Agenda pack
North Lanarkshire Council · 15 November 2022
Back to Adult Care and Social Work Committee — 15 November 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Our Ref: Your Ref: Contact: Tel: Fax: E-Mail: Date: Clare Louise McDonald 01698302190 mcdonaldcl@northlan.gov.uk 4 Nov 2022 Members of the Adult Care and Social Work Committee Chief Executive’s Office Archie Aitken Head of Legal & Democratic Solutions Civic Centre, Windmillhill Street Motherwell ML1 1AB DX 571701, Motherwell 2 www.northlanarkshire.gov.uk Notice is given that a Meeting of the ADULT CARE AND SOCIAL WORK COMMITTEE is to be held within the Council Chamber, Civic Centre, Motherwell on Tuesday, 15 November 2022 at 2:00 pm which you are requested to attend. The agenda of business is attached. Head of Legal and Democratic Solutions Members : Councillors: C Barclay, B Baudo, M Boyd, G Brennan, B Burgess, A Bustard, J Cairns, C Costello, W Goldie, M Hughes, L Jarvie, J Jones, P Kelly, J Keltie, B McCluskey, B McCulloch, M McCulloch, R McKendrick, J McPhilemy, A McVey, L Stubbs, J Toner, C Williams, N Wilson, G Woods. Page 1 of 236
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AGENDA (1) Declarations of Interest in terms of the Ethical Standards in Public Life Etc. (Scotland) Act 2000 OPERATIONAL (2) Suicide Prevention - Future Strategy for Scotland (page 5 - 16) Submit report by the Head of Adult Social Work Services providing an update on ongoing developments in Suicide Prevention and also the Health and Social Care Partnerships response to the Scottish Government consultation on a new Suicide Prevention Strategy and Action Plan for Scotland (copy herewith) (3) North Lanarkshire Alcohol and Drug Partnership (page 17 - 120) Submit report by the Head of Planning, Performance and Quality Assurance providing an update on the North Lanarkshire Alcohol and Drug Partnership (NLADP) (copy herewith) (4) Carers Act Implementation (page 121 - 162) Submit report by the Head of Planning Performance and Quality Assurance providing an update on the support in place for unpaid Carers across the community (copy herewith) (5) Quality Assurance Annual Report (page 163 - 184) Submit report by the Head of Planning, Performance and Quality Assurance providing an update on the Quality Assurance activity for the period 1 April 2021 until 31 March 2022 (copy herewith) (6) Self Directed Support (page 185 - 208) Submit report by the Head of Adult Social Work Services providing an update on the Self Directed Support Transformational agenda (copy herewith) PERFORMANCE (7) Adult Social Care Performance Report - Quarter 1 2022/23 (page 209 - 216) Submit report by the Chief Officer, Health and Social Care providing an update on the performance of key areas of activity within Adult Health and Social Care for the period 1 April to 30 June 2022 (Quarter 1) (copy herewith) FINANCIAL (8) Revenue and Capital Budget Monitoring Report: Adult Social Care Period 6 01/04/22 to 16/09/22 (page 217 - 230) Submit report by the Head of Planning, Performance and Quality Assurance providing a summary of the revenue financial performance of the Health and Social Care Partnership (H&SCP) - North Lanarkshire (Adult Social Care and Housing) and the financial performance of the Social Work Capital Programme (copy herewith) Page 3 of 236
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2 CONTRACTS (9) Contracts Awarded Below Committee Approval Threshold (page 231 - 236) Submit report by the Head of Asset and Procurement Solutions advising awarded between 1 July and 30 September 2022 with a value below the financial threshold requiring Committee approval (copy herewith) Page 4 of 236
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PO52.1 Suicide Prevention – Future Strategy for Scotland North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref DF/AB Date 15/11/22 From Diane Fraser, Head of Adult Social Work Services E-mail FraserDi@northlan.gov.uk Telephone Executive Summary The purpose of this report is to advise Adult Care and Social Work Committee of the Partnership response to the Scottish Government consultation on a New Suicide Prevention Strategy and Action Plan for Scotland, and to note that further development in the area of Suicide Prevention is ongoing In July 2021 the Minister for Mental Health and COSLA Health and Social Care Board agreed that the current Suicide Prevention Action Plan ‘Every Life Matters’ should be extended by 12 months, until August 2022. This extension period would allow for the development of a new Joint COSLA and Scottish Government outcome focused Suicide Prevention Strategy and Action Plan for Scotland, to be published by the end of September 2022. The new Strategy will be for a period of 10 years with 2-3 year action plans to support delivery. This report will provide information and update on the response provided to Scottish Government and the briefing provided for Cosla. Recommendations It is recommended that the Adult Care and Social Work Committee: i. Note the content of the report ii. Note that a future updated report will be received The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (14) Ensure the highest standards of public protection AGENDA ITEM 2 Page 5 of 236
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1. Background 1.1 The Scottish Government have developed a New Suicide Prevention Strategy and Action plan which was circulated to HSCP’s for consultation. The response was returned timeously to the Scottish Government on 23 August 2022. 1.2 Further a briefing note was provided to a Cosla Meeting on 25 August, to support an agreement to enable sign off on the final suicide prevention strategy and action plan. 1.3 The eight local priority areas for suicide prevention work within North Lanarkshire with recommendations for actions are set out in the North Lanarkshire Suicide Prevention Action Plan (2021/2022), this will be reviewed when evaluating the New Suicide Prevention Strategy and Action plan. 2. Report 2.1 The following report sets out the partnership response to the consultation, addressing the Visions, Principles, Outcomes and Priorities within the Strategy. 2.2 Proposed Vision The consultation describes the proposed vision set out for the New Suicide Prevention Strategy as ‘Our Ambition is a Scotland where everyone works together to prevent suicide’ We agree with the proposed vison however noted that we would have preferred a more ambitious statement which aspires to reducing suicide in Scotland and recognises the impact of wider social determinants, as opposed to individual risk. A vision for suicide prevention should offer hope that suicide is not inevitable, and everyone has rights and opportunities maximised. 2.3 Guiding Principles The consultation set out 6 Guiding Principles for consideration: 1. Suicide prevention is everyone’s business. We will provide opportunities for people across different sectors at local and national levels to come together to connect and play their part in preventing suicide 2. We will take action which addresses the suicide prevention needs of the whole population and where there are known factors such as poverty, marginalised and minority groups 3. All developments and decisions will be informed by lived experience. We will also ensure safeguarding measures are in place across our work. 4. Effective, timely and compassionate support that promotes recovery should be available and accessible to everyone who needs it including people at risk of suicide, their families/ carers and the wider community 5. We will ensure the needs of children and young people are addressed and their voices will be central to any decisions or developments aimed at them 6. To build the evidence base, quality improvement methodology and testing of new, creative and innovative practice will be embedded in our approach We agree with the 6 Guiding principles above. We noted in our response that we would like to share our learning, that implementation, delivery and evaluation should be guided by listening to individuals with lived experience. Page 6 of 236
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2.4 Outcomes The consultation set out 4 Outcomes for consideration 1. The environment we live in promotes the conditions which protect against suicide risk – this includes our psychological, social, cultural, and economic and physical environment. 2. Everyone has a clear understanding of suicide, its prevention, and associated risk and protective factors. Everyone is able to respond confidently and appropriately when they, or others, need support. 3. Everyone affected by suicide is able to access appropriate, high quality, compassionate, and timely support – that promotes recover. This includes people of all ages who experience suicidal thoughts and behaviour, anyone who cares for them, and anyone affected by suicide in other ways. 4. All suicide prevention activity is designed with lived experience insight. Action will be informed by up to date practice, research, intelligence, and improved by regular monitoring, evaluation and review. We agree with the 4 outcomes above, but note they are broad and aspirational. Outcome 2 requires clarity, does this include young children having a clear understanding of suicide prevention? Will consideration be given to age and stage of development? We view the future strategy as an opportunity to address the impact of suicide on families and communities locally and nationally. 2.5 Priorities The priorities areas below form the focus of the first Action Plan 1. Build a whole area of Government and whole society approach to address the social determinants which have the greatest risk link to suicide risk. 2. Strengthen Scotland’s awareness and responsiveness to suicide and suicidal behaviour. 3. Promote and provide effective, timely compassionate support – that promotes recovery. 4. Promote a co-ordinated, collaborative and integrated approach We agree with the priorities, however given the rising demands and particular needs of children, young people and their families, we would support a specific action for this group We would also consider there to be crossover between suicide, self-harm and mental health strategies. Including references to all 3 areas in the New Suicide Prevention Strategy may help align priorities and compliment action plans. 2.6 Action Plans The actions which make up the action plan are built around 7 themes; these themes sit under the overarching ‘Outcomes’ 1. Whole Government and Society Policy 2. Access to Means 3. Media Reporting Page 7 of 236
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4. Learning and Building Capacity 5. Support 6. Planning 7. Data and Evidence We agree with the action plan and would promote the use of local suicide prevention campaigns to target communities. Many of the actions are already being carried out at a local level. Our vision is that the current best practice around suicide prevention continues to develop in the new Strategy. 2.7 Next Steps Scotland’s Suicide Prevention Strategy & Action Plan were launched on Thursday 29th September, this will be reviewed alongside the North Lanarkshire Suicide Prevention Action Plan (2021/2022). 3. Measures of success 3.1 Not Applicable 4. Supporting documentation 4.1 – Appendix 1 ‘Creating Hope Together: Scotland’s Suicide Prevention Strategy 2022-2032’ 4.2 – Appendix 2 ‘Creating Hope Together: Scotland’s Suicide Prevention Action Plan 2022-2025’. 4.3 – Appendix 3 North Lanarkshire Suicide Prevention Action Plan (2021/2022) Diane Fraser Head of Adult Social Work Service Page 8 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Page 9 of 236
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Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The Strategy Group will develop a communications plan. This has been an important area of work with a communication plan is required to engage and consult with key stakeholders throughout the redesign. A communications plan is in place for the Home Support Programme Board. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? The risks for the implementation of the Suicide Prevention Strategy and action plan will be identified and managed in accordance with the agreed corporate programme risk management and methodology and monitored through the Suicide Prevention Strategy Group. The response to the New Suicide Prevention Strategy and Action Plan for Scotland will inform the North Lanarkshire Strategy and action plan which will be reviewed. Page 10 of 236
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Appendix 3 Suicide Prevention North Lanarkshire Action Plan 2021 Priority Outcomes 1. People at risk of suicide feel able to ask for help, and have access to skilled staff and well-coordinated support; 2. People affected by suicide are not alone; 3. Suicide is no longer stigmatised; 4. We provide better support to those bereaved by suicide; and 5. Through learning and improvement, we minimise the risk of suicide by delivering better services and building stronger, more connected communities. Action No Action Lead RAG Status Activity Outc ome No Update/progress Link to Performanc e Framework timescales 1. Suicide Prevention North Lanarkshire will continue to deliver the Living Works Training programme including ASIST, Safe TALK and Suicide TALK. The Scottish Government are funding the creation and implementation of refreshed mental health and suicide prevention training. Norma Lang Susan McMorrin 1. ASIST and Safe TALK organised centrally once per month 2021 2. Respond to specific requests for training depending on capacity, currently prioritising SFR and SAS 3. Suicide TALK T4T will be organised for November 2021 , a further 20 people will be trained, training pool will be increased to 70 4. Developing an After- Suicide Procedure, considering needs of family and work force 5. Contribute to the development of the national mental health 1 2 additional ASIST trainers have been trained and 2 safe TALK trainers ASIST and safe TALK have both resumed delivery following pandemic restrictions. 4 ASISTs offered March -December 2022 We have a shortage of trainers locally and no TFT planned by PHS so frequency will be restricted by capacity. We care considering to buying in sessions for ASIST to address this issue. Suicide ALERT online sessions continue to run. Work planned pan Lanarkshire to develop a new awareness level session incorporating PHS animations. Once developed this will replace SuicideALERT . Ongoing 1 Page 11 of 236
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Two trainers have completed Scotland’s Mental Health First Aid TFT. 2 courses scheduled for delivery Oct & Nov 2022. Places on all programs are routinely offered to partner & third sector agencies, for e.g SafeTALK sessions provided for Enable and ALERT for foster carers Autumn 2022. 3. After a Suicide facilitators notes have been developed. Capacity and procedure for delivery needs to be reviewed when new lead officer in post and suicide prevention training as requested by the National Leadership Group 2. Suicide Prevention North Lanarkshire will continue to develop and create a coordinated approach to public awareness campaigns, which maximises impact. Carolynne Coole Miller 1. Prepare a comms plan 2. Develop a performance framework 3. Respond to public need 4. Develop public awareness campaigns 5. Deliver Suicide ALERT 6. Develop an evaluation framework 3 Suicide Prevention NL Communications Plan developed for 2022-23 which includes support for Suicide Prevention Week, a Winter campaign (including Surviving Christmas and New Year), and a Spring 23 youth campaign. A framework for Ongoing 2 Page 12 of 236
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evaluation will be developed by December 2022 specifically relating to the communications plan. In addition, we are continuing the FeelWellNL initiative in specific locations of concern including Strathclyde Country Park, Drumpellier Country Park and Centenary Park/Railway Bridge as well as a few locations in Airdrie and Motherwell town centre on benches. 3. Suicide prevention North Lanarkshire will work with the NSPLG to ensure that timely and effective support for those affected by suicide is available across Scotland by working to develop a Scottish Crisis Care Agreement. Andrea Breen Gemma Maguire Ann Marie Darcey 1. Develop strategies to provide compassionate, high quality timely support for those bereaved by suicide 4 Mapping exercise required Andrea Breen, Gemma Maguire and Ann Marie Darcey will have a meeting to review and undertake mapping exercise, feeding back to the next suicide prevention partnership board meeting January 2023 4. Suicide Prevention North Lanarkshire will work with partners to develop and support the delivery of innovations in digital technology that improve suicide prevention Susan McMorrin 1. Further develop the SPNLC app 2. Consider use of digital technology for young people 3. Continue to promote the RU That Guy test messaging campaign 2 App being updated The app is being reviewed by the NHS Governess Group as the criteria and access does not currently meet the required guidelines. Susan McMorrin will keep the group updated on this and notes this is currently an issue for many apps used in public services. Ongoing 3 Page 13 of 236
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5. Suicide Prevention North Lanarkshire will identify and facilitate preventative actions targeted at risk groups. Gemma Maguire Lesley Mann 1. Identification of high-risk groups through local intelligence 5 Lesley and Gemma will continue to review notification sent by Police to look at frequency of recorded deaths and involvement with services. Lesley will contact Police Scotland to confirm representation at partnership group. In response to rises in suicides rates within Airdrie/Coatbridge areas in 2022, a cluster plan is in in place with a range of campaign activity targeting over 35s in these areas. This includes running tv adverts on STV digital player (specifically targeting this geographic region) and on social media channels. Posters and postcards have also been developed and sent to health centres, pharmacies, council leisure facilities, libraries, community groups and places of worship in the area. Ongoing 4 Page 14 of 236
