the wellbeing of our workforce and provide a range of options to ensure our staff are supported and motivated to thrive in their roles. What our workforce will look like across each of our service areas is highlighted below. Children, Families and Justice Services Across Children and Families Services we will effectively deliver on the Promise for children and young people. We will have developed a workforce that is able to respond effectively to the needs of local children and families at the earliest possible stage and provide more intensive support to those who need it. In our Early Years’ Service, we will have additional Health Visiting capacity in our most vulnerable communities in-line with wealth of robust evidence around the impact high quality health visiting services has on children's outcomes. We will have secured recurring SLA funding for student Health Visitor placements, supporting students in there learning and supporting them to choose a career in North Ayrshire. We will have developed an Improved skill mix within the School Nursing team to meet the needs of the school nursing pathway and to support models of whole family support. We anticipate our Child Immunisation Team may undergo further developments as a result of the Current Public Health Immunisation review. By 2025, in Justice and Intervention Services we will have realised the following workforce developments: o Consolidated a robust process for the electronic monitoring of Bail and will have developed a staffing group to support this. o Developed, consolidated, and enhanced our Making a Difference Project to improve Service Users engagement, support community sustainability and reduce the length of time involved in statutory services. Increase in referrals to Making a Difference. o Consolidated and enhanced our early intervention and preventative approaches through development of the Family Centred Wellbeing Team. o Restructured and appropriately staffed the Service Access Team, responding faster, robustly, and proportionately to high numbers of referrals and complex cases. This will reduce referrals onto other statutory services. 66
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34 o Established a robust team of Recovery Development Workers/ staff with lived experience complimenting the work across our services and developing strong links with community resources and services. Health and Community Care By 2025, we will continue to develop and enhance our Primary Care Services, attracting the required workforce across all MDT in our localities. This work will complement the development of the Caring for Ayrshire programme and its associated property improvement programme. On Arran, we will have established a Single point of contact for all people on the island to access Health and Social Care Services. Our Home First Model will be in place with enhanced overnight care provision, supporting vulnerable people to be cared for at home or in a community setting. The established Multi-Disciplinary Team will be supported by an additional Advanced Nurse Practitioner in complex care/frailty cases. There will also be a full Business case completed to support the build of an integrated hub on Arran. In Community Care, our registered services have improved on Care Inspectorate Gradings following support and joint working with HSCP services. To support staff, we will have in place an online training portal and learning and development opportunities for the Community Care workforce to support staff development and career progression. Over the next three years, we will provide a specific focus on the development of the Partnership's Reablement service, ensuring capacity and skillset is within the service to support our strategic commitment to care for people back to health at home or at least in a local community setting. By 2025, our Long-term Conditions service we will deliver our service and any operational changes in line with the recommendations from the forthcoming Community Nursing Review. The service will also be prepared for the handover of the Community Treatment and Care Service. Over the next three years, the service will also consider the feasibility of the development of an outreach service for stroke and general rehabilitation Mental Health, Learning Disability and Addictions In our Drug and Alcohol Recovery Service, we will have the capacity in service to respond quickly to the needs of local service users, meeting all established local and national standards and targets. The workload and capacity of the service will be closely monitored, and any additional resources will be identified and allocate quickly. By 2025, we will have developed a new Primary Care Mental Health Service and are able to attract qualified and experienced individuals into these roles. This service will work closely with other Community Mental Health Teams and acute mental health services, to address the demand on local mental health services. 67
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35 In our Psychological Therapy service, we will continue to build on the developments as identified over the next 12 months. However, in addition, we also endeavour to consolidate the service areas that are currently being developed over the next 18 months. This also includes a further expansion into new Scottish Government clinical areas such as Neurodevelopmental across the lifespan, MHS in Primary Care, and Early Intervention in Psychosis. Allied Health Professionals Over the next three years the service will undertake an AHP workforce review and Rehabilitation Commission exercise, to better understand service capacity against demand. This work will help the service identify appropriate actions to improve, which may include re- modelling AHP service provision. We will continue to have a strong contribution to practice based learning, offering placements to pre-registration students, and influencing the national agenda around AHP workforce and education for the future. The direction of travel for AHPs over the next three years will be increasingly to provide universal and targeted interventions; taking a population health, consultative approach to ensure earlier access to support when required, with a focus on prevention and self- management. In parallel, we will progress plans to support timely access to specialist services when this is indicated and continue to work as part of multi-disciplinary teams in progressing the wider partnership agendas – for example concerning the review of the eating disorders service, the commencement of the national Foxgrove services, the enhancement of community rehabilitation and primary care, and our contribution to early years services. In this way, and over the lifetime of this plan, our Allied Health Professional Services will continue to work collaboratively with partners, to embed improvements across all service areas of the Partnership, and to maximise the reach and impact of AHPs. Management and Support Services In our Finance Section, there is a stable workforce with effective skills development and succession planning in place to ensure the team is always at capacity and skills and experience are maintained within the team. In Business Support services, we will have function centralised support service that provides effective administration and clerical support across the Partnership. Following a feasibility investigation, the service will also consider creating a centralised Minute Taking team for provision across the HSCP. We will have created a Community Hub for Occupational Therapy Services, which will manage all service referrals and administrative support for the service. 68
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36 11. Third and Independent sector workforce To gather a better understanding of the workforce of Third and Independent organisations in North Ayrshire, a survey was distributed by our TSI partners. A total of 26 surveys were completed from across Independent, Voluntary and Third Sector organisations. Of those who responded, 23% were from the independent sector, with the remaining 77% from third and voluntary sector organisations. 69% of respondents are commissioned to provide services for North Ayrshire Health & Social Care Partnership, with 58% of all respondents having their own workforce plan in place. Services provided The respondents provide a range of services as outlined below, with the majority (54%) offering care services, either in a residential setting or within the home and community. The balance of respondents offers community-based support services, either in a more specialised and formal way, often with a focus on early intervention, or through informal activities and community groups. Services Provided % Respondents Care Sector (including Care at Home / in the community & residential) 54% Specialist Community Support Services (offering for example counselling, training, or more formal mental health inputs etc) 19% Community Support Services offering activities to support wellbeing and mental health (such as befriending, group activities etc) 27% Localities covered 50% of the respondents operate in all localities in North Ayrshire, with 35% only operating in 1 locality, 8% in two localities, the remaining 8% operating in 3 or more localities. Of those not operating across all localities, the Three Towns has the biggest representation at 23%, with the Garnock Valley and North Coast and Cumbrae following. Respondent organisation headcount Of the organisations and groups who responded, 52% have fewer than 10 staff, with 1 having no paid staff at all and only 16% have more than 100 staff. 27% of the respondents are heavily reliant on volunteers to allow their service to operate, as well as funding for their paid posts. 13 5 3 4 0-10 11-25 26-100 100+ COUNT OF ORGS HeadCount 5 2 3 4 8 13 Garnock Valley Irvine Kilwinning North Coast Three Towns All North Ayrshire COUNT OF ORGS Localities Covered 69
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37 Due to the variety of organisations and the type of support services offered, the findings have been split between Independent Sector (mostly offering Care at Home, in the Community or residential) and the Third / Voluntary Sector, mostly offering more targeted support and activities linked to early intervention, reducing social isolation, and improving mental health and wellbeing. Key Workforce Challenges Care Sector Staff retention and recruitment The pandemic has had a massive impact on the care sector nationally, with staff experiencing burnout and stress due to the undue pressure they have been under. Staff sickness rates are high, and some have gone without annual leave for lengthy periods, as well as having to work overtime to cover rotas due to vacancies and absence. This results in frequent rota changes and operational pressures in trying to manage capacity and demand. Social care jobs nationally are not being recognised as a profession but should be, and they should remunerated accordingly. Independent sector organisations have highlighted that there is a lack of parity on rates of pay and terms and conditions, causing many staff to migrate to work with statutory services or other providers. Organisations have reported that the commissioned rates for services make it very difficult to operate on a level playing field. Recruitment is in crisis and extremely labour intensive for many organisations who are seeing increased numbers of no shows at interview and when at final offer stage, due to being offered other opportunities. Some organisations are bypassing the usual pre offer protocols, such as taking up references, to get offers out faster. This may present risks to service delivery and service users in the future if appropriate employment checks are not carried out. Part time work is in much less demand due to the current economic climate. This is making it more difficult for organisations to service packages of care efficiently. There is also an ageing workforce in social care, many of whom were deemed to be at risk during the pandemic themselves and as such, were leaving the profession or choosing to retire early. Attracting nurses to nursing care roles is also particularly challenging which is leaving service gaps in more specialised care packages. Staff training and development Staff training and development opportunities have been restricted only to statutory requirements. Government employment schemes that are available to subsidise employers to take on and train staff cannot be accessed by most of the care providers. There is a minimum requirement of 35 hours per week, which is not necessarily feasible when someone is being recruited, as they are usually linked to packages of support and their hours may only increase over time. There are also barriers from the Care Inspectorate about taking on trainees. Rural care packages 70
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38 Staffing care packages in the Garnock Valley and other more rural locations is exceptionally challenging due to travel time and associated costs, which are not funded, as well as the efficiency challenges this causes at a time when resources are under immense pressure. It has been reported that there has been an increase in Social Work requests for organisations to take over packages of support that are deemed to be in Crisis, often where another provider has given notice to end their service provision due to staffing or feasibility issues. This can result in service users potentially being left without any support for extended periods. Providers that are not part of the HSCP commissioning framework are only able to offer support under an Option 2 agreement, which requires the carer to have guardianship in place to make this decision and sign the agreement on their behalf, slowing down the process of putting care packages in place. Community Groups / Third Sector Accessing ongoing funding for more than one year to allow sustainability of projects is a key challenge for the majority of third sector organisations and directly links to their capacity to support people. Short term funding impacts on recruitment and retention of staff. More opportunities to be commissioned to provide their service via the local authority would be welcomed. Recruitment of volunteers is also difficult. Most of these groups and organisations were not able to operate fully throughout the pandemic and regular volunteers fell away. Encouraging people back to volunteering, following a return to a more normal service, has proved difficult. With the current economic climate and rising cost of living and petrol especially, people are more reluctant to volunteer, even if they are being reimbursed some of their travel costs. The mileage allowance for volunteers and staff has not been reviewed in line with the rise in petrol costs. Current Service Gaps The recruitment and retention crisis within the social care sector has led to a significant gap in capacity for existing clients and new referrals requiring service provision. Many organisations are still operating below core headcount requirements, limiting availability for new contracted care packages. Community and Third Sector organisations are highlighting the gap in provision for people, especially older people, and whole families, requiring support. Often where they are not in receipt of statutory services, even though they might previously have been entitled to it. Some organisations feel it may be due to the pressure on social work teams managing their referral pipeline or the increase in eligibility criteria restricting access. 71
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39 Community groups also reported challenges in finding suitable venues for activities that they can afford, in addition to challenges around promoting services and targeting the right people most in need. Many of these groups lack the administration and social media knowledge or personnel to optimise awareness. Short Term Ambitions Care Sector Ultimately, the aim of the independent care sector is to provide good quality care, with sustainable high service standards. The short-term ambitions are centred around stabilising the workforce and promoting a better work-life balance. This will be achieved by increasing management capacity, improving staff retention, building an adequate compliment of relief workers, and removing reliance on overtime and cancelling annual leave to meet capacity demands. Innovation is seen as key, as is engaging with supported people to help review and develop more creative approaches to services, staff development and training opportunities, which will allow expansion to meet the capacity demand for new referrals. Some respondents are keen to identify and explore opportunities for more partnership working with community support services to enhance the service offering and one respondent is looking to become an accredited SQA centre. Community Groups / Third Sector For community groups and the third sector, short-term ambitions centre around the sustainability of existing projects and developing new initiatives, with securing funding to enable the employment of more paid workers, thereby reducing the reliance on volunteers, being a priority. Other priorities include: Creating lasting connections for people within their communities and continuing to expand the services offered, responding to challenges people are facing, ensuring they are offered support and advice as needed. Looking at ways to increase the number of trained volunteers in the sector, as well as identifying ways to help volunteers progress to paid employment, should they wish. Looking at new ways to promote the services and connect with people needing help, increasing the visibility of projects within community settings. Headcount Impact of Short-Term Ambitions Of the 26 respondents, although the majority indicated that additional staff would be needed, only 12 were able to provide an estimate of the potential short-term headcount 72
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40 implications. Many organisations said that it was too soon to tell. Of those who responded, the average headcount increase was 3.5 FTE, in addition to an increase in volunteer numbers. Primary Risks of Failing to Develop the Services Offered Within the care sector it was identified that existing capacity may not be sustainable, let alone growth to meet increased demands. If there is no opportunity to focus on strategic planning and innovation, this could further exacerbate staff attrition and gaps in service provision. Within the Voluntary and Third sector it was clear that if longer-term funding cannot be sourced, organisations and services would disappear completely. This would result in an increase in loneliness and isolation within communities in North Ayrshire and would undoubtedly put statutory services under greater pressure at a time when they are already stretched. Key Developments in next 3 years Within the care sector there is an ambition to work towards developing a more person- centred approach, increasing involvement of service users and families in the service design process. Building robust and collaborative relationships with the HSCP, especially commissioning and social work, looking at opportunities to expand the supported accommodation model, as well as creating a hub for meaningful opportunities to be experienced out with the traditional day service model, is also a priority. A further increase in contract rates from the HSCP to allow for greater wage parity, improved conditions and training has also been identified as fundamental. Within the Voluntary and Third Sector, many have identified that they struggle to plan 3 years out due to the short-term nature of funding, resulting in a reactive approach. There is a desire to increase visibility and the service provision within the Garnock Valley and Island Communities, as well as looking at ways to focus more on early intervention and new referral pathways. Headcount Impact of 3-year goals Most respondents commented that they were not able to determine headcount implications at this time. Risks of failing to deliver 3-year goals The risks are very similar to those highlighted already. It is very evident to see the significant impact and value that the Third and Voluntary Sector offers to the communities they operate in. There is a real risk of these organisations disappearing entirely, leaving significant gaps in the communities of North Ayrshire, which will result in an increase in social isolation, loneliness, and mental health problems - and reduce the amount of choice available for people in need. All of this will put severe and undue pressure on statutory services that are already struggling to cope with the demands on them. 73
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41 12. Supporting Wellbeing Maintaining the positive wellbeing of our staff is a priority for the Partnership. When people have high levels of wellbeing at work, they are happier, more motivated, and more likely to thrive in their daily role. Alternately, when wellbeing is, low, people may become more anxious about work that may negatively impact their ability to undertake their duties. As highlighted previously, staff wellbeing is currently a key challenge for our workforce, particularly following on from the impact and uncertainty of the Covid-19 pandemic. What affects our wellbeing Feedback from HSCP managers indicated several factors they recognised that has negative impact on the wellbeing of staff. Many of the negative factors identified can be seen as a direct result of the pandemic, with senior managers highlighting that staff members are still concerned over the health risks of returning to the workplace. Alternately to that, the impact of continued home working has also had a negative impact on staff, who have reported feelings of isolation and alienation from the workplace. There is also a concern that staff groups have lost some measure of their resilience due to uncertainty created during the pandemic, and this may be in part due to the lack of peer support in agile working conditions. Other negative factors which have been exacerbated by the pandemic include the impact of long-term absences on the workforce, and the subsequent increase in workloads for the remaining workforce. It is widely recognised that our workforce has risen to the challenge of the pandemic, however staff are now facing the prospect of unmanageable workloads. In addition to being unsustainable in terms of service delivery, the high workload levels lead to staff not prioritising their own wellbeing, with many thinking they simply do not have the time to take care of themselves. In some areas, due to shortages of relevant staff resources (e.g. admin and clerical), officers and practitioners often have to divert their time away from service delivery to undertake administrative tasks. This can lead to anxiety in staff as they feel they are not doing their ‘day job’ effectively. Other factors identified that negatively impact on staff wellbeing include: o A lack of adequate rest areas for staff in the workplace. No areas for staff to take effective time out from their day to focus on their rest and wellbeing. o It was also suggested that many staff groups feel that their hard work over the past few years has been unrecognised by management and senior leaders. o Concern was also highlighted about the continued separate terms and conditions for staff within the partnership, depending on the employing body. Improving our wellbeing To address concerns over wellbeing and to support a positive working group, the HSCP has several programmes, services and approaches in place for our workforce. These supports are 74
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42 both formal services available to staff, and informal approaches used at the team and individual level. During the pandemic, the HSCP quickly established Staff Wellbeing Support hubs across several sites in North Ayrshire. These hubs provided a place of respite for staff members, where they could access wellbeing advice and support from trained colleagues. Learning from this staff hub approach, other services have also provided spaces for staff members to participate in listening and reflection sessions. Senior Managers have underlined the need for staff interaction and peer support, staff being encouraged to have informal catch ups and “team blethers”. Some teams have prioritised 10 minutes in each day to take time-out for brief well-being activities. Other members of staff enjoyed organised wellbeing and fitness challenges, such as the ‘step-challenge’, held regularly in North Ayrshire. Making best use of available funding, the Partnership have made wellbeing grants available to staff groups, affording colleagues the opportunity take time away from the workplace on much needed wellbeing activities. Teams can identify their own activities, with some choosing to access wellbeing retreats, mindfulness sessions and spa days, while others have chosen more traditional team exercises such as fun days out, escape rooms, or going for a mean together. Feedback from managers and team leads has also identified the fantastic support provided from Human Resource, Occupational Health, and Trade Union as a strong element to help improve and maintain staff wellbeing. In terms of Work/Life balance, several new policies and working practices are supporting the wellbeing of our workforce. The roll out of agile working and greater flexible working approaches have benefitted many staff members. The opportunity to work from home on a more regular basis has had a positive impact on many members of staff. A positive side effect of the agile and flexible working arrangements is that staff feel more trusted by HSCP management. What has also been reported as useful is automatic prompts from email systems for those working at home, reminding them not to send emails out of hours, support staff to retain that work / home split. The special leave policies of both the NHS and NAC provide additional support to many members of staff in the advent adverse events (such as needing to take emergency or parental leave). More staff are also taking the opportunity to compress their working week to be provided with an extra day off. This is a recent development within the NHS (but has been available in NAC for many years). Staff are also being encouraged to make full use of their annual leave and to try to plan their leave well in advance to make sure it is taken. Going forward, North Ayrshire HSCP will learn from the good practice of the past in supporting staff wellbeing and continue to ensure the wellbeing of our workforce is prioritised over the lifetime of this plan. 75
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13. Our Workforce Action Plan To build the workforce that is needed to meet our identified current and future demands we have identified several key actions that we will progress over the next 3 years. These actions will help us to create the workforce necessary to provide effective care and support to all those in North Ayrshire who need it. We have aligned our actions to our five workforce priorities. Understanding our Workforce (NWS Pillar – PLAN) No# Action Desired Outcome Completion Date Service Area 01.01 Service leads will meet with HR representatives on a quarterly basis to review and inform workforce plans Heads of Service and Service leads have a clear overview of the current workforce, service demands and future planning requirements Mar 2023 (on- going) All 01.02 Review the suite of workforce information available to partnership leaders and managers. The workforce information we have is up to date and accurate and contains all relevant workforce metrics to support decision making. Mar 2025 Finance and Transformation 01.03 Develop an enhanced suite of workforce reports to be cascaded to all Team Managers. Workforce planning is embedded in teams across the partnership, supported by meaningful workforce reports containing team specific workforce information. Mar 2025 Finance and Transformation 01.04 Develop a focused workforce plan for the integrated hub on Arran supporting the new models of care. Workforce plan will set out the future needs and staffing requirement for the Integrated Hub on Arran March 2023 Health and Community Care 76
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44 01.05 Participate in the Allied Health Professional (AHP) Workforce Commission The Commission provides clear recommendations for the future development of the AHP workforce March 2025 AHP 01.06 Continue to work closely with local independent and third sector providers to identify workforce challenges and opportunities We have a strong understanding of the third and independent sector workforce in North Ayrshire and work together to strengthen the sector. March 2025 Contracts and Commissioning Promoting our Organisation (NWS Pillar – Attract) No# Action Desired Outcome Completion Date Service Area 02.01 Engage with education colleagues (LA, FE and HE) to support the promotion of the wide range of careers available in Health and Social Care in North Ayrshire HSCP The HSCP is well promoted across all educational institutions in North Ayrshire and the benefits and opportunities of a career in Health and Social Care are widely recognised March 2025 All 02.02 Engage with education colleagues (LA, FE and HE) to support the promotion of Health and Social Care courses. Seeing a career in Health and Social Care as a meaningful opportunity, people are encouraged to uptake relevant health and social care related courses and will see NAHSCP as an employer of choice when they graduate March 2025 02.03 Continue the delivery of locality-based recruitment events for Health and Community Care. We actively attract people to available vacancies in the HSCP, offering meaningful employment in people’s own communities. March 2025 Health and Community Care 77
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45 02.04 We will create/identify a calendar of wider job fairs and recruitment events ensuring HSCP representation. HSCP services are aware of all local promotional events and actively promote the partnership as a fantastic place to work. March 2025 02.05 We will create clear career pathways for potential and existing staff to highlight possible career progression routes and promotion possibilities. All staff within the HSCP will be aware of their career development and progression prospects. North Ayrshire HSCP will be known as an organisation that offers excellent career development opportunities for potential staff. March 2025 All 02.06 All posts created and advertised, will be highlighted for their professional and career development opportunity and for their value in supporting the HSCP. Future applicants for HSCP vacancies will be aware of the development and career potential the post will bring. March 2025 All 78
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46 Investing in our People (NWS Pillar – Train) No# Action Desired Outcome Completion Date Service Area 03.01 Publish and Implement Learning and Development Strategy for all Health and Social Care Partnership Staff. The HSCP has in place a clear Learning and Development Strategy that supports the skills development of the workforce. Apr 2023 Social Work, Standards, Practice and Governance 03.02 Explore feasibility of developing a ‘Primary Care Training Academy’ Staff within primary care multi-disciplinary teams have all their training needs support in the absence of the traditional GP-led approach. Oct 2023 Health and Community Care 03.03 Develop and implement a Universal Early Years (UEY) Staff Development Programme Universal Early Years staff have a designated development programme that builds experience and upskills team members effectively. The knowledge base with the UEY team is retained and passed on to newer team members. Oct 2023 Children, Families and Justice Services 03.04 Support staff members: encourage and support to access Social Work degree courses and SVQs We have invested in the development of our staff, and created ‘home-grown’ social workers. Beneficiaries will consider NAHSCP their employer to continue their career. March 2025 Social Work, Standards, Practice and Governance 03.05 Actively promote the completion of Personal Development Reviews/ Our Time To Talk on an annual basis to support staff development. All staff have a clear understanding of their role and responsibilities and have their training needs identified and reviewed on a regular basis. Oct 2023 All 03.06 Develop an online training portal for Community Care Staff Community Care Staff have an easy to access training and advice portal to support their skills and professional development. March 2025 Health and Community Care 79
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47 Offer GP trainees, GP WSI opportunities to remain in North Ayrshire Increase GP/ Specialist Support in Primary Care March 2024 Primary Care Continue Wellbeing programme for Staff All staff across sectors can attend wellbeing activities to enhance their wellbeing March 2024 Business Support Build our Workforce (NWS Pillar – Employ) No# Action Desired Outcome Completion Date Service Area 04.01 Continue all recruitment drives for Care at Home Services The Care at Home service is maximised with little to no vacancies across all localities On-going Health and Community Care 04.02 Review the role of Care at Home Assistant. A revised role profile will attract a greater volume of applicants to care at home vacancies. Oct 2023 Health and Community Care 04.03 Utilise the NAC Modern Apprenticeship Scheme, offering young people (under 20) the opportunity to start a career in Health and Social Care with NAHSCP We provide meaningful career and learning opportunities for school leavers and young people in North Ayrshire. Through these opportunities, young people will build a long-term career within health and social care in North Ayrshire March 2025 All 04.04 Utilise the NAC Graduate Scheme, offering recent local college and university graduates the opportunity to start a career in Health and Social Care with NAHSCP We provide meaningful career opportunities for recent graduates from North Ayrshire. We will achieve the mutual benefit of employing fully qualified individuals into appropriate roles and encouraging new graduates to build a career within health and social care in North Ayrshire March 2025 All 80
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48 04.04 Contribute to on-going review work by NAC HR Resources to improve the scope of platforms/methods to advertise vacant posts. North Ayrshire Council and the HSCP has an enhanced range of methods and platforms to advertise vacant posts to ensure maximum distribution Mar 2025 NAC Human Resources Continue to expand Primary Care MDT Teams Support for GP practices and communities from MDT Teams March 2023 Primary Care Developing our People (NWS Pillar – Nurture) No# Action Desired Outcome Completion Date Service Area 05.01 Develop a staff Health and Wellbeing Programme to include: ▪ Online mindfulness training ▪ Opportunities to access a range of activities ▪ Commission psychological wellbeing workshops We have improved the wellbeing of our staff and our staff are active in maintaining and improving their own mental and physical well-being. Oct 2023 Business Support 05.02 Develop a ‘Succession Planning’ guidance/toolkit for the Partnership. Potential future managers and leaders are identified and provided key development opportunities to prepare them for future roles in leadership positions Oct 2023 Finance and Transformational Change 05.03 Monitor the roll out of ‘Agile Working’ across impacted work groups to ensure positive wellbeing benefits are realised. Staff have fully adopted agile working procedures and are confident in balancing their work from home with location-based working. TBC Business Support 05.04 Develop a ‘career pathway’ guidance for all staff, to highlight possible career progression routes for the NAHSCP workforce. All staff will have the information available to make informed choices about their future career development TBC All 81
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49 05.05 Review the management and governance structure within the partnership, considering all levels of management. The Partnership’s management structure offers a stepped pathway as people progress in their careers. March 2025 PSMT/Heads of Service 82
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North Ayrshire Health and Social Care Partnership 14. Appendices Workforce Plan 2022-25 Appendix 83
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51 Appendix A - NAHSCP North Ayrshire Health and Social Care Partnership Services The information below highlights the range of services delivered by the North Ayrshire Health and Social Care Partnership. Partnership Services Most of our services are delivered in collaboration between North Ayrshire Council and NHS Ayrshire and Arran. Our service delivery teams include Allied Health Professionals (dieticians, physiotherapists, occupational therapists, speech and language therapists), addictions workers, care at home, care homes, child immunisation, community alarm and digital health, community link workers, welfare rights officers, nurses (including specialist nurses), paid carers, psychologists and psychiatrists, social workers (across all age groups) and social work assistants, residential adult and childcare staff and volunteers in a range of teams. In many services, we also have peer support workers, who are staff members with lived experience of services. In addition, dentists, GPs, optometrists, and pharmacists (primary care professionals) work together with us. We also work closely with the Third sector, the Independent Sector, Housing Services, NHS acute hospitals, Alcohol and Drug Partnerships, the other Ayrshire Health and Social Care Partnerships, Police Scotland, local councillors and many others. To ensure our service delivery and frontline services are able to do their job as best they can, our Business Support Services work to provide essential clerical, administration and technical support. Business Support plays a key role in supporting the wellbeing of all Partnership staff, providing guidance on health and safety, wellbeing at work and supporting staff attendance. Our Finance and Transformation service provides key strategic support for the Partnership. The service oversees the Partnership’s funding allocation, manages how we commission and procure services, undertakes our planning and performance function, and leads on our key transformation and change projects. In delivering effective health and social care services, we appreciate many things are out with the scope of either the NHS or North Ayrshire Council to achieve. That is why our partnership includes representation from the Third Sector Interface and from the local independent sector. North Ayrshire Third Sector Interface Third Sector Interface (TSI) North Ayrshire provides a single point of reference for all third sector organisations and community groups. TSI North Ayrshire is best placed to support the 84
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52 development and growth of local voluntary services that can provide invaluable health, care and wellbeing support for local people. The TSI North Ayrshire’s vision is of improved quality of life for the people and communities of North Ayrshire by building a strong, effective, and sustainable Third Sector. In North Ayrshire, the TSI is a partnership made up of Arran Community and Voluntary Service (Arran CVS) and The Ayrshire Community Trust (TACT). Both organisations have a long history of engaging with the local community, volunteers, community organisations and service providers. Independent Care Sector The independent sector in Scotland provides a wide range of care services for older people, those with long term conditions, learning disabilities, physical disabilities, dementia or mental health problems. Working together, we endeavour to meet the increasing local demand for community based social care services. This includes: • Independent Care Home Provision • Delivery of Care at Home Services Our independent care colleagues work closely with HSCP staff to meet our health and social care vision for the people of North Ayrshire and there is independent sector representation on the Integration Joint Board. 85
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53 Appendix B - Aligning and Defining our priorities In defining the workforce priorities for NA HSCP we reviewed the approaches of our parent organisations, North Ayrshire Council and NHS Ayrshire and Arran. In aligning these approaches, while still considering the five pillars of workforce planning, we identified five local priorities. How our Priorities Align to NAC and NHS Approaches HSCP Workforce Priorities National Workforce Strategy Pillars NAC Skills Pipeline NHS Ayrshire and Arran Workforce Plan Understanding our workforce PLAN 6 Steps Approach (Define, Map, Identify, Understand, Develop, Implement) Ensure workforce is affordable and sustainable Promoting our organisation ATTRACT Attracting our future Workforce Improve the image of NHS A&A as an attractive employer Investing in our people TRAIN Developing our Talent* Deliver an effective people strategy Building our workforce EMPLOY Recruiting Employees Implement improved businesses process to improve the utilisation and deployment of the workforce Growing our people NURTURE 6 Steps Approach (Define, Map, Identify, Understand, Develop, Implement) Support the health and wellbeing of staff Understanding our workforce PLAN Attracting our future Workforce Ensure workforce is affordable and sustainable Defining our Priorities Understanding our Workforce: To effectively develop our workforce to meet the current and future health and social care needs in North Ayrshire, it is vital that we have a high level of insight into our current staffing structures and both current and future demands of our service. We will make best use of our workforce and staffing information, ensuring it is available at all levels of the partnership. Through aligning our understanding of our workforce to our performance information and strategic needs assessment, we can better scope future need and plan our future workforce more effectively. This maps to the Scottish Government pillar of PLAN 86