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6. Suicide Prevention North Lanarkshire will ensure that all of the actions of the Suicide Prevention Action Plan consider the needs of children and young people. Ian McCauley Nancy Ferguson 1. Work with education to ensure the Suicide Safer Schools proposal is embedded in the Children’s Services Plan. 2. Work with Papyrus re Suicide Safer School, colleges and universities framework 5 Lifeline’s training continues to be rolled out to schools and on track. Further training for Education and Families and other partners is ongoing. DBI is now being piloted within some NLC schools. Progress update on this will be fed back at next partnership meeting Ongoing 7. Suicide prevention North Lanarkshire will work closely with partners to ensure that data, evidence and guidance is used to maximise impact. Improvement methodology will support localities to better understand and minimise unwarranted variation in practice and outcomes. Gemma Maguire Lesley Mann 1. Analysis and identification of themes and trends using the ScotSid figures as well as local intelligence 2. Set up a Locations of Concern multi agency meeting 5 Local data is analysed to provide information for the Locations of concern meeting which includes outreach youth work Lesley and Gemma will continue to review notification sent by Police to look at frequency of recorded deaths and involvement with services. Ongoing 8. Suicide Prevention North Lanarkshire will work the NSPLG and COSLA to develop appropriate reviews into all deaths by suicide, and ensure that the lessons from reviews are shared and acted on. Andrea Breen 1. Develop an internal review process with partners 2. Link with SAERS group, sharing information 3. Prepare a pan Lanarkshire bid to develop suicide reviews across Lanarkshire 4 Pan Lanarkshire proposal is being discussed to employ a Suicide Review Officer for one year- awaiting update from Scottish Government, Andrea will link with Adam Daly re this Ongoing 5 Page 15 of 236
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref MD/JH Date 15/11/22 PO52.1 North Lanarkshire Alcohol and Drug Partnership From Morag Dendy, Head of Planning, Performance and Quality Assurance E-mail dendym@northlan.gov.uk Telephone 01698 332093 Executive Summary North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on alcohol and drugs use issues locally. Members include agencies with an interest in providing treatment and intervention for people experiencing problem alcohol and drug use, and other key stakeholders. The NLADP Strategic Lead has been working closely with strategic partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence, regional scoping work and learning from commissioned services including the voices of lived experience. Recommendations It is recommended that the Adult Care and Social Work Committee: i) Note the content of the report. ii) Note the key actions to support the strategic direction of NLADP structures to deliver on the priorities in line with additional investment. iii) Note the additional investment and ring-fenced budget for each priority area: • Medication Assisted Treatment (MAT) Standards • Residential Rehab • Assertive Outreach and Crisis support • Harm reduction – including Naloxone provision • Whole Family Approach and Family Inclusive Practice • Lived and Living Experience iv) Approve NLADP Self-Assessment completion setting out the appropriate governance is in place to deliver that National Mission priorities and The Partnership Delivery Framework objectives. AGENDA ITEM 3 Page 17 of 236
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1. Background 1.1 North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on alcohol and drugs use issues locally. Members include agencies with an interest in providing treatment and intervention for people experiencing problem alcohol and drug use, and other key stakeholders. 1.2 The NLADP Strategic Lead has been working closely with strategic partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence, regional scoping work and learning from commissioned services including the voices of lived experience. 1. Prevention Early Intervention & Education 2. Treatment, Care and Recovery 3. Whole Family Approach 4. Public Health Approach to Justice 5. Reducing Alcohol Harms Group 1.3 All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. It will do this by: ➢ providing fast and appropriate access to treatment and support through all services ➢ improving frontline drugs services (including the third sector) ➢ ensuring services are in place and working together to react immediately for people who need support and maintain that support for as long as is needed ➢ increasing capacity in and use of residential rehabilitation ➢ implementing a more joined-up approach across policy and practice to address underlying issues. 1.4 A Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. 1.5 The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of: • Assessing need • Aligning resources • Agreeing delivery plans and priorities • Reporting and learning from outcomes The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (13) Improve preventative approaches including self-management and giving people information and choice over supports and services Page 18 of 236
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1.6 The self-assessment is designed to ensure key relationships are in place and that the local system is supporting the work of the ADP. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders. 1.7 The self-assessment will set out where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic Planning 2. Financial Arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight 5. The relationship between the ADP and the Integration Authority. 2. Report 2.1 The range of work to scope strengths and challenges in current arrangements, place the experience of people with lived experience and families at the centre of developments and engage with all stakeholders will significantly reshape the commissioning intentions, create a robust response to the challenge of preventable drug deaths in North Lanarkshire and inform the proposed Investment Plan. 2.2 The following actions have been taken to progress NLADP response locally 1. ADP Strategic Lead and support team have established the appropriate structures/representation required to support approval and delivery of the ADP Strategy in keeping with national priorities. 2. Rapid Review of treatment and care services undertaken (Feb – May 2022) setting out key recommendations, actions, and priorities to inform NLADP investment and planning 3. Additional investment for 2022 aligned with new funding streams and allocated 4. Residential Rehab oversight and operational groups established to review/establish robust pathways and processes with spending arrangements in place - details published 5. Residential Rehab training sessions complete with further briefings taking place throughout Autumn 6. Pan-Lanarkshire arrangements in place for MAT standards. Oversight and governance group established in September 2022 to drive forward plans to realise target to implement by March 2024 7. Proposals and commissioning priorities identified by each sub-group to allow NLADP to configure and commission the most appropriate services beyond 2023 8. Workforce Development needs analysis launched to shape the learning and development programme required to realise the collective skills, knowledge and expertise required to deliver on our priorities 9. Additional funds allocated to support ongoing Test of Change initiatives, local stigma action fund and wellbeing support to tackle some of the root causes of problematic substance use in collaboration with VANL 2.3 The strategic vision and proposed subgroups will carry forward the programme of work to be led by NLADP until 2024. The proposed priorities and structures will support the ADP to report on ministerial priorities given the increased scrutiny that will come with the additional investment directly or indirectly via integrated authorities. Page 19 of 236
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2.4 All actions and progress of the ADP to be recognised in the Self-Assessment setting out any work still to be done. 2.5 NLADP Reporting requirements 2022 2.5.1 MAT standards benchmarking supplementary appendix 27th June – complete 2.5.2 Residential rehab pathways processes publish – end of July 2022 – complete 2.5.3 ADP Annual review 5th August – complete 2.5.4 Treatment Target projections – 17th August – complete 2.5.5 MAT standards Self-Assessment - 19th September 2022 - in progress Note: NLADP commissioned services are due to submit a 6-month performance and engagement report in October 2022 - service delivery reviews will take place shortly after. 3. Measures of success 3.1 Medication Assisted Treatment (MAT) standards – 1-5 implemented and embedded by March 2024 (6-10 beyond) 3.2 Residential rehab – assessment and access for anyone who chooses/where appropriate as part of their care and treatment. Each ADP/Health Board should now publish rehab pathways online setting out how people can access residential rehab. 3.3 Harm reduction – consistent approaches and increase workforce confidence/capacity to deliver HR. Includes Naloxone provision. 3.4 Assertive Outreach – ADPs should define their approach for increased support with commissioning for effective assertive outreach/crisis support expected in 2023. 3.5 Treatment Targets – increase engagement by 9% (113) by 2024 3.6 Whole Family Approach – increase/widen Family Inclusive Practice (FIP) across all treatment and care settings 3.7 Recovery – Lived and Living Experience (LLE) involved in design, delivery, and evaluation of services. LLE Panels to be established. 3.8 Mental Health – Complex needs are fully considered and met via trauma informed workforce 3.9 Stigma – tackled at local level 3.10 Human Rights – are at the heart of how substance use services and wider supports are designed and offered. Page 20 of 236
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4. Supporting documentation 4.1 Appendix 1 NLADP Strategy 4.2 Appendix 2 NLADP Position paper on progress toward priorities 4.3 Appendix 3 NLADP Rapid Review 4.4 Appendix 4 Self-Assessment tool template Morag Dendy Head of Performance, Planning and Quality Assurance Page 21 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? Nationally, a commitment has been made to rolling investment for the next 5 years. ADPs are expected to use any reserves in full in addition to the new investment having to account for any reserve or carry forward fund year on year. All funding will be multi-year with an expectation there will be flexibility in how this is utilised for maximum output/impact. Nationally • £5 million of this is to expand access to residential rehabilitation • £5 million to support the priorities of the National Mission • £3.5 million to implement the Whole Family Approach framework. North Lanarkshire Actual Budget Spend YTD Key Initiatives Residential Rehab £317,148 £4,934 Rehab team allocate this spend based on treatment choice & new pathway National Missions £317,148 £119,004 Acute Navigators/Advocacy/ Positive support/IPS SAMH/Harm Reduction Whole Family approach £222,004 £40,000 Family plus/ Creative faces/ housing support Outreach £190,289 £59,278 VAW partnership/ ABI/Arrest Referral MAT Standards £380, 578 0 MAT oversight Group will allocate this spend Lived & Living Experience £31,715 0 Post Approved Page 22 of 236
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CORE Funded Adult support Phoenix £294,204 £108,336 Children Barnardos £270,000 £99,455 Integrated Addiction Team £260,858 £86,953 Youth Bridges £66,246 £21,544 Prison Through care £39,000 £13,000 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☐ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Page 23 of 236
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Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? As part of the updated oversight arrangements of the ADP, a new Risk Register will be formed which will feed through into the operational registers of the partnership and the strategic register of the IJB. Work is being undertaken to develop the ADP website with links to both NHS Lanarkshire and NLC websites to strengthen accessibility and visibility of information for the public and staff across partners. Page 24 of 236
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Appendix 1 NLADP Strategy North Lanarkshire ADP Strategy 2021 – 2024 Page 26 of 236
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About this Strategy This strategy has been co-developed through ongoing engagement with a broad range of stakeholders including people with lived experience across North Lanarkshire. It was vitally important to the success of any improvements we are trying to influence that individual voices and experiences were included in this process. Our approach, coupled with the existing and emerging evidence base for tackling harms from problematic substance use offer a robust and ambitious way forward that will see us confidently lead the way in keeping people safe, well and thriving in North Lanarkshire. This document sets out some of the challenges we face and how we intend to move forward. We have set out the appropriate Alcohol and Drug Partnership structures that will be tasked with implementing change and supporting more people to find their own type of recovery. A detail delivery plan will follow to support specific actions and outputs for the ADP sub-groups. This strategy does not exist in isolation and is intended to link with other strategic plans focussed on identifying and protecting those at risk of harm from substance use. This includes but is not limited to: ➢ North Lanarkshire Children’s services plan ➢ Mental Health and Wellbeing Strategy ➢ Community Justice Improvement Plan ➢ Strategic Commissioning Plan ➢ VANL strategic plan ➢ North Lanarkshire Town Visions ➢ NL Housing Strategy & Rapid Rehousing Plan About North Lanarkshire ADP North Lanarkshire Alcohol and Drug Partnership (NLADP) was established in 2019 as a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). Much of our work involves bringing people together to plan and improve services whilst setting out what needs to be put in place to support change and keep people safe and well. We do this by reviewing, monitoring, and evaluating the impact of investments targeted towards reducing substance-related harm and improving health and wellbeing. Page 28 of 236
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Our Approach North Lanarkshire Alcohol and Drug Partnership has drawn on the successes, challenges and learning from previously funded initiatives to form this strategy. In addition, we commissioned targeted scoping work through Scottish Drugs Forum and Scottish Families Affected by Alcohol and Drugs to give us direct insight from individual and family experiences. These offered first-hand accounts of the needs, challenges, and innovative ideas for change from those living in North Lanarkshire, including many who have been in contact with services for support with substance-related issues. We’ve also drawn from the invaluable wealth of experience, skills and local knowledge within our workforce and volunteers working across our communities. Policy Perspective In 2018, Rights Respect and Recovery 1and the Alcohol Framework2 were published setting out the Scottish Government’s commitment to reducing deaths from alcohol and drugs and tackling harms to individuals and those around them. For the first time there was direct recognition of the right to health for people who use alcohol and drugs and a focus on a wider approach moving beyond clinical services. This included a commitment to increasing harm reduction measures, tackling stigma, removing barriers to support, increasing community-based recovery opportunities, understanding the links to justice, tackling inequalities, and offering direct support for the whole family. At the same time, in Scotland’s Public Health Priorities, the focus on reducing the use and harms from alcohol, tobacco and other drugs and a focus on good mental wellbeing were reinforced taking a public health approach to improve the nation’s health3. Since the publication of Rights, Respect and Recovery and Scotland’s public health priorities, further commitments have been made nationally, as part of the Drugs Deaths Task Force, to refine the response in keeping the most up-to-date evidence-base for what works to support change. This includes the new priorities set out in the Partnership Delivery Framework4, the National Mission Priorities5, Tackling Stigma6 and implementation of the Medication Assisted Treatment (MAT)7 Standards. This document recognises the cross-cutting commitments, outcomes and priorities in each publication and sets out the role of the ADP in realising the whole systems approach required to achieve these. 1 Rights, Respect and Recovery : Scotland’s strategy to impro v e health by preventing and reducing alcohol and drug use, harm and related deaths Page 29 of 236
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(www.gov.scot) 2 Alcohol Framework 2018 - gov.scot (www.gov.scot) 3 Scotland's public health priorities - gov.scot (www.gov.scot) 4 Alcohol and Drug Partnerships: delivery framework - gov.scot (www.gov.scot) 5 Drugs policy - update: statement by the First Minister - 20 January 2021 - gov.scot (www.gov.scot) 6 https://drugdeathstaskforce.scot/media/1111/stigma-strategy-for-ddtf-final-290720.pdf 7 medication-assisted-treatment-mat-standards-scotland-access-choice-support.pdf (www.gov.s Page 30 of 236
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Alcohol and Drug Use in North Lanarkshire Drugs North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 94 people dying from drug-related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire. There were 2,812 drug related crimes in North Lanarkshire in 2019/20 [latest figure available]. This is a rate of 82.4 per 10,000 population share, this is contrasted to a rate of 64.6 across Scotland. Page 31 of 236
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Alcohol In 2020, 101 people died from alcohol-related causes in North Lanarkshire. Alcohol related hospital admissions were 3270 in 2019/20 [latest available figures]. There were 36,135 Alcohol related hospital admissions across Scotland. Age-sex standardised rate per 100,000 for North Lanarkshire in 2019/20 was 982.36 and 673.27 for Scotland. The age-standardised death rates for alcohol-specific deaths in the most deprived 20% of areas in Scotland has been consistently higher than the rest. The death rate in the most deprived areas is 4.3 times the rate in the least deprived areas in 2020 (41 deaths per 100,000 compared to 10). Since 2001 the death rate in the most deprived areas has remained the highest of all five SIMD quintiles although the gap has narrowed slightly. *1 Not from the full sample of 94 deaths as at the time of analysis we did not have the toxicology reports for all 94 deaths therefore this percentage is from the available data set (61 of 94 deaths) SIMD and DRD Across Scotland in 2020, 1339 drug-related deaths occurred. Seven hundred and seven (53%) were in SIMD quintile 1 and three hundred and sixteen were in quintile 2 (24%) therefore 77% in quintiles 1 and 2. This is most significant if we consider the population of North Lanarkshire where 59% (32% SIMD 1; 27% SIMD 2) of the population is in SIMD quintile 1 or 2*. The strong links between drug and alcohol related harms and poverty8, inequality and trauma are widely acknowledged. Deprivation has been linked as a significant factor9 in drug and alcohol problems developing. 8 Hard Edges Scotland | The Robertson Trust 9 Staying-Alive-in-Scotland-Digital.pdf (sdf.org.uk) Page 32 of 236
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What we see in North Lanarkshire is not unique and reflects a national picture where data trends are synonymous with the wider evidence base on substance- related harms10 It is vital we have the most relevant data and evidence available to us to target the response needed to tackle the root causes of problematic substance in a holistic way. This includes using tried and tested approaches and targeting specialist responses across key localities. This will help to improve links to universal services and support the right investment in initiatives that can influence change and prevent deaths at the earliest opportunity. Support for Families In the Scottish Families report ‘Hidden in Plain Sight’ commissioned by NLADP in 2020, the vast majority of community survey respondents (9 in 10 people) felt their community had an issue with alcohol or drug use, with just 7% believing this not to be the case. Levels of support across communities were significantly below the level of prevalence, with just over 13% feeling their community was supportive of those living with drug or alcohol addiction, rising to 19% who felt their community was supportive of families affected. For both of these statements, just over a third did not express a view (remaining neutral) but even taking this into account this indicates: • Very high levels of substance-related issues for communities (89%) • Very low community support for people living with addiction (13%), or for their families (19%). A strong message from the study was families in North Lanarkshire were hidden in plain sight. ‘There are thousands of families affected by substance use in the area but a tiny number reaching support’. Yet there was a significant number of community ‘touchpoints’ where families were engaging providing key routes for awareness-raising and links to early support. These include schools, churches/ faith communities, financial/ advice services, and workplaces. There was widespread recognition of the impact of stigma, shame, and secrecy on families. This often prevents families coming forward for support. Tackling stigma is not just about the media and communities, but also about those closest to families (wider family, friends, workplaces). * See appendix 1 for fuller data10 Problem drug use in Scotland (parliament.uk) Page 33 of 236
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COVID19 Covid19 has had a significant impact on the lives of many people living in North Lanarkshire and the services that provide for them. In some cases, this may have led to an increase in drug and alcohol consumption and increased risk and harm within the home11 Drug services and prescribing arrangements were adapted with some innovative practice offering realistic solutions for fast access to treatment and support including; electronic prescribing, distanced check- ins with people who use services, wider Naloxone distribution and wider choices in OST (including Buvidal). These were options not previously possible or permitted due to legislation but now offer learning that should be considered in our plans moving forward. What currently exists in North Lanarkshire? NLADP Support staff team is made up of a Strategic Lead, Development Officer x 2, Information and Research Officer, Administrator and Clerical Support. The ADP directly funds over 30 programmes and initiatives across North Lanarkshire aimed at reducing harms, providing recovery-focussed activities and improving lives. We still have much work to do to get it right and reach those in need of support who are still not known to our services. Moving forward we will place more focus on getting what people need, where they need it most whilst making it as easy as possible to access. Our vision A North Lanarkshire where individuals and families experience less harm from the effects of problematic alcohol and drug use. People are safer, healthier, and treated with dignity to make informed choices around their own care and empowered to find their own type of recovery. 11 Changes in alcohol consumption in Scotland during the early stages of the COVID-19 pandemic: Descriptive analysis of repeat cross-sectional survey data (publichealthscotland.scot) North Lanarkshire Alcohol & Drug Partnership Board ADP Chair NLADP Strategic Lead NLADP Administrator Clerical Officer Development Officer Development officer Information Research Page 34 of 236
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The way forward Actions will be centred on improving quality, offering choice and creating more of the connections to keep people safe, well and thriving. Realising a North Lanarkshire where: 1. Fewer people develop problem drug and alcohol use 2. People access and benefit from effective, integrated person-centred support to achieve their own type of recovery 3. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. 4. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. 5. Less harm is caused by alcohol. NLADP Structure ADP Board Finance Sub Group Prevention Treatment ROSC Whole Family App/FIP Justice & Health Alcohol Harms Page 35 of 236
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ADP Strategic Framework Prevention and Early Intervention Developing Recovery Oriented Systems of Care Getting it Right for Children, Young People and Families Public Health Approach & Justice An Alcohol Framework for North Lanarkshire Fewer people develop problem alcohol & drug use. People access and benefit from effective, integrated person- centred support to achieve their recovery. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. A Scotland where less harm is caused by alcohol. Prevention, Early Intervention, & Education Treatment, Care & Recovery Development Whole Family Approach /Family Inclusive Practice Justice, Health and Care public health to improve links to community Reducing alcohol harm and improving treatment pathways Embedding a Whole Systems Approach via Workforce development, collaboration & learning Partnership Work & Collaboration Lived experience, co- production & active participation. Ongoing evaluation, quality assurance and performance monitoring Communication, transparency & good governance are key Focus on the right to health, choice, fairness & equitable opportunities free from stigma Cross-cutting Sub-Group Priority Area National Outcome s Objectives Page 36 of 236
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21 Key Priorities & Actions 2021 – 2024 NLADP Strategic Lead and the support team will develop the structures and process required to deliver the programme of work set out including establishing the appropriate sub-groups tasked with leading the work. It is expected these groups will take a lead in informing the finance arrangements and facilitating wider stakeholder engagement. A delivery plan and commissioning strategy will be developed in the first six months with progress linked to the following priorities: 1. People have early access to support for problem substance use –early intervention strategies will be put in place to prevent problem use with support offered through a range of community-based responses. 2. NLADP will facilitate efforts to embed a Whole Systems Approach – including families and a broader range of stakeholders to reach those not already known to services. 3. Strengthen the links between physical/mental health & substance use taking a ‘No wrong door approach’ focussed around the needs of the individual and not solely focussed on the substance use or disorder/s. 4. Young people and families receive evidence based, effective education on substances, harm reduction and how to access help when problems develop. Through the provision of effective, evidence-based education both within and beyond school. 5. Workforce capability is increased through learning via a strategic workforce development plan including needs analysis to identifying gaps and opportunities to strengthen the workforce knowledge, skills, and confidence to respond. Drawing on local experience, knowledge, and assets to support quality Improvement and best value. 6. People are supported to make informed decisions about their own care through a range of treatment options including residential rehab for all those who will benefit. Including all those who want, and for whom it is deemed clinically appropriate, to access residential and/or community rehabilitation. 7. People are supported to remain in treatment for as long as requested – MAT standard 5, individuals are supported to remain in the treatment that is right for them, for as long as they want or need. 8. Improved early identification, assertive outreach & increased engagement (MAT standards – opiate/benzo with rapid access) so people at high risk are proactively identified and offered support – MAT standard 3 targeting at-risk groups. 9. Overdoses are prevented from becoming fatal – increasing provision of naloxone, strengthening proactive outreach for at-risk groups improving near fatal overdose pathways. 10. All people are offered evidence-based harm reduction – MAT standard 4. Provision of harm reduction materials such as injecting equipment, BBV and wound care for those who need it. 11. People who use drugs have access to information about risks and harm reduction – in person, digital and via phone information on drugs and harm reduction including WAND, EIP and DBST. Page 37 of 236
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22 12. More families are involved in the care and treatment of their loved ones with access to support in their own right – even where their loved one is not engaged with treatment. This includes choice and wider access to opportunities locally for adult family members, young adults as well as children and young people. 13. Effective pathways between justice and community services are established including prison through-care and diversion pathways. This will take account of housing, advocacy, and connections to the community. 14. Less harm is caused by stigma for people who use alcohol and drugs and their families in North Lanarkshire. NLADP will lead on a local stigma plan recognising individuals, families and communities should have access to a range of opportunities to support improved well-being, resilience and reduced feelings of isolation caused by stigma. 15. NLADP will develop an alcohol specific framework recognising the impact alcohol has on individuals, families and communities implementing targeted interventions to reduce harm, change attitudes to alcohol consumption and improve health & wellbeing. 16. NLADP Drug-Deaths Prevention Action Plan is refined and linked with key outcome areas from DDTF priorities using evidence of based practice whilst targeting those most at risk. Page 38 of 236
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24 Appendix 2 NLADP Position Paper – June 2022 This paper sets out the key commitments and responsibilities of North Lanarkshire ADP and relevant integrated authorities in working towards the national mission objectives, MAT standards implementation and residential rehab progress as set out in Rights, Respect and Recovery and the partnership delivery framework. In addition, proposals and recommendations have been made to progress each of these areas in keeping with North Lanarkshire ADPs strategy. A national benchmarking report was issued on 23rd June showing progress made across Scotland on a RAG status basis. North Lanarkshire is in a good position to implement the MAT standards however, there is still a lot of work to do to fully embed the standards across all six localities. A supplementary overview, setting out further details and actions required to achieve all standards, will follow on 2nd August. This was submitted to PHS on 27th June. All services involved were asked by the ADP to review and submit comments ahead of the deadline. MAT Standards - current status in North Lanarkshire 1. Same day access - All people accessing services have the option to start MAT from the same day of presentation. RED ➢ Choice - All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose AMBER ➢ Assertive outreach - All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. AMBER ➢ Harm Reduction - All people are offered evidence-based harm reduction at the point of MAT delivery. AMBER ➢ Retention All people will receive support to remain in treatment for as long as requested. RED Funding position North Lanarkshire received £380,578 for 2021/22 towards implementing MAT standards 1-5. A further £570,866 will be made available in 2022/23 to fully embed the MAT standards over the coming year. Chief Officers and Chief Executives have been asked to sign timed, specific, and published Improvement Plans for implementing the standards – to include the delivery recommendations being made locally with MIST which are to be published by PHS on 2 August. Progress so far The proposed model for MAT standards is a Pan-Lanarkshire model based on an assertive outreach delivered via an ‘Urgent Care Response Team’ to be established. Progress on this is expected from August 2022 and will include the use of telehealth and mobile outreach facilities to increase same day access to treatment. The approach will need to ensure transparency, full oversight and accountability in the delivery and evaluation of the MAT standards. There is an expectation that ADPs will monitor and report on progress via a full evidence review, numerical data and experiential qualitative feedback. There will be ongoing support from the MIST team nationally though Public Health Scotland. Page 40 of 236
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25 The ADP has already approached all services involved to report back on progress towards implementing and embedding the standards by 8th July. A full report and evidence review of clinical governance arrangements will follow. This will be handed over to the Project Lead to take forward with the Service Manager when in post. Page 41 of 236
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26 NLADP is required to submit the following to the Scottish Government: • MAT standard benchmarking supplementary appendix 27th June – complete • Residential rehab pathways processes publish – end of June 2022 – complete • ADP Annual review 5th August – complete • Treatment Target projections – 17th August – complete • MAT standards Self-Assessment - 19th September 2022 - in progress Drug and Alcohol Treatment Services- MAT standards 1-5 The recent ‘Rapid Review’ research commissioned by North Lanarkshire ADP acknowledges statutory services continue to work hard in supporting people who need drug and alcohol services. The unwavering commitment of staff across the sector has been well documented and widely acknowledged by individuals and those working in services at a consensus event on the 26th May. There is agreement that the current demand on services, coupled with challenges around premises, staff recruitment and retention have all lead to limited workforce capacity which remains significant. This has limited the ability of services to meet people’s needs consistently across all six localities in North Lanarkshire. Concerns exist around the current quality and consistency of care as well as ongoing support and development opportunities for the workforce. Recruitment is likely to become more of a challenge as investment increases across Scotland. It is understood it may become more difficult to find suitably qualified practitioners with the right skills, knowledge, capability, and values required to deliver the MAT standards. Next steps Immediate approval and sign-off on recruitment for a MAT standards Project Lead and Service Manager who will work closely with the ADP support team and key stakeholders to co-ordinate the operational requirements for MAT standards to be implemented and fully embedded. A decision to be reached on where these posts will be hosted in the current system including who will assume line management responsibilities and ongoing support and supervision arrangements for these posts to minimise disruption and maximise progress. Is this quality and performance/service delivery or other? Agreement that a MAT standards monitoring group will be established to oversee implementation, review progress and respond appropriately to ensure all operational elements are achieved in North Lanarkshire. Agree how the monitoring group, ADP and other stakeholders will report on progress into existing structures moving forward? Facilitate improved collaboration, input and support from Community Addiction Pharmacy and Quality Improvement colleagues sharing data and improving intelligence around all test of change initiatives linked to the MAT standards. Page 42 of 236