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54 Promoting our Organisation: We hope to promote the positive image of working in North Ayrshire Health and Social Care Partnership. The HSCP can offer a range of employment options and has need for range of skills, specialities and qualifications. We will promote our organisation as a great place to work, a place that will value its staff, providing excellent opportunities for development and enhancement. This promotion will focus on: ▪ Existing health and social care professionals, who will see North Ayrshire HSCP as a place to build or further their career ▪ School pupils and college/university students, encouraging them to consider a career in health and social care ▪ Local people, through our various recruitment drives This maps to the Scottish Government pillar of ATTRACT Investing in our people: To ensure we continue to deliver the highest levels of health and Social Care Services, we will ensure our staff have the skills and experience needed to undertake their roles. We will ensure that all professional qualification and accreditation is in place and that staff are provided with appropriate training and development opportunities. This maps to the Scottish Government pillar of TRAIN Building our workforce: We have recognised that, in the face of both the local and national health and social care landscape, our workforce will need to change and adapt to ensure that we can achieve our vision for the people of North Ayrshire. We will use appropriate methods to grow our workforce. We will seek to employ a variety of methods and mechanisms to promote our vacancies to ensure as wide a distribution as possible. We will consider our application and interview processes to ensure they are accessible to all, and those who require additional supports to work within the HSCP are provided with them. This maps to the Scottish Government pillar of EMPLOY Growing our people: In aligning with our other ambitions for our workforce, we hope to be a caring workplace that helps to support and maintain the positive wellbeing of our staff. By providing a supportive and nurturing working environment, we hope our staff will be happier in their day to day roles and motivated to deliver the best services they can. We will provide our workforce with greater career planning options, highlighting how each individual can progress in their chosen field. In addition, we will also put in place a Succession Planning tool, to help identify and grow the HSCP leaders of the future This maps to the Scottish Government pillar of NURTURE 87
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55 Appendix C Workforce Planning Approaches Workforce Planning - Approaches by parental bodies In developing this workforce plan we were mindful to recognise the approaches to workforce planning set out by our parent bodies in North Ayrshire Council and NHS Ayrshire and Arran. North Ayrshire Council Approach to Workforce Planning North Ayrshire Council have set out an agreed approach to workforce planning. The approach recognises the need to both ensure a workforce that meets current demands, but one that is also mindful of future requirements over the medium to long-term. It highlights the key factors that must be considered when developing a workforce plan, and offers clear advice on workforce management and designing a future workforce as well as providing a six step approach to workforce planning. These six steps are: 1. Define the plan 2. Map the service change 3. Define the required workforce 4. Understand workforce availability 5. Develop and Action plan 6. Implement monitor and revise As part of this workforce plan, we will ensure we adopt the advice and guidance in the NAC approach. NHS Ayrshire and Arran Workforce Plan (2019-2022) The NHS Ayrshire and Arran Workforce Plan sets of the vision for the organisation as it continues to review and improve its workforce and service delivery. The plan sets our clear workforce objectives for NHS Ayrshire and Arran which are: 1. Deliver a robust, quantifiable and iterative workforce plan that sets out how it will achieve its future workforce. 2. Implement improved businesses process to improve the utilisation and deployment of the workforce 3. Deliver an effective people strategy to improve the image of NHS A&A as an attractive employer 4. Support the health and wellbeing of staff I addition, the workforce plan aims to implement a culture of workforce planning across the organisation, ensuring that it is everyone’s business. It hopes to embed the idea that workforce planning is not a standalone activity but should be considered by all teams and services on a regular basis. 88
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56 Appendix D - Policy Drivers Local Strategies Our local policies and plans are informed by close engagement with local people and reflect the needs and priorities of North Ayrshire. Caring Together – NAHSCP Strategic Commissioning Plan 2022-30 In April 2022 we published our longer-term strategy, Caring Together, which provides strategic direction for the North Ayrshire Health and Social Care Partnership for the eight- year period up to 2030. The plan identifies our vision for the people of North Ayrshire, which is that: “People who live in North Ayrshire are able to have a safe, healthy and active life” To help achieve this vision, we have identified 5 strategic priorities to work towards, these are: We see these priorities as interlinked and expect that where we see success against one priority, it’s effect will positively impact against others. Caring Together represents the first time that a strategic priority around the development of out staff has been identified for action. The priority to, ‘Develop and Support our Workforce’ reflects the HSCPs recognition of the value our staff have on ensuring we can achieve our vision. Our workforce is one of our most valuable assets and it is essential that is developed appropriately to meet the health and social care needs of local people. We will endeavour to ensure that our workforce is fully supported to undertake their roles while also offering clear career pathways for those who wish to develop further and progress within the partnership. Primary Care Improvement Plan - Ambitious for Ayrshire In April 2018, the new Scottish General Medical Services (GMS) Contract came into effect. This contract changed the way how local GP and Medical Practices operate, and effectively changes the role of GPs. The contract aims to build on the strengths and values of traditional general practice by building multi-disciplinary teams. These teams contain a range of health professionals, including Advance Nurse Practitioners, Mental Health workers, Community Link Workers and Allied Health Professionals. The aim of this approach is to ensure you get Enable Communities Develop and Support our Workforce Provide Early and Effective Support Improve Mental and Physical Health and Wellbeing Tackle Inequalities 89
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57 the right care you need at the right time. By redirecting many tasks traditionally done by GPs to more appropriate health professionals, local people will receive better care - and freeing up GP capacity to focus on more complex health cases. Locally, the three Ayrshire Health and Social Care Partnerships have worked together to deliver the local Primary Care Improvement Plan (PCIP), ‘Ambitious for Ayrshire’ and have agreed the following vision for primary care: To deliver safe, effective, person centred, sustainable Primary Care Services at the heart of the healthcare system for the people of Ayrshire and Arran Through the implementation of the PCIP we shall remodel how we deliver primary care locally, ensuring that multi-disciplinary teams are available in each medical practice across North Ayrshire. This will help ensure that when needed local people will get the right care and support, they need. The development of multi-disciplinary teams across the Primary Care sector will mean a greater diversity in the skill set of staff. However, this also brings the challenge of ensuring appropriate supply is available to ensure MDTs can operate at capacity. The PCIP will link closely to the Caring for Ayrshire programme of work. Caring for Ayrshire is a 10-year programme in partnership with NHS Ayrshire and Arran and the three Ayrshire HSCPs to redesign how we provide local health and care services in the future. The programme understands the many demands on health and care services nationally and the need to do things differently. This strategic transformation programme that will build on developing an integrated health and care service model. This model will look at all aspects of health and care from birth, to end of life, with people being at the heart of the proposals ensuring our future services consider the changing population demographics (e.g. ageing population and increasing inequalities, particularly as a result of poverty). The Promise The Partnership will work closely with our national and local partners as we help to deliver ‘The Promise’ for Children, Young People and Families. The promise is responsible for driving the work of change demanded by the findings of the Independent Care Review. Made on 5th February 2020, the Promise seeks to improve the experience of all children, young people and their families if they require additional support. The promise will create a more compassionate care system for young people and families. In keeping the promise, five key foundations have been outlined against which all change must be grounded. • Voice: All children must be listened to and respected and appropriately involved in decisions about their care. Our decision-making culture must be compassionate and caring 90
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58 • Family: Children must remain with their families when they feel safe and loved. Families will be supported to overcome challenges, and to continue to love and nurture their children. • Care: When remaining with their family is not possible, siblings will not be separated and placed together in a nurturing, loving home. • People: Those who deliver care services to children and families will be supported to develop compassionate working relationships with those they support. These closer working relationships will lead to more compassionate decisions making and care. • Scaffolding: Children, families and the workforce must be supported by a system that is there when it is needed. The scaffolding of help, support and accountability must be ready and responsive when it is required. The implementation of The Promise will have a significant impact on the Children and Families Workforce. The Promise Plan for 2021-24 can be accessed here: https://thepromise.scot/plan-21-24-pdf-spread.pdf National Policies Scottish Government National Workforce Plan for Health and Social Care The National Workforce Plan for Health and Social Care was published in early 2022 and set out the Scottish Governments vision for health and social care in Scotland: o People are able to live more years in good health, and that we reduce the inequalities in health life expectancy This compliments the overall vision for the national health and social care workforce: o A sustainable, skilled workforce with attractive career choices and fair work where all are respected and valued for the work they do The national strategy sets out a tri-partite ambition to: • Recover: Create the conditions through which our workforce, and by extension our Health and Social Care services, can successfully Recover from the pandemic • Grow: Grow the Health and Social Care workforce sustainably, in line with Scotland’s population demographics, and the demands on our Health and Social Care services • Transform: Transform the ways in which our workforce is trained, equipped and organised to deliver Health and Social Care services, in order to achieve long-term sustainability through increased effectiveness and improved population health outcomes. To support the future development of the national health and social care workforce, the Scottish Government has identified five national pillars for action. These are: o Plan, Attract, Train, Employ, and Nurture 91
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59 It is advised that these five pillars are employed by health and social care organisations across SCOTLAND in the development of their own workforce plans. More information on these five pillars can be found in the methodology section of this plan (page 9) Development of a National Care Service Following the publication of the Independent Review of Adult Social Care (2021) the Scottish Government has agreed to progress legislation to develop a National Care Service. The Scottish Government will continue to develop legislation and make preparations for the creation of this new national service, which is expected to be implemented by the end of the current parliamentary period in 2026. In originally considering the proposals of a National Care Service, North Ayrshire Health and Social Care Partnership identified several positive opportunities that this new national service will bring, but also several challenges that must be addressed. These considerations were submitted to the Scottish Government in October 2021 in consultation response. In September 2022, the North Ayrshire Integration Joint Board submitted a response to a the Scottish Parliament’s Health, Social Care and Sport Committee consultation on the publication of the National Care Service (Scotland) Bill. The Bill highlighted a number of key concern areas for the IJB and the Health and Social Care Partnership, including how the future health and social care workforce will be structured, how services will be aligned and integrated, and the possible negative impact the development of a National Care Service could have on local people, service users and patients. The move to a National Care Service will have a significant impact on the Health and Social Care Workforce. As the legislation and plans develop, North Ayrshire IJB and HSCP will continue to engage and provide constructive feedback to ensure the wellbeing of staff and people who access our services is maintained. 92
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60 Appendix E - Additional Workforce Requirements The table below highlights the additional workforce requirements identified by HSCP service delivery teams. It identifies current gaps, short-term requirements needed over the next 12 months and future staffing required by 2025. The requirements set out below are aspirational as it is currently unknown if there is resource capacity to create and appoint to all these roles. CHILDREN FAMILIES AND JUSTICE SERVICES Team Current Requirements Additional Posts by 2023 Additional Post by 2025 Universal Early Years Band 7 Team Manager - Children's Services Band 7 Health Visitors: 3.0 WTE Band 6 School Nurses: 3.8 WTE Band 4 Health Visiting Support Worker: 0.8 WTE Band 6 Perinatal Mental Health Nurse Band 7 Community Infant Feeding Nurse – (interim until Nov 22) Band 5 Immunisation Staff nurse Band 4 support worker roles – ideally 2 per locality. Band 6 Perinatal Mental Health Nurse (Early Intervention) – 0.6- 0.8 WTE Band 4 Health Visiting Support Worker/ Dad’s Worker 1.0 WTE HV students – aim for 2 students on an annual basis As a minimum: Health Visitors x5 (locality based) Student Health Visitors x2 per annum Band 4 Support Workers x6 Justice and Intervention Services Electronic Monitoring Officer (Bail) – 1x 1WTE (temp) Family Centred Wellbeing Team – x 5 full time grade 7 staff. Rosemount Team - 2 x grade10 Project Worker Posts with irregular hours and 2 x Social Family Centred Wellbeing Team - 2 full time grade 7 staff. Rosemount Team - 1 grade 10 Project Worker Posts with irregular hours and 93
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61 Work Assistant grade 8 posts with irregular hours. Justice Locality Team - 2 x staff for EM Bail, 1 x Social Work Assistant for Making a Difference Projects, 1 x Court Social Worker, 1 x court Social Work Assistant. Partnership Delivery Team - 2 desistence Officers Unpaid Work – 1 x Employability Mentor Service Access Teams - 4 x Social Workers and 4 x Social Work Assistants MAASH - 1.5 x Social Workers and 2 x Social Work Assistants 1 Social Work Assistant grade 8 post with irregular hours. Justice Locality Team - 1 staff for EM Bail, 1 Court Social Worker, 1 court Social Work Assistant. Partnership Delivery Team - 1 Desistence Officers Unpaid Work - 1 Employability Mentor Service Access Teams - 2 Social Workers and 3 Social Work Assistants MAASH - 1 Social Worker and 2 Social Work Assistants Unpaid Work Team - 1 Community Payback Officers, 1 Supervisors Children Families & Justice Services We need a full complement of staff within existing resources (eg Team Manager Residential Care & 3 SW posts which are vacant) plus further lead posts eg Trauma informed lead officer As before 94
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62 Additional Social Workers (x6; one per locality) Additional Social Work Assistants (x6) Team Managers (x3) 95
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63 HEALTH AND COMMUNITY CARE SERVICES Team Current Requirements Additional Posts by Oct 2023 Additional Post by March 2025 Long term Conditions and Locality Services No outstanding vacancies Band 8a Clinical Nurse Manager 1x 1WTE Band 3 HCSWs – x4 Arran Services 11 x Care Home Workers (Montrose House) 10 x Care at Home Posts (including 4 overnight posts) 2 x Emergency Nurse Practitioner 1 x GP post 1 x Band 6 Physio post 1 x ANP for complex care/frailty 2 x Band 5 Nurse vacancies 1 x Admin Officer 1 x HCSW No future workforce need identified. Focus is on current recruitment to ongoing vacancies NA Intermediate Care & Community Rehabilitation Hub Referral management/AHP administration Admin support to service managers/team leads limited due to reduced workforce for AHP services. 2 x Band 4 WTE 1 x Band 3 WTE Likely 2x Grade 4 Administration Staff Older people and physical disability locality services/ hospital SW/ care home review team/ sensory impairment/ senior officers 1 x Social Worker WTE 2.5 Social Work Assistants None anticipated None Anticipated Primary Care 5 x WTE Mental Health Practitioners Subject to consultation and AHP Rehab commission 96
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64 1 x Community Link Worker 1 x 8a Pharmacotherapy post (Pan Ayrshire) 2 x Band 7 MSK Physio 2 x Band 5 MSK Physio 3 x CTAC posts (grades being determined) 1 x Band 7 OT 2 x Band 6 OT Community Care Gaps across all community Care Services • Care at Home • Day Services • OT Reablement • Anam Cara No Additional workforce identified as required. NA 97
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65 MENTAL HEALTH LEARNING DISABILITY AND ADDICTIONS SERVICES Team Current Requirements Additional Posts by 2023 Additional Post by 2025 Alcohol and Drug Services Challenges in recruiting to the following posts: • Recovery Development Workers (3 posts) RMN (2 posts) NADARS (core service): • Social Worker x 2 (short term ADP funding identified); • Occupational Therapist x 0.6 (ADP funding identified); NADARS– Essential for Medication Assisted Treatment Delivery (MAT) • 2 x Pharmacist Prescribing sessions; • 2 x GP Specialist Prescribing sessions No funding identified. A Business Case is being prepared Additional post for Ward 5 (nurse or AHP) following review of core programme and impact of new additional residential rehabilitation pathways Identify other staff through monitoring of service Community Mental Health Services Service experiencing gaps in: Psychology (two rounds of failed interviews) Psychiatry 6 x Social Work/MHO 8 x MH Nursing Staff 8 WTE MH Nursing Staff In Primary Care Mental health, additional posts will be required: • Mental Health Practitioners • Enhanced Psychological Practitioners Details on volume of staff required is still to be identified. In Community MH/Disorder Team Consideration of expanding workforce beyond 8 WTE identified for the short- term. 98
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66 Psychological Services Continue to face challenges in recruiting to CAMHS and AMH Community posts. Made more challenging due to competitive context. B4/5 Assistant Psychologists B7 Clinical Associates in Applied Psychology B8a Clinical Psychologists Additional 25 WTE Psychological Therapists (for deployment across several services) Resourcing of Multi-Disciplinary Teams including B7 Psychology Posts B8a Psychology posts Learning Disability Service Social Work Team Team Manager (Social Work – just gone out to advert for 3rd time in 2 years) 2 x social workers (at interview stage but poor response) 1 x social work assistant Intensive Support Service 2 x Band 6 charge nurses 1 x Band 3 support worker 1 x social worker Band 3 Occupational Therapy Assistant (or similar) Additional Service Manager Identify through monitoring service development requirements. 99
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67 ALLIED HEALTH PROFESSIONAL SERVICES Team Current Requirements Additional Posts by 2023 Additional Post by 2025 AHP - Occupational therapy and Physiotherapy (Children and Families) 1 x Physiotherapy Team Lead 1 x Skilled Practitioner 3 x Band7 Specialist Physio 4 x Physio Support Workers 3 x WTE Band 5 Occupational Therapists Review of Workforce to be undertaken Will await outcome of AHP Commission. AHP - Occupational therapy, Physiotherapy, Dietetics (Mental Health) 2.1 WTE Physiotherapists 4 WTE Occupational Therapists 1 x Band 7 Physiotherapist (Foxgrove) 3 x B6 Physiotherapist (Forensic) 0.5 x Band 5 Physiotherapist 1 x Band 4 Exercise Practitioner 1 x Band 3 Physio Support Worker 4 x Band 6 Physiotherapist 1.5 x Band 6 Physiotherapist 3 x Band 3 Exercise Practitioners 1 x Band 3 Physio Support Worker North Learning Disability: 1 x Band 6 Physiotherapist 2 x Band 5 rotational Physiotherapist 3.3 x Band 6 Physiotherapist 3 x Band 4 Physiotherapist 1 x Band 2 Physio Assistant 2 x Occupational Therapy integrated support worker Undertake AHP national rehab commission exercise to examine demand 100
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68 1 x WTE Perinatal Worker (increase from 0.6 WTE) Review OT skill mix 2 WTE x Band 6 Dietician (CMHT) 2 x Band 6 Dietician (CAMHS & CEDS) 1 x Band 3 Dietician 1 x Band 3 Support worker 1 x Band 6 Dietician (LD) AHP - Dietetics, OT, Physio and Podiatry (Health and Community Care) 1 WTE Occupational Therapist 2 x Band 6 Physiotherapist 1 x Band 7 Physiotherapist 1 x Podiatry Manager (across North/East HSCPs) 1 x Band 7 Advanced Podiatrist 0.6 WTE x Dietetics Service Manager 1 x Band 6 Dietetics Worker 0.6 WTE x Dietetics Support worker 1 x Physio Team Service Lead 1 x Band 6 Physio (Arran) 1 x Band 6 Physio (Mainland) Band 3/ 4 Staff to support admin. Possibility to include a Band 5 rotation post 1 x Band 5 Occupational Therapist 2 x Neuro Support Worker 1 x Band 6 Stroke Specialist 1 x Band 6 Dietician 1 x Band 5 Dietician 1 x Dietetics Support Worker 1 x Band 7 Advanced Podiatrist Undertake AHP national rehab commission exercise to examine demand 101
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69 FINANCE AND TRANSFORMATION & BUSINESS SUPPORT SERVICES Team Current Requirements Additional Posts by 2023 Additional Post by 2025 Finance Admin Assistants (Grade 5): 1x 1WTE, 1x 0.4 WTE and 1x 0.3 WTE (temp) Finance assistant (Grade 7) 1x 1WTE Finance Officer (Grade 12) 1x1WTE No planned increases No planned increases Business Support Additional admin support to service delivery teams required. 2 x WTE Staff to Moving Handling/CALM Team Future requirement subject to feasibility study. 102
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Integration Joint Board 20 October 2022 Subject : Mental Welfare Commission Report - Authority to Discharge Purpose : To provide an update on progress of the North Ayrshire Health and Social Care Partnership in relation to the action plan developed in response to the Mental Welfare Commission – Authority to Discharge Report (May 2021). Recommendation : IJB members are asked to note the report and the NAHSCP response to the recommendations. 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 MWC Mental Welfare Commission 1. EXECUTIVE SUMMARY 1.1 This report presents the progress made by the NAHSCP in relation to the action plan developed following receipt of the MWC Authority to Discharge report which was issued on 20 May 2021. The full report can be accessed here: AuthorityToDischarge-Report_May2021.pdf (mwcscot.org.uk) 2. BACKGROUND 2.1 As highlighted in the previous paper presented to the IJB on 21st October 2021, the Mental Welfare Commission (MWC) has specific legal duties in relation to safeguarding the rights of people who are subject to the welfare provisions of the Adults with Incapacity (Scotland) Act 2000 (AWI Act) and has a statutory safeguarding role in respect of adults whose capacity to made decisions or take actions to promote or safeguard their welfare is impaired due to a mental disorder. During the pandemic a number of stakeholders raised concerns with the Commission regarding whether the appropriate legal authority was used to safeguard people being discharged from hospital to care homes who did not have the capacity to make an informed decision Agenda Item 6 103
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to agree the move. These discharges are made under the powers of Section 13ZA of the Social Work (Scotland) Act 1968. 2.2 The Commission therefore carried out a review of the practice with specific reference to moves from hospital to care homes from 1 March 2020 to 31 May 2020 supported by information from HSCPs across Scotland on the moves during that period. The Commission then made further inquiries as to the rights-based practice and legal authority supporting the moves. The focus of this work was to identify any learning and to ensure that this learning takes place, where required, to support and uphold the rights of individuals. 2.3 The commission made 11 recommendations to be considered by HSCPs and the Care Inspectorate. In response and as agreed at the IJB in October 2021, a local focussed action plan was developed, and work undertaken to ensure improved processes and sustained good practice. 3. PROPOSALS 3.1 In responding to the recommendations North Ayrshire HSCP have attached a RAG status to each of the 8 recommendations relevant to HSCPs, a further 3 recommendations are specifically for the Care Inspectorate. 3.2 The position within North Ayrshire can be summarised below with full responses attached at Appendix 1: • There remains a robust system of recording AWI where a formal decision in respect of an adult with incapacity is agreed. • The HSCP hospital based social work team have extensive experience of discharge and the legal requirements. • Practitioner guidance is consistent with the principles of the legislation, but a need has been identified to update the Management Guidelines which were last reviewed in 2014. The guidelines have been reviewed and updated and will be tabled for ratification at the Social Work Governance Board in December 2022. Robust processes and decision making remains in place for all 13ZA discharges. • There continues to be an established learning and development programme in relation to AWI with the addition of a refresher training programme now established in response to the recommendations. This is delivered on a continuous rolling programme to all relevant staff. • The development and installation of a self-evaluation process including collating, reviewing and developing an audit framework with regards to AWI remains in progress. This has been delayed through changes in personnel and is now seen as a priority for completion and ratification via the Social Work Governance Board. Although the self-evaluation of process is not fully established and ratified, there is however continuous assurance activity by way of auditing on a continuous basis undertaken by a variation of personnel i.e., Learning & Development Team Manager, locality Team Managers and Senior Officers who all audit files regularly 104
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which will include those subject to AWIA measures. An example of audit template is attached in Appendix 2. 3.3 Support to service continues to be provided from the North Ayrshire Council Legal Services and team managers to ensure our local processes are robust and will ensure all moves are made with the legal authority in place. 3.4 Anticipated Outcomes The work of the Mental Welfare Commission is to support and safeguard the rights of people who lack mental capacity, the report and associated recommendations should ensure the rights of those individuals are protected. 3.5 Measuring Impact The North Ayrshire HSCP response to the recommendations will be monitored through the HSCP Social Work Governance Board with oversight by the Chief Social Worker. 4. IMPLICATIONS Financial: None Human Resources: None Legal: Required compliance with provisions in the Adults with Incapacity (Scotland) Act 2000 (AWI Act). Equality: Focus of the report is that people who lack mental capacity have their rights respected, have equality of access to representation and are safeguarded. Children and Young People None Environmental & Sustainability: None Key Priorities: None Risk Implications: Taking forward actions in relation to the recommendations minimises the risk of moving individuals with no legal capacity to do so. Community Benefits: Confidence in the activity of the NAHSCP. 5. CONCLUSION 5.1 IJB Members are asked to (i) IJB members are asked to note the report and the NAHSCP response to the recommendations. Caroline Cameron, Director For further information please contact David Thomson (Head of Service, Health and Community Care) on (01294) 317806 or davidthomson@north-ayrshire.gov.uk 105
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Appendices • Appendix 1 - Action Plan • Appendix 2 - Casefile Audit Template 106
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Appendix 1 NORTH AYRSHIRE HSCP – RESPONSE TO RECOMMENDATIONS MENTAL WELFARE COMMISSION REPORT AUTHORITY TO DISCHARGE: REPORT INTO DECISION MAKING FOR PEOPLE IN HOSPITAL WHO LACK CAPACITY Recommendation RAG Status Comments/Actions 1 HSCPs should undertake a full training needs analysis to identify gaps in knowledge in relation to capacity and assessment, associated legislation, deprivation of liberty definition and the human rights of individuals (as detailed in the report) to inform delivery of training programmes to ensure a confident, competent multidisciplinary workforce supporting safe and lawful hospital discharge planning. GREEN A programme of learning and development in relation to Adults With Incapacity is in place within NAHSCP, with two full days of training as part of the programme. The Partnership has reviewed this position and has identified an area for improvement in the provision of refresher training to bring parity with CP and ASP arrangements. Consideration is being given to including this in training programme, for a ½ to 1 day refresher course, with plans to have this in place by March 2022. Team Managers from locality adult Social Work Services are being consulted as part of this exercise and agreement and priority will be agreed through Social Work Governance Board. October 2022 update: The refresher training programme is now in place and is being delivered on a rolling progamme basis. Activity will be reported via the Social Work Governance Board on an annual basis. 2 HSCPs should establish a consistent system for recording when an assessment of incapacity has been conducted, by whom and in relation to which areas of decision making. GREEN Our social work information system records requests for assessment of incapacity, decisions and who carries out that assessment. The assessment is very specific in terms of recording details in relation to what specifically a person has capacity to agree to and the timeline of the capacity assessment and outcome. The system is accessible by all social work staff and there is standard protocol for recording which is consistently followed. 3 HSCPs should ensure that staff facilitating hospital discharges are clear about the status of registered care home placements, in terms of law (see EHRC vs GGC in the report) and with regards the financial and welfare implications of different types of placements for the individual. GREEN All NAHSCP teams across localities and including the hospital team have extensive experience of safely discharging to care homes in terms of the law. The Senior Manager responsible for these services held a session with team managers in July 2021 to reinforce responsibilities and ensure all had a comprehensive understanding of the guidance on discharge, with particular emphasis on 13za. Any 13za discharge cannot proceed by only a social worker and requires Team Manager approval with oversight from the Senior Manager. 4 HSCPs should ensure that practitioners facilitating hospital discharges have copies of relevant documents on file detailing the powers as evidence for taking action on behalf of the individual who is assessed as lacking capacity. GREEN As detailed in NAHSCP guidance practitioners require to ensure documentation is in place and on file regarding any evidence on capacity of individuals. The Hospital Based Social Work Team have access to the social work information system and patient medical notes which both include information pertaining to assessment of capacity. A Team Manger has been identified to lead self-evaluation of processes including collating, reviewing and developing audit frameworks in regard to AWI. In terms of those discharging from hospital into care homes, these assessments require to be agreed by two Senior Managers which ensures consistency and quality of assessment. All assessments require to be explicit in regard to the legal basis for discharge. This 107
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Appendix 1 requires to be in line with NAHSCP guidance and the Adults With Incapacity (Scotland) Act 2000. 5 HSCPs should ensure that assessments reflect the person as a unique individual with focus on outcomes important to that individual and not external drivers that have the potential to compromise human rights and/or legality of moves. GREEN It is embedded into practice from Social Workers, Social Work Assistants and Team Managers that assessments require to be outcome focused and have the person who owns that assessment and/or their representative at the heart of same. Assessments must be authorised by Team Managers before being signed by service users or their representative. 6 HSCPs should ensure that processes are in place to audit recording of decisions and the legality of hospital discharges for adults who lack capacity in line with existing guidance and the principles of incapacity legislation. AMBER It was previously identified that there is a need to update the Management Guidelines for the provision of discharging individuals who lack capacity. This document dates from 2014 and forms the basis of Team Manager and Social Worker practice in terms of ensuring the rights of individuals are upheld and that those discharged from hospital who lack capacity are discharged on a legal basis. A briefing note was produced by legal colleagues in March 2021 around the use of 13za in discharges, this was circulated to all team managers with consultation through locality social work meetings. Discussions have begun with the North Ayrshire Council legal team and suggestions have been made in updating the guidance, particularly in relation to deprivation of liberty. This work is ongoing. A Team Manger has been identified to lead self-evaluation of processes including collating, reviewing and developing audit frameworks regarding AWI. This will be strengthened by proposals to provide refresher training. This improvement work will be overseen by the Social Governance Board. (Timescales for updated Management Guidelines – by June 2022) October 2022 update: • The guidelines have been reviewed and updated by Senior Management Team and will be finally ratified at the Social Work Governance Board in December 2022. • The development and installation of a self-evaluation process including collating, reviewing and developing an audit framework with regards to AWI remains in progress. This has been delayed through changes in personnel and is now seen as a priority for completion and ratification via the Social Work Governance Board. Although the self- evaluation of process is not fully established and ratified, there is however continuous assurance activity by way of multiple auditing activity on a continuous basis undertaken by various personnel i.e., Learning & Development Team Manager, locality Team Managers and Senior Officers who all audit files regularly which will include those 108
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Appendix 1 subject to AWIA measures. It is proposed that the self-evaluation framework be presented to the Social Work Governance Board by March 2023. 7 HSCPs’ audit processes should extend to ensuring evidence of practice that is inclusive, maximising contribution by the individual and their relevant others, specifically carers as per section 28 Carers (Scotland) Act 2016. Refer to requirements 5 and 6 8 HSCPs should ensure strong leadership and expertise to support operational discharge teams. GREEN Operational leadership at Team Manager and Senior Manager level and skilled, experienced staff are in place to continue to ensure appropriate legislative frameworks. Enhanced Social Work Hospital Team in summer 2021 with dedicated Team Manager overseeing assessments for complex care arrangements including consistent application of guidance and legislation. 9 The Care Inspectorate should take account of the findings of this report regarding the use of s.13ZA of the Social Work (Scotland) Act 1968 and consider the scrutiny, assurance or improvement activity to take in relation to this. n/a – Care Inspectorate Recommendation 10 The Care Inspectorate should take account of the broader findings of this report beyond use of s.13ZA and consider how this might inform future scrutiny, assurance and improvement activity in services for adults. n/a – Care Inspectorate Recommendation 11 The Scottish Government should monitor the delivery of the above recommendations and work with Health and Social Care Partnerships and the Care Inspectorate to support consistency and address any barriers to delivery of the next two years. n/a – Care Inspectorate Recommendation 109
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Case File Audit SERVICE USER DETAILS SURNAME: FORENAME: CAREFIRST NO: DOB: AGE: GENDER: ETHNICITY: TEAM Other – Please State: Team Location: Team Manager: Allocated Worker: Time taken to complete Audit File Read By: Date Senior Officer – Feedback to Team Manager Date Team Manager – Feedback to Social Worker Date Please ensure you answer every question within this tool and include comments to enable full understanding of your findings and inform improvement. This must be completed with reference to the practice guidance. To rate the quality from level 1 – 6. Level 6 – Excellent, Level 5 – Very Good, Level 4 – Good, Level 3 – Adequate, Level 2 – Weak, Level 1 - Unsatisfactory Y N 110
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Section A1 - Chronologies 1.1 Is there a current chronology in the Care Record (paper or electronic) CareFirst/Care Partner 1.2 Is there evidence the chronology is being used across agencies? 1.3 Is there evidence that the chronology is used to inform the care plan? 1.4 Overall rate the quality of the chronology on file. Grade 1 – 6 (see rating) Comments: There is only a very short chronology recorded electronically, more work needs to be done to update this. Section A2 - Assessment Y N 2.1 Is there a current assessment on file? 2.2 Is the timing of the completion of the most recent assessment, in keeping with the needs of the service user and identified outcomes? 2.3 Overall rate the quality of the assessment on file. Grade 1 – 6 (see rating) Comments: Section A3 – Risk Y N 3.1 Is there any risk of harm to themselves, others or both? – Please specify in comments box below. 3.2 Is there an appropriate risk assessment in the file? 3.3 Overall rate the quality of the risk assessment on file. Grade 1 – 6 (see rating) Comments: 3.4 Is there an appropriate current risk management plan in the file? 3.5 Overall rate the quality of the risk management plan on file. Grade 1 – 6 (see rating) Comments: 3.6 Is there evidence that the risk management plan has been appropriately implemented? Comments: 3.7 Is there evidence that the risk management plan has been reviewed? Comments: Section A4 - Consent Y N 4.1 Is there evidence that consent has been sought? 4.2 Is there evidence of a signature to support consent? Comments: 111
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Section B – Care Plans Y N 1.1 Is there evidence that the Plan is outcome focused rather than a list of tasks? 1.2 Is there evidence that the plan is appropriately linked to the assessment and risk assessment? 1.3 Overall rate the quality of the plan. Grade 1 - 6 1.4 Is there evidence that the plan has been appropriately reviewed? Comments: Section C – Support/Services Provided Y N 1.1 Is there evidence that support and services received have followed the contents of the care plans? 1.2 From the information held in the records comment to what extent you consider the support provided and services received met their outcomes and minimised the identified risks? Comments: Section D – Service User Involvement Y N 4.1 Is there evidence that the service users views have been sought? 4.2 Is there any barriers to engagement identified? Comments: Section E – Partnership working Y N 1.1 Is there evidence that partnership working in the following (proportionate to the level of risk, need and statutory duties)? a. At the assessment stage? b. At the risk assessment and management planning stage? c. At care planning stage? d. At review stage? Comments: Section F – Monitoring Overview Y N 1.1 Is there evidence that team managers have had oversight of this case file? 1.2 Is there evidence that this case has been discussed within supervision discussions? 112
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Comments: Section G - Summary Please note below the overall strengths. Comments: Please note below the areas highlighted for improvement. Comments: 113
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Annual Delivery Plan April 2022 - March 2023 Agenda Item 8 115
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 2 of 18 Author: Gillian Arnold, Head of Planning & Information Name Job Title or Role Signature Date Authored by: Gillian Arnold Head of Planning & Information Completion of the following signature blocks signifies the approver has read, understands, and agrees with the content of this document. Version Date Approval Scottish Government 1.06 22.09.22 NHS Ayrshire & Arran Board Meeting East Ayrshire Integration Joint Board North Ayrshire Integration Joint Board South Ayrshire Integration Joint Board 1.06 1.06 1.06 1.06 03.10.22 19.10.22 20.10.22 12.10.22 116
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 3 of 18 Author: Gillian Arnold, Head of Planning & Information Table of Contents 1.0 Introduction 4 2.0 Workforce 5 2.1 Recruitment and Retention of Our Health and Social Care Workforce 2.2 Staff Wellbeing 3.0 Recovery and Protection of Planned Care 6 3.1 Funding 3.2 Planned Care Recovery 3.3 Outpatients 3.4 Inpatients and Daycases 3.5 Diagnostics 3.5.1 Endoscopy 3.5.2 Medical Imaging 3.6 Cancer 3.7 National Treatment Centre 4.0 Stabilising and Improving Urgent & Unscheduled Care 11 4.1 Primary Care 4.2 Redesign of Urgent Care 4.3 Unscheduled Care 4.4 Mental Health and Wellbeing 4.5 Tackling Health Inequalities 5.0 Supporting and Improving Social Care 16 6.0 Sustainability and Value 17 6.1 Cash Releasing Efficiency Savings 6.2 Covid-19 Costs in 2022/23 117