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27 Assertive Outreach & Crisis Support MAT Standards 1,3 & 4 The Lanarkshire Overdose Response Team (LORT) was established in September (2021) with 4 outreach staff and 1 coordinator. This is service is funded through the Drugs Death Task Force (DTTF) until February 2023. Following the model set up on Glasgow in 2019, a proposal to complement current provision and directly address key gaps and vulnerabilities were identified as: • The absence of ‘out of hours’ provision; • The absence of persistent and assertive ‘wrap-around’ care at point of crisis; • The inconsistency of intervention and follow-up care after near fatal overdose. The Turning Point Scotland service provides a rapid response to near-fatal overdose (NFO) providing a short, focused period of support to each person and assertively engaging them with mainstream alcohol and other drug services. Next steps Investment and support is urgently required to stabilise existing services and ensure equitable access to treatment, care and support across all localities. Approval work to commence to identify clinically viable premises to deliver treatment and care services. The output from this work should set out what investment/approaches are needed to offer accessible and approachable treatment services that are fit for purpose. Approval and sign-off for a full review of treatment, care and support services should be initiated (alcohol, drugs and mental health. This is vital to understand current delivery capacity and any additional investment/reconfiguration of services required to meet local need in line with current demand. Staff recruitment and retention remains a significant challenge. Further consideration should now be given to how addiction services can incentivise those staying or coming to work in North Lanarkshire. This will help not only to build capacity but to build the capability needed to ensure we have the right skill set, values and commitment within our workforce. This is significant as we move closer to same day access via the Medication Assisted Treatment (MAT) standards. Workforce development needs should be fully reviewed via a training needs analysis to upskill and inform ongoing practice in keeping with national priorities, clinical guidelines and a rights- based approach including; • more frequent care and treatment reviews, • better access and choice in treatment and care services, • increasing family inclusive practice, • routine harm reduction screening at each point of contact. Consideration should be given to workforce wellbeing through protected time and wellbeing networks for staff working across localities to come together. Page 43 of 236
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28 The team received and responded to a total of 113 referrals during the initial reporting period. These referrals came from a variety of different sources that the team had built pathways with, in order for them to refer into the response with as much ease as possible, including a 24hr free phone number and a simple referral form which can be emailed direct to the team. The 113 referrals represent 92 individuals, with 76 of these having a single referral and 16 having 2 or more referrals. NLADP has recently approved funding for a dedicated worker to monitor and co-ordinate the overdose response approach. This post will be linked with the harm-reduction team and is a shared post with SL ADP. MAV Navigators – Assertive Outreach MAT standards 1,3 & 4 North Lanarkshire APD has approved continued funding for year 2022/23; to support the development of an assertive outreach model (navigator programme) to improve engagement of service users within the acute setting and onward referral to community-based drug and alcohol support services. The service was extended in 2021 via the ADP board based on local needs and demand. Increased funding was required to cover both the major trauma centre at UHW and Monklands Hospital in North Lanarkshire. Navigators are uniquely placed within the ED to provide the earliest intervention, to be there at the time of crisis and also to be there at the time of reflection (the reachable moment) when that window of opportunity to plant the seeds of change is open. In 2021/22, the service within Wishaw ED has engaged with 127 individuals from North Lanarkshire (50F:76M) since July 2021(as well as a further 38 (24M:14F) seen between April to June 2021 who were seen under the previous joint funding arrangement). Of the 127 North Lanarkshire patients 74 (58%) patients actively and immediately engaged with the service and 20 (16%) were unable to engage immediately (usually due to intoxication or serious injury). 33 (26%) refused the offer of support. Next steps Drawing on learning from the Turning Point interim report and Rapid Review further consideration should now be given to extending the operational hours of the ART services to meet the needs of individuals and families who need support in crisis. The sustainability of the overdose response team beyond February 2023 needs consideration. Will this be part of our core funded response and MAT standards, or should this be commissioned separately by the NLADP moving forward? Will the MAV Navigators and additional capacity provided by Substance Misuse Liaison Nurse roles be extended and funded via core or continue to be funded via the ADP beyond 2023? Page 44 of 236
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29 Treatment Targets In North Lanarkshire, a 9% (113 people) increase is expected by April 2023 across statutory drug treatment services. This approach is linked to the evidence-base that acknowledges those engaged in treatment are less likely to experience a fatal overdose. The update from the Scottish Government, March 2022, shows the current picture across Scotland based on CHI capture. At present, the CHI capture rate of those accessing Opiate Substitution Therapy (OST – Methadone/Buvidal or other) in North Lanarkshire sits at 55%. NLADP Strategic Lead has initiated discussions with Community Pharmacy colleagues to understand more with a view to improving CHI capture – more work is required to develop a strategy to meet this target. Alcohol treatment targets will follow in 2024. Page 45 of 236
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30 Harm Reduction – MAT standards 1-5 There is significant harm related to drug injecting related to blood borne viruses, bacterial infections, injection site wounds and overdose risk. Within existing NHS Addiction services these issues are often not picked up - as appropriate questions are not asked and assessments of injecting risk are not undertaken. The Medication Assisted Treatment Standard 4 highlights this and aims to integrate harm reduction with the delivery of OST. The WAND assessment consists of: • Wound care • Assessment of injecting risk • Naloxone • Dry Blood Spot Tests Next steps Support from SLT to communicate treatment target requirements and identify who is best placed to support NLADP to take this forward. Approval for a SLWG to be established to fully consider the targets and to develop a strategy with the ADP to meet the targets. To establish a closer relationship across the ADP with the Community Addiction Pharmacy service to support the wider workforce capability and what the current offer is of those accessing OST in the community including Buvidal. Next steps Support from SLT to communicate the requirements and identify who is best placed to take this work forward. Agreement to increase capacity for WAND consistently across all services and at each point of contact across North Lanarkshire Wider Naloxone provision should be explored with effective monitoring so that Naloxone is offered at each point of contact across North Lanarkshire including acute sites and CPS. Agreement that all practitioners and community members likely to come into contact with people who use drugs are encouraged (possibly via a local campaign) to undertake Naloxone training and have access to a kit. All health board and local authority premises should have a nominated Naloxone contact with a supply kit available to respond in the event of an emergency situation as with first aid, AED or other heath need that is routinely expected to be met. Page 46 of 236
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31 Residential Rehab – MAT standards 2 & 5 Improving access to residential rehabilitation as a treatment option is a key part of the National Mission to save and improve lives. The Government is clear that residential rehabilitation should be part of the full range of drug prevention and treatment services available to people in all local authority areas. The approach and commitment is set out here Work has been undertaken through the Lanarkshire residential rehab operational and oversight working groups. The group has set out clear pathways and processes for individuals seeking to explore residential rehab as part of their care and treatment planning. • North Lanarkshire residential rehab funding 2021/22 - £317,148 • North Lanarkshire residential rehab funding 2022/23 - £ 317,148 Independent advocacy Commissioned by the ADP, the independent advocacy service (Equal Say) continues to link with individuals via referral from statutory and voluntary sector colleagues. Work is underway to strengthen pathways and referral links across all alcohol and drug services (ART). This is particularly significant given the additional investment in Residential Rehab across Scotland, MAT standards and the right for individual and their families to be involved in the co- production, delivery and evaluation of substance use services. Whole Family Approach (WFA) and Family Support There is a commitment to meeting the needs of children and young people Lanarkshire-wide through stronger links and collaboration with community planning partners to achieve our shared Next steps A more consistent approach and understanding of the residential rehab process is now required. Training for all staff in treatment and community services will commence across Lanarkshire, led by the Scottish Recovery Consortium, to ensure staff working in services (statutory and voluntary sector) understand the approach, referral pathways and assessment criteria. NLADP will lead the work focussing on how residential rehab options and access are communicated to individuals and their families as part of a wider package of treatment and care options. All data and costs associated with Residential Rehab assessment and access will be shared with NLADP on a quarterly basis. This is needed to strengthen transparency, accountability and understanding of the true picture for those being referred, assessed and placed in residential rehab. Page 47 of 236
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32 objectives in preventing children and young people from developing drug, alcohol and mental health problems. Work should be carried out to scope and identify opportunities to link and share financial investments for prevention and early intervention (including diversionary activities). Currently, through Rights, Respect and Recovery and the national holistic whole family approach framework there is an expectation and right for families to be involved in the care and treatment of their loved ones (where appropriate) and a right for families to have support in their own right, even if their loved one is not in treatment. There is currently support available to families via Phoenix Futures, Barnardos and carers services but this is in no way comparable to the capacity and availability of support available via statutory and voluntary sector services for those needing treatment and care for drug and alcohol issues. Lived and Living Experience Rights, Respect and Recovery sets out the right to health, choice and quality in care and treatment services. This includes participation from those with lived experience in the design delivery and evaluation of services. North Lanarkshire continues to make great progress in involving the views and experiences of those who have used or need access to drug and alcohol services in shaping the way forward. NLADP commission North Lanarkshire Recovery Community, Phoenix futures and Barnardo’s who all have lived and living experience representatives involved in shaping the design, delivery and evaluation of services. In addition, the ADP commissioned Scottish Drugs Forum to lead a third phase of peer research and the addiction worker training project. The rapid review also takes account on individual and families views. Work is ongoing via the ADP support team to establish lived experience panels to connect to Voluntary Action North Lanarkshire (VANL) and Community Solutions to strengthen participation and engagement of people with lived and living experience across all services. As part of the MAT standards readiness to implement, all lived experience reports have been reviewed and NLADP is well on track to deliver on our commitment here. Next Steps More parity is required to rectify this and ensure the offer of family support via treatment and care services is increased significantly. The evidence tells us that family support can be a protective factor for those not engaged in services. We have limited data and intelligence to understand the levels of family involvement in care and treatment including; care planning and family support offered via statutory services. This needs to be reviewed and a plan put in place to increase family inclusive practice, this is a right and a need that remains largely unmet. Agreement for the WFA allocation from the Scottish Government to be used to increase capacity and engagement with families based on recommendations and actions from the WFA sub-group. Page 48 of 236
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33 Governance, future decision making and reporting • Approval for the work set out in this paper to be the focus of the ADP Treatment, Care and Recovery Sub-group delivery plan for the next 18 months. A suitable lead and Co-lead will be identified to take the group forward. • Discuss and agree the most appropriate way forward to monitor progress and ensure oversight in relation to drug related deaths, MAT standards, National mission priorities. Where/how will the ADP report on these priorities and progress moving forward? • Support a review of NLADP board/finance group membership to ensure appropriate influence, oversight and information sharing to the relevant accountable groups and forums. • Set out who is best placed within North Lanarkshire to support decision making moving forward in line with the Public Protection Agenda. • Consider how best to strengthen collaboration across/between Integrated Authorities, voluntary sector and Community Planning Partners in tackling the root causes of problematic substance use and shared interests in reducing substance-related deaths. Background & further information: Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on the progress toward the MAT standards. on 23rd June, 2022. https://www.parliament.scot/chamber-and- committees/official-report/what-was-said-in- parliament/meeting-of-parliament-23-06- 2022?meeting=13840&iob=125537#orscontributions_M1735E440P776C2417362 Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on Accountability for Delivering the National Mission to Reduce Drug Deaths and Improve Lives. 26th May, 2022. The speech is approximately 10 minutes long with 20 minutes for questions. The full statement is available to watch back: https://www.scottishparliament.tv/meeting/ministerial- statement- accountability-for-delivering-the-national-mission-to-reduce-drug-deaths-and- improve-lives-may- 26-2022 Next steps Agree that lived and living experience voices are heard, valued and acknowledged by all stakeholders and practitioners delivering care and support services in North Lanarkshire. To seek recognition that it will take time with the right financial investment to make an impact and see progress being made here. The ADP has funding set aside/approval for a lived experience support worker to work with all commissioned services and partners to take this work forward. Page 49 of 236
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34 Date Name and comment 27/06/22 John Holleran - NLADP 28/06/22 LK reviewed Page 50 of 236
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35 Appendix 3 RAPID REVIEW OF SUBSTANCE USE SERVICES IN NORTH LANARKSHIRE May 2022 Abstract This report presents findings from interviews with sixteen stakeholders and fourteen individuals, working in or have experience of substance use or substance use services in the area. This review set out to understand current provision, what is working well and what is not, and also what people want it to be. Briege Nugent and Ian Clark briegenugentresearch@gmail.com and ian@iconic-consulting.co.uk Page 51 of 236
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36 Contents Executive Summary ............................................................................................................. i Background and Methods .................................................................................................. 1 The Current Situation ......................................................................................................... 3 What is working well? ......................................................................................................... 3 What is not working well? .................................................................................................. 5 What drives partnership working? ................................................................................... 13 Groups not accessing support ........................................................................................ 14 Future Service Provision .................................................................................................. 15 What support do people want and need? ........................................................................ 15 ‘The ideal’ .......................................................................................................................... 16 Opportunities .................................................................................................................... 18 Wider evidence of good practice ..................................................................................... 19 Conclusion and recommendations .................................................................................. 21 Case Studies ..................................................................................................................... 25 Acknowledgement We would like to take this opportunity to thank the North Lanarkshire ADP – Treatment, Care and Recovery sub-group for commissioning this research, and especially thank all the stakeholders and individuals who were open, honest, gave their time and trusted that this process would help to lead to positive change. Page 52 of 236
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i Executive Summary North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub- group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. The review involved interviews with 16 professionals from across North Lanarkshire working in this field, and 14 individuals who have issues with alcohol and drug use and, their families. Interviews were undertaken in April and May 2022. The study also involved a workshop with over 30 stakeholders in late May to share and discuss emerging findings. What is working well? Stakeholders and individuals identified the following as issues that are working well in North Lanarkshire: ➢ The recovery community ➢ Services that are accessible via out of hours support and assertive outreach ➢ Phoenix Futures ➢ Advocacy ➢ Improvements in partnership working and communication across the ADP ➢ Some of the connections and digital support developed during the pandemic What is not working well? Consultees highlighted the following as issues that were not working well in North Lanarkshire: ➢ Access to addiction, and mental health, services can be challenging ➢ Statutory addiction services under-pressure ➢ Inadequate and unequal provision across areas ➢ Incompatible cultures and short-term funding inhibiting partnership working ➢ GP treatment choices and an information gap ➢ Lack of follow-up support ➢ The negative impact of the pandemic ➢ Stigma Barriers to engagement The following barriers to engagement were identified: ➢ Stigma and perceptions ➢ Lack of resources and inappropriate responses ➢ Professional attitudes: Lack of empathy and understanding ➢ Lack of information sharing between services ➢ Lack of exit plan for methadone use What drives partnership working? The key drivers of partnership working in North Lanarkshire were identified as: ➢ Good communication ➢ Taking a holistic approach ➢ Co-location of services Page 53 of 236
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ii Groups not accessing support Stakeholders identified the following as groups that were not accessing support: ➢ Those isolated and living on their own ➢ Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) ➢ Young people aged 8-11 (as services are not available for this age group) ➢ LGBTQ+ ➢ Victims of domestic abuse ➢ Mothers ➢ People from ethnic minority backgrounds ➢ Elderly people What support do people want and need? ➢ Services need to be person-centred and holistic ➢ Services need to be responsive ➢ Services should be available out of hours and be able to provide assertive outreach ➢ Services should have a single shared assessment ➢ Prioritise prevention Elements of the ‘ideal’ future service Stakeholders and individuals proposed ‘ideal’ future service provision in North Lanarkshire should consist of the following: ➢ A one stop shop with wraparound care ➢ Responsive services with no waiting times ➢ Holistic services that take a whole family approach and address the root causes of addiction ➢ Providing out of hours and outreach support ➢ Accessible residential rehabilitation ➢ Follow-up service ➢ Connecting people into ‘something meaningful’ ➢ Individual recovery plans Opportunities Stakeholders suggested the following opportunities existed to enhance service provision in North Lanarkshire: ➢ Relating to provision: • Improve provision for those in crisis and families • Expansion of the recovery community • Digital connections ➢ Relating to cultural shifts: • Support for staff • Partnership working • Services to promote flexibility • Including the voices of people with living and lived experience in service design and delivery Page 54 of 236
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iii Recommendations The following recommendations are made by the report authors, based on the findings of their research with stakeholders and individuals in North Lanarkshire: • Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. • The development of a crisis service which is a hybrid between an addiction service and an emergency response. • Services to move towards more provision that offers out of hours support and outreach. • Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. • Development of accessible rehabilitation and detox beds. • Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. • To commit to having no unplanned discharges. • More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. • Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). • More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. • Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. • Drawing on lived and living experience, working with third and statutory services, create a day programme for people. • Substance use services in local areas to make connections with GPs, schools, local voluntary sector to open up avenues of communication and referral pathways. • For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ • Services to be trauma informed. • NLADP remain committed to the development of the Stigma plan. • A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers. Page 55 of 236
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iv Background and Methods North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub- group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. This research is part of a wider body of work and research being undertaken in North Lanarkshire to inform future planning of service provision. As this report will highlight, North Lanarkshire’s Strategy for 2021-2014 aligns with many of the key priorities and actions that will be recommended, but also adds new insights too. This research set out to bring together expertise from professionals, and from individuals with lived and living experience of substance misuse. The two main areas of enquiry were, firstly, to understand and hear directly from people ‘on the ground’ what current provision in North Lanarkshire is like, and secondly, what improvements or developments people would like to see to better meet the needs of people with substance misuse issues in North Lanarkshire. Methods and limitations This review involved interviews with 16 professionals from across North Lanarkshire working in this field, and through them, contact was made and discussions carried out with 14 individuals who have issues with alcohol and drug use, and their families. Eight were males and six were females. All were North Lanarkshire residents except two individuals who lived in South Lanarkshire but were engaging with support services in North Lanarkshire. Interviews ranged in length from 30 minutes to one hour 45 minutes. Two interviews were face-to-face and the rest were by telephone or video conferencing. The findings from both stakeholder and individuals’ interviews were brought together to establish key messages. These key messages were shared during an online workshop with 27 stakeholders who were invited to reflect on the findings and feedback further; their contributions are included in this report. This report is structured in three sections. Firstly presenting what participants described as the current situation in North Lanarkshire, secondly, what they said they would like future provision to look like and finally, the conclusions and recommendations formulated as a result. The main limitation for this piece of work has been time, and ideally even more stakeholders, individuals and families would have been interviewed. As it stands, there was only one family member interviewed and no young people directly although professionals who work with both these groups did contribute to the research. North Lanarkshire has already published the ‘Hidden in Plain Sight’ research which showed there are thousands of families affected by substance use but only a ‘tiny number’ reaching support. That research also drew attention to the stigma and shame felt, not just generally from the wider public, but even from within family circles. A particular strand of research is now being taken forward in North Lanarkshire to hear from families further and this report should be read as being complementary to those findings. The limited voice of young people was highlighted at the stakeholder workshop. There was a view that further research was required into the experiences and needs of young people from North Lanarkshire who have experience of substance misuse in their lives. As with any qualitative research, this work was reliant on people to open up and to be able to tell it like it is. Interviewees were not pushed for answers, but it would be fair to say that those who participated seemed to trust in the process and hoped that their testimonies would go some way to promoting positive change. They welcomed the opportunity to be heard and were encouraged by the idea that there was a sense of bravery about what provision could become. It was also clear from the interviews that across North Lanarkshire, those working across services are passionate, committed and driven to make positive change. All interviewees have been made anonymous. Page 56 of 236
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2 The Current Situation What is working well? * The recovery community Stakeholders and individuals reported that the recovery communities are doing exceptional work, helping people to connect to one another, creating genuine support networks, combatting isolation, and creating spaces where people feel understood and achieve a sense of belonging. The involvement of people with lived experience was seen as crucial as they were able to empathise and support people going through similar situations as their own. The availability of recovery cafes at different venues and times throughout the week was also important as it provided people with options and somewhere to go when they needed it. Two individuals described how when they had taken more of a lead role in these initiatives, that is when they felt most purposeful and had been at their most stable. “Last year and a half and I have got involved in community recovery. That is done more for me than all the other things the past 30 years. Firstly, it is addicts together. Speaking to someone who is not an addict, they never understand…You know everyone there is like you, under the same dark cloud as you. We are all trying to get a bit of sun...I found them on Zoom in the first year of the pandemic. There were meetings every day. There was different support out there for different folk.” (Sarah) “The recovery cafes are a godsend because they are all going through the same things… The people who work in them are brilliant because they are all recovering addicts so they know what you are going through”. (Shona) * Services that are accessible via out of hours support and assertive outreach Individuals and stakeholders felt that the best services, and which there are still so few, such as the Overdose Response Team and High Resource User Project, are able to be responsive to need, are ‘not 9-5’, proactive, and go to people, offering assertive outreach, rather than functioning on an appointment basis. One of the priorities in North Lanarkshire’s Strategy, reflecting the MAT standard 3 is the targeting of at-risk groups. One individual praised the support they were receiving from the Addiction Recovery Team (ART) highlighting how flexible and supportive they had been. This individual explained that their addiction worker picked him up once a month to go to a neighbouring town for a buvidal injection. The individual commented “They are great, couldnae ask any more of them” and they had no suggestions on additional services or how existing services could be improved. Page 57 of 236
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3 * Phoenix Futures Many stakeholders, individuals and the family member said that Phoenix Futures was a good service because of the holistic support they offer, and that they provide support to families in their own right. Consultees also highlighted the person-centred approach and compassionate way that workers supported service users. “Phoenix – they were good. If you could go and meet your worker – get acupuncture for an hour, do that, there is a wee art group.” (Alan) “They had said they offered family counselling… We met with the counsellor…it gave myself and sister a chance to say what we were feeling, be validated and get techniques to deal with it. We were thrust into this world… My role in the family is the fixer, because I know, I do and I fix… The counsellor is great with me, I am on edge that the relapse has happened. She said there is nothing I can do.” (Lorraine, family member) “I was with Phoenix Futures, that was amazing. Loved it there…My mentor… could understand me as she was a recovering addict, she knew what you were going through, she wasn’t a textbook worker. She had living experience and that makes a difference. I like them because they didn’t judge you. I was there a few times a week. They had SMART recovery group meetings when you’d go round the table and everybody tells you a little about their week. And an art class on a Friday was good cos it got you away from talking about addiction all the time. The place had a nice feel about it. And if you didn’t go for a week they’d phone you to see if you were alright. A lot of people don’t have family support so at least they’ve got that”. (Shona) * Advocacy The North Lanarkshire addiction advocacy service delivered by Equal Say was not known by all individuals, but those who had used it, reported that it had been invaluable. The opportunity to talk to someone impartial who was able to provide information, signpost, and tell people about their rights was very much welcomed by those who had used the service. “He’s (worker from Equal Say) really good. He did everything he could to get me back into the homeless unit because they were going to kick me out as I’d broken the drugs rules. He pointed me in the right direction for a few different things. He phones every wee while to make sure I’m alright.” (Shona) In addition, several people with lived experience who were unaware of the service, felt it could be helpful to people with substance misuse issues. Some suggested addiction services should do more to advocacy. * Improvements in partnership working and communication across the ADP It was felt by stakeholders that over the past year in particular, there had been an improvement in services working together and North Lanarkshire ADP had played an important part in facilitating this. The meetings now being held which give organisations a chance to share practice were especially welcomed. There were some specific examples given by stakeholders of good partnership working, for example, such as the Occupational Therapy doing joint assessments with the Addiction Recovery Team (ART), and the Individual Placement and Support Service (IPS). The Department of Work and Pensions (DWP) have also been working more closely with the recovery community and this brought to light people were missing appointments with their workcoach to make meetings, risking being sanctioned. The DWP can support people in their journey by providing ‘easements’, and this means they will not be Page 58 of 236
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4 sanctioned. At present the service are developing ‘single points of contact’ within each area, so they have a specific role for engaging with the recovery community and for example, can run outreach clinics at a recovery café to help individuals with issues relating to their benefits. * Some of the connections and digital support developed during the pandemic As well as being challenging the pandemic also led to some positive developments. Stakeholders and some individuals felt that physical delivery of methadone to those unable to get to chemists highlighted the extent of needs and legal barriers to the provision of naloxone had been lifted. Digital communication had also created new avenues for communication and opportunities. For example, the recovery community now offer digital sessions and reported that this widened participation from people in more rural areas. Moreover, innovative practice by the Harm Reduction Team, to link up professionals to provide digital consultations has reduced waiting times. What is not working well? 17. Access to addiction, and mental health, services can be challenging Individuals, a family member and stakeholders reported that access to addictions and mental health services was, sometimes, challenging. This can lead to people not accessing a service in the first place, voluntarily withdrawing, or choosing not to engage with a service at a later date. A number of specific challenges were raised which are summarised below. Individuals repeatedly said that services, particularly statutory services, could respond quicker and with greater understanding when people first ask for help. They explained that when they had asked for help, when they were at their worst, the processes put in place acted as serious barriers. The length of time it took to be able to see a worker was a particular concern, with some individuals reporting that they had been given appointments a number of weeks in the future, They felt that when they asked for help it should be immediate. The testimonies also further highlighted the lack of understanding individuals felt existed in services about the realities of addiction (stigma is discussed later in this section as a specific issue). “See when I was at my worst and I decided I needed help and phoning up the services, Integrated Addiction Services and your first appointment is a fortnight down the line. It’s not like the next day. When you need to speak to somebody, you get turned away. I went to the hospital with my mother and I was in my third day withdrawal and I was in a bad way, that doctor at Monklands Hospital told my mother to take me out on to the street and buy me heroin because there was nothing they could do. I wanted help. I wanted to go into hospital and I got turned away. We get judged, I did get judged. He asked what was the matter and the minute I told him it was a heroin addiction his whole attitude changed. My Mum was with me and she said to him if I wasn’t here I wouldn’t have believed it. In the early stages there’s just not much help there, there isn’t. I know they say you’ve got to make sure they need it but a lot of people are dying through it… in that fortnight (waiting for an appointment) you are going to use, you are going to do it to make yourself feel better. If they could give you an appointment the next day, people who could speak to you, you’d have more hope but you come out with no hope. I didn’t think I could get better because I didn’t have any hope because nobody actually sat and spoke to me and told me what could be done”. (Shona) A family member described trying to call addictions services but none of the advertised numbers on the internet were correct. They eventually relied on a friend working in a different Page 59 of 236