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 4 of 18 Author: Gillian Arnold, Head of Planning & Information 1.0 Introduction The Annual Delivery Plan (ADP) has been prepared collaboratively with our partners, to provide Scottish Government with confirmation that we have plans in place to demonstrate how our health and care system will stabilise and improve as we recover from the Covid-19 pandemic. It will focus on a set of priorities for 2022/23 to enable our system and workforce to recover from the incredible pressure experienced over the past two years, whilst we start to take forward improvement work that will strengthen our services for any future Covid-19 waves and the demands of winter. Building on the previous two year’s Remobilisation Plans, the ADP sets out our key priorities for 2022/23 as we seek to build back stronger as part of medium to longer term recovery and stabilisation. This plan sits alongside our 10 year strategic ambition, Caring for Ayrshire, which is our whole system health and care redesign and reform ambition. The Caring for Ayrshire vision will deliver care as close to home as possible, supported by a network of community services with safe, effective and timely access to high quality specialist services for those whose needs cannot be met in the community. Partnership working with local communities, third sector, voluntary and independent organisations will be essential in delivering the right care, in the right place, at the right time for people in Ayrshire and Arran. NHS Ayrshire and Arran Realistic Medicine priorities aim to embed Realistic Medicine and it’s principles in to the redesign of Caring for Ayrshire. We want it to become second nature within Ayrshire and Arran to support people using healthcare services, and their families, to feel empowered to discuss their treatment. That is why the promotion of shared decision making is high on NHS Ayrshire and Arran Realistic Medicine Team’s agenda. We strive to facilitate a move away from the “clinician knows best” culture and encourage the professional and the patient to have more meaningful discussions about the treatment options available as well as their risks and benefits. This move requires a strong Realistic Medicine Network. We have established and are continuing to grow our network of Realistic Medicine champions to help us spread the message and to gain feedback from them also. We will continue to develop our local Realistic Medicine Network by encouraging Champions to join us from each department and by embedding education around Realistic Medicine into training junior clinical staff when they join the board. This plan closely aligns with the NHS Recovery Plan 2021/26 and offers opportunities with regard to the proposed National Care Service to ensure right care in the right place at the right time by the right person. Detailed actions for the recovery and stabilisation of our services are included in Delivery Plan Appendix 2 and align with our four agreed Organisational Priorities for 2022/23: • Right Sizing the Bed Footprint To deliver safe, effective and quality care within agreed funded footprint 118
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 5 of 18 Author: Gillian Arnold, Head of Planning & Information • Right Sizing the Workforce Aligned to the right sizing of the acute bed footprint • Electronic Patient Record (EPR) and Records Management Digital Services activities contributing to the EPR and Records Management Programme • Distributed Working and Estate Rationalisation Right-sizing the estate through rationalisation of non-acute support accommodation in line with new Distributed Working Policy 2.0 Workforce The deliverables set out in the Annual Delivery plan mirror those that are included within the NHS Ayrshire and Arran Workforce Plan. This plan, when taken in conjunction with the three Health & Social Care Partnership Workforce Plans, provides a composite health and social care economy view for Ayrshire. This narrative sets an overview of what is articulated within the NHS Ayrshire and Arran workforce plan. NHS Ayrshire and Arran has a pre-existing People Strategy which directly informs our Workforce Plan and is thematically built around four pillars – Attract, Retain, Develop, Support. These local pillars effectively encompass the thematic content and intent of the five pillars detailed within the National Health & Social Care Workforce Strategy and reflect the direct read across between our People Strategy and Workforce Plan. 2.1 Recruitment and Retention of Our Health and Social Care Workforce A key workforce issue relates to the supply and capacity of our registrant workforce. As set out in our Workforce Plan the Board has a corporate risk relating to this issue and our actions thematically aligned to our four pillars all materially contribute to ongoing efforts to mitigate and control the level of risk associated with this. Fundamentally, in common with other Boards we have a perfect storm of wicked problems – latent and emerging vacancies with associated national supply limitations; increased demand for clinical registrants from all health providers both regionally and at wider Scottish, UK and indeed international contexts; having additional beds on our Acute sites in excess of baseline bed complement due to demand and flow requirements; and the residual ongoing impact of both Covid-19 and Non-Covid sickness absence materially impacting upon workforce capacity. Against this challenging operating backdrop, as a system, we recognise the need to stabilise and reset post pandemic in order to provide a strong foundation on which to base our strategic service reform agenda articulated by Caring for Ayrshire. In the context of our workforce this, as a basic principle, means we need to right size our workforce in year and forward plan in terms of sustained delivery, and encompasses: 119
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 6 of 18 Author: Gillian Arnold, Head of Planning & Information • Reducing our reliance on high cost supplemental staffing solutions in medical and nursing job families; • Transitioning staff aligned with unfunded beds into funded roles as we right size our bed complement; • Recommencing our routine application of nursing and midwifery workforce and workload planning tools; and • Supporting our staff health and wellbeing to improve our unplanned absence rates, and encouraging wider access and uptake of wellbeing services that have successfully been deployed during the pandemic. Successful delivery of these stabilising actions are essential as we seek to progress wider innovation in terms of longer term workforce supply and capacity, namely using international recruitment as a lever, development of complementary clinical roles – including Medical Associate Professions (MAPs) roles but also our advanced practice roles, consideration of skill mix e.g. Band 4 nursing roles, and implementing our Employability Strategy which will directly support those from disadvantaged backgrounds and far from the workplace and strengthen our role as an Anchor Institution and contribute to community wealth building. All of these actions materially contribute to ensuring the ‘best care every time’ which ergo can only be achieved by ensuring the quality of our staff experience is high and we are able to attract and retain staff. 2.2 Staff Wellbeing We are committed to valuing, supporting and retaining our current workforce, as such we are embedding our current Staff Wellbeing Programme through this next stabilising stage and into the winter period, encouraging staff to take time to rest and recover and to access the local and national resources that are available. We have made capital investment in creating three Staff Wellbeing Hubs, at our Acute sites and on the Ayrshire Central Hospital Site, and these were delivered over the summer / early autumn. During 2022/23 we will commence work in developing a Health & Social Care Wellbeing programme and this will be underpinned by a staff wellbeing needs assessment. We have organisationally communicated the importance of all staff utilising their annual leave entitlement for rest and recuperation at regular intervals throughout the year. 3.0 Recovery and Protection of Planned Care Planned care recovery is being approached through a process of Protect, Stabilise and Recover. The Covid-19 pandemic has resulted not only in significant backlogs of patients awaiting assessment and treatment, but also a number of practical constraints which are restricting our ability to return to pre-pandemic levels. All services are now re-mobilised and are working towards the targets set out in the National Clinical Prioritisation Framework. 120
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 7 of 18 Author: Gillian Arnold, Head of Planning & Information On 6 July, the Cabinet Secretary announced a set of ambitious targets aimed at addressing the long waiting times that have arisen during the pandemic. The targets are to eliminate: • two year waits for outpatients in most specialities by the end of August 2022; • 18 month waits for outpatients in most specialities by the end of December 2022; • one year waits for outpatients in most specialities by the end of March 2023; • two year waits for inpatient/day cases in most specialities by September 2022; • 18 month waits for inpatient/day cases in most specialities by September 2023; and • one year for inpatient/day cases in most specialities by September 2024 We are working closely with the new National Elective Coordination Unit (NECU) and Centre for Sustainable Delivery (CfSD) developing a targeted action plan which will look to deliver the new targets, including opportunities for insourcing, outsourcing and accelerating planned improvements. Insourcing is in place for Neurology, Dermatology, Respiratory Medicine and Ophthalmology, and is being explored for gastroenterology and ENT/Audiology. Outsourcing is currently being explored for ENT. In addition, to reduce backlogs of care specifically longest waiting patients the NHS will work together through the provision of mutual aid, and that will mean some patients will be offered appointments out with their local health board area to provide treatment more quickly – for example the Golden Jubilee University National Hospital or at National Treatment Centres as they become operational over the next year. 3.1 Funding The Scottish Government have recently provided clarity regarding the financial allocation process, to support NHS Board plans to deliver planned care and specifically reduce the number of long waiting patients. NHS Ayrshire and Arran have submitted plans setting out the impact on long waiting patients by specialty and the overall cost and await confirmation of funding allocation. It is expected that activity will increase as new initiatives are embedded. However, it should be noted that this will fund many existing initiatives which have repeatedly been funded non-recurringly and are already incorporated into existing activity. May require further input once confirmation of funding received. 3.2 Planned Care Recovery NHS Ayrshire and Arran are working through the updated National Clinical Prioritisation Framework to guide clinical prioritisation, with the revised guidance being fully implemented by 31 August 2022. This guidance supports a change in prioritisation to include how long a patient has already waited as one of the factors influencing the relative priority for each patient. We will initiate this process firstly in those services where this re-prioritisation can be absorbed with least impact on other clinically urgent pathways, whilst we continue to pursue other options to create additional routine 121
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 8 of 18 Author: Gillian Arnold, Head of Planning & Information capacity in other more challenged specialties. We will also use information on the volume of long waiting patients in each specialty to inform decisions on the allocation of operating theatre capacity. As we make progress towards tackling long waits, a number of service changes designed to support and protect service provision through the pandemic have already been implemented. These include the reconfiguration of trauma and elective orthopaedics onto separate hospital sites, relocation of day case chemotherapy and outpatient breast cancer clinics services to a non-acute site and focussing of Covid- 19 critical care on one site. In addition, we increased the use of Digital technologies, including the use of NHS NearMe, video calls and telephone consultations to allow appointments to continue to be provided during the pandemic. The learning from this change in working practice, in particular, telephone consultations, has been accepted as good practice across many specialties and will continue to be embedded to provide an alternative to 'face to face' consultations, where appropriate. Other potential service changes to some of our surgical specialties which would further separate emergency and elective care, are being considered. However further understanding of capacity and impact is required and we are working on a series of recovery modelling scenarios with our colleagues at Cap Gemini to develop a resource modelling tool. We anticipate that this resourcing tool, when used in conjunction with the Regional Planned Care Modelling Tool, will allow us to better plan the allocation of beds, operating theatres and other resources. It should be noted that although this work continues to progress, the Cap Gemini tool still requires some work before it will be ready to deliver this. Meanwhile, there will be a close focus on utilisation of capacity and redesign opportunities in order to maximise activity. Working alongside the NECU to support and plan further remobilisation, whilst refocusing our current activity to urgent and long waits: NHSScotland Approach to Delivery NHS Ayrshire and Arran Actions Working across boundaries - regionally and nationally We are working actively with other Health Boards and NECU to access mutual aid, in particular around Neurology, General Surgery and Urology. Further options are being explored for Trauma and Orthopaedics and Gastroenterology Maximising theatres sessions and evening and weekends We are focussing significant attention on maximising theatre utilisation, and have demonstrated good improvement in this regard since June 2022. We are seeking additional capacity by opening evening and weekend sessions where possible, although this is limited by staff availability. Adopting robust waiting list validation We are undertaking robust waiting list validation for both outpatients and inpatients/daycases and have put in place some additional administrative resource to support this. As a minimum we are following a 2-stage validation process, and where clinical capacity allows we are adopting 3-stage clinical validation of waiting lists. Accelerating high impact changes such as ACRT and PIR ACRT and PIR are implemented in some specialties, and further roll out as part of our Bringing it Together programme continues to be a priority. We are monitoring this in 122
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 9 of 18 Author: Gillian Arnold, Head of Planning & Information conjunction with CfSD colleagues using a HEAT map approach Accelerating roll out of national initiatives such as the NECU We are working closely with NECU to maximise opportunities to benefit from national approaches, including clinical validation support Increasing activity to pre- Covid levels by March 2023 We monitor activity against pre-Covid levels on a continual basis, and are progressively implementing initiatives to increase this. As at July 2022 the current re-mobilisation rates are : Outpatients : 74% Inpatients and Daycases : 68% Endoscopy : 68% We are exploring further opportunities to work to achieving pre-Covid levels by March 2023, including the potential acquisition of mobile theatre units (staffed) 3.3 Outpatients Outpatient activity has remobilised to 74% as at July 2022 of pre Covid activity levels. The table below details expected remobilisation by end of March 2023. Access Plan Target 22/23 July Activity as % pre-Covid-19 Outpatients 93% 74% Sustained high referral rates in some areas still pose some challenges to reducing overall waiting lists. Workforce capacity is a significant contributing factor with a high level of vacancies existing as referred to in the 3 year Workforce Plan. Additional actions across most specialities which will contribute further improvement in 2022/23 include: • Outpatient redesign through the Bringing it Together programme and implementation of High Impact Changes such as ACRT; • The reinstatement of an outpatient clinic suite which had been re-purposed during the earlier pandemic waves; and • Expansion of 3-Stage waiting list validation 3.4 Inpatients and Daycases Inpatient and Daycase activity has remobilised to 68% as at July 2022 of pre Covid activity. The table below details expected remobilisation by end of March 2023. Access Plan Target 22/23 July Activity as % pre-Covid-19 Elective Surgery 75% 68% 123
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 10 of 18 Author: Gillian Arnold, Head of Planning & Information The challenge to achieving the waiting time targets for Inpatient and Daycase is multi- faceted and relates to workforce capacity with a high level of vacancies existing as referred to in the 3 year Workforce Plan and constraint on access to recovery space. The day surgery recovery area at University Hospital Crosshouse, continues to be re- provisioned for use by Critical Care Service. The use of this space, and other alternative options to address this are under review along with the progression of recruitment to vacancies. Additional actions across most specialities which will contribute further improvement in 2022/23 include: • Maximise operating theatre productivity - NTIG Theatre utilisation data (April – June 2022) indicates an average overall theatre utilisation of 89.5% for this period which is close to the Scottish average but affords room for further improved utilisation as we work towards a local target of 95%; • Weekly theatre utilisation meetings are giving further focus and scrutiny through a new Theatre Utilisation and Governance group; • Maximising Daycase rates as part of the CfSD improvement work and HEAT map monitoring. Daycase rate in June 2022 is reported as 96.7% against a target of 96.4%, demonstrating a high BADS performance during the remobilisation process; • Review approach to ensuring that surgical procedures planned are in line with the Effective and Quality Interventions Pathways guidance (EQuIP); • Additional operating theatre sessions run as ‘Super-Saturdays’ or similar will be targeted at the longest waiting patients; • Embed a clinical validation step into the current administration validation process; and • Trial a prehabilitation screening approach for the longest waiting patients and we expect this to complement waiting list validation processes. 3.5 Diagnostic 3.5.1 Endoscopy To reduce the number of patients waiting for an Endoscopy, a 4th Endoscopy Room at University Hospital Ayr will be created by the end of 2022. In addition, the following developments have been implemented and work continues to further embed them in practice: • Waiting list validation, focused around the use of qFIT as a risk screening tool with an initial trial of qFIT validation of the longest waiting patients awaiting colonoscopy undertaken in May 2022, and will be scaled up through 2022/23; and • Colon Capsule Endoscopy (CCE) and Cytosponge continue to be delivered with the aim of 28 and 25 procedures per month respectively. Work is ongoing to further embed these new methods of care with the clinical teams, and it is hoped that a national clinical guideline for Cytosponge will be developed to provide some added governance and assurance to clinical staff. 124
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 11 of 18 Author: Gillian Arnold, Head of Planning & Information 3.5.2 Medical Imaging Additional capacity for MRI, CT and Ultrasound is being progressed to reduce the level of patients waiting long periods to access. Improvements include a mobile MRI scanner being located at University Hospital Ayr for 12 months with a 2nd mobile scanner for 3 months currently being sourced and the progression of extended 7 day working for CT and MR scans. 3.6 Cancer A prehabilitation service for cancer patients is currently in national discussion although cancer patients can access existing rehab services within NHS Ayrshire and Arran. Early Cancer Diagnostic Centre has now been in place for 12 months and is working well. An additional ANP has been recruited to support with patient care, assist with education and expansion of the service for secondary care referrals. 3.7 National Treatment Centre NHS Ayrshire and Arran will host one of ten National Treatment Centres (NTC) across Scotland. Within the Ayrshire and Arran National Treatment Centre the focus will be on Orthopaedics. The new Centre will plan to treat 800 patients per year who need hip or knee replacements, 1200 patients who require a Daycase orthopaedic procedure and 700 orthopaedic patients who need minor procedures requiring local anaesthetic. There is capacity in addition to this for local anaesthetic procedures from other specialties. The NTC will be operational by 2025. It is expected that recruitment will be phased over the next 18 months to allow time for training and education. 4.0 Stabilising and Improving Urgent and Unscheduled Care 4.1 Primary Care As primary care services recover from the Covid-19 pandemic, a framework of measures is underway to support remobilisation and continued safe and effective delivery of services to patients. General Practice is currently facing national workforce and recruitment challenges which is being experienced locally. Going forward local oversight will be monitored through the Practices Sustainability Oversight Group to look at focussed options for any Practice experiencing difficulty from workforce gaps. Specific dedicated support is being provided to those Practices struggling to fill GP posts as well as working with the local GP community to promote the benefits of working within Ayrshire and Arran to attract new recruits. A review of Enhanced Service provision will also support sustainability of General Practice and ascertain how potential changes could improve service delivery models for practices and patients. 125
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 12 of 18 Author: Gillian Arnold, Head of Planning & Information Work continues to implement the new GMS Contract 2018 via the Primary Care Improvement Plans. Scoping is ongoing to provide an urgent care service within General Practice and consideration being given to how this could align to the Redesign of Urgent Care (RUC) programme. The Community Treatment and Care service is embedding well with most GP practices having access to the service. Further roll-out of staff is ongoing though accommodation continues to prove challenging as additional MDT roles are incorporated into General Practice. Various models are being considered for further implementation of the Primary Care Improvement Programme, including the use of community monitoring and investigation hubs to enable transfer of care into a community setting which would increase accessibility for patients. Focussed work is ongoing with all practices and the pharmacy team to achieve full task transfer for Level 1 Pharmacotherapy Service by end of 2022/23, although there are risks to achieving this in every practice. The position of this will be more understood in October 2022. Pharmacotherapy has recruited a significant proportion of their workforce from community pharmacy and acute services with recruitment now becoming more of a challenge. Various innovative actions are being progressed through the Workforce Plan to maximise skill mix. Various digital programmes are ongoing across primary care to enhance patient pathways and increase access to services. Further roll-out of E-Consult across General Practice is being encouraged as well as community pharmacy and optometry having access to the digital clinical portal to support decision making. Community Optometry is working closely with Acute to increase shared care which will support additional eye conditions being screened or managed by Community Optometrists and thus reduce waiting times for treatment or the need for urgent referrals. Since the easing of infection control measures, General Dental Practitioners have increased activity to an average of 90% of pre-pandemic levels facilitating more patients to receive routine care. There is still a significant backlog for dental practices to work through as they re-introduce routine care. Dental practices are facing challenges to fill Dentist vacancies therefore ongoing national workforce initiatives will be essential in recovering the dental sector further. An increase in Dental Body Corporates could also create additional challenges with recruitment and retention of dentists within General Dental Practices which can impact on the availability of routine NHS dental care. Additional recruitment is underway within the Public Dental Service to increase provision of emergency dental services and care to non-registered patients whilst General Dental Practices continue to recover. Further recruitment will sustain our 7 day delivery of the Covid-19 Therapeutic service. This provides assessment and treatment for a specific cohort of patients deemed as very high risk of progression to severe disease and/or death if they develop Covid-19 symptoms and test positive for the virus. 126
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 13 of 18 Author: Gillian Arnold, Head of Planning & Information 4.2 Redesign of Urgent Care Phase 2 of the Redesign of Urgent Care programme will further enhance the pathways implemented during Phase 1. The Flow Navigation Centre (FNC) will continue to be developed as a single point of access for many services across the whole system. One of the most successful introductions to date is the joint working with Scottish Ambulance Service (SAS) to support patients by a GP within the FNC or be supported to alternative pathways. NHS Ayrshire and Arran were also a pathfinder for a mental health pathway. The first phase has been to implement a direct pathway via the FNC for Emergency Services (Police Scotland and SAS) with direct access to specialist practitioners within the Emergency Mental Health Teams, avoiding unnecessary attendance at Emergency Departments, and provision of interventions from the right services as quickly as possible for these patients. Scoping and analysis of demand will define all available pathways across the system to ensure patients can access the most appropriate urgent care pathway suited to their condition. A MSK urgent care pathway is being scoped which would optimise self and community care and allow direct referral. A communication strategy will be developed to engage with the general public and inform of available health services and professionals accessible for urgent care. This will support signposting patients to access appropriate care to prevent conditions worsening or as an alternative to presenting at Emergency Departments. This pathway is also linked to the Primary Care Improvement Plans within general practice for MSK. Additionally there is a Community Pharmacy pathfinder in development based on access via the FNC, into and out of Emergency Departments. This will ensure that patients accessing Pharmacy First, who should be attending Minor Injury Unit or Emergency Department will do so via the FNC and be provided with an appropriate appointment, and will also support redirection pathways out of Emergency Department back into Community Pharmacy. 4.3 Unscheduled Care As Covid-19 restrictions have lifted urgent and emergency attendances and admissions have returned to pre pandemic levels. This increase in attendances, combined with high levels of delayed discharges, recruitment gaps in allied health professionals and community-based care professional impacted patient flow. As the bed base increased to accommodate demand, infection control measures and staff absence was added to the complexity of managing patient flow our acute care settings became congested, with occupancy being >96% consistently. The existing Unscheduled Care Programme including Discharge without delay, Interface Care, Virtual Capacity and Redesign of Urgent Care are delivering internal improvements, however more is needed. We have completed a whole system Urgent & Unscheduled Care self-assessment, in response to the SG relaunch of Urgent & Unscheduled Care Collaborative and we have system support to progress with our High Impact Changes, as highlighted through our Self-Assessment. 127
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 14 of 18 Author: Gillian Arnold, Head of Planning & Information NHS Ayrshire and Arran will work with the national Urgent & Unscheduled Care teams with an initial focus on the top three High Impact Changes:- High Impact Change Virtual Capacity High Impact Change Urgent & Emergency Assessment High Impact change Community Focused Integrated Care In addition to this we will be continuing our Discharge without Delay (DwD) programme started through our pre, intra and post hospital groups and amalgamate this with the newly launched collaborative high impact changes. NHS Ayrshire and Arran are committed to increase Hospital at Home capacity from 6 to 28 virtual beds by January 2023. In addition, we will scope and analyse the demand for our outpatient antibiotic therapy service, which will inform and enable a business case to help reduce in patient bed days and create an alternative to in-patient stays. Further scoping of remote health monitoring, near patient testing and community diagnostics will be undertaken through a directed programme of work with three distinct Delivery Programmes each with their own area of focused work which will tie in with the Urgent & Unscheduled Care Collaborative work high impact changes. In addition NHS Ayrshire and Arran will hold a programme of focused Full System discharge without delay events throughout the summer months with the ambition of achieving the lowest bed base possible throughout the winter to ensure our remaining areas are as well-resourced as possible. We will run a full system event for three days monthly and in addition hold a 7 day event in September. These events are multi agency and multidisciplinary events with senior sponsorship from across the Health Board and its partners – these events will be held at executive level to support real time problem solving for patients stranded in the acute setting. These events will be additional to the “business as usual” DwD work which will be led by x 2 senior appointed members of staff and a team of DwD “Home First” practitioners. 4.4 Mental Health and Wellbeing It is the vision to create a Mental Health and Wellbeing service for Primary Care that is consistent across Ayrshire and Arran. Work will continue over the next few years to develop detailed plans. It is our ambition that by March 2026, the service will comprise a multi-disciplinary team composed of Mental Health Practitioners, Community Link Workers and Occupational Therapists. Self-help Workers, Enhanced Psychological Practitioners (EPPs), Administration and other roles will also be under consideration as detailed planning is completed. At present, the multi-disciplinary team offers a triage and assessment service predominantly for adults (although younger age ranges are available within some areas). At present there is limited scope for treatments. It is the anticipation that as staff levels rise, the age range and treatments offered will expand to all ages and a limited range of short treatments. Online treatment options and group sessions are areas that will be explored alongside more traditional psychological therapies. 128
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 15 of 18 Author: Gillian Arnold, Head of Planning & Information There are great benefits to having these roles working directly in GP Practices, however, as the team grows in numbers so too will the space requirements. The first year of funding (2022/23) for the Mental Health and Wellbeing in Primary Care Service will focus on the recruitment of Mental Health Practitioners whilst taking time to scope subsequent years of funding and actions in greater detail. The transition and recovery plans for mental health continue to deliver targeted actions to ensure a whole system response to the challenges presented, addressing backlog management as we continue to innovate; adapting our offer, providing new pathways to services, redesigning services and using digital delivery to retain and maximise as much support as possible as services increase face to face activity and group therapy. Within North, South and East Ayrshire Health and Social Care Partnerships there are specific Drug Related Death (DRD) Prevention Groups with identified Improvement/Action Plans in place to prevent DRD’s. Working in partnership with local Alcohol and Drug Partnerships there has been a focus on specific actions to prevent DRD’s which include, but is not limited to, the following: • Implementation of new Medication Assisted Treatment (MAT) standards; • New responses and pathway of support for individuals following a Non-Fatal Overdose; • Delivering on a new Substance Use Treatment target; • Improving the multi-agency pathways of support for individuals with a ‘Dual Diagnosis’; and • Identification of pathways to support individuals to access residential rehabilitation support 4.5 Tackling Health Inequalities Health inequalities have been compounded by the socio-economic impact of the Covid-19 pandemic and are likely to have a disproportionate impact on people living in areas of multiple deprivation; those who were not in a good position prior to the pandemic and those from ethnic minority groups. Tackling inequalities is a key priority and we believe by helping to reduce the impact of inequalities locally, we can improve the long-term economic, social and health outcomes for the people of Ayrshire and Arran. However, we recognise that addressing local inequalities is not something we can do alone and it will take a collaborative effort. As such, we will continue to work closely with our partners and the people of Ayrshire and Arran to help tackle inequalities together. 129
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 16 of 18 Author: Gillian Arnold, Head of Planning & Information 5.0 Supporting and Improving Social Care Whilst we are optimistic that we may be over the worst of the direct impact of the pandemic, its long-term impact is not as well understood. We expect our services to face on-going challenges, including supporting those who have not been able to access, a health and social care professional due to demands and restrictions, and addressing the rise in poor mental wellbeing in our communities. We have learned much from our pandemic experience, such as recognising the strength and resilience within our communities, discovering how truly determined and hard-working our workforce is and finding greater ways to work in collaboration with our partners. One consequence of the Covid-19 restrictions has been the increasing deployment of digital technology; both for providing flexible services to those we support and in enabling HSCP staff to operate in a dynamic way using a range of remote access technologies. We will ensure our future way of working embraces the opportunities that digital platforms provide. Our collective ambition is for strong engagement with service users and carers, driven by quality data and information and committed to continuous service improvement. Across Ayrshire and Arran we continue to find new and innovative ways to shift the balance of care, ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes for people, with a focus on bringing down delayed transfers of care to ensure capacity for those patients that require acute hospital care. 130
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 17 of 18 Author: Gillian Arnold, Head of Planning & Information 6.0 Sustainability and Value Cash Releasing Efficiency Savings The CRES we were able to achieve in 2021/2022 was c£10 million and in 2020/2021 it was about c£11 million. Below is a table showing planned CRES for 2022/2023: Service Level Agreements £2,000,000 Acute prescribing £1,561,000 Primary Care prescribing £2,000,000 National services £350,000 Energy efficiency £69,000 Corporate £600,000 Acute £1,600,000 Total £8,180,000 Corporate schemes for estate rationalisation, reducing energy consumption and clinical waste are being scoped therefore there is a higher degree of risk regarding delivery of these. Excluding IJBs and New Medicines Fund, 68% of budgets for acute and corporate services are pay for workforce. During 2021/2022, securing enough workforce has been a challenge therefore very little CRES in 2022/2023 is targeted against workforce. This restricts the scope for savings to about 32%, or £254 million of budget, therefore the savings of £8.2 million shown above represent about 3.2% of this restricted scope. COVID-19 Costs in 2022/23 Scottish Government will not receive any Barnett Consequential funding in 2022/2023 in relation to Covid costs. The projected Covid costs for 2022/2023 require to be reduced as far as possible. The contact tracing staff have fixed term contracts until the end of September 2022 but will be redeployed where possible from May or June. After three months of 2022/23 Covid related expenditure was around £8.0 million across the health economy and this is likely to grow to c £36 million. A Covid-19 envelope of £16.5 million for non-delegated services has been advised by Scottish Government. The Health Board is actively engaging with IJBs and Scottish Government in order to minimise Covid-19 costs incurred during the year. 131
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Version: 1.06 Date Approved: 03.10.22 Status: Final Page 18 of 18 Author: Gillian Arnold, Head of Planning & Information The table below shows the Health Board projected Covid-19 costs for 2022/23. The above estimated costs exclude Test and Protect, Point of Care Testing, Laboratory Capacity, and Contact Tracing. These are expected to be funded separately by Scottish Government. 2022/23 fund £000 Additional PPE 600 Covid-19 & Flu Vaccination 8,000 Scale up of Public Health Measures 400 Additional Bed Capacity/Change in Usage 5,910 Cleaning 665 Other Additional Staff Costs 8,827 Digital/ IT costs 200 Patient Transport 200 Sub-Total Covid-19 Costs - NHS Board 24,802 Additional Beds 545 Additional Staff Costs 3,145 PPE 981 Social Care Provider Sustainability Payments 3,147 Social Care Support Fund Claims 410 Children and Family Services 2,340 Additonal FHS Contractor Costs 75 Primary Care 68 Loss of Income 571 Other 31 Total Covid-19 Costs- HSCP 11,313 Total planned spend in 2022/23 36,115 Availabe Reserves 36,332 Reserves c/f to 2023/24 217 £000s 132
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Contents 1 Staff Wellbeing 2 Recruitment & Retention 3 Recovering Planned Care 4 Building Resilience & Recovery in Urgent & Unscheduled Care 5 Supporting Social Care 6 Sustainability & Value 133