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5 area to get them the right contact information. Another individual recalled her own challenges accessing support after she had engaged and her experience resulted in her saying she ‘hated’ the local addiction team. She explained: “They wanted me to travel to X, with no money, in the snow all the way to pick up a prescription… and they know I’ve got a heavy, major fear of the outside because of what I’ve been through… I thought nah, fuck you… it wasnae happening. So I thought I’ll get through it… my partner, he supported me”. (Leanne) Access to mental health services was also a challenge for some people with both mental health and addiction issues. One stakeholder said that they have never had so many people request to be sectioned as they recognised this was the only way they would get the support they needed and wanted. This finding was echoed by individuals and a family member who said that when they called NHS24 for help, they were informed that they would only get someone to come out to them if they were suicidal. Several consultees referred to the need for people with addiction issues to be clean/sober for a period of time before they could access mental health services. They added that this could be very challenging for some people who used drugs/alcohol as a means of self-medication for mental health issues. A particular area of concern and which is likely to affect the majority of people using substances, is when they also have mental health issues. In these cases, and a finding which is not new, is that people are passed from mental health services to substance use services and round again, because it is argued they have to be stable to get access to mental health services, and this ‘hamster wheel’ as one stakeholder called it, means people are essentially without support. “The links into mental health – that stopping someone if they are using drugs and vice versa, they don’t get a service. I happened to get someone who I was able to get into treatment within three days, but that was me being stubborn and his sister also being stubborn and persistent.” (Stakeholder 6) 18. Statutory addiction services are under-pressure Individuals and some stakeholders suggested that statutory addiction services do not generally have time to engage meaningfully with individuals. As a result, consultees felt, these services are symptom led rather than dealing with underlying causes of substance use. Staff have substantial caseloads and were viewed as ‘firefighting’. For example, several individuals stated that they only saw their addiction worker for a short period of time once a month; they also reported that workers regularly moved on making it difficult to build trust and continuity. Although there were exceptions reported in one area, with a stakeholder and a couple of individuals stating they had fortnightly, sometimes weekly hour-long appointment with their community addiction worker, this was not the experience of any of the other individuals interviewed from across North Lanarkshire. The ART team highlighted that problems with staff recruitment and retention resulted in high caseloads, and accommodation issues added to the pressured environment. It should be noted that statutory addiction service have met the targets set by the Scottish Government throughout covid and this is despite with depleted staffing levels. Generally, other stakeholders understood the pressures the team was operating under. Individuals felt that it was when they were really able to speak to someone, to understand the underlying reasons why they took substances that real change was able to happen, highlighting that meaningful engagement is imperative. In North Lanarkshire’s Strategy, what is referred to as the ‘No wrong door approach’, this promotes the need to focus not only on Page 60 of 236
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6 the substance use or disorder but all the needs people may have. A third sector representative observed that statutory services “don't have time to dig deep into the myriad of peoples’ problems” and this was instead felt to be left to the third sector to do the ‘heavy lifting’, leading to staff burnout. The rise in cost of living and the support people needed to deal with poverty was also highlighted as something statutory services do not have the time to deal with. Individuals also said that statutory workers did not let them know of the different options available to them in the community, and instead there was an emphasis only on prescribing methadone, medicalising what was recognised to be a psychosocial problem. “I think the problem is that no one is really speaking to you about why you are drinking or taking drugs. You don't have that time. I was going to get my script and there are 12 people in there at a time and they are all waiting to be seen by 3 or 4 workers, and so you feel like you are taking up peoples’ time. You can also hear what people are saying, so you don’t have privacy. You are also seeing different people all the time, so you don’t build that relationship with the worker… I have had lots of different addictions workers and it has got to the point where I don’t know who I am going to see when I go in there.” (Kate) “I think is my 10th or 11th addiction worker. It’s hard because you only see them for about 10 minutes about once a month or something. A lot of the time they just want to keep you on a script. I went to them in April to ask about the rehab and was told there was no funding and they asked if I wanted to up my methadone rather than come off it…The addiction workers don’t know what you are going through and they don’t have the time to sit and get to know you…Addiction services don’t offer you things. So unless you know about it. It is only when you go to the recovery cafes that you hear about these things and you think why didn’t my addiction worker mention it. They’re happy to up your methadone though, it’s crazy.. Also use other things other than medication. They want to medicate everything. It’s only now I know that’s not the answer because I was addicted to painkillers for years. It’s not the answer. You need to sort out the problem before you can medicate it. ” (Shona) “I have a drugs worker but you see her once a month and I don’t really get any help. They ask how things are going – I can see that the worker I have is stressed out of her mind and so I am thinking – right get out the door. So I think that needs to change, there should be more of her. You can feel the stress that they are going through, you don't want to take up any of their time.” (Peter) As a result of the lack of meaningful engagement, fewer connections are occurring to mental health provision or access to counselling - which can help people to open up and begin to understand and address underlying causes. “I have a sickly feeling he will be on buvidal for the rest of his life. We are not addressing any of the issues.” (Lorraine, family member) “They need to sit down one-on-one with people and get into their story why, and exactly what help they need. Listen to the patient, not what they have read in a book. They can’t relate to how I have lived. They don’t come from our areas. They come from nice affluent areas, mortgages and they come down here and it is different. I don't think I have ever had a meaningful conversation with my drugs counsellor. I probably could speak to them, but they don't have that experience. The biggest thing for me is that they can’t relate to how I have lived.” (Mark) Page 61 of 236
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7 19. Inadequate and unequal provision across areas Consultees highlighted a number of issues regarding service provision which they felt was either inadequate or unequal across North Lanarkshire. There was a strong agreement that crisis support in North Lanarkshire was inadequate. In situations where services can only offer appointments a number of weeks in the future, as reported above, stakeholders and individuals felt there was no service where people in crisis could be seen at short notice. Some individuals and stakeholders mentioned the Crisis Centre in Glasgow as being good practice. Stakeholders and individuals also highlighted the lack of residential rehabilitation options and hospital detox beds. Most of the individuals with lived experience had not been offered residential rehab and had no expectation of it being a treatment option; they were aware that finances was the reason. “False economy at the moment. Guy in his early 40s continually relapsing in hospital for 10 days, back out with no support to a sparsely furnished flat in the middle of a scheme, relapse, re-admitted to hospital, until eventually he died – at no point was he offered residential rehab.” (Stakeholder 7) “No. The addiction services gave me a stable prescription. They never helped. They never suggested a detox, rehab, nothing.” (Sarah) A number of individuals and stakeholders reported that the recovery pathways were unclear and this was regarded as a significant issue. Several individuals stated they did not know what support and treatment was planned and, significantly, what the milestones would be that triggered the next step in their journey for example, progressing from a methadone prescription in the community to residential rehab. They stated they would welcome an individual recovery plan that clearly set out the support and treatment they would be following. Similarly, several stakeholders felt there was no clear treatment and support pathway which set out how services in North Lanarkshire would support people in different situations. This meant they were unable to provide clarity to individuals they were working with. “When people turn up at statutory services they need to be given a plan, knowing what is expected of them, so they know the steps they need to take to get there”. (Stakeholder 7) One particular area of concern was the limited support for people when they leave prison. In North Lanarkshire’s Strategy this is a particular group highlighted as requiring support and needing a partnership approach, taking account of housing, advocacy and connections to the community. Interviewees observed the importance of family support and felt that at present this is an area which needs to be addressed in North Lanarkshire. One stakeholder suggested that having a recovery café specifically for family members and having a local Scottish Families Affected by Drugs and Alcohol, to offer face to face support would be beneficial. One of the key priorities in North Lanarkshire’s Strategy is the development of support for families in their own right. It transpired that in different areas there are particular issues relating to the poor infrastructure inhibiting engagement. In Bellshill in it was reported by both stakeholders and individuals that the current buildings for addictions support are inadequate, with no waiting area and people having to ‘hang around’ outside feeling especially stigmatised as a result. At the stakeholder workshop it was raised that the Wishaw ART team had to temporarily operate Page 62 of 236
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8 out of Motherwell because of accommodation issues, which meant service users could be faced with three different modes of public transport to make appointments. In rural areas, in particular, stakeholders felt more should be done to provide people access to support. Individuals and stakeholders also reported that in some areas there is a lack of access to buvidal. It was also reported that generally across services there is a problem with recruitment and retention of ‘good’ staff. It was felt that this can add affect the support available to people with substance misuse problems across North Lanarkshire. 20. Incompatible cultures and short-term funding inhibiting partnership working Stakeholders reported that as yet, there is a lack of integration and information sharing between statutory services and the third sector. It was also reported that some staff from statutory services had displayed a level of ‘professional snobbery’ in their interactions with staff from the third sector. There was a view that short term funding and competition could inhibit partnership working between third sector organisations. It was also reflected that short term funding restricts the extent to which services can recruit high quality staff. 21. GP treatment choices and an information gap Three individuals reported that GP prescription of opiate-based painkillers had led to a heroin addiction either when the prescription ended or when they self-medicated by taking heroin as well as their painkillers. These individuals felt the ten-minute time limited appointment was not long enough and their addiction may not have developed if the GPs had taken a different approach. For example, one of these individuals who had experienced childhood trauma was prescribed co-codamol as a teenager when she enquired about counselling, and was prescribed dihydrocodeine in her 20s, when she had another traumatic experience. Some individuals and stakeholders suggested that some GPs did not know what support people could access for addiction and mental health problems. Individuals reported they had found this information through engagement with the recovery community or when they had hit crisis point. “I didn't know where to ask for help. My cheese had slid off my cracker. I had gone into fits outside and taken into hospital. I think if there had been one person I could have spoken to, if I had been able to say, I wouldn't have got so extreme… I think even a leaflet through the door so people know what support is there. Rather than Domino’s pizza leaflet.” (Peter) 22. Lack of follow-up support Individuals described points in their life when they had relapsed soon after getting stable through support such as rehab or a Drug Treatment Testing Order (DTTO). They explained that the lack of follow-up support once these interventions had ended had been a key factor in their relapse. As highlighted earlier, people leaving prison also reported a lack of follow-up support. Page 63 of 236
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9 23. The negative impact of the pandemic Partnership working between statutory and third sector services that had begun to take place in one area stopped as a result of the pandemic and was said to have not started again. Over this time, contact was lost by statutory services with people. By May 2022, face-to-face contact by statutory services was reported to still not be happening to the extent it had, prior to the pandemic. Individuals reflected on the staff shortages and subsequent lack of continuity of service, and stakeholders noted the rise in referrals, with the impact on staff stress levels. 24. Stigma Individuals and stakeholders reported that people working in some services, especially statutory services, could make people feel stigmatised, and there was much work to be done to challenge stigma. “When I was in hospital having caused this injury through using drugs, half the nurses looked at me as a drug user, and half as a patient. Most of the young nurses treated me like a drug user, it was the older ones that were better, they didn’t have the experience.” (Alan) A few individuals opened up about the realities of living in poverty and that the areas they lived in were rife with drugs and people felt stigmatised more generally. “There are three big high rise flats down the road and everyone calls them ‘Heroin Heights’, they put everyone who is in the same situation in the same places.” (Kate) In North Lanarkshire’s Strategy there is a commitment for the NLADP to lead on a local stigma plan. Barriers to engagement 1. Stigma and perceptions Stigma felt from the wider public and professionals is a significant barrier to people engaging with help. Individuals reported even feeling stigmatised by the chemist they went to, when picking up their prescription. “You can’t talk to anyone who looks down on you. The Chemist look down on you. They make you wait. Some of them are awkward. They don’t need to look down on you. Why are they working with people they don’t like?” (Neil) Stakeholders reflected that many people with an addiction have experienced systematic failures over their lifetime and distrust services, and overcoming this is a significant barrier. “Some people think what’s the point. You have an addictions issue and an addiction workers and they ask you to keep a diary, what’s that all about. It seems quite passive – here’s a leaflet, here’s a website. There’s a feeling of self-loathing scum. People need to be grabbed by a community like the recovery community who can say you’re not scum, I was like you and look at me, and I’ll come on the journey with you.” (Stakeholder 7) Page 64 of 236
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10 2. Lack of resources and inappropriate responses Many participants, both stakeholders and individuals reported that at present people ask for help and the response is not timely, with waiting times a particular barrier, preventing people from engaging. The lack of provision for mental health support was also identified. “When people make that decision they need help that day. They don’t need a referral for a fortnight’s time. We need walk-in clinics that are staffed by prescribers. Somebody who can say to them that day this is what the plan is, they leave with an NHS prescription, and they are asked to come back again tomorrow to maintain support. Something to get through the night. To be grabbed at that point.” (Stakeholder 6) “The initial referral, you need to wait three weeks before you see a drugs counsellor. Within those three weeks, they insist on you giving a dirty sample. If I said to them, I have gone through cold turkey, but they can’t start you on treatment unless you are giving in a dirty sample…Access to psychiatrist. I have been waiting a year.” (Mark) As already mentioned, mental health services and addiction services not being integrated meant that some people were in a situation without any support. Stakeholders reflected that where a medical intervention for substance use was not clear, gaps arose, and this was also echoed by individuals. “All the services seem to be focussed on opiates. People don’t want to go there if they’ve got a problem with cocaine, alcohol, diazepam – don’t want to go in as its seen as the junkies place.” (Leanne) In addition, stakeholders and individuals felt services operating on a mainly 9-5 Monday to Friday, appointment-only basis were inhibiting levels of engagement. 3. Professional attitudes: Lack of empathy and understanding Stakeholder and individuals observed that the current model of working of discharging people who miss a number of appointments, fails to recognise the realities of the challenges people face and the practical barriers that are likely to also exist. A number of barriers were highlighted including public transport links, distance, finance, family/relationship issues, ongoing substance misuse, mental health, and the support that was likely to be provided during the appointment. Consultees suggested a more flexible approach with assertive outreach was required. One stakeholder suggested that people who were missing appointments should be the focus of intensive proactive support – the opposite of the current situation when they are likely to be discharged from services. 4. Lack of information sharing between services Third sector services felt that at present statutory services generally do not share information in a way that would enable wider access to support for individuals and this needs to change. 5. Lack of exit plan for methadone use Individuals reflected on being put on methadone on a long-term basis without an exit plan and viewed this as replacing one addiction for another. Page 65 of 236