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Region Board Priority Area select from drop down list Service Area Reference Jun'22 status Key Deliverable - Name and Description Key milestones Progress against deliverables end June 22 Lead delivery body Key Risks Controls/Actions Outcome(s) Major strategies/ programmes the deliverable relates to Impact of deliverable on health inequalities West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123 Green To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Pain Service Redesign Ref Template 2 : Activity projections Ref Template 3 : Wait List Trajectory Phase 1 recruitment complete and service established. Evaluation of success against deliverables to be undertaken Phase 2 recruitment to be undertaken once Access funding confirmation is received from SG Recruitment PC1 Pain Management Recovery Framework NHS Recovery Plan This initiative positively benefits patients with a level of disability (due to chronic pain), this also being more prevalent in higher deprivation populations West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123.1 Suspended To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Ophthalmology Clinic Redesign (Ophthalmology Improvement Programme) Ref Template 2 : Activity projections Ref Template 3 : Wait List Trajectory This remains a risk and priority area for NHS Ayrshire and Arran, but has not been funded in the 2022/23 Access funding and so is paused. Not funded Interim non-recurring insourcing initiative in place instead PC1 NHS Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123.2 Green To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Create additional clinic capacity through Insourcing contracts and WLIs Insourcing contracts awarded WLIs being scheduled as available Delivery of Insourcing contract activity Staff availability for overtime PC1 NHS Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123.3 Green To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Roll out clinical validation 3 stage validation being rolled out. 5 specialties completed and other specialties underway Clinician time / capacity Seeking mutual aid from other Boards PC1 NHS Recovery Plan Has potential to disadvantage those with lower health literacy who fail to respond to communications from NHS West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123.4 Amber To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand HEAT map / Bringing it Together Reduction in referral demand through use of Active Clinical Referral Triage (ACRT) (numbers to be agreed with CfSD in July 22) ACRT Top 9 specialities : ACRT T&O : Reduction in clinic demand through use of Patient Initiated Review (PIR) PIR Top 9 Specialities : PIR T&O : Reduction in referral demand through use of national pathways for gastroenterology - coeliac disease pathway, IBS Pathway, community nurse IBD follow up Centre for Sustainable Delivery (CfSD) have prepared new HEAT map template. Workshop attended and revised HEAT map to be submitted end June 22 Progressing with individual projects and quarterly Steering Group meetings to coordinate overall programme. Clinician & Management time / capacity Clinician engagement Dashboard in development Shared learning with other Boards PC1 CfSD HEAT map Has potential to disadvantage those with lower health literacy who fail to respond to communications from NHS West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2021-AA123.5 Suspended To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Rapid Access Speciality Unit Development of new service/facility for management of urgent outpatient referrals same week, and focus on rapid Active Clinical Referral Triage (ACRT) of non-urgent referrals. Based on successful model of care implemented in Cardiology, but rolled out to other medical specialities Roll out service model in new facility July 22 This remains a risk and priority area for NHS Ayrshire and Arran, but has not been funded in the 2022/23 Access funding Where possible, some small local changes will continue to be progressed within existing resources Lack of revenue funding Lack of capital funding Recruitment Clinician time to progress changes Where possible, some small local changes will continue to be progressed within existing resources PC1 NHS Recovery Plan Redesign of Urgent Care (RUC) West of Scotland Ayrshire and Arran Recovering planned care Planned Care Elective Surgery 2021-AA124 Amber To reduce waiting list size and waiting times by increasing elective surgical activity and creating an Orthopaedic elective centre of excellence (UHA) to create sustainable orthopaedic elective capacity and a National Treatment Centre within Ayrshire and Arran Elective Surgery Introduce extended operating days Create additional planned care beds to support additional throughout. By September 21 Failed to recruit additional theatre nursing and so unable to implement as a permanent feature at present, but additional extended day sessions being delivered on an adhoc basis as WLI Additional 17 beds for planned care at UHA to be available from August 2022 on redesign of WoS vascular service Further slippage in dates for vascular service reconfiguration Theatre Nursing Recruitment Surgeon / Anaesthetist capacity International recruitment Introduction of Allocate system to assist with job planning PC1 NHS Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Elective Surgery 2021-AA124.1 Green To reduce waiting list size and waiting times by increasing elective surgical activity and creating an Orthopaedic elective centre of excellence (UHA) to create sustainable orthopaedic elective capacity and a National Treatment Centre within Ayrshire and Arran Elective Surgery - Ortho Elective Centre for Excellence (UHA) All in-patient elective surgery delivered at UHA Roll-out of 4 joint day Creation of additional arthroplasty theatre, linked to vascular reconfiguration Elective inpatient orthopaedics remobilised in May 22 4-joint days underway where possible Urgent care pressures may result in further pausing of elective orthopaedics Further slippage in dates for vascular service reconfiguration may delay access to additional theatre Patient deconditioning during pandemic will mean that many patients required longer in operating theatre, impacting deliverability of 4- joint days Risk balance analysis undertaken to support re-start of elective orthopaedics Realistic Medicine funded project re. pre-operative screening and pre hab for longest waiting patients PC1 NHS Recovery Plan Trauma and Orthopaedic Recovery Plan Reconfiguration of vascular services WoS Trauma Service Redesign West of Scotland Ayrshire and Arran Recovering planned care Planned Care Elective Surgery 2021-AA124.2 Green To reduce waiting list size and waiting times by increasing elective surgical activity and creating an Orthopaedic elective centre of excellence (UHA) to create sustainable orthopaedic elective capacity and a National Treatment Centre within Ayrshire and Arran Elective Surgery - National Treatment Centre NHSAA Planning Work FBC submission by December 22 Capital works estimated to commence June 23 Projected completion date December 23 Design and FBC work is progressing as per plan Cost drift on capital project FBC approval not granted Failure to recruit Clinician /managers time & capacity to contribute Risk Register being maintained for programme PC1 National Treatment Centres Trauma and Orthopaedic Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Medical Imaging 2021-AA125 Proposal Reduce waiting list and waiting times by creating additional capacity for MRI, CT and Ultrasound Secure capital funding for CT/MRI hub at ACH Capital build programme Procurement of MRI scanner Staff Recruitment CMT support in principle pending identification of capital funding Awaiting confirmation from SG re capital funding availability This is dependent on Access Funding being confirmed Mobile scanner remains in place PC1 SG Radiology 5-Year plan Will improve access to MR/CT service particularly in North Ayrshire, with less travel for patients from this area West of Scotland Ayrshire and Arran Recovering planned care Planned Care Medical Imaging 2021-AA125.1 Green Reduce waiting list and waiting times by creating additional capacity for MRI, CT and Ultrasound Mobile MRI scanner at UHA for 12 months 2nd mobile MRI scanner for 3 months Mobile scanner contract finalised and scanner in place Still seeking availability of 2nd mobile scanner Availability of scanner Cost increase due to demand and availability NHS Scotland national framework PC1 SG Radiology 5-Year plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Medical Imaging 2021-AA125.2 Amber Reduce waiting list and waiting times by creating additional capacity for MRI, CT and Ultrasound Extended Working day/7 day working for CT and MRI scans Recruitment of various grades of staff still to be undertaken This is dependent on Access Funding being confirmed PC1 SG Radiology 5-Year plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Medical Imaging 2021-AA125.3 Amber Reduce waiting list and waiting times by creating additional capacity for MRI, CT and Ultrasound Train / Appoint 3.46WTE sonographers Awaiting confirmation of funding to progress recruitment Staff recruitment Interim use of locums where available PC1 SG Radiology 5-Year plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Medical Imaging 2021-AA125.4 Amber Reduce waiting list and waiting times by creating additional capacity for MRI, CT and Ultrasound Train 3 Assistant Practitioners Awaiting confirmation of funding to progress recruitment Staff recruitment Free up staff time to deliver training PC1 SG Radiology 5-Year plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care Endoscopy 2021-AA126 Amber Additional endoscopy capacity. Reduction in Endoscopy waiting list. Reduction in Endoscopy waiting times. Cancer pathway - improved performance against 62 day target for colorectal & upper GI pathways Re-divert ring-fenced funding for mobile endoscopy unit to create 4th Endoscopy Room at UHA and staff with agency team Completion of works by end 2022 Design work completed Capital work to commence June 22 Equipment ordered Funding for staffing confirmed, recruitment in June 22 This is dependent on Access Funding being confirmed Funding for agency staffing as contingency for any delays in permanent staff recruitment PC1 NHS Recovery Plan Recovery and redesign: Cancer Services Framework for Effective Cancer Management Reduction in waiting times for investigation Positive benefit for more deprived populations where incidence of cancer / later stage cancer is higher 134
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West of Scotland Ayrshire and Arran Recovering planned care Planned Care Endoscopy 2021-AA126.1 Green Additional endoscopy capacity. Reduction in Endoscopy waiting list. Reduction in Endoscopy waiting times. Cancer pathway - improved performance against 62 day target for colorectal & upper GI pathways Endoscopy Remobilisation Establish funded/staffed Cytosponge Service Further roll out CCE usage 300 Cytosponge procedures in 2022/23 336 Colon Capsule Endoscopy (CCE) procedures in 2022/23 Continuing to engage actively with national programme to support increased usage Clinician engagement PC1 CfSD HEAT map Reduction in waiting times for investigation Positive benefit for more deprived populations where incidence of cancer / later stage cancer is higher West of Scotland Ayrshire and Arran Recovering planned care Planned Care Endoscopy 2021-AA126.2 Amber Additional endoscopy capacity. Reduction in Endoscopy waiting list. Reduction in Endoscopy waiting times. Cancer pathway - improved performance against 62 day target for colorectal & upper GI pathways Roll out of qFIT to routine waiting list/ referrals Establish qFIT as primary care based test Establish qFIT testing capacity & results which are accessible to GPs Initial test of change qFIT of cohort of longest waiting routine patients Paper to GP sub committee in June 22 re. primary care issuing of test kits GP engagement Laboratory space / staffing System access PC1 NHS Recovery Plan Recovery and redesign: Cancer Services Reduction in waiting times for investigation Positive benefit for more deprived populations where incidence of cancer / later stage cancer is higher West of Scotland Ayrshire and Arran Recovering planned care Planned Care Cancer 2021-AA127 Amber Improved performance against 31 & 62 day cancer target. Improved pathway and experience for patients Develop and implement Vague Symptoms Pathway Progress implementation of Cancer Management Framework June 21 Vague Symptom pathway in place and undergoing academic evaluation Updated action plan for Cancer Management Framework submitted in May 22 Significant increase in cancer referral demand Constraints in remobilising investigation capacity (endoscopy) Staff recruitment (breast radiologist) Implement Cancer Management Framework action plan PC1 Recovery and redesign: Cancer Services Framework for Effective Cancer Management Reduction in waiting times for investigation Positive benefit for more deprived populations where incidence of cancer / later stage cancer is higher West of Scotland Ayrshire and Arran Recovering planned care Planned Care 2021-AA128 Green Workforce HEAT Map ADEPt Additional capacity across various areas - endoscopy, elective surgery, outpatients Work with CfSD and Workforce Academy to progress planning and implementation of new roles. Bring forward funding proposals for these new posts. Progress being made across a number of ADEPt areas including Anaesthetic Associates, Theatre Practitioners, Endoscopy Assistants, Peri-operative and Anaesthetic Assistant Nurse training via NHS Academy Staff Recruitment Challenges releasing staff for training PC1 CfSD HEAT map West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA31 Amber Workforce Planning and Recruitment Delivery of AHP Rehabilitation Services to achieve safe, high quality care and support for the people of Ayrshire and Arran. Creation of workstreams to plan and deliver on future workforce requirements. Submit proposal for Investment in AHP Services. Creation of Quality Assurance Measures dashboard. Rehabilitation Commission work to continue into phase 2 including, service reform, capacity/ demand/ quality analysis and stakeholder engagement planning. Work continues to focus investment on key areas of service delivery risk in line with Caring for Ayrshire objectives for reform. This work was further delayed by service demand pressures but will now commence. Work continues on Quality Assurance dashboard. Phase 2 of the Rehabilitation Commission commenced in May 22. This will focus on service reform and job planning for AHPs in line with the Healthcare Staffing Programme. Proposal for investment in AHP Services submitted. North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Scale of requirement for investment. Potential of variable funding from the 3 HSCPs leading to inequity across Ayrshire. If investment is non- recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. The need to identify a funding stream from national investment for rehabilitation services pending the work of the National Rehabilitation Advisory Board linked to Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020) remains. Reduction in service delivery and further prioritisation of services using business continuity plans is ongoing. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine The impact of AHP services on health inequalities is widely documented nationally and internationally. This has obvious implications for patient safety and personal outcomes for our population. It also has a significant impact on staff health and wellbeing due to stress, burnout and widely reported challenges with the quality of care we can provide. Provision of services for those in the lower SIMD index levels are more at risk of being unable to access appropriate levels of support and care. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA32 Red Transforming Roles Increased development of non- medical models of care to deliver the right care in the right place by the right person whilst improving performance on national 12 hour wait target Mapping exercise of current roles. Educational needs analysis. Scoping of funding required for education and development of workforce. By June 22 Scoping of reformed services to deliver future models of care. There is a National Advanced Practice SLWG which will meet to progress this work in line with the national AHP education review. Locally we will work to implement the plans that come from this work. We are looking to identify training and education funds for AHPs to develop their skills at all levels of practice including advanced practice, funding is required to enable our ability to progress this work. NES currently re-starting this work nationally with no agreed timescales in place. NHS Ayrshire & Arran North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Scale of requirement for mapping and potential investment. Potential of variable funding from the 3 HSCPs leading to inequity across Ayrshire. Timescales for the planning of these roles to allow for training to be undertaken by staff and subsequent academy model supervision completion. If investment in training is not available or funding for recruitment is non-recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. Identify funding stream from NES as this is a National Programme. Unable to provide reformed service if funding and skill development are not achievable. PC1 NHS Recovery Plan Pain Management Recovery Framework Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). Scottish Government Modernising Patient Pathways Programme By creating new and transformed roles AHP would be able to deliver reformed services and reach our population earlier in their life curve using realistic medicine principles and deliver safe care closer to their home. AHPs in transformed roles have a greater ability to reach the wider population and make a tangible impact on health inequalities. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA33 Proposal Adult Acute Rehab Services Facilitation of faster discharge and reduced length of stay to improve patient outcomes and deliver the right care in the right place by the right person. Submit proposal for Investment in AHP Services to address the staffing levels identified through the AHP Rehabilitation Commission Workforce Review. Rehabilitation Commission work to continue into phase 2 including, service reform, capacity/ demand/ quality analysis and stakeholder engagement planning. This work remains at proposal stage. No progress has been made in terms of improving safe staffing levels to reduce patient safety risks. Proposal for investment in AHP Services submitted. NHS Ayrshire & Arran South Ayrshire HSCP East Ayrshire HSCP Scale of requirement for investment. Potential of variable funding response from the 3 HSCPs leading to inequity across Ayrshire. If investment is non-recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. AHP Rehabilitation Commission report highlighted to SPOG and CMT prioritisation of need and highest risk areas. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Missed care and omissions of care have the greatest impact on those in the lower SIMD index levels are more at risk of being unable to access appropriate levels of support and care. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA34 Green ICU Delivery of AHP services as per FICM guidelines. Respond to the Scottish Government scoping which identified additional capacity of 2 beds. Progress recruitment in response to the AHP Rehabilitation Commission Workforce Review which identified deficit in current safe staffing levels to meet FCIM guidelines. Additional AHP funding secured non recurring for 2 further ICU beds. Planning to identify permanent funding to make all posts permanent is ongoing. NHS Ayrshire & Arran South Ayrshire HSCP East Ayrshire HSCP Non recurring funding for UHA posts may result in recruitment and sustainability challenges. Reconfiguration of posts to ensure recruitment has been required. Additional funding was secured for a skill mix of roles to create a sustainable model for succession planning and future reform planning. Further planning to extend the reach of the InSPIRE programme. PC1 NHS Recovery Plan Pain Management Recovery Framework Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). Scottish Government Modernising Patient Pathways Programme FCIM Guidelines Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA35 Red Ensure timely AHP intervention and transition of care to community. Delivery of Home First Model at Front Door and CAU Scottish Government funding secured on non recurring basis for AHP team at front door and CAU. Unable to recruit to non- recurring roles. SLT and Dietetic roles have been funded for 9 months via EAHSCP, these have been recruited to. Proposal submitted to CMT to request recurring monies, no funding secured as yet however planning is ongoing. NHS Ayrshire & Arran South Ayrshire HSCP East Ayrshire HSCP Funding for these posts from the Scottish Government was non- recurring - this has an impact on AHP recruitment and retention. AHP Rehabilitation Commission workforce review identified high risk related to recruitment to short term funded posts. Posts are advance practice and require training budget to enable development of staff. Current funding covers staff pay costs. Secure further funding (£907 K per annum) to extend the length of time for posts to test and implement a sustainable AHP model at front door. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA36 Amber Trauma and Orthopaedics Delivery of AHP services as part of trauma and orthopaedic redesign. Occupational Therapy and Physiotherapy posts to be approved and recruited to in response to the recent AHP workforce review. Successful completion of recruitment to OT post. Currently working on Quality Improvements and patient safety standards in relation to the National Hip Fracture audit data. NHS Ayrshire & Arran East Ayrshire HSCP Lack of investment for dietician and orthotics demand that may delay discharge. The QI work on the hip fracture audit has highlighted a need to review OT staffing levels. Identify funding for 1 WTE dietician and orthotics 1 session per week to meet demand and safe staffing. This was included in the AHP rehabilitation commission workforce review but no funding has been allocated. PC1 NHS Recovery Plan Pain Management Recovery Framework Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North East and South HSCP Strategic Plans (2020/21) West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA37 Amber Stroke Services Transform roles in stroke to enable a flexible approach to the Acute and Community needs. Progress recruitment to posts Complete East Ayrshire HSCP have secured recurring money for the stroke posts identified in RMP3 and linked to University Hospital Crosshouse. OT, Dietetics, SLT and Physio posts have now been recruited to. Clinical staff in this area have submitted an SBAR to the Senior Management team highlighting the gap that still remains within stroke services. NHS Ayrshire & Arran South Ayrshire HSCP East Ayrshire HSCP Finance secured for additional bed capacity at UHC. AHP Rehabilitation Commission Workforce Review has identified deficits in safe staffing levels across stroke services. Identify funding for AHP workforce identified for safe staffing of stroke services (4.5 WTE experienced practitioners and 4 additional HCSW for UHC and Rehabilitation ward). This was included in the AHP rehabilitation commission workforce review but no funding PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter PreparednessWest of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA38 Red Adult Community Hospital Inpatient Services Facilitation of faster discharge and reduced length of stay to improve patient outcomes and deliver the right care in the right place by the right person. Respond to the AHP rehabilitation workforce review which identified resources required. Rehabilitation Commission work to continue into phase 2 including, service reform, capacity/ demand/ quality analysis and stakeholder engagement planning. Investment in AHP Services submitted. Investment achieved does not mitigate the risks identified within these areas of service delivery. Different models of care are being explored however the risk remains. NHS Ayrshire & Arran North Ayrshire HSCP East Ayrshire HSCP Scale of requirement for investment. Potential of variable funding response from the 3 HSCPs leading to inequity across Ayrshire. If investment is non-recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. AHP Rehabilitation Commission report highlighted to SPOG Criteria led referral process and prioritisation of need PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness 135
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West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA39 Green EACH (East Ayrshire Community Hospital) Facilitation of faster discharge and reduced length of stay to improve patient outcomes and deliver the right care in the right place by the right person. Respond to the AHP workforce review of current service at EACH which identified deficit in staffing level. Funding secured from EACH to invest in AHP resource required to meet staffing requirements. All registered clinical posts have been filled in this area. East Ayrshire HSCP Focus is on AHP cover for the specialist dementia unit at EACH. Further development of the model is required. Work is ongoing to develop the HCSW roles. PC1 East Ayrshire Strategic Plan NHS Recovery Plan Pain Management Recovery Framework Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). Scottish Government Modernising Patient Pathways Programme Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA40 Amber Intermediate care and community rehabilitation Avoidance of unnecessary acute hospital admission, and delivery of high quality rehabilitation and recovery. Respond to the AHP rehabilitation workforce review which identified resources required. Rehabilitation Commission work to continue into phase 2 including, service reform, capacity/ demand/ quality analysis and stakeholder engagement planning. Proposal for Investment in AHP Services submitted. Varied levels of investment has been secured across the three HSCP's with further opportunities being explored. NHS Ayrshire & Arran North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Scale of requirement for investment. Potential of variable funding response from the 3 HSCPs leading to inequity across Ayrshire. If investment is non-recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. AHP Rehabilitation Commission report highlighted to SPOG Clinical triage and prioritisation of referrals PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment CentresWest of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA41 Green Pain Services Delivery of AHP pain services through MSK to support patients through self management and prevention approach Develop a 5 week Pain Association Programme that will support the further enhancement of service for patients to reduce GP, OOH and Front door attendances. Additional physiotherapy post has been advertised as part of service development plan. Recruitment to posts has been completed NHS Ayrshire & Arran North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Difficulty recruiting to 15 hrs physiotherapy vacancy within core staffing leading to increased waiting times and variation in service delivery. Digital inclusion for patients who struggle to access online resources. Physiotherapy post has been increased to 18.75 hours to attract candidates. HR process underway. Development of pain management service resources that reduce digital divide. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC) Six Essential Actions (6EA) Primary Care Improvement Plans (PCIPs) Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine. Pain Management Recovery Framework Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. Reducing digital divide through the use of face to face and audio podcasts versus all online offer. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA42 Amber Long Covid Delivery of a safe clinical pathway suitable for implementing the management of Long Covid ensuring that the person is cared for by the right clinician at the right time. Implement the SIGN161 Guideline released on 18/12/20 to meet the needs of people with Long Covid without significant loss or impact on existing service recovery. At present attempting to meet these needs impacts on resource allocated for recovery for both urgent and routine health care. The process of a benchmarking exercise with a multi-disciplinary attendance to gain expert knowledge on the status of the Board’s current response to Long Covid management and also determine next steps has been completed. We have now secured non- recurring funding for a small Long Covid service within Ayrshire and Arran. This service will focus on long term condition management and holistic assessment and onward signposting for people with long Covid symptoms. North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Funding for these posts from the Scottish Government is non- recurring - this has an impact on AHP recruitment and retention. Current funding covers staff pay costs and not the digital components within the bid. A Once for Scotland approach is being used for this which may cause delays in implementation and delivery. Recruitment is underway and the service will be hosted within HARP to increase sustainability and reduce risk. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Primary Care Improvement Plans (PCIPs) Winter Preparedness Realistic Medicine, SIGN 161 Managing the long-term effects of Covid-19. Cossette Report 2020. Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Recovering planned care Rehabilitation 2021-AA43 Proposal Prehabilitation Prehabilitation, delivered as a considered part of the rehabilitation continuum, could have significant positive impact on the systems and services which are currently trying to deal with many of the issues/conditions that could be otherwise prevented or at least minimised if a pro-active approach was applied. Progress initial discussions on the scoping of prehabilitation services. Review of previous test of change data and mapping of future reformed service needs. Planning and creation of relevant business case. Complete The proposal was submitted to the NTC team writing the business case for Scottish Government funding for this model, no update has been received to date. NHS Ayrshire & Arran North Ayrshire HSCP South Ayrshire HSCP East Ayrshire HSCP Scale of requirement for investment. Potential of variable funding response from the 3 HSCPs leading to inequity across Ayrshire. If investment is non-recurring there is potential for recruitment challenges. If funding is not available future service reform may be unable to be delivered as planned. Funding stream from national investment for rehabilitation services from the work of the National Rehabilitation Advisory Board linked to Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020) has been agreed. PC1 Framework for Supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic (2020). Caring for Ayrshire. North, East and South HSCP Strategic Plans (2020/21). NHS Recovery Plan. Redesign of Urgent Care (RUC). Six Essential Actions (6EA). Primary Care Improvement Plans (PCIPs). Trauma and Orthopaedic Recovery Plan Winter Preparedness National Treatment Centres Realistic Medicine. Care and Wellbeing Programmes. Recovery and redesign: Cancer Services. Framework for Effective Cancer Management. Centre for Sustainable Delivery Heat Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Recovering planned care Estates and Capital Planning 2022-AA1 Green Delivery of National Treatment Centre for Orthopaedics New national treatment centre for elective orthopaedic care operational and treating patients by 2025. Strategic Initial Agreement and Economic Case approved. Progress on work to complete Full Business Case proceeding to programme. Property acquired and under NHS Ayrshire and Arran control. Professional team appointed and in place. Adopted programme being driven at pace. Ongoing project scrutiny and engagement via programme board. Professional team appointed and in place. Adopted programme being driven at pace. Ongoing project scrutiny and engagement via programme board. PC1 Caring for Ayrshire Strategy. Reducing elective care waiting lists. West of Scotland Ayrshire and Arran Recovering planned care Planned Care 2022-AA2 Amber Provision of sustainable safe head and neck service Redesign/relocation of Ward 5A to support Head and Neck (H&N) inpatients; ensure staff training for airway care and emergencies Full recruitment to OMFs consultant team (3 of 4 posts filled) Continue discussions with D&G ENT team to ensure mutual aid is maximised Increase ENT core weekly theatre and consideration of weekend working including cochlear Internal consultation underway regarding 3 options for protection of dedicated H&N beds. Further feasibility requires to be assessed with a decision expected by August 2022 Plan being worked up for additional evening / weekend cochlear implant theatre lists Urgent care impact on bed availability Staff capacity / willingness to work overtime Consultant recruitment PC1 NHS Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Planned Care 2022-AA3 Red Provision of sustainable safe Systemic Anti Cancer Therapy (SACT) service Build on future service delivery model work already undertaken by the SACT Executive and WoSCAN Investment in Nursing, Pharmacy workforce to increase Non-Medical Prescribing Continue with local delivery plans for SACT provision including identified option for community T3 in North, East Ayrshire This remains a risk and priority area for NHS Ayrshire and Arran, but has not been funded in the 2022/23 WoSCAN recurring funding however non-recurring funding through cancer access funding will provide some continuation of this work. Recruitment for medical and nursing is complete. Community support for this is still being sourced. This is dependent on Access Funding being confirmed PC1 Cancer Strategy - national SACT investment Low risk chemo will be delivered in communities and therefore reducing health miles. West of Scotland Ayrshire and Arran Recovering planned care Planned Care Outpatients 2022-AA4 Amber To reduce waiting list size and waiting times for Outpatients by increasing clinic capacity and reducing referral demand Dermatology Initiate photo triage service Employ GPwSI / locum Staff recruitment underway This is dependent on Access Funding being confirmed PC1 NHS Recovery Plan West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5 Green Improve waiting times within Gynaecology Services Implementation of Active Clinical Referral Triage / Enhanced vetting March 23 Develop Education & Relationships with Primary Care December 23 Improve Digital Resources September 23 Team identified to take work forward Lack of available IT resources to support Appointment of 2 new Consultants PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.1 Green Improve waiting times within Gynaecology Services Implementation of Patient Initiated Review September 22 Team identified to take work forward PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.2 Green Improve waiting times within Gynaecology Services Consultant job planning to meet service needs September 22 Team Service Planning in progress PC1 Waiting Times Improve access to meet National Waiting Times Standards and reduce waits for patients 136
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West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.3 Green Improve waiting times within Gynaecology Services Waiting List Initiatives June 22 WLI rolling programme in place Volume of WLI's required becomes unsustainable Potential use of Consultant Retire & Return to mitigate demands on Consultant establishment PC1 Waiting Times Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.4 Proposal Improve waiting times within Gynaecology Services Consultant Retire & Return for additional capacity October 22 Consultant requests in progress Funding not available PC1 Waiting Times Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.5 Proposal Improve waiting times within Gynaecology Services Develop Business case for nurse specialist roles June 22 Recruit to Train - courses start October 22 Service Delivery - start October 23 Business case complete Funding not available PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.6 Proposal Improve waiting times within Gynaecology Services Establish feasibility in estate footprint July 22 Establish suitable patient cohort July 22 Establish equipment / training required July 22 Deliver unit dependant on outcome of feasibility study New deliverable Unit is not feasible due to lack of estate / funding Funding for second ultrasound machine PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Positive impact on IP/DC waiting times West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA5.7 Green Improve waiting times within Gynaecology Services Develop use of Robot Assisted Surgery March 24 Team identified to take work forward Funding not available Consultant training time PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Positive impact on IP/DC waiting times West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA6 Proposal Ensure robust Termination of Pregnancy (TOP) service Assess needs of TOP Service, identifying capacity gaps in light of increasing demand Identify additional estate to support increase in demand September 22 New deliverable inappropriate current accommodations PC1 Women's Health Plan Improve health outcomes and health services for all women and girls in Scotland West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA7 Green Develop robust MDT Pelvic Pain Endometriosis Service Development of MDT Pelvic Pain Endometriosis Service / Pathway December 22 Endometriosis nurse business case July 23 Team identified to take work forward availability of nursing and medical time for service provision PC1 Women's Health Plan Improve health outcomes and health services for all women and girls in Scotland West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA8 Green Enhance service for women with acute menopause symptoms Enhancement of service for women with acute menopause symptoms December 22 Primary care education March 22 Workplace wellbeing August 22 Team identified to take work forward PC1 Women's Health Plan Improve health outcomes and health services for all women and girls in Scotland West of Scotland Ayrshire and Arran Recovering planned care Women and Children Gynaecology 2022-AA9 Green Sexual Health Standards Assess and deliver services to meet standards - whole system Completion of Baseline Analysis - Ayrshire System September 22 Development and delivery of Improvement Plan - Ayrshire System (TBC) Baseline data gathering in progress PC1 Sexual Health Standards Improve Sexual Health Services for young people and adults of Ayrshire West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA10 Green Best Start Implementation of the Best Start Recommendations and Sustainability of Service. Complete Gap Analysis of progress and scope remaining requirements June 22 Gap Analysis and Scoping completed PC1 Best Start Improving access to and quality of services in line with Best Start recommendations West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA10.1 Green Best Start Implementation of the Best Start Recommendations and Sustainability of Service. Develop business case for sustainability of model of care December 22 New deliverable PC1 Best Start Improving access to and quality of services in line with Best Start recommendations West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA10.2 Green Best Start Implementation of the Best Start Recommendations and Sustainability of Service. Conclude delivery of implementation of Best Start recommendations 2025 New deliverable, milestones pending outcomes of gap analysis. PC1 Best Start Improving access to and quality of services in line with Best Start recommendations West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA11 Green Complex Care Meeting the needs of complex and high risk pregnancies Consultant job planning to meet service needs commence September 22 Team Service Planning in progress PC1 West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA11.1 Proposal Complex Care Meeting the needs of complex and high risk pregnancies Development of Rainbow Clinics feasibility and capacity review November 22 New deliverable PC1 Improve access to specialist care West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA12 Green Early Pregnancy / Pregnancy Loss Support for Women experiencing early pregnancy loss Develop 7 day scanning service in EPAS utilising midwife sonographers. March 23 Midwife enrolled on training to start October 22 PC1 West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA12.1 Proposal Early Pregnancy / Pregnancy Loss Support for Women experiencing early pregnancy loss Implement Bereavement Liaison pathway / clinics March 23 New deliverable PC1 West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA13 Proposal Outpatient Services Care available closer to home Establish Outpatient Induction of Labour Clinics November 22 New deliverable PC1 Caring for Ayrshire West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA13.1 Proposal Outpatient Services Care available closer to home GTT / Health Education to be available in Community settings December 22 New deliverable PC1 Caring for Ayrshire West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA13.2 Proposal Outpatient Services Care available closer to home Suitable Community Accommodation to be identified in all localities progress update March 23 New deliverable Lack of suitable available clinic space in community settings in any or all areas. PC1 Caring for Ayrshire West of Scotland Ayrshire and Arran Recovering planned care Women and Children Maternity 2022-AA14 Green Service Quality Access to readily available quality data Develop Maternity data Dashboard March 23 New deliverable Lack of Business Intelligence Resource PC1 Best Start MCQIC West of Scotland Ayrshire and Arran Recovering planned care Women and Children Paediatrics 2022-AA15 Proposal Improve waiting times within Paediatric Service Plan & Costing of refurbishments to accommodate OP clinic rooms July 22 Agreement to Proceed with works TBC Scoping in progress Funding not available PC1 Waiting Times Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Paediatrics 2022-AA15.1 Green Improve waiting times within Paediatric Service Implementation of Active Clinical Referral Triage / Enhanced vetting October 22 Develop paediatric handbook for primary care March 23 Improve Digital Resources March 23 Team identified to take work forward Lack of available IT resources to support PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Paediatrics 2022-AA15.2 Green Improve waiting times within Paediatric Service Implementation of Patient Initiated Review November 22 Team identified to take work forward PC1 Waiting Times Modernising Patient Pathways Bringing it Together Caring for Ayrshire Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recovering planned care Women and Children Paediatrics 2022-AA15.3 Green Improve waiting times within Paediatric Service Consultant job planning to meet service needs October 22 New deliverable PC1 Waiting Times Improve access to meet National Waiting Times Standards and reduce waits for patients West of Scotland Ayrshire and Arran Recruitment and retention Workforce 2022-AA16 Amber Improve supply of registrant clinical staff (ATTRACT) (1) Latent vacancies within registrant workforce reduced Ongoing (2) Reduction in the level of high cost supplemental staffing being utilised i.e. agency - by end of Q2 and sustained (3) Compliance with the forthcoming Health & Care Staffing (Scotland) Bill - in line with national direction (1) NQN recruitment, for those graduating in September 22, has been completed with candidates matched to funded vacancies (2) Right sizing workforce group have set targets for reduction in agency spend for both nursing and medical. Work underway in Acute Services to strengthen authorisation of agency usage (3) Work underway in completing H&C Staffing Bill self assessment template. Application of nursing tools re-commenced with timetable across organisation for the use of the tools. Corporate risk 764 relates to registrant workforce supply and capacity and directly impacts on all 3 deliverables International recruitment used as lever Planned exit programme for high cost locums in Acute Services In keeping with WoS colleagues unified approach to the recruitment of NQNs RR1 Right Sizing Workforce Workforce Plan Financial Plan National Treatment Centre Plan People Strategy National Health & Social Care Workforce Strategy 137
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West of Scotland Ayrshire and Arran Recruitment and retention Workforce 2022-AA17 Green Introduce new complementary roles/support development of existing staff (RETAIN) (1) Strengthened multidisciplinary team working and development March 23 (2) New career pathways and opportunities for both existing staff and those new to the NHS March 23 (3) Staff enabled through support and development to work to the top of their roles March 23 (1) New role development underway. Anaesthetic Associate roles for NTC have been advertised. Advanced Critical Care Practitioners also in progress. Agreement on WoS basis to proceed with Physician Associates for the West region with effect from FY 2023. (2) Linked to 1 but also work underway looking at Advanced and Extended Scope practitioners across nursing and AHPs. (3) Steering Group established to progress the work for Band 2/3 review of HSCWs (1) New role development and ongoing supervision and support to those in training impacts on clinician time further impacting on wider service recovery capacity (2) staff moving into new roles creates domino effect of vacancies in wider workforce (3) Lead in time associated with new roles (MAP roles 2-3 years) before staff can bring capacity to services (3) Staff willingness to expand practice (1) Buy in from clinical teams set out early and seek opportunities of scale locally / regionally which could mitigate capacity issues. (2) Early planning for introduction of roles and clear messaging of associated lead in times so no false expectation. Lack of pump priming from SG could create an inhibiting factor (3) Engagement with staff to encourage working to top of role RR1 Right Sizing Workforce Workforce Plan Financial Plan National Treatment Centre Plan People Strategy National Health & Social Care Workforce Strategy West of Scotland Ayrshire and Arran Recruitment and retention Workforce 2022-AA18 Green Deliver the ambitions of our Employability Strategy (DEVELOP) (1) Opportunities for those far from employment March 23 (2) Growing our own staff, offering non- linear career routes and pathways March 23 (3) Improving the visibility of the range of NHS careers and opportunities, particularly for those in education March 23 (1) Kickstart programme in place (2) Agreement to proceed with modern apprenticeship programme at larger scale than undertaken in Ayrshire before - target of approx. 50 (3) Employability Strategy approved by Corporate Management Team and work now underway to develop action plan to underpin strategy. Intent to take strategy to NHS Board in October along with Workforce Plan (1) Funding to support employability programmes and ensuring that those undertaking programmes can move into roles once have completed programme (2) Capacity of services to support employability programmes (1) Access available funding routes and consideration of employability at scale as opposed to smaller numbers (2) Engagement with wider colleagues across Scotland to take learning from approaches and models and look for potential economies of scale. RR1 Employability Strategy Workforce Plan Financial Plan People Plan National Health & Social Care Workforce Strategy Anchor Institution Fair Work Employability West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA11 Green To continue to meet increased service demand, and to facilitate timely hospital discharges and increased pressures over winter, including weekends and public holidays Complete Re-design of Ayrshire and Arran unscheduled care service Recruitment of RN to support complex hospital discharge and assessment and Store Technician Community Equipment Store. Improvement Area - Hospital Discharge Locality and Community Care Service Update: Over the past year there has been additional investment in Hospital based assessment teams to support a multi-disciplinary approach to discharge. Roles with teams now include: MHOs, Occupational Therapy Assistants, and additional SW and Management capacity. Weekend and public holiday working continues to be facilitated by the assessment teams. Community Care Senior Managers are part of the 'Discharge without Delay' programme, including the post hospital and planned data of discharge workstreams. North Ayrshire HSCP Unable to recruit or recruit fully due to temporary nature and non- recurring budget. Hospital delays will increase into the winter period putting additional pressure on staff and the system Challenge of continued unmet need in community due to resource focus on hospital discharge. Ongoing recruitment activity, including fairs and events. Workforce Planning Discharge without Delay programme SC1 NAHSCP Strategic Plan Caring for Ayrshire Winter Preparedness A faster facilitation of discharge from hospital will address health inequalities by supporting people back to health in a community setting. Evidence suggests that there is a detrimental impact to people staying in a hospital setting or longer than necessary. A more effective discharge process will support people to leave hospital care as soon as is medically possible to allow them to recover more effectively in their own home. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA12 Amber To continue to support Care Homes within North Ayrshire with the training and supervision of staff Undertake a review of the North Ayrshire Care Home Commissioning Process - including (1) Needs Assessment (2) Market Analysis (3) Provider engagement (4) Commissioning modelling March 23 Progess has been slow to date due to Covid and other competing priorities. However, new base dataset has been sourced looking at Care Home data from March 2022. This will now be analysed for trend information to support a new commissioning strategy. North Ayrshire HSCP Unable to offer additional support to Care Homes Care Home Oversight Group still in place, meeting weekly to provide support to local care home sector. SC1 NAHSCP Strategic Plan Caring for Ayrshire People living in care homes are perhaps among the most vulnerable in our communities, by supporting care homes to provide the most effective care will positively impact on residents. By providing overarching support to all care homes, we can help ensure a high-level of care is available in all North Ayrshire establishments, this should positively impact on those service users living in Care Homes. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA13 Amber Increase dementia Post Diagnostic Service (PDS) capacity in localities Recruitment of three band 5 community psychiatric nurses to deliver increased support for patients diagnosed with a dementia. Gather data on compliance against standards including numbers of patients referred, numbers offered an appointment within 7 days and uptake up the offer of post diagnostic support. As a service the service has advertised for 3 x 30 hour band 5 RNs without success. The advert has been reviewed and the service readvertise for 2 x 37.5 hour staff with a view to increasing interest. The service continues to deliver PDS to all patients with a diagnosis of dementia however as we have been unable to recruit we cannot at this time expand or develop and implement other supports. North Ayrshire HSCP If unable to recruit will be unable to release experienced CPNs to focus solely on PDS Service may not meet key targets in line with standards and PDS commitments Staff within the team will continue to offer PDS in line with standards Monitor compliance with standards and data provided to Scottish Government SC1 NAHSCP Strategic Plan Caring for Ayrshire National Dementia Strategy 2017-2020 Scottish Government Covid-19 Dementia Recovery Plan Commitment 4 - Post-Diagnostic Support Through enhancement of this service, those identified with dementia and their family/carers will be provided with much needed early support. This service will support families at the early stages of their journey, ensuring that they are provided with adequate information, guidance and support and are better prepared to cope with the dementia diagnosis. Failure of this service can impact negatively on patients, families and carers as they may face challenges to identify suitable support. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA15 Amber To meet the ongoing demands of the Occupational Therapist service and assist with winter planning & Covid recovery Improvement Area - Community waits for assessment and review Recruitment to posts has been delayed due to review of scheme of delegation. This has now been completed and recruitment process will now start. North Ayrshire HSCP Additional risk to service delivery if funding not available after March 2022 Further risks to service delivery with other vacancies in the team. If funding not continued may have to meet within existing resources which not sustainable within the current service Recruitment to vacant posts is underway however if unable to fill posts risks will remain SC1 NAHSCP Strategic Plan Caring for Ayrshire Winter Preparedness Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA16 Amber Continue to meet the ongoing demands of the ICT service and assist with winter planning Improvement Area - Hospital Discharge/Admission Avoidance Enhance role of enhanced ICT - following review of service. Plan to be developed - to incorporate tasks not undertaken and ensure capacity to support 'Hospital at Home' Model Posts have been recruited to - 2 practitioners and the assistant post on hold North Ayrshire HSCP Due to the temporary nature of the posts and the non-recurring monies the posts may not be recruited Ongoing risk of demands of service delivery and increased acuity of patients treated Continual prioritisation of workloads and review of service SC1 NAHSCP Strategic Plan Caring for Ayrshire Winter Preparedness Delivery of this model will reduce health inequalities as people will receive the correct care at the right point in their journey. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA17 Amber Develop an Integrated Hub on Arran, including effective review of care bed provision on the island and implementation of a sustainable 24/7 care service. Continue to support the additional GP rota for AWMH to enable the transition to the new model of nursing care and support the Covid response on Arran Progress the New Models of Care work building on from the complex frailty MDT work and Frailty collaborative Progress Single Point of Contact and patient flow via care navigation and introduction of Netcall. Need to make the GP flex funding permanent to align with the 2 ED posts to ensure service delivery for urgent care. Netcall is going live 15th June 22 as key infrastructure for delivery of SPOC on Arran. Project Team to take forward Initial Agreement to OBC and FBC being reinstated in July 22. North Ayrshire HSCP Unable to continue posts in 2022/23 due to the temporary nature of the posts and non-recurring budget Critical and Essential services and 24/7 rotas cannot be sustained due to workforce challenges and multi- site delivery model. Re-submit the Initial Agreement to Scottish Government for an Integrated Hub on Arran to progress to Outline Business Case and Full Business Case in line with Caring for Ayrshire Continue to recruit into all current vacancies – rolling advert, recruitment fairs. Continue to use bank and agency staff in interim to ensure safe services. SC1 NAHSCP Strategic Plan Caring for Ayrshire Winter Preparedness Establishment of the Integrated Hub will provide a more effective service to the people of Arran. In particular, the additional development of a 24/7 care service on the island will bring particular benefits to many of the islands vulnerable and at risk people. Many frail or infirm people are often at risk during the night, leading to high levels of emergency admissions to AWMH or residential care. With a 24/7 care service, effective OOH or overnight care can be provided in a patients own home, reducing the need for hospital admissions. This service will also provide a similar approach to what is available on the mainland. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA18 Green To enhance resilience with the care at home service to improve hospital discharges and reduce the waiting list for Care at Home Services Reduce the number of people waiting for assessment Reduce the number of people on the waiting list for a Care at Home service in the Community Winter investment funding – Care at Home Capacity Plan Enhance in-house care at home service Enhance workforce Plus 2 TEC workers A number of newly funded posts as part of the winter investment fund have now been filled. This remains under constant review with on-going recruitment activity. North Ayrshire HSCP Recruitment is unsuccessful and unable to fill vacant posts. Retention of existing workforce. External care at home providers capacity for care delivery and ongoing sustainability. Robust recruitment and advertising campaign. Promote health and wellbeing initiatives for existing workforce. Ongoing contract management with External Providers. SC1 Winter preparedness Enhancing resilience within the care at home service will have the benefit of ensuring people awaiting community care packages will receive the needed support faster. It will also ensure Care at Home workers are adequately supported to fulfil their role, reduce burnout and ensure they are able to deliver effective services over the long term. West of Scotland Ayrshire and Arran Social care Health and Community Care 2021-AA27 Amber Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Provide additional capacity in the CAH service to enable flow from reablement, minimise DTOCs and prevent unnecessary admissions Deteriorated Commissioned CAH -20% compared to June 21 (9900hrs). - 22.5% in house capacity compared to June 21. South Ayrshire HSCP SC1 Adult & Older People Service Plan Home First Frailty Winter Preparedness West of Scotland Ayrshire and Arran Social care Care Home Professional Support Team 2021-AA44 Green Establish Care Home Professional Support Team (CHPST) to increase support for Care Homes, improve professional and IPC standards and improve standards of care (1) Establish Care Home Professional Support Team (CHPST) June 22 (2) Develop an improvement plan September 22 (3) Develop an evaluation plan March 23 Team appointed with the exception of AHP and Clinical Psychologist. AHP recruitment progressing. Alternatives being considered for the Clinical Psychologist as recruitment has been unsuccessful to date. Improvement Plan being scoped. Risk to continuation of programme if no funding identified for non- recurring element Scoping options for alternative source of recurring funding SC1 Enhanced Care Home Professional Oversight Arrangements - Scottish Government Directive Care Home Framework Healthcare Quality Strategy for NHSScotland Independent Review of Adult Social Care in Scotland Caring for Ayrshire NHS Recovery Plan The support from the CHPST will help to address educational needs and support staff in care homes to provide good quality care. In doing so, residents will have optional choice to remain in their place of care with care home staff recognising deterioration more timeously. West of Scotland Ayrshire and Arran Social care Children's Health Care and Justice 2021-AA8 Green Prison Health Care Review of and investment in the mental health / addictions workforce within HMP Kilmarnock to address waiting times and ongoing provision of timely interventions to the prison population in line with mental healthcare, Hep C Elimination and Medicated Assisted Treatment Standards (MATS) Completion of Health Needs Assessment for HMP Kilmarnock October 22 MAT standards to be implemented in early adopter custodial settings April 23 Stakeholder reference group established. Work of core data gathering is in progress with patient and staff engagement planned for the summer period. Local mapping work on current levels of need and identification of issues to MAP implementation. Nationally pilot work planned in HMP Perth September 22. Engagement with the MIST implementation team There are continued vacancies in the addiction and mental health teams. Caseloads have been triaged to prioritise service delivery. Successful general nurse recruitment will ease pressure on these teams to support core duties East Ayrshire HSCP High levels of staffing turnover, interdependencies with the adult nursing workforce, risks through unplanned staffing absence, limited training packages being delivered. These pressures and mitigating actions remain in place. Workforce planning lead supporting with workforce review. Supported to advertise and recruit to vacancies at the earliest opportunities. Close links with workforce solution. Profiling of prison healthcare services. Priority area for recruitment through for newly qualifying nurses which have identified successful candidates. Highlighted for candidates from foreign nurse recruitment. SC1 Mental Health Transition and Recovery Plan; Medicated Assisted Treatment Standards (MATS); Hepatitis C Elimination in Scotland; BBV/Sexual Health 138
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West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA19 Green Reduce the Waiting list for Social Work Assessment and Review Use of Scottish Govt Winter Pressures Funding Recruit 2 Social Workers plus 3 Social Work Assistants - to be in place by April 22 Impact on Waiting list by Q3 October 22 Additional social work posts (SW & SWAs) aligned to locality Social Work teams to support complex assessment to support discharge, review, AWI and support ICT social care requirements. Improvement Area - Community waits for assessment and review 5 additional posts have been identified through Scottish Government funding. Posts include 2 SW and 3 SW Assistants. Posts have now been been subject to interview, and appointments have been made. Anticipated that all posts will be in place from July 22 North Ayrshire HSCP Increase in local demand outstrips worker capacity. Knock on impact on other service areas in the HCC system. Ongoing review by Team Managers. Existing risk management protocols in teams. Workforce Planning. SC1 People who require care must receive it as soon as possible following the presentation of need. Any delays in this process may result in the need becoming more complex, more difficult to manage and may require critical intervention. By ensuring our SW assessments are completed quickly, and reviews are routinely carried out, we can support local people to effectively manage their identified needs supporting them to live a healthier life for longer. West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA20 Amber Review local models of respite provision Review use of respite with Anam Cara (reflecting on current step down status) Review current respite use (planned vs unplanned) Create working group to review/consider models Scoping exercise across private Care homes to review capacity for respite opportunities Programme of review has stalled. No decisions on the review of respite models have been made. No indication that low respite opportunities is negatively impacting on families. This has been since advent of Pandemic. North Ayrshire HSCP Lack of respite provision negatively impacts on Carers and Families Planned Respite is still available to support demand for those assessed as most critical. SC1 The value that local carers bring is widely recognised. Without the support of local carers, the demand placed on statutory health and social care services would increase significantly. However, it is recognised that role of carer can be both physically and mentally challenging with the long term risk of negative health impacts. Through provision of appropriate respite opportunities, carers can receive a break from there caring duties and hopefully be able to continue in their caring role for longer. West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA21 Green Explore opportunities and extend model to implement a range of effective palliative care and end of life care models through joint working, including with carers Establish contracting requirements of service provider Develop agreement with Ayrshire Hospice for 2 Palliative Care Beds / Day Cases for EA Clarification sought from Primary Care Contracting Team whether Primary Care provider must deliver services or whether this can be delivered by Advanced Practice Nurses. Have agreement with the Hospice in relation to Hospice Legacy Plans within EA to provide additional 2 Palliative Care Beds/Day Cases supported by the Ayrshire Hospice. East Ayrshire HSCP There is a risk of delayed commission for medical services to the Care Home Palliative Care beds due to other demands on these services Explore viability of ANP provision instead of GP provision SC1 Palliative Care Strategy West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA22 Green As part of Caring for Ayrshire, review and implement recommendations for Front Door Services. Seek approval to appoint Support Assistants March 22 Approval to progress recruitment of support assistants is underway. Approval awaited for other implementation East Ayrshire HSCP Recruitment delays may occur which risk delay in implementation of the new integrated model A leadership group has been established to ensure protected time for this key area SC1 Caring for East Ayrshire Caring for Ayrshire Technology Enabled Care Programme Digital Health & Care Strategy Providing a wider range of services closer to people's homes may reduce health inequalities within the geographic area and make more accessible services available within EA. West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA23 Green As part of Caring for Ayrshire, review and implement recommendations for Community Nursing as part of MDTs. Progress recruitment to Community Nursing March 22 ~Senior ANP in recruitment process - 4 x DN Specialist Nurses appointed - Community Nursing Clinical Governance established. EA representatives in attendance - 10+ HCSWs appointed - AND has provided feedback sessions to EA Community Nurses on next steps in implementation - Capacity constraints remain due to absence of 2 x CNMs - Set of meetings planned to determine further implementation priorities East Ayrshire HSCP Training, development, competencies and skills require to be defined and delivery supported as implementation progresses. The risk of staff absence and capacity may affect programme milestones and deliverables. A leadership group has been established to ensure protected time for this key area SC1 Caring for East Ayrshire Caring for Ayrshire Realistic Medicine Quality Strategy Technology Enabled Care Programme Digital Health & Care Strategy Providing a wider range of services closer to people's homes may reduce health inequalities within the geographic area and make more accessible services available within EA. West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA24 Green As part of Caring for Ayrshire, implement the new model of care for East Ayrshire Community Hospital (EACH) to continue to progress redesign of place-based models of care in Cumnock and Irvine Valley Explore alternative models of medical staff provision Develop specification and carryout consultation Establish Micro-board to re-engage and consult on future model of clinical care March 22 ~Explore 2 x alternative models of medical staff provision - Specification for medical services out for consultation - Micro-board established to re-engage and refresh previous consultation around future model of clinical care at EACH - Regular meetings with Senior Manager AHPs regarding new clinical models of care - Ayrshire Hospice currently using the spare ward capacity. This has a material impact on implementation East Ayrshire HSCP Availability of space at EACH is constrained until June 2024. This will limit some implementation of new models of care within those areas. Implementation will be prioritised for recommendations which do not require reconfiguration, refurbishment or the temporary current unavailable space. SC1 Caring for East Ayrshire Caring for Ayrshire Realistic Medicine Quality Strategy Dementia Strategy Technology Enabled Care Programme Digital Health & Care Strategy Providing a wider range of services closer to people's homes may reduce health inequalities within the geographic area and make more accessible services available within EA. West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA25 Green Focus on ongoing and intensive rehabilitation support for people to recover from the effects of Covid19 and lockdown Implement the recommendations of the 2020-21 review of older people's mental health following completion of final agreement March 22 EMH Clinical Governance Meeting/Clinical Director have advised that clinical services should be in a safe position to re-open the review implementation from late August 22. This will be confirmed July 22. East Ayrshire HSCP Further Covid absences within the clinical teams will risk the capacity of the teams to engage and implement the recommendations. To prioritise recommendations and plan delivery of these over an extended period. SC1 People at the heart of what we do Dementia Strategy Mental Health Strategy MDT Programme People living with mental illness/disorder are subject to greater inequalities than the general population. The implementation of this review has deliverables which focus on addressing health inequalities, health improvement and enablement for the older person . West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA25.1 Green Focus on ongoing and intensive rehabilitation support for people to recover from the effects of Covid19 and lockdown Develop frailty initiatives, including Hospital at Home approaches, across multi-disciplinary teams to reduce hospital admission and length of stay March 22 Hospital @ Home "soft launch" in East Ayrshire Apr 22 - collaborative approach to roll out and alignment of models ongoing Frailty - awareness raising major focus of learning & development agenda for all staff; pending release of elearning modules from NES by end August 22 East Ayrshire HSCP Frontline staff & organisational capacity to drive forward changes and release from duties to undertake learning Programme oversight via NHSA&A Urgent & Unscheduled Care Collaborative/ DwD Advisory groups SC1 People at the heart of what we do Improve access to treatment, care & support for frailest in society West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA25.2 Green Focus on ongoing and intensive rehabilitation support for people to recover from the effects of Covid19 and lockdown Widen enablement approaches across the range of Locality Health and Care Services March 22 Establishment of Social Care Learning Hub - Enablement a key focus of learning & development priorities for social care staff; will be progressed alongside other critical L&D needs Reablement service to be established - high level framework for progressing establishment of new service by end July, with commencement of detailed planning thereafter. East Ayrshire HSCP Lack of sufficient recruitment to permanent posts to deliver new model Covid spikes Organisational & staffing capacity to progress changes Oversight of progress via Pentana reporting/ SCLUB Implementation SC1 People at the heart of what we do Caring for East Ayrshire Improve physical, social and emotional health through improved focus on achieving outcomes with intensive support West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA26 Green Implementing effective multidisciplinary teams and models around Localities, Learning Communities, GP Clusters and community assets through investment in service redesign Delivery of development programme for Multi Disciplinary Team working in Locality Health and Care March 22 Constituted a transformation programme for the establishment of integrated multi-disciplinary teams within 5 geographic localities of EA. Using Scottish Approach to Service Design Methodology at design phase East Ayrshire HSCP Milestone dates and programme deliverables have been adapted due to Covid demands Focussing on recruitment of key leadership posts and through the winter planning investment recruiting additional frontline staff across Health & Social Care SC1 Caring for East Ayrshire People at the heart of what we do Ensuring there is capacity within locality and place based teams to address health improvement and health inequalities as well as service delivery West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA26.1 Green Implementing effective multidisciplinary teams and models around Localities, Learning Communities, GP Clusters and community assets through investment in service redesign Implement Phase II of the Best Value Review Improvement Action Plan in care at home with a focus on assessment, care planning and review in the context of personalisation and choice October 22 Progress delayed due to Covid pressures; planning underway with plans to implement new model of oversight & review for SDS Option 3 cases transferring to Option 2 following people being offered "Choices" of care provider. East Ayrshire HSCP Organisational & staffing capacity to progress changes External provider viability Regular planning meetings & clear timescales Regular monitoring meetings with providers as part of Quality assurance/ Contract & commissioning framework SC1 People at the heart of what we do Improve physical, social and emotional health through improved focus on achieving outcomes with intensive support West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA27 Green Developing aligned service redesign in day opportunities for older people, local residential services for adults and across our prevention and early intervention programmes and initiatives Carry out re-phased Best Value Service Review Programme in Locality Health and Care Services Older People's Day Care services reopened on all appropriate sites by end August 22. Stages 1 through 6 of rapid review of Older Peoples' Day Care Services complete with final implementation plan to be ratified at SCB and IJB August 22. Parallel development of wider day opportunities for older people - early discussions of strengthening collaboration with partners. East Ayrshire HSCP Lack of sufficient recruitment to permanent posts to deliver new model Covid spikes Regular planning meetings & clear timescales Clear Health & Safety guidance and practices in place with regular reviews SC1 People at the heart of what we do Improve physical, social and emotional health through improved focus on achieving outcomes with tailored support West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA28 Green Build on the learning over the Covid19 pandemic to improve interventions to protect people through our multi-agency public protection arrangements Implement any improvement actions arising from the multi-agency inspection of Adult Support and Protection (expected publication date August 2021) March 22 ASP Improvement Plan established around improvement actions identified. Good progress achieved - 44% complete. Key Actions, Performance Indicators and Risk Register review and updated on an ongoing basis. East Ayrshire HSCP Increased service pressures, staff turnover and vacancies leading to increased vulnerability of adults at risk ASP Multi-Agency reporting data Governance group established to provide oversight SC1 Safe and protected West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA29 Green Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Improve our approach to commissioning to ensure we get enhanced quality of care and best value from our contracts. Contract development for Learning Disability September 22 Contract development for Mental Health April 23 A new Quality Assurance framework has been implemented and reports are taken to CSOG for approval and consideration. Regular online forums are held. New Flexible Contract for Care at Home has been implemented effective from 1st April 22 for a period of 4 years. Further ongoing contract development for LD and MH frameworks have been scheduled for September 22 and April 23 respectively. South Ayrshire HSCP SC1 South Ayrshire Health & Social Care Partnership Integration Joint Board Strategic Plan 2021 - 31 West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA29.1 Amber Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Invest in and redesign our new Reablement Service to support delayed discharges and optimise service user’s independence. Reduce delays to 0 March 23 Recruitment has stalled over the last year. 85% of those requiring a POC from hospital come through reablement. Mainstream CAH hours has reduced from 12,000 to around 10,000. People being reabled is currently 40%. South Ayrshire HSCP SC1 South Ayrshire Health & Social Care Partnership Integration Joint Board Strategic Plan 2021 - 31 139
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West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA29.2 Amber Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Improving our approach to data analysis for delayed discharge and unscheduled care. Weekly meetings focus on those patients delayed for over 10 days as the operational teams work to identify actions to ascertain capacity across the system. The system remains challenged due to a number of factors and the HSCP remains in a position where demand continues to outstrip capacity. Progress made - - Additional resource has been created within the Planning and Performance Team to support increased delayed discharge recording and reporting - Initial process mapping undertaken - A Test of Change is being implemented to use a Single Point of Contact to administer and monitor delayed transfers of care South Ayrshire HSCP SC1 South Ayrshire Health & Social Care Partnership Integration Joint Board Strategic Plan 2021 - 31 West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA29.3 Green Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Increase our mobile attendant service to provide capacity to transport individuals home out of hours from University Hospitals Crosshouse and Ayr. In March 22, ELT agreed to the creation of permanent 6 posts which have been recruited to. This is having a positive impact on our ability to respond to alarms, support telecare installation and discharges from the hospital. Response times for mobile attendants have reduced significantly. Comparing April data from 2020 and 2021: - There is an average improvement of 37 minutes for personal care (1hr 26mins in 2020 and 49mins in 2021) - 5 minutes for no response (39mins in 2020 and 34 mins in 2021) - 5 minutes for falls (40 mins in 2020 and 35 mins in 2021) South Ayrshire HSCP SC1 South Ayrshire Health & Social Care Partnership Integration Joint Board Strategic Plan 2021 - 31 West of Scotland Ayrshire and Arran Social care Health and Community Care 2022-AA29.4 Green Ensuring people are supported within the community where possible rather than in a hospital or institutional setting to improve outcomes and reduce delayed transfers of care Implement a Home First model for complex discharges Funding was provided from Scottish Government to support the delayed transfers of care. We have focused on this approach and used interim beds in care home facilities to support those individuals who are delayed in hospital due to capacity challenges in care at home services. Going forward we are continuing to work with our care home providers to progress an interim bed approach, this will be done in conjunction with the proposals of utilising the top floor in South Lodge as a “step down” preventative approach. South Ayrshire HSCP SC1 South Ayrshire Health & Social Care Partnership Integration Joint Board Strategic Plan 2021 - 31 West of Scotland Ayrshire and Arran Social care Public Health Health Protection 2022-AA30 New Manage Health Protection outbreaks and contribute to National Covid Review Provide a robust response to any outbreaks and produce a review of local Covid activity to meet national deadlines Planning for review has begun, with training being undertaken Winter pressures and flu and other potential outbreaks may put considerable strain on the Health Protection capacity to deliver a service and undertake a review A project co-ordinator will be aligned to support the review process to provide continuity. Should key clinical personnel not be available to contribute to the review due to core Health Protection duties - this will require to be escalated to SG SC1 Joint Health Protection Plan Undertaking this review will provide insight into the effect of the pandemic on health inequalities West of Scotland Ayrshire and Arran Social care Public Health Caring for Ayrshire 2022-AA31 New Scope and implement programmes that can deliver on the prevention aspects of CfA and contribute to CRES Plans on a Page to be developed and implemented Scoping has commenced Key PH staff taking this work forward have to be redirected to Health Protection work should there be further variants Prioritise this work alongside Health Protection activity SC1 Caring for Ayrshire Prevention programmes will be targeted towards those populations of greatest need and will have a clear focus on reducing inequalities West of Scotland Ayrshire and Arran Social care Public Health Screening 2022-AA32 New Plan and deliver programme of work to reduce screening inequalities across all PH screening programmes Develop screening inequalities action plan by September 22 Planning has commenced Many actions require additional resource and screening inequalities funding not yet confirmed Prioritise this work alongside Health Protection activity SC1 National screening inequalities strategy currently being developed by NSO This work aims to improve uptake of screening among deprived and/or vulnerable groups, and therefore reduce inequalities in cancer outcomes. West of Scotland Ayrshire and Arran Social care Public Health Vaccinations 2022-AA33 New Pneumococcal and shingles catch- up vaccination programme targeting care homes residents and housebound peoples. Produce data and make available re care home residents and housebound peoples who are unvaccinated against pneumococcal and/or shingles; develop consent forms for both vaccines; gather consents for vaccination; develop housebound clinic lists; progress staff training. Complete Commence service delivery Catch-up programme on schedule to commence mid June 22. Potential side effects following co- administration of vaccines to more vulnerable patients. Vaccines will be delivered during separate vaccination visits. SC1 JCVI Guidance, Vaccination Transformation Programme, Scottish Immunisation Programme. Too early to determine. Demand for new service will be monitored and patient evaluation planned and implemented in future months. West of Scotland Ayrshire and Arran Social care Public Health Vaccinations 2022-AA34 New To deliver an extended Vaccination Programme including Mass Vaccination to the peoples of NHS Ayrshire & Arran Covid-19 Vaccination Autumn/Winter Booster Programme Robust data to support the Vaccination programme Publish JCVI Guidance regarding Autumn/Winter programme; Plan and agree delivery programme with key stakeholders; Recruit sufficient workforce Complete Commencement of service delivery September 22 Completion of programme December 22 With opportunities for mop up available during January/February 23. JCVI Guidance expected July 22. Mass vaccination clinic accommodation not available; delays to vaccine supply; issues associated with national scheduling system; vaccination fatigue amongst peoples; request from national programme to enact surge delivery of programme. Accommodation hire agreed well in advance of Autumn/Winter Programme; contingency start date agreed and expected vaccine supply dates monitored; continue to work closely with NVSS re. national scheduling and increase local resilience re. scheduling; work closely with national programme re. programme messaging; surge plan, highlighting risks and support from national programme submitted to national programme (May 2022). SC1 JCVI & MHRA Guidance, National Vaccination Transformation Programme, National Covid-19 Pandemic Response, NHS Ayrshire & Arran Policies & Procedures Too early to determine. Demand for new service will be monitored and patient evaluation planned and implemented in future months. West of Scotland Ayrshire and Arran Staff wellbeing Workforce 2022-AA35 Amber Support the health and wellbeing of our staff (SUPPORT) (1) Staff access and utilise the range of wellbeing services available - ongoing. (2) Sickness absence levels remain below 5% - monthly monitoring. (3) Staff utilise their annual leave entitlement in order to ensure they rest and recuperate - monthly monitoring (1) Action plan, as per Right Sizing Workforce Group, to do focused work on ASDOM absence including roll out of stress risk assessments (2) Routine monitoring of sickness and Covid absence rates. Work ongoing looking at reviewing long Covid staff in line with recent DL (3) Guidance note being issued to managers in July reminding them of policy context and good practice/principles in managing annual leave (1) Capacity of OHS services to manage demand for highest reasons for absence - ADSOM and MSK (2) With move to Covid no longer being recorded as special leave from Aug 22 the likelihood is that absence will be in excess of 5% (3) Staff defer taking annual leave to provide capacity to support (1) Review of OHS underway (2) Monthly monitoring of staff absence on ongoing basis (3) Monthly monitoring of annual SW1 Right Sizing Workforce Workforce Plan Financial Plan National Health & Social Care Workforce Strategy People Strategy National review of Occupational Health Services West of Scotland Ayrshire and Arran Sustainability and value Digital 2022-AA36 Green Distributed Working and Estate Rationalisation Identification, procurement and deployment of digital desk booking and management system Q3 2022/23 Limited action completed - target for end of calendar year 2022 (Q3) Funding for implementation from Capital Investment Plan. Requirements, specification and scope being developed to establish likely costs. VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the people of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. West of Scotland Ayrshire and Arran Sustainability and value Digital 2022-AA37 Green Electronic Patient Record and Records Management Programme Transition to Digital Clinical Records and transition to the removal of paper case notes within general hospital settings. Q4 2022/23 Transition complete in some outpatient clinics. Working group established to rollout programme across acute settings. Funding for implementation from Capital Investment Plan. Requirements, specification and scope being developed to establish likely costs. VS1 NHS A&A key priorities Electronic Patient Record and Records Management programme and "Caring for Ayrshire" strategy, to provide a collated digital source of patient information which is accessible by all relevant staff in order to improve patient care. Provide a collated digital source of patient information which is accessible by all relevant staff in order to improve patient care. West of Scotland Ayrshire and Arran Sustainability and value Estates and Capital Planning 2022-AA38 Amber Delivery of National Secure Adolescent Inpatient Services (NSAIS) "Foxgrove" New national mental health facility Foxgrove. Operational by Q4 2022/23. Advance package of work on site. FBC awaiting final approval following NHS Assure "supported status". FBC approval and supported status by NHS Assure, Construction Inflation and combined delay impact upon programme. Workforce recruitment. Ongoing engagement with NHS Assure to close out remaining concerns. VS1 Adolescent mental health - national programme. Delivery of specialist services for patients within Scotland. West of Scotland Ayrshire and Arran Sustainability and value Infrastructure Support Services 2022-AA39 Amber Lead the transition to a full electric NHS AA commercial fleet to support the wider organisation function while ensuring compliance with SG legislative requirements by 2025 Procurement of new NHS AA EV commercial vehicles. Ensure the appropriate infrastructure is in place across the boardwide estate to support the transition of the commercial fleet. Obtain national funding to support these changes in full. The development of business case to support the transition to an EV i l fl t Successful in obtaining funding from Transport Scotland via 2021/22 bid with infrastructure being implemented. Awaiting outcome of 2022/23 bid to Transport Scotland for further infrastructure requirements. Working on 2023/24 bid which will be supported by a Business Case. Affordability. Full details on Project Risk Register. EV Project transition group set up to review and oversee programme progress VS1 Full compliance with Scottish Government legislative requirements. The reduction in greenhouse gas CO2 emissions generated by commercial fleet from baseline. Climate Change & Sustainability. NetZero West of Scotland Ayrshire and Arran Sustainability and value Organisational and Human Resource Development 2022-AA40 Green Distributed Working and Estate Rationalisation Build our approach to distributed working, and any relevant skills development, into recruitment and induction programmes and procedures Q4 2022/23 Limited action completed - note inter-relationship with other distributed working and estates rationalisation workstreams. Employee engagement to ensure that distributed working is understood and a success. Programme group responsible for developing programme includes HR and Employee Directors. VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the communities of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. 140