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11 What drives partnership working? 1. Good communication Stakeholders welcome the partnership meetings now being convened by the ADP. Stakeholders also spoke about the success of different partnerships developed, between the third sector, and also some examples of the statutory and third sector working together too. “Same goals and working together and the opposite of that is services getting precious.” (Stakeholder 3) 2. Taking a holistic approach Stakeholders reported that the best partnership working was when services worked with whole person and family, understood the complexity of the issues, the extent of the support needed and prioritised building relationships with the person around this, ‘being human’. An example of good practice was discussed whereby the Simon Community Housing First Team are working closely with addiction services, doing outreach and helping people sustain their tenancies and connect to relevant services. “In the statutory services there needs to be more of a shake up, what they see as their role, the old school speak about how they approach their job and there is a lot of burn out. There isn’t role validation, is what I am doing right? There is also a fear of change too. Are statutory services welcoming to people? MAT standards, same day access to treatment, we don’t even have that for assessment! If someone wants help, they want help, you want to help them then. We send people away and then they have to come back, and then back again.” (Stakeholder 6) “I had been in rehab for six months, years ago and it was good, but I was back drinking more or less as soon as I got out as I was back in the same area and same problems, nothing had changed…I do think if I had got the help that I am getting now, to be able to talk about the things that happened to me, the abuse when I was younger I might not have handled things the way I did… I remember last time getting the taxi (after the detox) to take me straight to the shops and I bought drink. No one is looking at the reasons why you are drinking. You are left to the same things that you left, the only difference is now you can get drunk faster. The area I was living in, everyone was taking drugs… I have numbed my feelings all these years and now when I stopped they are all coming back. There is always a reason why people drink the way they drink. I feel like I have been born again as I am having to learn all about my feelings again. ” (Kate) 3. Co-location of services Although rare, a few stakeholder said that when services are co-located together it makes partnership working easier and promotes ongoing communication. The example of statutory sector addiction and housing staff sharing office space in Motherwell was highlighted as an example. Page 66 of 236
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12 Groups not accessing support The following are the key groups that stakeholders felt were not accessing support: ● Those isolated and living on their own ● Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) ● Young people aged 8-11 (as services are not available for this age group) ● LGBTQ+ ● Victims of domestic abuse ● Mothers ● People from ethnic minority backgrounds ● Elderly people Raising awareness of what is available to people who are not in supported accommodation and not connected with services was felt to be key, and some noted that the GP could be a ‘way in’ for this group. It was felt that for people who are LGBT+, mothers and people from ethnic minority backgrounds, they face additional layers of stigma which makes seeking help especially challenging. It was felt by most that it is important therefore for substance use services to try to reach these groups building links in the community. “I think women with young kids are definitely more unlikely to be able to engage, so the fear of losing their kids, and that has been an ongoing issue. It is about letting people know that it is ok to ask for help. We need to raise awareness of that.” (Stakeholder 5) One stakeholder however also raised that at present, services are not giving those who are coming to services, good support, and therefore trying to engage with those ‘missing’ would not be a good use of time, as resources are already stretched. Future Service Provision What support do people want and need? 1. Services need to be person-centred and holistic Individuals and stakeholders emphasised the importance of people having a choice and being informed about the options available to them, and services designed around needs and wants, for example to be age and gender specific. Good practice was identified when it was felt that services took a holistic approach, to link in with partners, supporting people to make links to help that was meaningful to their whole lives, working towards positive mental, physical and social health. 2. Services need to be responsive A key message across groups was that people need to get support quickly, and they described the need for a crisis service which was a hybrid between an addiction service and an emergency response. Interviewees felt this service should be an accessible walk-in service that provided immediate support for people seeking assistance with a substance misuse issue, including overnight accommodation if required. They also felt the service should fully support people to access the most appropriate substance misuse service in the days following their initial presentation. Page 67 of 236
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13 3. Services should be available out of hours and be able to provide assertive outreach At present it was felt that generally services are designed for service providers and not for the people the service is for. Taking account of the needs identified, good practice was felt to be when services provided both assertive outreach and out of hours support. The interim report of the Overdose Response Team (Evans et al.2022), which operates in the area of North Lanarkshire, highlights the benefits of this type of provision. “The worker gave me a list of numbers but I prefer one to one and have not phoned anyone… I think having people come to you, so I had the workers come to me when I was out of hospital and it really helped.” (Kate) 4. Services should have a single shared assessment Statutory service providers reported that the referral systems and bureaucracy involved mean that staff are having to spend a lot of time between different systems to gather information and link people in appropriately, and a single shared assessment across services would work better. 5. Prioritise prevention One stakeholder observed that addiction is inextricably linked to poverty and inequalities and one of the best ways of addressing this is to offer universal services to young people by way of breakfast clubs, free meals and afterschool care that are preventative in nature. They recognised this was a ‘brave’ move in terms of future commissioning, but also felt that the current system including a focus on people who are using opiates is not working. ‘The ideal’ Stakeholders and individuals were asked what the ideal provision would look like. Some felt that service provision should be completely overhauled and to get ‘the ideal’ it is a case of starting again. “What we need to do is not tinker and look at workforce planning and job roles. We need to start again to fundamentally change how things are done”.(Stakeholder 7) 1. A one stop shop with wraparound care The majority of consultees wanted North Lanarkshire to have a ‘one stop shop’. A physical building with staff who are trauma informed, that individuals could self-refer into at any time, that offered a range of support options. Staff from a variety of services would have time to meaningfully engage, and practical help could be provided to help people make links to the support they needed and wanted, and they would be provided with aftercare. “I think people need a personal worker, so they can phone people day to day, appointments, things like that, take them out for something to eat.” (Leanne) Essentially the vision is that people could get crisis management support and a forward plan would be developed, taking account of people’s needs, wants and capabilities. Page 68 of 236
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14 2. Services are responsive and there are no waiting times Echoing earlier findings, stakeholders and individuals wanted services to be responsive and, ideally, there would be no waiting times. “Services need to be set-up so they can rapidly respond when folk make that decision.. Timing is so important – striking while the iron’s hot. Someone might be ready to do it one week but the next week they are back using again. If you had the service set-up with a rapid response with a multi-disciplinary team that they should be able to help someone enough within that week when they are open to help for them to think it’s not worth going back to their old life. Someone leaving detox may only have a small window of clarity but if they are going straight back to a homeless unit with an appointment in three weeks’ time to speak to an addictions worker, they are likely to slip and the moment has passed. Find it difficult when people are at that stage. Temptation there when they are being offered street valium for a fiver.” (Stakeholder 7) “I think it takes too long to the time people ask for help to when they get it. When people are chapping the door for help, they want it now, they don’t want it in a month. When they go to an addictions worker, they want that help. You can’t go to A and E even. It is time people have not got…I have went for help before, I chapped the door, and then they are away. I am on the bender. I went to the addictions team in X to ask for help, they took all my details, by the time I went for urine tests and they finally got back to me, I was on a binge. I think I really wanted the help and I don’t think I would have had those other years if they had given it to me then.” (Neil) 3. Services are holistic, taking a whole family approach and addressing the root causes of addiction As already discussed, consultees felt that the best approaches took a holistic view, listened, learned and responded to what people and their families wanted and needed, providing or connecting people to appropriate practical and emotional support, and taking time to help address the root causes of addiction. 4. Providing out of hours and outreach support A common theme was the need for out of hours and outreach support. “Going to people, out of hours. There are people who can’t get out as much. I feel that they would respond more towards their recovery, if they had that ability to sit in their own house, make the person a tea and coffee, instead of hard chairs and made to rush. You are in your own home. There needs to be a thing of time.” (Alan) The Overdose Response Team and Harm Reduction Team were identified as providing excellent support and ‘bending over backwards’ to help people get the support they want and need. Page 69 of 236
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15 5. Accessible residential rehabilitation Stakeholders and individuals felt that in North Lanarkshire there was much need for accessible residential rehabilitation, actively promoted and not limited by funding. “I asked for rehab three years ago and still waiting. I ask every fortnight about getting into rehab…we don’t have a rehab in North Lanarkshire. For the last 18 months, every other person on Zoom from Glasgow has been in and out of rehab. We have been told there are 3 beds available in North Lanarkshire, you would need to be really lucky to be one of the three. Where does our worth start?” (Sarah) 6. Follow-up service Individuals and stakeholders also felt follow-up provision was required. This would ensure people are supported by a ‘checking in’ service when they are at home . 7. Connecting people into ‘something meaningful’ One of the key findings in this report is the importance of the recovery community to supporting people to make connections with others, engage in meaningful programmes, support and groupwork. Two individuals spoke about when they were at their most stable they had taken more of a leading role in the recovery community and it was felt by all, that supporting people to have a sense of purpose and linking into their communities was the ideal. Many individuals spoke about the benefits of the recovery community and of being able to access groups in the community. “These groupwork sessions, art or computer course, little things, acupuncture, meditation, open up something like that…you have no friends when you stop using. Most people who are in recovery, they don’t have a place to go and meet people who are focused on the same thing as them. Get to know more people. Play games, be social. We were experienced in recovery ourselves, see other people. There are not these places about. It is expensive to travel to these other places.. Part of my problem was the isolation and then I had this recovery café, you made friends. ” (Alan) “So the café that I go to, it has opened an allotment. So different days they do different things. There are five different cafes on from Motherwell, sometimes you can get lifts.” (Sarah) One stakeholder described a Community Day Programme that had existed in North Lanarkshire years ago, that provided health information, groupwork and provided people with structure. There was support for something similar to be re-introduced. 8. Individual recovery plan Individuals and stakeholders reported that every person should have their own individual recovery plan. The plan would set out a tailored treatment and support plan including clear milestones that triggered progression to the next stage of the plan. Page 70 of 236
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16 Opportunities Stakeholders were asked where they felt the opportunities were in North Lanarkshire and what change they would like to see happen. The key messages: Relating to provision: 1. Improve provision for those in crisis and families The need to address the lack of crisis services and support for families currently available was a particular focus. 2. Expansion of the recovery community The value of the recovery cafes was clear and it was hoped that they would exist in all areas throughout North Lanarkshire, and there would be specific provision for families too. 3. Digital connections One stakeholder discussed the opportunities that digital connections open up and are yet to be fully utilised. Relating to cultural shifts: 4. Support for staff At present it was felt that staff, particularly in statutory services are overworked and had become reductive in their practice, so having adequate support and development for staff is needed. Another stakeholder said the one thing they would like to change is that staff are ‘nice’ and have compassion for people. In North Lanarkshire’s Strategy one of the key priorities focuses on the need to develop the workforce. 5. Partnership working Across sectors the benefits of working in partnership are clear and there was a commitment for this to happen more. It was suggested that services offer opportunities to staff across sectors to shadow one another, and in doing so understand their working practices, challenges faced and ideally arrive at solutions together to address them. Stakeholders and individuals alike noted the important role GPs could play in helping people to link into service provision and the need for more information raising. Individuals felt that the responsibility for service provision design and delivery needed to involve statutory, third sector and people with lived experience, and that it was only by working together that real change is possible. 6. Services to promote flexibility It was felt that closing down the cases of people who have not made appointments needs to change and instead barriers to engagement needed to be decreased as much as possible. 7. Including the voices of people with living and lived experience in service design and delivery It was raised by one stakeholder that there is much value in having people who are still using substances included in decision making, and this should be treated as one form of evidence, so that decisions are informed by as many stakeholders and evidence as possible. Wider evidence of good practice The following were ideas given by stakeholders of initiatives that could be tried, drawing from the wider evidence base: ● Rehabilitation services run by people who are in recovery and offering a day programme. ● In Forth Valley there is a paid member of staff from the recovery community who works with the Housing First team there, to support people with any practical and/or emotional needs Page 71 of 236