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West of Scotland Ayrshire and Arran Sustainability and value Organisational and Human Resource Development 2022-AA40.1 Green Distributed Working and Estate Rationalisation Produce an Ayrshire and Arran Guide for Leaders on Distributed Working that provides a self-management resource Q4 2022/23 Limited action completed - note inter-relationship with other distributed working and estates rationalisation workstreams. Ensure that guidance is user focussed and positive providing adequate resources to ensure positive and effective deployment of distributed working. Programme group responsible for developing programme includes HR and Employee Directors. VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the communities of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. West of Scotland Ayrshire and Arran Sustainability and value Property & Strategy 2022-AA40.2 Green Distributed Working and Estate Rationalisation Formal implementation of “distributed working”, “zero desk working” and “corporate landlord property management model” policies Q2 2022/23 Policies have been approved by IPB Advisory Group and Infrastructure Programme Board (IPB). Final approval required from Corporate Management Team (CMT) before implementation. Integration with HR / OD issues including alignment with national policies. Programme group responsible for developing programme includes HR and Employee Directors. VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the communities of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. West of Scotland Ayrshire and Arran Sustainability and value Property & Strategy 2022-AA40.3 Green Distributed Working and Estate Rationalisation Establish Local Authorities common technology requirements for sharing accommodation Q3 2022/23 Limited action completed - target for end of calendar year 2022 (Q3) Potential difficulties in agreeing common technical standards across all 4 organisations (NHSA&A and NAC, SAC and EAC). Establish technical forum involving all 4 organisations (NHSA&A and NAC, SAC and EAC). VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the communities of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. West of Scotland Ayrshire and Arran Sustainability and value Property & Strategy 2022-AA40.4 Green Distributed Working and Estate Rationalisation Complete draft long term Caring for Ayrshire property strategy identifying planned lifespan for existing accommodation, to plan future investment & exit / disposal plan Q4 2022/23 Work underway to update PAMS and to review the demolition plan. Dedicated programme managers have been appointed to work with each of the three partnerships (NAHSCP, SAHSCP & EAHSCP) and acute services to develop future requirements for their respective services. External Healthcare Planners have been appointed to progress Caring for Ayrshire strategy. Affordability around delivery of output strategy - reliant upon significant SG funding. Conflict around prioritisation of projects. Ongoing engagement with all stakeholders including CIG leads. Adoption of SG data based modelling and prioritisation tool. VS1 NHS A&A key priorities "Distributed Working & Estates Rationalisation" programme and "Caring for Ayrshire" strategy, to deliver a future proofed, service focussed and financially sustainable estate. Supporting the delivery of a health service to better meet the needs of the communities of Ayrshire by improving flexibility and patient centred care and reducing ancillary property costs. West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA41 Green Ensure the Realistic Medicine workstream informs the clinical redesign pathways within the Board Attend Clinical Senate Ongoing The Realistic Clinical Leads were invited to the first Clinical Senate, led by the Chief Executive and Medical Director. This will ensure the Realistic Medicine workstream informs the clinical redesign pathways within the Board. RM Team to be included in future meetings. Service demands/constraints influence the impact and buy-in of Realistic Medicine priorities in the design of clinical pathways Attendance and representation of RM at Clinical senate VS2 Realistic Medicine / Value Based Health and Care RM is at the heart of caring for Ayrshire redesign, and this will deliver person centred care, in the right place at the right time by the right person West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA42 Green Becoming Improvers and Innovators Realistic Medicine Workstreams and Collaborative Working Ongoing The RM Team are constantly trying to come up with new ways in which we can highlight RM within the Board, they are also in many sub groups looking at new and progressive ways of working. The RM team support others who approach them with innovative ideas for improvement and try to link them in with the right people to further the ideas. Staff weary due to current clinical constraints and pandemic fatigue/ weariness. Bi-annual symposia, quarterly newsletter to stimulate innovation. Value Improvement Fund annual applications VS2 Realistic Medicine / Value Based Health and Care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA42.1 Green Becoming Improvers and Innovators Progress School Mentoring Programme September 22 Year 1 of pilot with Robert Burns Academy, Cumnock completed. Students wishing to pursue NHS career offered one-to-one mentoring support for applications. Challenges due to ongoing Covid measures in school, and students not comfortable with email as communication method. We hope to expand into the 3 locality areas in 2022-23 academic year with face to face meetings in schools. Schools to be identified and RM Team liaise with Senior CDF. Requires large amount of input from CDFs who change annually. May lose momentum and engagement due to Covid restrictions. Maintaining regular contact with CDFs involved VS2 Realistic Medicine / Value Based Health and Care This programme aims to empower people from a young age to be involved in their healthcare journey and to learn about shared decision making so that they too can achieve person centred care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA42.3 Green Becoming Improvers and Innovators Progress School Outreach Programme August 22 Scripts written, storyboards made, awaiting confirmation of filming date for "It's OK to Ask" videos school campaign. Continual liaison with Senior CDF regarding the mentoring programme and other school outreach events. Large amount of time and effort to produce. School engagement required. CDF doctors change every year which may thwart momentum Maintaining regular contact with CDFs involved VS2 Realistic Medicine / Value Based Health and Care This programme aims to empower people from a young age to be involved in their healthcare journey and to learn about shared decision making so that they too can achieve person centred care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA42.4 Green Becoming Improvers and Innovators Establish Realistic Medicine Network and Champions January 22 A RM champions network has been established and is expanding. A quarterly newsletter has been set up and well received, which communicates info re current work by the RM to champions to allow info and ideas to be disseminated. It also contains a quarterly challenge for the RM Champions. Feedback on this to the RM team is encouraged. Regular meetings with the RM Champions. Low numbers of RM champions and lack of engagement to promote and share RM aligned work/projects. Encourage RM champions at every opportunity, quarterly newsletter with open communication to RM team. VS2 Realistic Medicine / Value Based Health and Care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA43 Green Promote and engage with clinicians and GPs on the Realistic Medicine agenda First Hybrid Realistic Medicine Event June 22 An exciting programme has been pulled together for the event with attendance from both the Chief Executive and Medical Director who are providing presentations. Event has been widely advertised across the Board, including targeted at clinicians and GPs, and on social media. This hybrid event follows an extremely successful virtual event earlier in the year where the feedback suggested there was an appetite for a hybrid event. Covid infection risk with face-to-face events. Encouraging attendees to register for either face-to-face or virtual attendance. Cancellation of speakers due to Covid. Covid friendly conference with option for virtual attendance. VS2 Realistic Medicine / Value Based Health and Care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA44 Green Shared Decision Making Develop/educate clinicians via NES Shared Decision Making training module on TURAS October 22 Further develop/educate clinicians via discussions at Clinical Directors' forum and via new TURAS module. Liaise with Director of Medical Education to get this module included in FY1 Virtual Induction Passport. FYPD to get back with potential dates for educational programme commencing August. RM Clinical leads have been asked to speak at GP trainee education also. Lack of engagement from clinical staff to complete the TURAS module. Staff well-being following pandemic demands may contribute to fatigue and weariness to engage. FY educational programme co- ordinated by FY programme directors Publicising SDM module via Medical bulletin/ twitter and raising awareness via the CD forum and Daily Digest VS2 Realistic Medicine / Value Based Health and Care Direct promotion of shared decision making to patients allows them to understand how to get involved in the decisions relating to their care. It is hoped this multidirection approach will reach a wider audience of patients West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA44.1 Green Shared Decision Making Promote Shared Decision Making via Social Media Feed Ongoing Shared decision making post previously shared on Twitter. The aim will now be to have monthly posts on Twitter and Facebook to maintain the focus. Maintaining momentum, interest and engagement with social media platforms. Low follower engagement. A programme of regular posts and engaging material whilst sharing RM relevant posts from other HBs VS2 Realistic Medicine / Value Based Health and Care Direct promotion of shared decision making to patients allows them to understand how to get involved in the decisions relating to their care. It is hoped this multidirection approach will reach a wider audience of patients West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA44.2 Green Shared Decision Making Promote and raise awareness of BRAN Questions: (1) inclusion of BRAN questions in out- patient invitation letters September 22 (2) awareness training for clinicians of BRAN October 22 (3) promoting BRAN in waiting rooms and hospital clinics August 22 Liaise with Head of Health Records to get BRAN (Its OK to ask) questions incorporated in the out-patient invitation letters. Letter has been redesigned and awaiting this to be approved. Clinical Lead to attend the Clinical Directors' Forum to advise of plans to include BRAN questions in out-patient and posters within clinic areas. Awareness session with clinicians to be arranged. Quote awaited for printing of It's OK to Ask posters for dissemination through NHS Ayrshire & Arran. Targeting the public via outpatient letters requires sustainable resources to maintain. Clinical awareness to allow for BRAN conversations during consultations may cost more time and therefore discourage clinicians. Promotional posters require financed/ printed and displayed across health care buildings Maintaining regular contact with Head of Health Records and relevant staff to maintain success of BRAN addition to outpatient letters. Clinical awareness to be publicised at CD forum. Poster displaying in all public facing clinical areas. VS2 Realistic Medicine / Value Based Health and Care Direct promotion of shared decision making to patients allows them to understand how to get involved in the decisions relating to their care. It is hoped this multidirection approach will reach a wider audience of patients West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA45 Green Reduce Unwarranted Variation Develop Atlas Maps to identify and tackle unwarranted variation Ongoing Clinical Leads liaise with NSD Team re the Atlas and have requested consideration of flash reports for new Primary Care Atlas. GP Atlas was advertised in June Medical Director's Bulletin. Atlas of Variation for Primary Care new and awareness currently low amongst GP practices. Secondary Care Atlas of Variation currently not being populated following pandemic redeployment Examples of use of Atlas of Variation publicised as well as its existence for QIPs. VS2 Realistic Medicine / Value Based Health and Care West of Scotland Ayrshire and Arran Sustainability and value Realistic Medicine 2022-AA46 Green Reduce Harm and Waste PPE management in line with NHS Ayrshire & Arran Eco Policy Ongoing Liaising with Energy Manager regarding NHS Ayrshire and Arran Eco Policy. RM Champions have been challenged to look at eco policies within their departments, getting involved with PPE management. Lack of engagement due to pandemic apathy Encourage Reduced Carbon Footprint projects. VS2 Realistic Medicine / Value Based Health and Care West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA100 Green To increase capacity to undertake statutory Mental Health Officer (MHO) reports. To allow individuals to meet their own personal outcomes and support needs where legal intervention is required. To provide a Guardianship assessment and reporting function. Reduction in waiting times for service users. Recruitment ongoing for MHO coordinator and additional MHOs to create dedicated workforce. South Ayrshire HSCP Resource through additional funding Recruitment to posts UC1 141
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA101 Green Enhance support to care home to enable more people to be supported within care home environment and reduce unnecessary admissions Recruitment to posts Reduce unnecessary admission to MH Support the transfers of people admitted to acute Work in conjunction with existing CHLNs, ANP and psychiatry colleagues to support patients and staff within the care home setting Additional care home liaison staff are in post and offering support to care homes across South Ayrshire. Positive feedback received from both care homes and SW staff. South Ayrshire HSCP Resource through additional funding Recruitment to posts. availability of community venues and facilities to see individuals UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA102 Green Additional Mental Health Practitioners (MHP) to offer assessment and triage within GP practices to enable increased capacity of other MDT staff to focus on wider GMS contract activities. Recruitment to posts Assessment and triage of individuals at GP practice level Developing a Pan Ayrshire model for 2022/23 Confirmation of additional SG funding has been received although not awarded to date. Consolidated PC team to bring together MHPs, CLPs and SHWs. Development of scaled up model to include range of treatment and support options being developed for 22/23. South Ayrshire HSCP Recruitment to posts. availability of community venues and facilities to see individuals UC1 PCIP Primary Care Urgent Care Assessment and triage of people with mental health in GP Practices ensuring the right people and provided with the right support/service at the right time. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA105 Amber To identify and address issues impacting on GMS service delivery / sustainability and understand any potential implications early. Regular "check ins" with all practices to monitor the impact of Covid across general practice. Best practice shared for learning. 3 monthly review There are a number of GP practices struggling with recruitment of GP's and workforce capacity issues. The Primary Care Team are meeting with these practices on a weekly basis to review and provide intense support to look at sustainability options. Practices Sustainability Oversight Group being established to provide focussed oversight for those practices in difficulty. This is Chaired by the Head of Service and also includes the Clinical Directors from each HSCP area to provide wider support to the primary care team. Continued sustainability of GP practices while new GMS Contract is being implemented and practices work to re-mobilise. Bi-monthly meetings with Practice Managers and PQLs to understand issues and risks to remobilisation. Weekly Welfare Checks to high risk practices. Programme of PLT (one afternoon bi-monthly) for service development and business planning for GP practices. UC1 NHS Recovery Plan Supports access and delivery of General Medical Services to patients ensuring the most vulnerable patients with the most urgent need are prioritised. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA106 Amber Progress a digital programme to support the priorities identified by primary and community services to improve access for community practitioners and peoples of Ayrshire and Arran. Providing Comm Pharmacy and Optometry access to digital portal March 23 Agreement reached for roll out programme. Current challenges being worked through with information governance and IT Security due to Pharmacies and Optometrists being Independent contractors and not NHS employed. Engagement with Digital Services colleagues to bring this to a resolution. Dependencies on digital team providing implementation timeline. Escalation to senior colleagues within Digital services via the Senior Manager for Primary Care Services UC1 Digital Health & Social Care Strategy Supports patients to receive improved continuity of care by community primary care providers able to access and share relevant information pertinent to a patient's healthcare needs. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA106.1 Green Progress a digital programme to support the priorities identified by primary and community services to improve access for community practitioners and peoples of Ayrshire and Arran. Roll out E-Consult to GP practices Mar 23 18 GP Practices are using this platform to support patient access. 1 Practice chose to close down the use of e-consult due to reduced clinical workforce. All 18 practices have participated in engagement sessions to review the use of e-consult and shared learning across practices. A patient experience questionnaire will also be explored to provide further feedback. Regular engagement sessions continue with practices to encourage the use of this digital platform. Increased access 24/7 puts more pressure onto the practice, and all requests must be reviewed by a clinician. Until the new system is fully embedded practices may view this is an additional workload for GP Practices whilst running two systems. This has resulted in practices requesting to turn e- consult off periodically which is confusing for the public Ability to turn e-consult off when the practice is at reduced workforce capacity. UC1 Digital Health & Social Care Strategy Increased uptake by General Practice will allow more patients to communicate with their GP Practice at a time convenient to them 24/7, for follow up from the practice within an agreed timescale. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA108 Green Increase shared care, access to services and patient experience within Community Optometry. Co-Management Service - Support additional eye disease being managed by Community Optometrists in conjunction with the Hospital Eye Service. March 23 Three new Optometric Advisors recruited and progressing various workstreams. The Eyecare Integration Group has been reformed and now has regular scheduled meetings. The group are working on expanding the current shared care model to hopefully include the screening of Juvenile Idiopathic Arthritis in community practices with other potential services being discussed such as Anterior Eye Conditions. Securing funding to move to implementation. Potential lack of engagement either from acute services or community optometrists to progress The integration group membership to be reviewed to ensure appropriate representation and leadership to support implementation UC1 National introduction for co-management by Optometrists for more complex conditions. Increased Shared care between community optometrists and acute services will support reduced waiting times allowing more eye treatments to be carried out in the community. This will also reduce the need for urgent referrals due to a patient's condition deteriorating whilst awaiting an acute appointment West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA109 Green Work with General Dental Services to increase service delivery and remobilise following Covid-19. Supporting Dental Practices to increase activity where possible Ongoing 2022/23 Activity levels since the relaxation of IPC guidance in April shows that Dental Practices in NHS Ayrshire and Arran have increased activity to 90% of pre pandemic income levels. Some practices are struggling to recruit Dentists, and therefore the National Activity as described at 2.1 on the Annual Plan, for Scottish Government to maximise recruitment and retention opportunities for the dental team from UK and international graduates will be essential in recovering the Dental Sector further. PDS becoming overwhelmed should emergencies continue to increase. Oral Health Improvement Plan NHSAA Oral Health Strategy 10 year Plan 2013-2023 UC1 Oral Health Improvement Plan NHSAA Oral Health Strategy 10 year Plan 2013-2023 Covid-19 highlighted the health inequalities children and families face, therefore during the pandemic food banks, community groups and schools were given oral health products such as toothbrushes, toothpaste etc. to support home tooth brushing and this will continue whilst dental practices work to recover to pre-Covid activity levels. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA110 Amber Develop the concept of community monitoring and investigation hubs. Identify what range of investigations and procedures could transfer from being delivered in GP surgery or a hospital outpatient setting. Concept is supported due to different ways of working during the pandemic. Development groups are established to take forward by September 22. Failure to get agreement on services to be delivered as well as identify suitable sites leading to inability to implement community hubs resulting in disparate access to services across Ayrshire. Discussion required with key colleagues across the wider system to ascertain timescales and agree way forward. UC1 PCIP Caring for Ayrshire Right Care, Right Place, Right Time Care and Wellbeing Programmes This will support people to access services closer to home rather than attend an acute setting for specialist care. This will positively impact patients with reduced mobility or multi co- morbidities where travel can be difficult. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA111 Amber Implementation of contractual elements of the new 2018 GMS Contract Implement Level 1 Pharmacotherapy Service for full task transfer. March 23 Pharmacotherapy is being delivered to all Practices across Ayrshire & Arran, with all 53 Practices having full or partial access to this service. Full task transfer is difficult to measure which has been recognised across all Health Boards. Work on implementing Level 1 Pharmacotherapy Service for full task transfer will continue be taken forward for completion throughout 2022/23. As at June 2022, a total of 103.3WTE Pharmacotherapy staff have been provided to General Practice through the PCIP. Ability to identify additional professional staff to fill the new roles within the PCIP. Some GP practices unable to accommodate additional workforce capacity due to infection control guidance and increased appointment times reducing capacity. There are also growing concerns regarding accommodation within GP Premises to be able to accommodate staff. Work closely with Service Leads to identify recruitment risks. Monitor allocation of resource to practices. Utilise whole system workforce planning to forecast recruitment predictions. Following recent PCIF discussions, measures in place to look at added resilience within the service and introduce new roles to support with the task transfer and aid succession planning to ensure the service is more resilient. UC1 PCIP Caring for Ayrshire The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Implementing the new GMS contract is an opportunity to mitigate health inequalities where possible. The purpose of the work is to help people access the right person, in the right place, at the right time in line with the Scottish Government Primary Care Vision and Outcomes. Including: • Maintaining and improving access • Introducing a wider range of health and social care professionals to support the Expert Medical Generalist (GP) • Enabling more time with the GP for patients when it’s really needed • Providing more information and support for patients. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA111.1 Amber Implementation of contractual elements of the new 2018 GMS Contract Roll-out serial prescribing service to support Level 1 Task Transfer. March 23 Practices to participate in a QI project to progress and improve on the current systems and processes in place to ensure we are on target for task transfer All GP practices across Ayrshire & Arran are ‘live’ with serial prescribing. In total there are 26,711 patients in Ayrshire and Arran currently receiving serial prescriptions. This is just over 12% of all patients on repeat medicines. Recruitment to posts for key staff will be vital in order to deliver this additional work. Engagement of some practices to work with the service to implement changes to ensure safe transfer. Monitor the recruitment of staff within the service. Monitor the engagement of practices and progress of improvements. Identify any GP Practices that require further support at an early stage. UC1 PCIP Caring for Ayrshire The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Implementing the new GMS contract is an opportunity to mitigate health inequalities where possible. The purpose of the work is to help people access the right person, in the right place, at the right time in line with the Scottish Government Primary Care Vision and Outcomes. Including:West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA111.2 Green Implementation of contractual elements of the new 2018 GMS Contract Provide all practices with a CTAC service. March 23 52 of the 53 GP Practices now have access to CTAC resource. Further recruitment is underway to provide resilience within the service. There are some challenges with accommodation which is making it difficult to provide all practices with their full CTAC allocation. A test of change is being explored in the North and South Ayrshire HSCP for CTAC hub model. This test of change will support those practices with accommodation issues. As at June 2022, a total of 45.8WTE CTAC nurses and 19.3 HCSWs have been allocated across 53 GP Practices in Ayrshire. In addition to this there are now 6 Practice Educator's aligned to the CTAC service to support training and development of the nursing workforce. This is split across all 3 HSCP's and are fixed term posts for 2 years. Lack of accommodation within GP practices due to increased infection control and social distancing leading to practices being unable to access CTAC staff resulting in inequitable patient access to services. Due to the volume of MDT's being allocated to GP Practices, space is becoming a real issue and concern. Discussions ongoing with practices to identify issues and proposed solutions. Implement locality models where GP practices can't accommodate additional staff. Work to identify community hubs (as per above deliverable) or shared resource as a medium term measure. Wider planning with HSCPs in line with Caring for Ayrshire for new improved premises. Practice Educator role to provide training and support to CTAC staff across all three HSCPs UC1 PCIP Caring for Ayrshire The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Implementing the new GMS contract is an opportunity to mitigate health inequalities where possible. The purpose of the work is to help people access the right person, in the right place, at the right time in line with the Scottish Government Primary Care Vision and Outcomes. Including: • Maintaining and improving access • Introducing a wider range of health and social care professionals to support the Expert Medical Generalist (GP) • Enabling more time with the GP for patients when it’s really needed • Providing more information and support for patients. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA111.3 Green Implementation of contractual elements of the new 2018 GMS Contract Provide practices with additional professional roles to provide a MDT approach to care enabling GPs as Expert General Medicalist. March 23 Discussions have take place with HSCPs to understand priorities and recruitment plans for implementation during 2022/23. This includes additionality and resilience for all additional professional roles. As at June 2022, a total of 12.2wte Advanced MSK Physios are in place, 28.9 wte Mental Practitioners and 20.1wte Community Link Workers are in post to support General Practice across Ayrshire and Arran. Lack of accommodation within GP practices due to increased infection control and social distancing leading to practices being unable to access additional MDT staff resulting in inequitable patient access to services. Discussions ongoing with practices to identify issues and proposed solutions. Implement locality models where GP practices can't accommodate additional staff. Work to identify community hubs (as per above deliverable) or shared resource as a medium term measure. Wider planning with HSCPs in line with Caring for Ayrshire for new improved premises. UC1 PCIP Caring for Ayrshire The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Implementing the new GMS contract is an opportunity to mitigate health inequalities where possible. The purpose of the work is to help people access the right person, in the right place, at the right time in line with the Scottish Government Primary Care Vision and Outcomes. Including: • Maintaining and improving access • Introducing a wider range of health and social care professionals to support the Expert Medical Generalist (GP) • Enabling more time with the GP for patients when it’s really needed • Providing more information and support for patients. 142
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2021-AA111.4 Amber Implementation of contractual elements of the new 2018 GMS Contract Provide an urgent care service to General Practice. March 24 Each HSCP are currently identifying how they will deliver Urgent Care within their HSCP and plans are currently being put forward for spend in 2022/23. Funding will be key to allow this workstream to grow and develop. Establish a school of Primary Care model to look at 'grow your own models' for first point of contact practitioners. UC1 PCIP Caring for Ayrshire RUC The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Implementing the new GMS contract is an opportunity to mitigate health inequalities where possible. Changes to how urgent care services are accessed may positively impact patients who have reduced mobility or multi co- morbidities where travel can be difficult as there will not be a need to travel and the infection risk will be reduced. West of Scotland Ayrshire and Arran Urgent and unscheduled care Unscheduled Care 2021-AA122.6 Suspended Improve discharges across the site and support the management of patients delayed awaiting a Care Home Place or Care at Home Package A joint project with Scottish Ambulance Service (SAS) to pilot taking all patient ambulance bookings on site negating the need for ward staff to spend long periods booking transport via the West of Scotland booking line. This has not been progressed to date - will be picked up at a later date. UC1 Winter Preparedness West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2021-AA135 Green Provide a Covid-19 Therapeutic pathway to patients with worsening Covid symptoms in order to prevent deterioration and potential acute admission Recruit a small team for 12 month period to sustain delivery of a single pathway in A&A June 22 Successfully implemented in December 21. With a total of 539 patients receiving Covid Therapeutics since that time. Only 3% of patients treated have then entered into the acute system. This service will continue to be provided during 2022/23. Unable to secure workforce. Working with skillmix of staffing teams to identify sustainable workforce plans and peripatetic support. UC1 RUC Covid 19 Remobilisation & Recovery Sustainability of providing treatment to our most vulnerable patients with worsening Covid symptoms reducing the need for secondary care intervention. West of Scotland Ayrshire and Arran Urgent and unscheduled care Infection Prevention & Control 2021-AA45 Amber Re-establishment of Core IPCT Service and compliance with national IPC standards, National Infection Prevention and Control Manual and National Standards and Indicators (Reduction in CDI, SABs and ECB's) Implement the interim planned programme for 2022-23 March 23 IPCT resource continues to support Covid outbreaks within acute and community hospitals. Re-mobilisation of audit and training has progressed. Recruitment continues to prove challenging. The interim planned programme has been developed for the year 2022-23 and will remain a live document with the ability to react to changes in Covid guidance. Unknown prevalence of Covid. Recruitment due to limited IPC trained workforce nationally Continue to work collaboratively with external agencies such as ARHAI and SG to highlight the impact of Covid and recruitment challenges on IPC service UC1 National IPC Standards, National Standards and Indicators and the National Infection Prevention and Control Manual West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Inpatients 2021-AA59 Amber Sustaining safe inpatient service delivery well in excess of 85% predictor. Ensuring safe staffing levels to meet service need in excess of planned activity levels and with increased acuity. With exception of Covid-19 related absence maintaining staff absence within 22.5%. No requirement to board persons out of area. Bed occupancy in admission wards remains in excess of 90%, 95% for Older Adults. As a result waiting lists are required to prioritise admission while retaining some capacity for urgent emergency admissions. Improvement in overall staff absence through month of May and June compared to previous periods, have remained within 22.5% absence rate excluding Covid. Despite bed pressures have not required to board anyone out of area. North Ayrshire HSCP Adverse incident of person in community or inappropriate care setting awaiting psychiatric inpatient admission. Risk of poor clinical outcomes, patient experience due to inadequate staffing levels/skill mix. Reputational risk if require to board person out of area, poor care experience Bed management processes to prioritise admission referrals and identify beds for unavoidable admissions. Focus on discharge from admission and recording of Delayed Discharges for review at Discharge Liaison Groups. Generation of contingency plans including internal boarding to ensure beds available for urgent admissions. Supporting staff via Promoting Attendance Policy to sustain/improve attendance at work. Timeous recruitment to vacant posts. Daily huddle to deploy available staff to best effect - look at next 48 hour demands for early escalation of shortages. Process for reporting escalation when under exceptional pressure -beds and/or staffing. Ensuring responsible rostering practices. UC1 Caring For Ayrshire, NHS A&A People Strategy, Mental Health Act, Criminal Procedures Act, Mental Health Strategy, Ayrshire and Arran Discharge Planning Agreement, NMC Code of Conduct Persons requiring psychiatric inpatient assessment/treatment will receive the right care at the right time by a competent workforce as close to home as possible West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Inpatients 2021-AA60 Amber Managing risk of Covid-19 outbreak within MH inpatient setting. Regularly reviewed Operational Guidance to support staff to manage persons on admission until Covid-19 status known, symptomatic persons and positive cases. Minimised risk of creating outbreak by uncontrolled mixing of asymptomatic Covid positive person after admission. Effective management/containment of person symptomatic/positive to avoid outbreak. Wards being closed due to outbreaks affecting availability of beds and not being available for admissions. As with the majority of health care settings there have been outbreaks across inpatient areas and persons identified through on admission screening as being Covid positive. Without exception outbreaks have been well controlled in 2022 with little spread after the initial case was identified - test amount to effective Infection Control practices. North Ayrshire HSCP Loss of service provision due to wards closed to admission due to outbreak = increased chance of adverse event if unable to admit someone. Risk of poor clinical outcomes, patient experience due to inadequate staffing levels/skill mix. Service user/staff health impact if acquire Covid in hospital. Longer term inavailability of staff if develop Long Covid. Risk of legal/criminal processes if significant harm due to hospital acquired Covid infection - financial and statutory Increased financial cost of staffing wards to ensure safe numbers of large number of staff are absent. Asymptomatic testing on admission and at Day 5. Offering longer term patients vaccination as per guidance. Encourage staff uptake of vaccine. Monitoring inpatients for Covid symptoms. Ongoing adherence with Infection Control guidance with regards to hand hygiene practices and use of PPE UC1 NHS Ayrshire and Arran Infection Control Standards, NHS A&A Covid Testing Strategy Persons requiring psychiatric inpatient assessment/treatment will receive the right care at the right time by a competent workforce as close to home as possible. Person will not come to harm as a result of inpatient admission. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2021-AA62 Amber Development of Unscheduled Care Pathway for Children & Young People (Workforce) Workforce in place and aligned to roles July 22 Significant proportion of Charge Nurse Workforce recruited and Team Leader in post. Recruitment to Band 5 posts in July in preparation of full 7 day service being on line 7am - 9pm in November 22 North Ayrshire HSCP Delays in recruitment Accommodation capacity Accommodation requests being considered UC1 National Specification for CAMHS 2020 National Specification Neurodevelopment 2021 The Promise GIRFEC Better access across the 7 days of the week for children and young people presenting with risk or psychological distress. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2021-AA63 Amber Development of Unscheduled Care Pathway for Children & Young People (Care Pathways) Pathways established February 23 Working with Paediatric Services and Adult Services to establish pathways and synergy between services North Ayrshire HSCP Pathways between services - No local beds and dependence upon other services, namely Skye House (Regional) Woodland View Adult and Crosshouse Paediatric Services Full engagement with Paediatric and Adult Services - Request for bed capacity in Woodland View with specific CAMHS ward being sought UC1 National Referral to Treatment Targets Psychological Therapies National Specification for CAMHS 2020 National Specification Neurodevelopment 2021 The Promise GIRFEC Better access across the 7 days of the week for children and young people presenting with risk or psychological distress. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2021-AA64 Amber Reconfiguration of CAMHS Unscheduled Care Neuro Services Community CAMHS Workforce in place and aligned to roles February 23 Organisational change processes underway, Team Leaders aligned and Admin function developed to meet needs. North Ayrshire HSCP Accommodation capacity HR Function capacity Org Change process and Staff Side contribution Regular meetings planned with the APF and HR UC1 National Referral to Treatment Targets Psychological Therapies National Specification for CAMHS 2020 National Specification Neurodevelopment 2021 The Promise GIRFEC Better access across the 7 days of the week for children and young people presenting with risk or psychological distress. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2021-AA65 Amber Reduce waiting times & backlog Reaching optimum capacity of referrals to providers by August 22 External contract agreed with two key providers to add increased capacity for assessment, diagnosis and treatment North Ayrshire HSCP Capacity within external providers and internal systems being able to get enough referrals over to externals. Families preferring to wait for CAMHS Working with providers and monitoring contract on monthly basis. UC1 National Specification for CAMHS 2020 National Specification Neurodevelopment 2021 The Promise GIRFEC West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA66 Green Provision of Psychological Services to Staff Wellbeing. Monthly data activity reported to SG regarding number individuals seen, along with alignment and demographic. Increase in provision of group work and tier 1 – 2 level interventions to ensure capacity of the psychology workforce. Provision of reflective practice sessions to staff teams/wards to continue across all sectors. Reflective practice sessions from within the Psychology component of staff wellbeing, both covering acute, community and Primary Care/HSCP. Recruitment of an assistant psychologist has allowed for research project to commence. Back fill for maternity leave has commenced, meaning limited impact on service. Group work development continues in conjunction with Staffcare colleagues. Wider wellbeing work continues through Consultant supporting the wellbeing and trauma champions within the HSCP. Wellbeing Hubs have been created in the three main hospitals in Ayrshire, with a remit of providing supportive and therapeutic space for staff. North Ayrshire HSCP Short term funding of 8a post expires March 23. Psychology has funded a temporary bd7 post PT to cover maternity leave. Potential for extension being discussed to cover loss of 8a role. UC1 A&A Health, Safety and Wellbeing Everyone matters, 2020; Health Workforce Vision, SG, 2013. 143
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA67 Green Maternity and Neonatal Psychological Interventions (MNPI) and Perinatal CMHT service developed from dedicated SG funding. MNPI recording of national outcomes has commenced with consultation with national Psychology group. Local collaboration with IT and Information Governance to ensure adequate data capture and online case-note taking systems are in place. Both services have reached full staffing, although vacancies have arisen through natural attrition within nursing and OT. Further developments have occurred in terms of the creation of an Infant Mental Health service, which will sit alongside both teams. Both Psychology and Nursing have recruited, with start dates approximately September 22. OT and admin recruitment is in progress. North Ayrshire HSCP OT and nursing vacancies Both posts will be advertised in the coming weeks; consideration of consolidation of OT post with IMH to increase attractiveness UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA68 Green Intensive Care Unit Psychology Service in line with the national Cossette Report recommendations. The service will formalise the provision of psychological services to the population who have been admitted to ICU, with initial aims linked to the recommendations of the Cossette Report. Continued work has ensured that approximately 75% of the hospitalised Covid population have been contacted regarding their experiences and needs, in line with recommendations from the Cossette Report. This has been achieved through the support of a fixed term assistant and dedicated administrative cover. It is hoped this will reach 100% by end of 2022. SG funding is fixed term until March 23 but Lead Partnership has given support to recruit to a permanent contract for the Lead Psychology post. North Ayrshire HSCP Loss of assistant due to natural attrition Funding for assistant will continue to be provided from within core budget for Psychological Services. UC1 Cossette Report West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA69 Green Neurodevelopmental Strategy and Empowerment Team. To provide a cost-effective Neurodevelopmental Strategy and Empowerment Team coordinating a robust online and physical information service, the Considerate Communities award scheme and pre/post assessment programme. This work will be in partnership with clinical services, 3rd Sector and government agencies. Service delivery is now underway. Appointments to the Programme Lead and Project Lead posts have been made. Website will be launched imminently. Links with local clinical and 3rd Sector services established and a rolling programme of training will be available in the coming months. Awaiting identification of physical base for team to ensure wide accessibility for the community and to allow the Service to meet all its key performance indicators. North Ayrshire HSCP Lack of availability of physical base. Mitigation of absence of physical base will be made through temporary booking of meeting/ training spaces in the community and working from home for members of the Team. However, this does limit accessibility of the Service for members of the community. UC1 Scottish Strategy for Autism Ayrshire & Arran Strategy for Autism Scottish Government Learning/Intellectual Disability & Autism: Transformation Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA70 Green External service commissioning for neurodevelopmental assessments within Community Paediatrics. Procure external provider. Create data Protection Impact Assessment. Monthly feedback regarding case completion and impact upon waiting lists within Community Paediatrics Patients on Community Paediatrics Psychology neurodevelopmental waiting list are now being sent to external providers. Pathways for and processes have been developed and refined and are working well. North Ayrshire HSCP Lack of capacity in external providers. Communication with external providers to ensure capacity is sufficient to meet service needs. Preparation to engage with additional providers if required. UC1 SG waiting times guarantee for Mental Health Services. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2021-AA71 Green To clear waiting time backlogs by March 2023 as specified in the MH Recovery and Renewal Funding with additional Psychological Therapies staffing resource from dedicated allocation. Appoint to vacancies within established posts. All posts to sit within our established clinical multi-disciplinary teams where there is clarity on the focus of their additionality and where there are established referral criteria and pathways. Local data analysts, with support from SG data analysts, to develop a waiting times trajectory plan to identify requirements to achieve and sustain 90% waiting time compliance for PT by March 23. The SG funding allocations have been utilised. New postholders will be appointed through 2022. Recruitment to vacancies within established posts is being progressed through local and national recruitment drives and reconfiguration of posts to increase attractiveness in the current competitive context. Awaiting confirmation of further SG funding for PT to progress identified priorities for backlog and unmet need. Trajectory plan, using PHS national model, has been applied to two clinical services. Expansion of the trajectory plan for the whole service is currently being developed. Current waiting time compliance is 90.6% May 22. This additionality is not sufficient to meet unmet need in clinical service areas where demand is managed relative to available capacity. North Ayrshire HSCP Inability to recruit to new and vacant posts to develop the required staffing capacity to achieve and sustain waiting time compliance. Reconfiguration of posts to increase attractiveness - permanent contracts, variation in contracted hours, skill-mix, banding, split-posts UC1 Psychological Therapies Waiting Times standard. MH Recovery and Renewal Fund. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2021-AA72 Green Prioritise recovery from drugs and alcohol to significantly improve outcomes for service users Comprehensive clinical assessment & recovery focussed treatment support to clients with a range of alcohol and drug problems including mental, sexual and physical health related issues. Involved in alcohol detox, ORT and medication monitoring, RADAR, Duty. General waiting times targets will be met. Implement MAT standards in line with Drug Death Task Force Investment. August 22 RADAR is now operational and has shown a 15% increase in referrals to treatment services. East Ayrshire HSCP Recruitment and retention of staff. Lack of suitable premises/infrastructure to support delivery. Team remodelling to support delivery. Infrastructure investment in line with Caring for Ayrshire. UC1 East Ayrshire ADP Strategic Improvement Plan 2020-24 New Treatment Standards (MAT) for Drug Users Everybody Matters - Preventing Drug Related Deaths: A Framework for Ayrshire & Arran 2018-2021 East Ayrshire HSCP Strategic Plan 2021-2030 People affected by drugs and alcohol are some of the most marginalised in society. Supporting them into treatment support services provides early access to the relevant support service enabling change to begin and making recovery possible. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2021-AA73 Green Provide Trauma Training Addictions Services – Decider Skills. Purchase external training to provide trauma training for new staff who have and will be joining the team in keeping with MAT Standards. Will be arranged for later in the year November/December 21 when all new staff have joined the team. Trauma training continues to be delivered as new staff join the team. East Ayrshire HSCP are identifying a key post holder to continue to drive improvements. East Ayrshire HSCP Team pressures and vacancies could result in lack of focus. Dedicated post holder will support on-going key deliverables are met. UC1 East Ayrshire ADP Strategic Improvement Plan 2020-24 New Treatment Standards (MAT) for Drug Users Everybody Matters - Preventing Drug Related Deaths: A Framework for Ayrshire & Arran 2018-2021 East Ayrshire HSCP Strategic Plan 2021-2030 Many people who have drug and alcohol issues experience multiple complex traumas. This impacts on their ability to manage their lives effectively and so lessens the opportunities available to them in terms of training, employment which contribute towards improved outcomes and less inequalities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA74 Amber To support people with severe and enduring mental health problems and introduce Physical Health Checks with patients attending Depo clinics. Support improved physical health for people with severe and enduring mental health problems. Less crisis admissions to acute care. Job description is going through job evaluation. Recruitment will follow. East Ayrshire HSCP Delays in recruitment. Primary and acute care support till posts holders are in place. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Framework for supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic 2021 The inter-relationship between poor mental health resulting in poor physical health and vice versa is well evidenced. Living with these diagnoses results in reduced opportunities and in some instances premature death. Supporting improved physical health will help to reduce the inequalities gap for this population. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA75 Amber To provide early intervention for mental health and wellbeing within the community through support to GP Practices. Rapid access to mental health support. Self- management. Early intervention to prevent deterioration of symptoms. Mental health practitioners in place in all GP practices. Self help workers are aligned to promote self management approaches. East Ayrshire HSCP Short term funding for 3 self help worker posts Considering other sources of funding to minimise impact on outcomes. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Framework for supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic 2021 Supporting early intervention and prevention in Primary Care reduces stigma often associated with mental health problems. Improving access for new people presenting enables the right support at the right time early in the person's journey. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA76 Red To increase capacity to undertake statutory Mental Health Officer (MHO) reports. To allow individuals to meet their own personal outcomes and support needs where legal intervention is required. To provide a Guardianship assessment and reporting function. Reduction in waiting times for service users. Significant pressures on MHO staffing compliment creating risks in relation to fulfilling statutory responsibilities. East Ayrshire HSCP MHO recruitment/retention. Increase in volume and complexity of people requiring support from MHO. Disparity across the country in terms of remuneration leading to attrition. Chief S/W dedicated focus to support improvement plan. Focused recruitment drive around qualified S/W posts. Caseload management to free up capacity to support compliance with legislative requirements. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Mental Health (Care and Treatment) (Scotland) Act 2003 Adequate MHO capacity is required to ensure the rights of the individual are protected. Lack of capacity in this area jeopardises this and risks people with mental health, learning disability and addictions being subject to measures which are not person centred or proportionate. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA77 Green Sustain and further develop the broad range of wellbeing supports and activity established through the Wellbeing Coordinator and associated resources. Wellbeing Newsletter developed with information on wellbeing support and resources. Wellbeing Learnpro Module developed on workforce wellbeing. Mindfulness Course developed and delivered Lifestyle Medicine Project developed and delivered in partnership with Kilmarnock GP Practice. Training in mindfulness and self-care. Wellbeing Sessions undertaken with Independent Care Home Sector. 70 1:1 workforce wellbeing sessions undertaken since 1 April 2021. Finding Inner Calm Programme developed and extended to include Care Homes, HSCP, Educational Services. Milestone targets achieved. Continued focus to embed the cross- cutting wellbeing partnership arrangements established during the pandemic to ensure continuity of legacy actions and maximise the opportunities for collaboration Range of workforce wellbeing supports developed in response to winter and system pressures including: Community Wellbeing Hubs with access to restroom facilities to aid rest and recuperation for primary care and social care staff working in the community; First Aid for Mental Health programme developed targeting the primary care and social care workforce including the 3rd and independent sectors in collaboration with the EAC Health Working Lives Team; communication and promotional materials and resource packs produced and distributed; Finding Inner Calm and Mindfulness wellbeing interventions delivered to ensure workforce has full access to supportive wellbeing options. East Ayrshire HSCP Increased demand for wellbeing supports and interventions arising from workforce and system pressures. Impact of work-related stress on wellbeing and absence levels. Ongoing monitoring and review. Oversight through HSCP SPG UC1 CPP Wellbeing Delivery Plan 2021-24 East Ayrshire HSCP strategic plan 2021-2030 Covid-19 Recovery and Renewal Framework Physical and psychological supports firmly focussed on proactive preventative action to support employees deal with workforce and system pressures West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA78 Green To assist in the introduction of Trakcare within Adult MHS and to maintain the system when in place. Develop system ensuring all referrals are actioned through E vetting. Develop audit and reporting procedures All referrals actioned through E vetting and follow up appointments booked on Trak. Audit reports in progress and 18 week reporting progressing using a collation of data from databases and trak. 90 % Complete North Ayrshire HSCP Backlogs in getting outcomes and appointments etc onto the system in a timely manner due to staff absence. Waiting lists are being scrutinised and any queries resolved promptly in conjunction with the project team. Meetings set up with team leaders and data analyst to familiarise them with the reports available. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Adult with Incapacity (Scotland) Act 2000 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health AHP 2021-AA79 Green Reduction of waiting times to CMHT Occupational Therapy Service- to meet RTT target of 18 weeks. Provision of OT assessment and interventions to individuals with mental health difficulties that impact on their independence in Activities of Daily Living. Milestone target has been exceeded and work will continue to maintain East Ayrshire HSCP Non-recurring funding for 2 key OT posts which jeopardises the progress made leading to poor outcomes for people. Consideration of alternative routes of funding to support maintenance of progress. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Framework for supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic 2021 Many people with severe and enduring mental health problems experience a significant impact on their ability to maintain their daily functioning. Lack of a dedicated focus around functional assessment and care planning to support improved outcomes will result in lack of opportunities for this population. 144
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA85 Amber Additional Mental Health Practitioners (MHP) to offer assessment and triage within GP practices to enable increased capacity of other MDT staff to focus on wider GMS contract activities. Source Funding by 2nd quarter of financial year. Progress recruitment to ensure resource in place by end of financial year Service that ensures an individual with mental health difficulties presenting at general practice can be seen by a MHP by beginning of new financial year (at latest, ideally within this current financial year). Funding from Mental Health in Primary Care investment requested to uplift MHP numbers to previous business case, with additionality to cover for absences (akin to other primary care development funding). Awaiting SG feedback on allocation based on proposal submitted. In anticipation of funding, we have relevant paperwork completed to progress to recruitment ASAP. North Ayrshire HSCP Without full business case implementation with appropriate uplift there continues to be exponential demand on GP’s for mental health concerns. As such, there is a risk of delay to assessment, duplication of effort, delay to treatment etc, until fully funded. • Currently there are no mitigations that can be put in place, without having a negative impact on other practices. • Where possible, we have spread the MHP resource, primarily based on demand. • In partnership with East and South Ayrshire, we plan to recruit together to minimise risk of recruiting from same pool, and hopefully not depleting existing services. A publicised targeted recruitment drive would hopefully bring others from out with area. UC1 Caring for Ayrshire Primary Care Implementation Plan Mental Health and Wellbeing in Primary Care This will ensure that at any time an individual with mental health difficulties presenting at general practice can be seen by a MHP, this will ensure Right person, first time principle. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA86 Amber To increase capacity to undertake statutory Mental Health Officer (MHO) reports. To allow individuals to meet their own personal outcomes and support needs where legal intervention is required. (1) Recruit Staff for both parts of the service by 2nd quarter of the year. (1.1) Revised MHO Service will include Guardianship reviews across North Ayrshire Partnership, this and guardianship applications will be the initial focus of this Team. (1.2) Revised Care Management Team, will review care and care provision of service users and work with care providers to ensure service users are receiving the care they require. After a successful pilot in North Ayrshire it was agreed that the Mental Health Social Work Team would separate into 2 Teams – Mental Health Officer Team and Social Work Care Management Team. Funding has now been provided by North Ayrshire Health & Social Care Partnership to ensure the sustainability and deliverability of this new model. Whilst navigating recruitment processes, Agency Social Work and MHO posts have been implemented (although to varying degrees of success) North Ayrshire HSCP Ability to recruit to posts Adjustments to the MHO payment in North Ayrshire will hopefully attract social workers and MHO’s from other areas and from training. Consideration of MHO training opportunities to ensure quantity, quality, and continuity of training. Utilisation of agency staff where possible, to plug gap until successful recruitment. UC1 National Care Service Mental Welfare Commission (regarding MHA and AWI Legislations) The implementation of this new model will enable legislative timescales to be achieved and met, including Guardianship applications and Guardianship reviews, which will help delayed discharges and planning of care for the residents of North Ayrshire. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA87 Red Referrals have increased into the service, additionality will ensure timely assessment and treatment of these individuals. Ability to respond to increased demand of CMH service. As such, there is a requirement to increase nursing staff to meet increase in demand and current deficit in capacity Requirement to increase nursing staff to meet increase in demand and current deficit in capacity Submit pressure bid highlighting shortfall in staff (8 WTE CPN's required to address current shortfall). Complete Updated papers being submitted to PSMT with new risk mitigations. Complete Further contingency planning arrangements enacted to ensure safety and wellbeing of staff and service users. Ongoing Recruitment still remains a challenge and have been unable to recruit to posts. No further forward in terms of staffing uplift. North Ayrshire HSCP 1) Patient experience or outcome 2) Staffing and competence 3) Service / business interruption 4) Objectives and projects 5) Injury (physical and psychological) to patient’s staff. 6) Complaints / claims Risk is not mitigated fully at this time. Short term control measures have reduced some risk, but not of significance as such, risk has been entered onto risk register. Further control measures required to further mitigate risks without requested investment. Without this, we will be unable to stabilise core service. Current control measures: a) Reduced the frequency of assessments clinics. We are now at the point where our clinics just meet demand and these cannot be reduced any further. b) Appointment of a short- medium term CPN to carry out all triage activity. c) We have implemented ‘Live documentation’ this is to reduce work pressures in having to return to base and type up all notes. d) Reduction of duty hours to 9am-5pm, akin to core hours. Long Term control measures: 1) There requires to be investment in CPN in terms of finance of new posts. 2) There requires to be investment in CPN in terms of training and development. UC1 The Scottish Government have recently engaged a piece of work regarding secondary mental health service, in which community mental health services will be included. Parity of esteem is spoken about between, physical and mental health and tackling this Health inequality was paramount in government papers, however we are now seeing an inequity within Mental Health Services themselves, investment in specialist services has been the focus in recent years – however Core Service has not had parity in terms of investment resulting in inequality in care provision across the spectrum of MH care treatment. If funding is delivered, these core services will be able to tackle the incoming increase in referrals (40% increase in recent years) that has resulted as we move out of the pandemic. North Ayrshire has extremely high social deprivation and as such inequalities abound. Investment will mean that those who require mental health care and treatment will have access to services at the right time from the right person. Investment will also mean that those requiring same day care and intervention from core service will receive this. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Unscheduled Care 2021-AA92 Green Redesign of Mental Health Urgent (Unscheduled) Care Service Deliver a 24/7 Emergency Services Mental Health Pathway May 22 Deliver an Alcohol and Drug Liaison Service to operate 7 days June 22 Develop a Mental Health Unscheduled Care Assessment Hub to be situated within Ward 7B, Woodland View. Awaiting outcome of option proposal. Likely to receive July 22. Following securing further Action 15 monies all posts are filled. The ESMHP went live from the 3oth May 24/7. The Alcohol and Drug Liaison Team (ADLT) currently delivering a 5 day service North Ayrshire HSCP The possibility that referrals to the Pathway may outstrip capacity, especially now that SAS can access the pathway. Accommodation requested for the Alcohol and Drug Liaison Team within Mental Health Unscheduled Care Service at Lister Street. If this is unsuccessful then service provision will be affected. Monitor and review the data as well as review current workforce across the whole of Unscheduled Care MH to ensure that staffing is adequate to deliver the pathway. If we are unable to secure accommodation we will have to utilise a blended approach for agile working. This could however have an impact on service response times. UC1 Urgent and Emergency/Unscheduled Care Redesign of Urgent Care (Locally & Nationally) Caring for Ayrshrie Parity of esteem between, physical and mental health West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2021-AA94 Green Responding to increased demand for services and increased caseloads. Exploring use of remote clinics in non- NHS venues, increasing Near Me uptake. Development of outreach strategies and increased Naloxone provision Increased number of clinical venues within the community to see individuals as part of MAT standards roll out. South Ayrshire HSCP Recruitment to posts, availability of community venues and facilities to see individuals UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2021-AA96 Green Meet all ‘Access to Treatment Time’ Standards. Service to continue to be adaptable, available and flexible in supporting new clients receive treatment appropriate to their recovery. 90% of clients referred to commence treatment within 3 weeks 100% of clients to commence treatment within 6 weeks Complete and ongoing South Ayrshire HSCP Resource through additional funding Recruitment to posts UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2021-AA97 Amber To support Addiction workers to work more agile. Purchase laptops for community venues /facilities to provide addiction services (rather than in NHS Clinic Space). Following review of existing equipment and technology it was identified that iphones offered more versatility either as connection option for existing laptop or for telephone/NearMe consultations in alternative community venues. South Ayrshire HSCP This equipment was ordered many months ago however supply issues have meant that they have yet to arrive. UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA98 Amber Reintroduce range of therapeutic options. Delivery of group based interventions: Creative group. Increase number of individuals taking part in therapeutic groups Group based interventions - some now up and running although roll out has been challenging due to limited community venues and suitable accommodation. South Ayrshire HSCP Resource through additional funding Recruitment to posts. availability of community venues and facilities to see individuals UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2021-AA99 Green Increase range of treatment options and create capacity for wider service redesign. Delivery of decider skills. Development and implementation of care pathways. Provide clinical assessment and treatment to people referred to CMHT/PCMHT First decider skills group planned for September 2022 South Ayrshire HSCP Resource through additional funding Recruitment to posts. availability of community venues and facilities to see individuals UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Implement, evaluate and improve our delivery of the new Medication Assisted Treatment (MAT) Standards By March 23 MAT Standards 1 is partially implemented (Rag status - Amber) whilst Standards 2 to 5 are fully implemented (Rag status - Green). New Improvement Plan to be agreed by August with MIST support team North Ayrshire HSCP Full MAT delivery - delays or inability to recruit to key posts since by June 2022, no confirmation received from the Scottish Government regarding MAT funding. Also challenges with HR timescales in job evaluation processes. Work with the SG to transfer the MAT funding to HB and recruit to essential posts UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47.1 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Delivery of Alcohol Brief Interventions (ABI) and meet the national standard By March 23 Engagement and processes in place with services across Priority and Wider Settings. Further ABI training made available over the next 3 months North Ayrshire HSCP UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47.2 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Implement, evaluate and improve the new Non Fatal Overdose (NFO) response pathway By March 23 NFO response pathway in place. Continuing to work with key partners, including the Scottish Ambulance Service, to improve the overall pathway. North Ayrshire HSCP UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan 145
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47.3 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Continue to deliver training on Naloxone and continue to supply Naoxone to priority settings By March 23 Detailed Improvement Plan in place identifying key partners who could benefit from the roll out of Naloxone training and supply. North Ayrshire HSCP UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47.4 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Work with partner services to increase and improve the support for individuals with a 'Dual Diagnosis' By March 23 Updated 'Dual Diagnosis' Care Pathway is in the process of being signed off by key partner services. Plan is to deliver multi agency awareness sessions over the next year and to re-establish inter team Community Mental Health Team Alcohol and Drug Services clinical and support meetings. North Ayrshire HSCP UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA47.5 Green Reduce the number of drug and alcohol related deaths through the implementation of local plans and responses Deliver and meet the new 'Substance Use Treatment Target' 959 individuals will receive supportive treatment in North Ayrshire By April 24 Measures in place, including access to MAT, to ensure an increase to the number of people in protective treatment. North Ayrshire HSCP UC1 Medication Assisted Treatment (MAT) standards: access, choice, support; Scottish Drug Deaths Taskforce - Forward Plan (2021-2022) Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland - Our Emergency Response; Improving Scotland's Health - Rights, Respect and Recovery; North Ayrshire ADP - Preventing Drug Deaths Action Plan West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA48 Green Ensure quick access to treatment for individuals with alcohol and drug problems by meeting the national 'Access to Treatment' waiting times Standard Ensure that 90% of individuals referred for alcohol and/or drug treatment commence treatment within 3 weeks of referral; By March 23 Ensure that 100% of individuals commence treatment within 6 weeks By March 23 Individuals receiving quick access to treatment. Most recent verified data confirms that 99% of individuals were commenced on treatment within 3 weeks and 100% of individuals were commenced on treatment within 6 weeks. North Ayrshire HSCP UC1 National 'Access to Treatment' Standards West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA49 Amber Support implementation of the Alcohol and Drugs Partnership Strategic Plan 2020-24 Early intervention for individuals, families and communities to prevent issues from arising. Promotion of recovery. Reduction in stigma. Reduction in trauma. Good progress around implementation of MAT Standards 1-5. Further progress being made in relation to progressing MAT 6-10. Key post holder being recruited to support anti-stigma approaches across East Ayrshire HSCP. Scale up of local grass roots funding has supported more people with lived experience being able to lead and direct innovative approaches to recovery. Feedback from lived experience representatives is positive in supporting people to get support early in their journey. East Ayrshire HSCP Issues with recruitment and retention jeopardises the progress with MAT 1- 5. Additionally further emphasis is required from Primary Care and Justice services to promote compliance with MAT Standards in these settings. Support from HR and scrutiny to minimise recruitment delays. Strategic groups established to ensure momentum in Primary Care and Justice settings to support MAT delivery. UC1 East Ayrshire ADP Strategic Improvement Plan 2020-24 New Treatment Standards (MAT) for Drug Users Everybody Matters - Preventing Drug Related Deaths: A Framework for Ayrshire & Arran 2018-2021 East Ayrshire HSCP Strategic Plan 2021-2030 People affected by drugs and alcohol are some of the most marginalised in society. Supporting them into treatment support services provides early access to the relevant support service enabling change to begin and making recovery possible. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Addiction 2022-AA50 Amber Utilise MDT approach to increase access to residential support for Drugs and Alcohol Services Ready access to residential rehabilitation places.Targeted,person centred approach to lifestyle change. Retention in residential programme. Improved outcomes for individuals following placement. S/W post has been recruited to. Referrals are being processed. Contracting agreements are being developed to support placements and demonstrate robust model of support and effective support outcomes. East Ayrshire HSCP Small numbers of individuals seeking residential rehab placements. Inability to meet national target, approx 7 per annum. Supporting staff to consider individuals seeking residential support options. Marketing to support uptake. UC1 East Ayrshire ADP Strategic Improvement Plan 2020-24 New Treatment Standards (MAT) for Drug Users Everybody Matters - Preventing Drug Related Deaths: A Framework for Ayrshire & Arran 2018-2021 East Ayrshire HSCP Strategic Plan 2021-2030 Access to residential rehabilitation for some people using drugs and alcohol is an essential element to support improved outcomes and recovery some individuals. Lack of access to this type of support has been an inequalities issue recognised by SG hence new, welcomed investment. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health AHP 2022-AA51 Green To support the vision from the 2018 General Medical Services Contract (Scotland) and recent MOU (2021) for GP Practices to receive additional professional services, GP practices will be supported by an Occupational Therapist. The ambition is to maximise the contribution of Occupational Therapists in providing earlier interventions to people with mental and/or physical health needs. The programme will also enhance the Occupational Therapy Frailty Pathway to identify people in mild to moderate stages of frailty; and to work with individuals proactively to maintain or improve levels of frailty. Occupational Therapists will be based or closely aligned within practices providing assessment and interventions for individuals with mental and / or physical health and/or frailty needs who are experiencing an impact on their occupational performance to enable independence and prevent further decline for individuals, at the right time and in the right place. Recruitment supported via the funding of Permanent posts has been successful. Funding was secured via action 15 (3 posts) and the South Ayrshire HSCP (10 posts). Recruitment is ongoing for a further 2 posts. Engagement with practices across Ayrshire is ongoing with sessional work commenced across 11 of the 15 practices within South Ayrshire. Work will continue to provide coverage to all GP Practices within the South Ayrshire partnership. South Ayrshire HSCP Recruitment challenges and ability to fill posts Service pressures and ability to meet deliverables For all areas continue to explore innovative ways to recruit and remobilise services post Covid. UC1 Mental Health Strategy 2017-2027 South Ayrshire HSCP strategic plan 2021-2030 Framework for supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic 2021 Caring for Ayrshire AHPs are able to achieve earlier intervention and see patients right place, right time to enable more positive patient outcomes. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health AHP 2022-AA52 Amber To meet the ongoing demands of the AHP service to improve patient outcomes and deliver the right care in the right place by the right person Secure funding for permanent posts Complete Progress recruitment Ongoing Permanent funding received from North Ayrshire HSCP and agreement to recruit to posts on permanent basis which has been successful with the exception of Speech and Language Therapy. Have reviewed role and will go back out to recruit on amended role with greater confidence to recruit. North Ayrshire HSCP Recruitment challenges and ability to fill posts Service pressures and ability to meet deliverables For all areas continue to explore innovative ways to recruit and remobilise services post Covid. UC1 NAHSCP Strategic Plan Caring for Ayrshire AHPs are able to achieve earlier intervention and see patients right place, right time to enable more positive patient outcomes. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2022-AA53 Green Delivery of National Secure Adolescent Inpatient Services (NSAIS) "Foxgrove" Pathways agreed Q3 2022/23 Workforce agreed and in place Q4 2022/23 Unit Operational Q4 2022/23 Recruitment delayed due to NSD North Ayrshire HSCP Delays in recruitment Referrals NSD Decision making Regular stakeholder meetings UC1 Mental Health Strategy 2017-27 Child & Adolescent Mental Health Services: national services specification Children and adolescents will be provided with the complex mental health care and support services they need within an appropriate environment in Scotland West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2022-AA54 Green Prevent admission of under 18s to Intensive Psychiatric Care Unit (IPCU) Soft Launch in Jul/ Aug - 7 day working All Band 6 Charge Nurse posts recruited to. Soft launch imminent - staff will work 7 days from 9am -5pm North Ayrshire HSCP Recruitment and Retention of staff Accommodation capacity UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health CAMHS 2022-AA55 Green Develop and implement service to provide an early intervention for people with a first episode of psychosis Develop Pathway March 23 Initial conversations being had. Operational Responsibility and model to be explored North Ayrshire HSCP Clinical Governance framework & accountability yet to be decided UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA56 Green Increase access to diagnostic support for patients with dementia Recruitment to posts Develop Care Pathway Post diagnostic support staff in post. CST groups now up and running in Troon, Prestwick and Ayr. Girvan planned for August 2022 South Ayrshire HSCP Resource through additional funding Recruitment to posts Post Covid delays in patients presenting and therefore further along their illness trajectories consequently may have difficulty with understanding See families and provide support UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA57 Green To carryout a workforce analysis to ensure the right people are in the right place to meet service need To provide Link Workers in every GP Practice to link people to voluntary and third sector support Adequate Community Mental Health Team to respond to the new National Mental Health standards for CMHT Recruitment complete for community link practitioners. Now secured 10 CLPs across South Ayrshire servicing every GP practice as well as offering specific locality based support to the Wallacetown area. Workforce analysis completed in CMHT which identified shortfall in capacity. Additional funding being sought from range of funding options. In interim, clinical activities are being RAG rated and prioritised to ensure risks are reduced as much as is possible. South Ayrshire HSCP Resource through additional funding Recruitment to posts UC1 146
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA58 Amber Identify essential infrastructure for service bases and for delivering interventions i.e. group therapy and one to one treatment. Carry out a scope of accommodation across the NHS and Local Authority estates portfolio so as to be able to provide interventions as close to local communities as possible. By October 22 New key deliverable North Ayrshire HSCP Without this essential infrastructure it will be difficult to stabilise and reform. Utilisation of digital platforms for on-line groups Exhaustions of NHS/ NAC facilities Exhaustions of community resources available Funding of external opportunities Purchase of accommodation appropriate to needs UC1 Delivering Core Service. Accommodation will ensure that services, care and treatment is delivered local and as close to the individual requiring this care and treatment as possible. Without appropriate accommodation, waiting lists are likely to increase, with potential for associated risks. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA59 Green Deliver key 2021-22 actions and improvements identified in the Suicide Action Plan Reduce deaths by suicide. Increase staff and community awareness in line with NES training framework. Deliver outcomes in line with national suicide prevention strategy. Review all deaths by suicide to support learning and improvements. Actions included in 21/22 action plan were progressed. Also contributing to the review of national suicide strategy to inform new approach. Seeking to recruit dedicated post holder to support progress in relation to East Ayrshire's action plan. East Ayrshire HSCP Lack of dedicated , full-time resource to support this agenda. This important issue becomes subsumed into a range of additional priority areas. Re-energise the agenda to support key improvements. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030, Every Life Matters 2018 Inequalities is a key issue for those at risk of suicide. Lack of opportunity, trauma, the increase in cost of living, debt and lack of employment each have the capacity to result in people feeling hopeless, helpless and at risk of considering suicide. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA60 Amber Implement Distress Brief Interventions pathways Improved pathways for people in distress Ayrshire is an associate to the national DBI programme. Pathways are being scaled up in GP practices and ED Ayr. Penumbra is the delivery partner and North Ayrshire leads on contract monitoring. East Ayrshire HSCP Lack of progress with scale up across all Ayrshire GP practices. Lack of scale up in ED due to competing pressures. Both could result in disinvestment in DBI programme. DBI board is operational and scrutinising data. Formal review is scheduled to be undertaken to support scale up. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030, Every Life Matters 2018 Often people present in distress as a result of poor home circumstances, trauma and many of the inequalities that result in poor personal outcomes. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA61 Amber Re-design Adult Mental Health Services to simply access pathways Clearer Access Points for individuals and referrers to mental health services and supports. Better outcomes for individuals with mental health issues. Early intervention and prevention/ self management approaches for people with milder symptoms. Clear treatment pathways for mild and more severe conditions. Mental Health Practitioner 's, self help workers and community connectors in Primary Care support early assessment and signposting to community support organisations. Additionally guided self-help supports development of self management for lower level symptoms. East Ayrshire HSCP Lack of recurring funding for 3 self help worker roles funding via remobilisation funds could result in more reliance on more formal supports. Consideration being given to alternative funding routes to support retention of staff. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Framework for supporting People through Recovery and Rehabilitation during and after the Covid-19 Pandemic 2021 Focusing on self management, early intervention and prevention helps prevent worsening of symptoms and enables individuals, families and communities to be more mentally well. This in turn promotes better outcomes. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Community 2022-AA62 Green Undertake a review of the provision of 24 hour packages of community based supports: Right Support in the Right Way at the Right Time Fewer people reliant on paid supports on an individual 1-1 basis. Sharing of support services across a close geographical area. Use of technological devices in order to reduce in person support where indicated. Robust risk assessments to ensure safety and well being outcomes are maintained. People live more independent lives and develop personal self management skills and confidence. Numerous responder hubs are operating across East Ayrshire with staff support hubs available for ad hoc supports. Further responder hubs are in the planning stages. East Ayrshire HSCP Implications for provider sustainability as formal overnight supports are reduced. Deterioration of people's condition resulting in increased care and support needs. Providers are made aware of the intention to support individuals to live as independently as they are able. Additional opportunities are available for providers to consider. Careful planning and assessment of individual capabilities is undertaken and very gradual, individualised reduction in support hours are made. If a person requires additional support at any time, this is assessed quickly and facilitated. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Adult with Incapacity (Scotland) Act 2000 Traditional models of support for people with learning disabilities was limiting in terms of independence and created a reliance on formal supports rather than enhancing life skills. This approach goes some significant way to redressing the balance. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Inpatients 2022-AA63 Amber Consideration of extended response service for those 65 and over, at home Band 6 secondment for 12 months to scope effectiveness of outreach model to facilitate early discharge and prevention of admission/readmission in association with South CMHT(E). Expect report out at September 23. Recent addition to Elderly Liaison services will be reviewed and considered with outreach model above what preferred new service could be. Initial agreement given at North PSMT, paper being presented to SPOG for sign off in July 22. North Ayrshire HSCP Continued increased demand for inpatient beds beyond capacity. Risk of adverse event in community/inappropriate care setting of person awaiting psychiatric inpatient bed. Risk of admission when community support could/should have been offered. Requirement to place person in out- of-area bed if no capacity in A&A. Input from CMHT€ Out-of-hours support from unscheduled care services Input from Elderly Liaison services to persons in Acute Hospital and Community Hospital settings Effective discharge planning UC1 Caring For Ayrshire, Mental Health Act, Dementia Strategy, Mental Health Strategy, Ayrshire and Arran Discharge Planning Agreement, NMC Code of Conduct Persons requiring psychiatric inpatient assessment/treatment will receive the right care at the right time by a competent workforce as close to home as possible West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Inpatients 2022-AA64 Amber Re-provision of Forensic Rehabilitation Services within a community setting at Warrix Avenue To develop outline business case by March 23 Briefing paper to describe request/ambition yet to be tabled at North OSMT, SPOG - presumably IPB for consideration/approval. Will aim to do so by September 22. North Ayrshire HSCP Current provision in Ward 7C both benefits from co-location and is hindered by being in a hospital setting. Success of Warrix Avenue has proven this could be done differently and embrace rehabilitation benefit/freedom being in community setting would bring. Current service being successfully delivered from 7C. Warrix Avenue provision useful to inform this future plan. UC1 Caring For Ayrshire, Mental Health Act, Criminal Procedures Act, Mental Health Strategy, Ayrshire and Arran Discharge Planning Agreement. Support destigmatisation of 'Forensic' population by being placed in the community. More effective delivery of service by being in the community. Equitable service for this client group by being placed in the community as are those in Warrix Avenue. Less restrictions as would not be in a Hospital setting West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA65 Amber Enhance Mental Health and Learning Disability teams to support complex care in the community, avoiding acute admission and supporting timely assessment and review. Job Descriptions for Nursing Staff (anticipated Band 6 and Band 3) submitted for Job Evaluation - June 22; Set up steering group - June 22 Develop relevant evaluation plans/capacity - September 22 Complete recruitment to ISS - October 22 Establish team and initial ways of working/links to existing services - First meeting of planning group linked to LD Intensive Support Service took place in June 2022, with a focus on the need to progress job descriptions for various team roles. Job descriptions have now been submitted to job evaluation for Nursing roles in first instance. North Ayrshire HSCP The potential challenge of recruiting to the various posts with in the ISS has been highlighted. Roles being secured by internal candidates thus putting a strain on other parts of the service in terms of experienced staff. B road discussions to take place with local profession leads around using existing resource in different ways (e.g. supplementing existing hours), but also careful consideration to variety of forums posts are advertised in, as well as how they are advertised (e.g. showcasing the ISS as an innovative development within a service which is seeing significant investment on a variety of fronts) UC1 Coming Home Report (Scottish Government, 2018); Coming Home Implementation Report (Scottish Government, 2022); Keys to Life (Scottish Government, 2013); Keys to Life Implementation Framework (Scottish Government, 2019); Caring for Ayrshire; NAHSCP Strategic Commissioning Plan 2022-2030 The ISS will have a key role in supporting individuals with complex needs to link to and benefit from the broad range of supports and opportunities within their communities, as well as skilling up provides and others to better respond to the needs of individuals. In this way, it will act to address inequalities in wellbeing outcomes which can be linked to lack of flexibility/skills/knowledge in services and communities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA66 Amber Review 7A model of assessment and treatment in order to establish necessary capacity in terms of beds, staffing, and ability to meet client outcomes. Gather baseline data and present to management team – June 22 Establish ongoing data reporting mechanisms to enable improvement/capacity revision – August 22 Develop proposal around new model (environment, bed numbers, practice) – November 22 7A successfully applied to be part of a learning collaborative led by Healthcare Improvement Scotland, linked to the SPSP agenda in Mental Health services. As part of this, 7A staff are exploring, in partnership with other involved wards and Quality Improvement colleagues, improvement activities which relate to the collaborative aims. 7A has also undertaken some initial data gathering around activity since opening, and will continue to build on this as part of exploring/evolving its practice. North Ayrshire HSCP Sickness/absence and the challenges of the ward environment continue to impact on staff availability and create a frequent reliance on bank staff who are not appropriately trained so as to fulfil the full remit of their role within the environment and with the client group. Address staff welfare as well as broader good practice as part of SPSP collaborative work. UC1 Keys to Life (2013); Keys to Life Implementation Framework (2019); Caring for Ayrshire; NAHSCP Strategic Commissioning Plan 2022-2030; Scottish Patient Safety Programme Ward 7A is an in-patient environment. As part of reflecting on seclusion/restraint practice within the HIS collaborative, 7A staff are considering the role of activities and purposeful engagement, and means of further promoting this within the ward. Potentially, any work undertaken in this regard will impact on the ability of individuals to be included within and benefit from a broader range of community opportunities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA67 Amber Implement new ways of working within Trindlemoss Day Opportunities in order to facilitate a shift from building based to community focused activities, with integration, inclusivity, and the achievement of meaningful outcomes at their core. Complete organisational/staffing restructure – July 22 Establish effective ongoing methods of engagement with clients, families, and other stakeholders – November 22 Evidence a clear shift in the variety and location of activities clients are linked to, including an increase in the number of collaborations with community partners across North Ayrshire – June 23 As part of this, Trindlemoss has reviewed staffing roles, implemented a new staff structure, and has almost completed a significant programme of staff transition and recruitment. It also continues to work with HIS, in Phase 3 of a learning collaborative focused on redesigning day services for people with learning disabilities North Ayrshire HSCP Scale of change being sought has and may in the future meet with resistance from some stakeholders. Should the new ways of working not be fully embraced and embedded, sufficient capacity may not be created to fully meet the needs of younger people in transition. Trindlemoss is developing a plan for ongoing engagement with stakeholders, and creating new opportunities for involvement such as work to be facilitated by 2 interns from the Glasgow School of Art. It will also benefit from an Engagement post which is to be trialled for 1-year within the Learning Disability Service. UC1 Keys to Life (2013); Keys to Life Implementation Framework (2019); Caring for Ayrshire; NAHSCP Strategic Commissioning Plan 2022-2030 Greater integration of people with learning disabilities within their communities is core to the aims of Trindlemoss. As part of this, Trindlemoss is linking with a broad range of partners to create and promote greater equality and new opportunities in relation to issues such as physical activity (e.g. partnering with Woodland Wakeup in relation to new outdoor learning opportunities) and employment (e.g. linking into discussions within the Local Employment Partnership around new approaches to promoting employment opportunities for people with disabilities). West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA68 Amber Undertake needs assessment to identify the future needs of the population of individuals requiring complex care arrangements in North Ayrshire, to meet these needs and identify infrastructure gaps / opportunities. Baseline scoping exercise to be completed – July 22 Identify models of good practice elsewhere across Scotland/UK and visit/connect as relevant – October 22 Engage with existing clients/families and relevant partners (complex/PMLD) around their experiences of current provision with a view to shaping plans around future provision – January 23 Develop proposal around necessary infrastructure development – March 23 An initial scoping paper has been drafted regarding the current state of play in relation to individuals with complex needs in North Ayrshire, drawing in issues such as Housing and in-patient provision. North Ayrshire HSCP Provider economy within North Ayrshire remains fragile; Providers continue to open new facilities within North Ayrshire which draw in clients from other areas, but place additional demands on local services. Intensive Support Service will enable a new dialogue with providers, focused on developing their existing capacity. Better understanding of local complex needs population and existing resource will help us to work better with providers to help shape the local market appropriately, and continue to foster pro-active discussion about potential future developments on both sides. UC1 Coming Home Report (Scottish Government, 2018); Coming Home Implementation Report (Scottish Government, 2022); Keys to Life (Scottish Government, 2013); Keys to Life Implementation Framework (Scottish Government, 2019); Caring for Ayrshire; NAHSCP Strategic Commissioning Plan 2022-2030 Complex needs are in part a function of the needs and abilities of individuals, and in part a function of the availability/flexibility (or lack thereof) regarding local services and opportunities. Better understanding the challenges experienced by those who can be considered as presenting with complex support needs will help us to shape services and communities appropriately, and thereby promote greater equality in health and other outcomes. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA69 Green Implement Phase 2 of New Models of Assisted Living Programme, in line with East Ayrshire Council's Strategic Housing Investment Plan Individuals with complex needs are supported to live good quality lives as independently as they are able. Additional supported accommodation tenancies are available in line with the Strategic Housing Investment Plan There were some build delays as a result of the pandemic. This is now back on track with the next supported accommodation, Quarryknowe, on track for opening end August 22. Individuals have been identified for these tenancies and are being supported through the legal process to support the moves. East Ayrshire HSCP Unexpected delays with contractor could delay handover of the property. People previously identified for the property could choose not to move. Delays in the legal process at court could delay the move for individuals. Regular meetings with the contractor to ensure any delays are highlighted. Individuals and families have been involved throughout the planning stages so unlikely that people will withdraw. If someone chooses not to move, there are a number of other individuals who could also be offered a tenancy. In terms of the legal process, staff are being encouraged to process intervention orders quickly in order to expedite. UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Adult with Incapacity (Scotland) Act 2000 People with learning disabilities and complex needs are often subject to stigmatising in their local community. In addition many people with learning disabilities experience poorer health outcomes and have less access to services and supports enabling them to live good quality lives. This approach supports the person to maximise their independence whilst having access to ad hoc support should the need arise. 147
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA70 Green Implement the new Day Services Model Blended model of day service support which is individually tailored to the person's needs. Less reliance on building based supports and more community based activities. Revision of staffing structure to support more autonomous practice. Day service BSVR has been completed and is fully implemented. East Ayrshire HSCP Complete Complete UC1 Mental Health Strategy 2017-2027 East Ayrshire HSCP strategic plan 2021-2030 Adult with Incapacity (Scotland) Act 2000 Supporting people with learning disabilities to utilise community based activities supports a reduction in stigma and increases opportunities to challenge the inequalities faced by this group of people. West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA71 Green New South Ayrshire Learning Disability Strategy IJB Endorsed - Jun 22 Strategy Launch - August 22 Establish SPOC and embed MDT working within LD Services - December 23 Quarterly report to the local government groups on the deliverables and action plans culminating from the strategy South Ayrshire HSCP UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA72 Green Implement a 7 day building based service to develop new ways of working within Day Opportunities in order to consider combining building based services with community focused activities, and the achievement of meaningful outcomes for residents with a LD in South Ayrshire . Complete consultation on a 7 day building based service with support from SCLD and the league of champions board – August 22 Establish individual with service users, carer, legal proxy’s and staff – November 22 Evidence a clear shift in the variety and location of activities clients are linked to, including an increase in the number of collaborations with community partners across North Ayrshire – June 23 Working with HIS, as part of the learning collaborative focussed on redesigning day services for people with learning disabilities South Ayrshire HSCP UC1 Keys to Life (2013); Keys to Life Implementation Framework (2019); Caring for Ayrshire West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA73 Green Undertake needs assessment to identify the future needs of the population of individuals requiring complex care arrangements outwith South Ayrshire, to look at needs and identify opportunities to return home. ELT paper to be completed requesting a band 6 and social worker to assess and review our South residents who are out of area – July 22 Liaise with establishments in South Ayrshire to identify models of support to replicate the care provided required to bring residents home – March 23 Engage with existing clients/families and relevant partners (complex/PMLD) around their experiences of current provision with a view to shaping plans around future provision – January 23 Develop proposal around necessary infrastructure development – March 23 An ELT paper has been drafted to request use of Coming Home monies from Scottish Government to fully assess and review South Ayrshire residents and ascertain if we can provide the care within South Ayrshire South Ayrshire HSCP UC1 Coming Home Report (Scottish Government, 2018); Coming Home Implementation Report (Scottish Government, 2022); Keys to Life (Scottish Government, 2013); Keys to Life Implementation Framework (Scottish Government, 2019); Caring for Ayrshire West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Learning Disability 2022-AA74 Green Implement 3rd Core and Cluster in Ayr Town centre Individuals with complex needs are supported to live good quality lives as independently as they are able. There will be a supported accommodation flat to accommodate individuals who are in crisis and no longer able to remain in the family home or community. This will minimise the need for hospital care. The Core and Cluster will be complete and open in December 22. Individuals have been identified for tenancies, enhanced telecare and provider is being secured. South Ayrshire HSCP UC1 Coming Home Report (Scottish Government, 2018); Coming Home Implementation Report (Scottish Government, 2022); Keys to Life (Scottish Government, 2013); Keys to Life Implementation Framework (Scottish Government, 2019); Caring for Ayrshire West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Psychological Therapies 2022-AA75 Green Develop and Implement Infant Mental Health Service Pathways developed and service operational March 23 Infant mental health service recruitment has commenced, with both nursing and psychology successful in filling all vacancies. Start dates ca September/October 22. OT and Admin in process of recruitment. North Ayrshire HSCP Lack of physical space Initial plan is to use hot desking within Perinatal services, whilst long term aims are to raise with estates and examine further options. UC1 West of Scotland Ayrshire and Arran Urgent and unscheduled care Mental Health Unscheduled Care 2022-AA76 Green Elderly Mental Health Liaison Team continue to work at full capacity To increase the nursing workforce, by end of financial year. Secured funding for 2 X permanent Band 6 Charge Nurses and 2 X Band 5 staff Nurses. All 4 members of nursing staff are in post. North Ayrshire HSCP Demand continues to rise as a result of complex patients being admitted to acute hospitals. The impact of delayed discharges on Elderly Liaison is having patients longer on their case loads. Test of Change is currently undergoing with MH ANP within the team which will benefit both Nursing staff as well as Medical staff. Also currently reviewing what other disciplines within the team would be advantageous thus allowing a more holistic approach to patients. UC1 Urgent and Emergency/Unscheduled Care Redesign of Urgent Care (Locally & Nationally) Caring for Ayrshire West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2022-AA77 New Review the Enhanced Services currently provided by GP practices to ensure fit for purpose and sustainability. 2022/23 Develop and produce a commissioning plan to define all enhanced services including current activity / cost and agree clear specification, audit ownership and assurance plan. Terms of Reference and Group established with clear aims and outcomes. Some Enhanced Services have not been reviewed for some time therefore significant input across organisations/partners may be needed to ensure still fit for purpose or service changed / removed from provision. EQIAs may be required for any potential changes impacting on service delivery. Engagement from GPs to continue providing Enhanced Services and additional financial commitment may be required. Any change to service delivery will be implemented on consultation with LMC / GP Sub and CMT. Reps from appropriate teams will be consulted on content of ES. Consider use of EQIA Assessment for relevance to establish if full EQIA is necessary for any ES being changed. UC1 PCIP and primary care recovery programmes Supports access and delivery of General Medical Services West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2022-AA78 New Delivery of the Recovery of Children's Oral Health and Dentistry Delivery of the Additional Toothbrushing Packs Implementation of targeted interventions Recruitment of Additional Dental Health Support Workers in progress Development of programmes of work to identify the children for the targeted interventions UC1 Oral Health Improvement Plan NHSAA Oral Health Strategy 10 year Plan 2013-2023 The programmes of work associated with this additional funding will increase toothbrushing resources and direct support from Dental Health Support Workers to our most vulnerable families. Ensuring these families are registered with a dentist and are supported to attend appointments regularly. The primary focus of the work will be supporting families from SIMD1 areas and ethnic minorities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Primary Care 2022-AA79 New Recovery of Public Dental Services Return to pre-pandemic waiting times Increased provision of Emergency Dental Services while GDS remobilises Recruitment of additional Dentists, Therapists, Dental Nurses and other support staff in progress Development of new Patient pathways Maximise utilisation of skill mix within the Dental Team Inability to recruit to key professional roles resulting in decreased access to emergency dental care or increased waiting times for routine treatment for unregistered patients. Monthly review of Waiting Times UC1 Oral Health Improvement Plan NHSAA Oral Health Strategy 10 year Plan 2013-2023 Increased sustainability of the PDS will support patients access emergency care or unregistered patients to receive routine care whilst General Dental Practice continues to recover from the pandemic. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA80 Green Joint pathway between Ayrshire Urgent Care Service and SAS to provide Professional to Professional decision support to avoid unnecessary conveyance of patients to acute hospital sites. Implement pathway between SAS and AUCS to support advanced paramedic practitioners (APPs) who clinically assess all referrals to support alternatives or a scheduled presentation that doesn’t require SAS attendance. June 22 SAS/FNC model in place to avoid unnecessary conveyance. Shared experience and knowledge has aided improvement of pathways. Call volumes: on average 10 calls per day from SAS supported with alternative pathways Pilot initiated to determine a system to encourage information and advice sharing between SAS Advanced Paramedic Practitioner and GP from within AUCS with an aim to support appropriate patients to be redirected to alternative pathways. Continuation of workforce commitment and co-location arrangements. Shared learning and reflection of key benefits is being undertaken and co-location of team is well established - any arising risk could be mitigated through discussion between operational managers involved. UC1 RUC Mental Health Recovery Strategy Unscheduled Care Creates a more effective patient journey ensuring patients are routed to the most appropriate service for follow up care and potentially prevent an inappropriate acute attendance . West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA81 Green Enhanced Mental Health Pathway via FNC for Emergency Services (SAS/Police Scotland) to access direct care for patients requiring emergency mental health interventions. Mental Health pathway into Unscheduled and Urgent Care reviewed and enhanced. Building on established pathways with enhancements based on RUC Workstream aims. June 22 Emergency service (SAS/Police Scotland) pathway in place through FNC to access Urgent Mental Health Services. An average of 25 people per week have been accessing this alternative pathway since going live in May 22. Plans are in place to centralise emergency MH interventions in a community hospital based hub, to facilitate short term admissions up to 72 hours. Recruitment to posts for key staff will be vital in order to deliver this additional work. Utilisation of Flow Navigation Centre as single point of access to appropriate mental health team response. Management of recruitment and key initiatives has oversight provided by Service Manager, Pan Ayrshire Unscheduled Care Mental Health. Join working arrangements with AUCS/FNC team members. UC1 RUC Mental Health Recovery Strategy Unscheduled Care Supports improved and enhanced patient pathway for patients suffering from mental health crisis ensuring they receive the most appropriate care at the point of contact. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA82 New Implement Redesigned Community Pharmacy pathways into Urgent and Unscheduled Care, and create pathways for patients to be redirected to pharmacy interventions appropriately out of ED. Introduce a pathway between Pharmacy and ED via FNC for appropriate scheduled referral to ED. December 22 Scoping work initiated; Analysis of Demand Profile; Linking with Primary and Community Teams in signposting to appropriate primary and community delivered health and care Ability to schedule appointment in ED is dependant on availability Scheduling availability informed by USC Demand and Capacity model UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home and HI2 Redesign of Urgent Care Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. 148
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA83 New Implement Alternative pathways to enable additional Signposting/Redirections to FNC where appropriate Complement the pathways from ED via FNC for redirection of patients into appropriate other services. Utilising Near Me Scoping work initiated; Analysis of Demand Profile Service pressures on ED team may lead to lack of time to signpost patients to appropriate services in future as an alternative to ED attendance. Other pressures on the wider system may reduce the number of alternatives. HCSW funded by RUC to support redirections/signposting of patients to alternatives UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home; HI2 Redesign of Urgent Care; HI4 - Urgent and Emergency Assessment Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA84 Green Expansion of FNC model to support each patient's journey, from community, through each episode of care, back to the patient returning home. Building on phase 1 of RUC Programme identify alternative referral pathways for patients to provide the right care, as close to home as is possible and provide this as quickly as possible for each individual patient. FNC established in November 2020 continues to operate scheduling to ED/MIU and offer doctor advice or onwards referral. Flow Navigation Centre acts as a hub and single point of access but there is considerable potential for further expansion to refer to other pathways. Current risks include system pressures leading to scheduling being paused due to two service delivery models then in place which creates a two tier service for patients. Work to commence in developing a more sophisticated model of scheduling to allow appointments to only be given when capacity allows. This will link to, and be informed by wider collaborative work on modelling unscheduled care. UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home and HI2 Redesign of Urgent Care Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA85 Green Musculoskeletal (MSK) - Urgent Care Pathway (1) Scope Demand (2) Pilot and Embed enhanced triage (3) Pilot and Embed direct referral (4) Optimise Self Care (5) Optimise Community Support (6) Evaluate, review and improve Scoping work initiated Recruitment to key posts initiated Ability to recruit to key posts central to the progression of the pathway. Building consensus for service delivery model across a broad spectrum of operational stakeholders • Detailed Test of Change documentation and project plan • Regular Programme Management Meetings • Regular Performance Monitoring and evaluation UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home; HI2 Redesign of Urgent Care; HI3 - Virtual capacity Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA86 New Integration of FNC as triage route for ambulatory interface care programmes (1) FNC to facilitate local expansion of remote health monitoring for respiratory patients (2) FNC to expand prof to prof consultation between SAS crews and local services such as RRR and Falls teams Scoping work initiated; Analysis of Demand Profile; Linking with Primary and Community Teams in signposting to appropriate primary and community delivered health and care FNC Capacity Effective use of technology Predict demand based on previous activity and resource FNC appropriately to meet need UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home; HI2 Redesign of Urgent Care; HI3 - Virtual capacity; HI8 - Community Focused Integrated Care Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA87 Green RUC Pathways: Accessible pathways of care for patients based on the Scottish Approach to Service Design (Discover, Define, Develop, Deliver). Clear public Messaging and Comms (1) Assess and define all available RUC pathways and how they intersect (2) Assess the best and most effective ways to communicate these to the general public, health services and professionals (3) Engage with NHS A&A Comms Team and design and implement a communications strategy RUC Phase 1 set out the public messaging around accessing urgent care and patients being able to access appointments to MIU/ED. Next steps would be to build on this. Lack of accessibility to the appropriate pathways to ensure all services help navigate patients to the appropriate service, regardless of entry point Effective communication channels, agreed service navigation points, adequate knowledge within staffing groups, monitoring and evaluation of patient experience through pathways UC1 Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home; HI2 Redesign of Urgent Care; HI4 - Urgent and Emergency Assessment Ensuring patients access the right pathway of care for them at the appropriate time is imperative. Scheduling allows patients with accessibility issues time to arrange transport to the appropriate care if required, or alternatively to access patient transport. This ensures that no patient is disadvantaged in accessing their healthcare needs based on availability of transport, distance travelled, or caring responsibilities. West of Scotland Ayrshire and Arran Urgent and unscheduled care Redesign of Urgent Care 2022-AA88 New Implementation of a Covid/Non- Covid Remote Health Monitoring integrated pathway utilising pulse oximeters, supported by digital services Implement Respiratory RHM pathway providing pulse oximeters, alongside clinical advice within GP practices, within GPOOH services and at Acute front Door (ED/CAU). July 22 Through provision of pulse oximeter devices alongside clinical advice and support integrate the local pathway approach with the national Covid RHM pathway to expand the inclusion criteria, supporting more people to self manage and escalate to appropriate care as needed Development of pathway criteria alongside clinicians to scope benefit and impact of implementation of local pathway. Sourced additional devices and distribution plan based on data identifying areas of need across Ayrshire and Arran. Development of patient leaflets to advice patients of points of escalation, as advised by their clinician. Supply of devices to meet all patient need. Management of demand for devices with registration of patients through a clinical mailbox. UC1 Covid 19 Remobilisation & Recovery Urgent and Unscheduled Care Collaborative - HI1 Care Closer to Home; HI2 Redesign of Urgent Care; HI3 - Virtual capacity Sustainability of providing treatment to our most vulnerable patients with worsening Covid symptoms reducing the need for secondary care intervention. Supporting informed self-care when safe and appropriate to do so. West of Scotland Ayrshire and Arran Urgent and unscheduled care Unscheduled Care 2022-AA89 Green Right sizing the bed footprint High Impact Change 3 (Virtual Capacity) Develop Hospital at Home & increase capacity Scope potential demand to inform business case for expansion of OPAT Rapid Respiratory Home Service Model in place in 3 areas for East Ayrshire Focus on development of Home First & rapid response community & hospital transition teams. Increase Hospital at Home capacity from 6 to 28 virtual beds by January 23 Expansion from Lower limb cellulitis to further OPAT service not developed as yet Expansion of Rapid Respiratory home service beyond existing East Ayrshire model not in place as yet. Home First Band 6 posts out to advert x 4 in post with an additional 5 required to roll out Home First/DwD work Inability to recruit & retain adequate workforce UC1 Urgent & Unscheduled Care Programme & SG Self- Assessment RADAR Pre, intra & post hospital Workstreams as part of the USC Collaborative work including 6 essential actions, Discharge without delay & interface work. 7 Days of Solutions/Perfect week & Full System DwD focus events. West of Scotland Ayrshire and Arran Urgent and unscheduled care Unscheduled Care 2022-AA90 Green Right sizing the bed footprint High Impact Change 3 (Urgent & Emergency Assessment) Model & develop a data suite to enable us to right size the acute footprint to speciality level which includes projected virtual capacity Review of rapid access to diagnostics Review of time to senior decision maker in ED & CAU Review & development of alternatives to inpatient stays including hot MDT Clinics. Optimise acute care as a speciality with a focus on the first 48 hours of the patient journey. Information Team working with CapGemini to model acute footprint to enable right sizing the bed footprint. Review of diagnostic waits started through the DwD work & will continue through continuing Full system DwD events Currently we have an acute cardiac clinic in place further scoping of other specialities under review. Acute medicine governance work to be picked up through CAU teams to identify information & enable an informed plan. UC1 Urgent & Unscheduled Care Programme & SG Self- Assessment RADAR Pre, intra & post hospital Workstreams as part of the USC Collaborative work including 6 essential actions, Discharge without delay & interface work. 7 Days of Solutions/Perfect week & Full System DwD focus events. West of Scotland Ayrshire and Arran Urgent and unscheduled care Unscheduled Care 2022-AA91 Green Right sizing the bed footprint High Impact Change 8 (Community Focused Integrated Care) Review acute wards LOS & prioritise areas above the Scottish average through the DwD Home First Programme. Review all community rehab wards LOS with a focus on benchmarking comparable H&SCP's & then targeting through DwD "Home First" work Undertake System Wide DwD focus events as per below information 18th 19th and 20th July 18th 19th and 20th August 7th - 14th September 7 days of solutions 5th 6th and 7th October 24th 25th and 26th October 14th 15th and 16th November 28th 29th and 30th November All acute areas have had focused all system DwD event and a 7 days of solutions event by end June 22 Plan to replicate Full System Event in community hospitals with next full system DwD event. Inability of teams to participate in Full system events UC1 Urgent & Unscheduled Care Programme & SG Self- Assessment RADAR Pre, intra & post hospital Workstreams as part of the USC Collaborative work including 6 essential actions, Discharge without delay & interface work. 7 Days of Solutions/Perfect week & Full System DwD focus events. West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Gynaecology 2022-AA92 Proposal Ensure a robust Unscheduled Care Service for Emergency Gynaecology Emergency Gynaecology - formalise model of care, collection of operational data & patient feedback as baseline for future developments scoping 2022 / 23 New deliverable UC1 Unscheduled Care Model Improve delivery of USC for Women experiencing Gynaecology concerns West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA93 Green Develop a Paediatric Forensic Medical Suite Build of Paediatric Forensic Medical Suite July 22 Readiness for facility commencement July 22 Build on track for handover Preparation on track UC1 CMO Taskforce Rape & Sexual Assault (CYP) Improve health outcomes for vulnerable CYP Child Protection / Child Sexual Abuse West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA94 Green Neonatal / Best Start Deliver all neonatal requirements of the Best Start Agenda Fully develop Homecare service November 22 Test of change in progress UC1 Best Start Improving access to and quality of services in line with Best Start recommendations West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA95 Green Neonatal / Best Start Deliver all neonatal requirements of the Best Start Agenda Review of Neonatal ITU / HDU / SCBU Space in light of National Best Start changes March 23 New deliverable UC1 Best Start Improving access to and quality of services in line with Best Start recommendations 149
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West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA96 Proposal Ensure a robust Unscheduled Care Pathway for Paediatric Service Review current USC pathway Ayr / UHC / CAU against relevant standards Jul 22 Develop Action plan as required by review findings (TBC) Engage stakeholders / family participation in any required redesign and deliver redesigned service (TBC) New deliverable UC1 Serious Case Review Requirements (Child P) Improve delivery of USC for Children and Young People to ensure safe, effective service West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA97 Proposal Unscheduled Care Pathway Children's Assessment Unit Plan & Costing of refurbishments to ensure fit for purpose July 22 Agreement to Proceed with works (TBC) Scoping in progress Funding not available UC1 Serious Case Review Requirements (Child P) Improve delivery of USC for Children and Young People to ensure safe, effective service West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA98 Green Mental Health Collaborative working with CAMHS Psychiatric Liaison (Acute Care) (1) Build of YP De-escalation Suite on Paediatric Ward, Planning Phase July 22 (2) Build staff confidence with training to support therapeutic observations - CAMHS to deliver training March 23 (3) Develop sustainable Psychiatric Liaison Model with CAMHS (1) Funding secured, planning in progress (2) New deliverable (3) New deliverable UC1 Caring for Ayrshire Improve outcomes for CYP admitted to Acute Care with associated mental health needs West of Scotland Ayrshire and Arran Urgent and unscheduled care Women and Children Paediatrics 2022-AA99 Proposal Mental Health Collaborative working with CAMHS Neurodiversity Shared Care (1) External review of shared care pathways CAMHS / Community & Acute Paediatrics including family & CYP participation TBC 22 (2) Develop clear integrated pathways as appropriate (1) Scoping in progress UC1 Caring for Ayrshire Improve integrated care for CYP with Neuro developmental needs 150
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NHS Ayrshire & Arran - Annual Delivery Plan 2022 - 2023 Key for status: Proposal - New Project/funding not yet agreed New - New project/funding agreed but not yet started Red - Unlikely to complete on time/meet target Anber - At risk - requires action Green - On Track Complete - Complete/Target met Suspended - Currently suspended - details of why/how long should be included in 151
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Integration Joint Board 20th October 2022 Subject : Meeting Dates 2023 Purpose : To advise members of the proposed timetable for meetings of the IJB and PAC for 2023. This report is for approval. Recommendation : That IJB agree the dates for meetings of the Integration Joint Board and Performance and Audit Committee. 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 PAC Performance and Audit Committee 1. EXECUTIVE SUMMARY 1.1 The schedule of meetings for the Integration Joint Board (IJB) and Performance and Audit Committee (PAC) is required for the forthcoming year. 2. BACKGROUND 2.1 The IJB in agreed in September 2021 to reduce to 8 meetings during 2022 to avoid the council recess periods and the period of purdah during the local government elections in May 2022. 3. PROPOSALS 3.1 The number of meetings for 2023 has been reinstated to 9 meetings per year, with ad hoc private sessions arranged as and when required. 3.2 The Performance and Audit Committee will continue to meet on a quarterly basis. Agenda Item 9 155
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3.3 As in previous years, the timing of meetings has taken budget reporting and performance schedules into consideration and the timetable has been created to avoid clashes with key NHS and Council meetings, avoiding some recess periods of the Council. 3.4 The proposed dates for IJB and PAC meetings are detailed below. The schedule of meetings is attached in Appendix 1. Integration Joint Board Performance and Audit Committee 9th February 2023 3rd March 2023 16th March 2023 23rd June 2023 11th May 2023 1st September 2023 15th June 2023 24th November 2023 24th August 2023 21st September 2023 12th October 2023 16th November 2023 14th December 2023 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 Consultation has taken place with the Chair and Vice Chair, IJB and Chair, PAC as well as other relevant officers on the proposed timetable. Caroline Cameron, Director For further information please contact Karen Andrews, Team Manager (Governance) on (01294) 317725 or kandrews@north-ayrshire.gov.uk Appendices • Appendix 1 – Schedule of IJB Meetings 156
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Appendix 1 NORTH AYSHIRE HEALTH AND SOCIAL CARE PARTNESHIP MEETING SCHEDULE 2022 INTEGRATION JOINT BOARD / PERFORMANCE AND AUDIT COMMITTEE Integration Joint Board Performance and Audit Committee 12th January 2023 [Private Session] 3rd March 2023 9th February 2023 23rd June 2023 16th March 2023 1st September 2023 11th May 2023 24th November 2023 15th June 2023 24th August 2023 21st September 2023 12th October 2023 16th November 2023 14th December 2023 157
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