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17 they may have, as well as actively linking them in with the recovery community, reducing isolation. ● To have people with lived experience paid as experts to inform every aspect of provision. ● Better pathways for rehabilitation, taking the holistic approach to involve the recovery community and family, to understand the best time for this person and the support they require. ● Injecting rooms and being able to test drugs. ● Therapeutic communities. ● Have no unplanned discharges like Norway. ● Legalise and regulate the supply of drugs. Conclusion and recommendations This conclusion draws together the key messages from across the different questions. There was a lot of synergy between what stakeholders and individuals with substance misuse problems said in terms of what the current provision is and what people want for the future. Significantly, there was also a collective commitment and desire to make this happen. There was a sense that this could be a key moment in time when real change for the better began. What is working well? Interviews recognised the backdrop of poverty, backgrounds of trauma, abuse and long- standing issues people faced as being the underlying reasons why individuals had issues with substance use. The services felt to be working well therefore viewed people holistically, often doing outreach, offering out of hours support, taking time to really listen to and understand people, promoting their rights, and worked hard to link people into support they wanted and needed, particularly mental health provision. They also provided or linked people in so they could avail of whole family support, understanding the ripple effect substance use has. The importance of human connection and meaningful engagement, relationships built over time and trust was further emphasised by interviewees’ recognition of the good work carried out by services such as Phoenix Futures, the Overdose Response Team, Equal Say and the recovery communities. Many wanted this outstanding work by these organisations to be expanded further. What is not working well? Lack of resources The responses to what is not working well could be divided into resource and cultural issues. In terms of resources and provision, it was felt that crisis support, accessible rehabilitation options, detox beds, the length of waiting times for treatment and support for families was inadequate. Stakeholders and individuals were concerned about the rise in the cost of living and reflected that deprived areas are already badly affected by drugs. It was reported that the extent to which people with mental health issues are requesting to be sectioned so they can get support has never been seen to this level before. The lack of support for people leaving prison was also noted. Cultural barriers Issues relating to cultural barriers were that addiction and mental health services are sometimes not easy to access, not responsive and people who have a dual diagnosis can fall between mental health and addiction services. Although, there were exceptions reported, stakeholders and all individuals felt that at present, statutory addiction services are overwhelmed and do not have time to meaningfully engage with individuals. All felt that this model meant culturally the focus was on the symptoms rather than addressing the underlying Page 72 of 236
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18 causes of addiction, and essentially medicalising what is a psychosocial problem. There was a perceived cultural divide between statutory services and the third sector, while short-term funding could inhibit partnership working between third sector organisations. A few individuals felt their addiction could have been avoided if they had received better support from their GP and it was also suggested that GPs could play a more proactive role in linking people in to treatment or community support options. Individuals praised the support they had received from completing a DTTO and within rehab, but the lack of follow-up support meant that this was not able to be sustained. At the time of writing, statutory services are still not seeing people face-to-face to the extent they had prior to the pandemic. Culturally, the stigma around substance use is a significant barrier and as well as the general public, both individuals and stakeholders, felt this also came from professionals who worked in the field. Barriers to engagement Stigma about addiction was felt to be the main barrier to people asking for help and that when they do, services are not always responsive, with lengthy waiting times for a first appointment. Interviewees reflected on the inflexibility of the current model of working, which tends to be 9- 5 Monday to Friday and appointment based. Further, if people do not attend a number of appointments they tend to be discharged by services which underlines the lack of empathy and understanding within the current system. Limited information sharing between services was also noted as a barrier to people connecting to appropriate support. Finally, individuals revealed that a barrier to engagement is the concern of going on methadone long-term without an exit plan, and this is essentially linked again to people not having meaningful engagement with workers. Partnership working Good partnership working was felt to be when services are working together towards the same goals, have good communication and when services worked with the whole person and their family, echoing the move towards this being viewed as the ideal way to support people. Co- location of services was also observed as promoting links, for example in Motherwell between housing and health services. Groups not accessing support There were particular groups identified and felt to currently not be accessing support, namely, those living on their own, those not taking opiates, young people, LGBT+, victims of domestic abuse, mothers, people from ethnic minority backgrounds and those who are elderly. GPs were mentioned as a potential ‘way in’ for these groups but also the need to widen partnerships even further. Future service provision Most interviewees emphasised the importance of person-centred and holistic support, giving individuals and their families options and choice, finding out what support they want and need, creating a single shared assessment and connecting them to services and clear treatment plans as quickly as possible. Services would also ideally be designed around persons’ needs, offering out of hours provision, assertive outreach and accessible residential rehabilitation. Effectively what people want is to have a ‘one stop shop’ with wrap-around care provided, connecting people also into ‘something meaningful’ in their communities, with the recovery community viewed as playing a vital supporting role, for example by running a day programme. Stakeholders were asked about what they felt the opportunities were in terms of change. As well as those already discussed relating to the need for more provision, expansion of the Page 73 of 236
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19 recovery community and digital connections, the need for cultural shifts were discussed. It was said that staff need to be supported and would benefit from shadowing and sharing practice across organisations, to understand more and support one another to overcome current challenges. Services needed to be more flexible, taking account of the people they are supporting, and including the voices of those with lived and living experience going forward. It was also felt that digital connections which worked well during the pandemic could continue to support people into the future. Wider evidence Drawing on wider evidence, interviewees also suggested better links between housing, addiction and recovery; involving the family and recovery community in treatment plans; having a commitment to have no unplanned discharges; creating injecting rooms; developing therapeutic communities and, finally, legalising and regulating the supply of drugs. Recommendations 1. Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. 2. The development of a crisis service which is a hybrid between an addiction service and an emergency response. 3. Services to move towards more provision that offers out of hours support and outreach. 4. Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. 5. Development of accessible rehabilitation and detox beds. 6. Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. 7. To commit to having no unplanned discharges. 8. More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. 9. Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). 10. More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. 11. Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. 12. Drawing on lived and living experience, working with third and statutory services, create a day programme for people. 13. Substance use services in local areas to make connections with GPs, schools, the local voluntary sector to open up avenues of communication and referral pathways. For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ 15. Services to be trauma informed. 16. NLADP remains committed to the development of the Stigma plan. 17. A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers. Page 74 of 236
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20 Case Studies Rab: Alcohol addiction, lack of aftercare in the past but in recovery with vital support from Phoenix Futures and AA Rab drank heavily all his life from a young age and this was the culture he had grown up in, to the point that he drank, not for enjoyment but to get through the day. He had ‘always’ been a ‘secret drinker’, and would go to the pub, but described that it was when he got home that is when he really started to drink, and yet always made his work the next day. He described losing friends because they had helped him too many times over the years, with debts or just even getting himself ready, when he would go on spells of not washing or looking after himself. He had been to hospital many times before for a detox, but was ‘straight out’ and back drinking. Just before lockdown he had was suicidal and called Phoenix Futures who sent the police around to his house and he was taken into a psychiatric ward. He realised if he didn’t stop drinking he would die. Over the past two years he has been engaging with Phoenix and the worker, who has lived experience and feels this has been a real turning point for him. He does not remember being offered support like this before and said that aftercare in the past had been ‘non-existent’. He tried AA in the past and had rejected it, but now attends local meetings. He explained ‘you go there with your bag of shit, put it down and leave it there.’ He says attending the meetings helps him to keep his head clear and he said, ‘I get a wee cuddle off people’. Other services he feels have been excellent were the housing officer that helped him with his debt. He was given support also by a mental health charity but felt that their time frame of working with him for 12 weeks only was not realistic. Rab has stayed sober and feels that one of the reasons is that he is the main carer for an elderly aunt, which is ‘all consuming’ and has given him ‘a real sense of purpose’. Rab felt the main thing missing from services at the moment is communication, with people not having read your file and feeling like you have to explain yourself all the time. His GP also refused to give him medication to deal with withdrawals from alcohol. Rab has found support from the psychologist to be really useful and felt for the first time he was learning about his emotions. The doctor at the hospital also said he could call anytime and he has found this person really helpful too. Rab felt that he had to be suicidal to really get help and felt this should not be the case. Shona: Prescription drug addiction led to longstanding illicit drug use, in recovery with support from the recovery community and various services When she was 16, Shona was prescribed co-codamol and diazepam by her GP after enquiring about counselling to help address childhood abuse. For a number of years, Shona continued to take the drugs to “block things”; she was also self- harming. In her 20s Shona was raped. By then she was also taking dihydrocodeine. On an occasion when she could not get the tablets an acquaintance told her dihydrocodeine was heroin in a tablet so she started using heroin. She became addicted to heroin and also started using street valium and crack cocaine. Her addiction continued with sporadic attempts to get clean. On one occasion she had “a major relapse and ended up in hospital” when a doctor told her Mum there was nothing they could do and her best option was to buy Shona heroin. After her relapse, Shona ended up back in hospital with an abscess. At that point she said, “I was done, I was exhausted and I got put on to methadone”. She has not used illegal drugs for two months and said she was “feeling brilliant, feeling really good”. Shona regularly attends recovery cafes throughout North Lanarkshire as well as CA meetings. She described the recovery cafes as a “godsend” adding that “it keeps you busy and gives you something to look forward to; there’s a lot of boredom otherwise”. She has previously been supported by Phoenix Futures and described them as “amazing” but “fell away from it and relapsed again” during lockdown. Page 75 of 236
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21 Shona also has experience of the Addiction Recovery Team. She described having 10 or 11 addiction workers and felt that none of them had the time to support her and focus on the traumatic events which had led to her substance misuse. In the past she had asked about rehab but was told there was no funding and, she reported, her worker asked if she wanted to up her methadone dose. Shona felt her GP had missed numerous opportunities to recognise her dependency on prescription drugs and subsequent use of illegal drugs. Shona was identified by the High Resource User Project as a frequent A&E attender. She has been supported by this project and by the Homes First service. She was very complimentary about both services. Shona has also been supported by Equal Say’s addictions advocacy service which helped greatly when she was at risk of being homeless after leaving hospital. Equal Say’s involvement stemmed from Shona’s mum who was told about the service by SFAD. Shona described her mum’s help as invaluable, “she’s been great, she’s my rock, so she is”. Shona’s mum has continued to engage with SFAD including Zoom calls and added “they’ve been really good for her; they’ve given her an understanding of what it’s like to be an addict”. Shona suggested that, to improve, services needed to “make a point of seeing people more often, and for longer, offer the services that are available other than medication (like counselling) as they want to medicate everything”. Shona also suggested it would be ideal if there was more funding for rehab places. Page 76 of 236
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Appendix 4 ANNEX A IMPROVING GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS WITHIN ALCOHOL AND DRUG PARTNERSHIPS: SELF ASSESSMENT TOOL Alcohol and Drug Partnerships Partnership Delivery Framework Self-Assessment Tool Page 77 of 236
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June 2022 Introduction to the Self-Assessment Tool This Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. The Scottish Government and COSLA coproduced the Partnership Delivery Framework for Alcohol and Drug Partnerships which was published in 2019. It sets out the expectations for the role of Alcohol and Drug Partnerships (ADPs The purpose of the self-assessment The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of • Assessing need • Aligning resources • Agreeing delivery plans and priorities • Reporting and learning from outcomes ADPs are strategic planning partnerships that set out plans to delivery national and local priorities. To effectively deliver these priorities ADPs undertake strategic planning, formulate delivery plans and report outcomes. They do this on a partnership basis that aims to be inclusive and transparent with representation from stakeholders affected by alcohol and drug harms. Increasingly alcohol and drug harms are seen as a “whole system” issue and not just the realm of specialist drug and alcohol services. Page 78 of 236
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ADPs are not Statutory Public Bodies, i.e. they are not “organisations” and therefore rely on the Integration Authority for financial governance and ratification of investment as well as performance oversight. Community Planning Partnerships hold the overall responsibility for population level outcomes set out in the National Outcomes Framework for Scotland and therefore provide ADPs with an overarching forum for reporting achievement of outcomes. Local areas will also have other strategic partnerships which are required in statute such as Children Service Boards, Community Justice Partnerships etc and it is important to ensure that there are strong links between ADPs and these partnerships. The self-assessment is designed to help local stakeholders ensure that these key relationships are in place and that the local system is supporting the work of the ADP and vice versa. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders. The Scottish Government use of the Self-Assessment reports As stated, the self-assessment tool is for local stakeholders to ensure that they are creating the right conditions and operating environments for ADPs to function effectively. The Scottish Government will have oversight of the self-assessment reports and the information will be used to help develop programmes of support for local areas when required and will help facilitate peer discussions with ADPs about best practice and achievements. Where an ADP signals it would like further discussion or support in responding to local barriers, this will initially be provided through discussion with the ADP Liaison leads within the ADP Support Team in the Scottish Government. External Validation ADPs are asked to assess their own ability to deliver against the Quality Standards and highlight any issues. At a future point the Scottish Government will seek to validate the self-assessment through a third-party organisation such as the Care Inspectorate or Health Improvement Scotland. On that basis, ADPs should complete the self-assessment from the perspective of “if an external person reviewed our approach would they find the same evidence we are presenting?” How to complete the Self-Assessment Tool The self-assessment should tell a story about where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic planning Page 79 of 236
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2. Financial arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight 5. The relationship between the ADP and the Integration Authority A representative national working group agreed the following five standards in relation to the Partnership Delivery Framework. The five quality standards are: Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Quality Standard 5: The work of the Integration Authority and the ADP is aligned, and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Structure of the Self-Assessment Tool The Self-Assessment Tool should be completed in conjunction with the Self-Assessment Criteria (Appendix 1 page 25-34). The criteria outline the minimum supporting evidence required to demonstrate the ADP is delivering and working in line with the Partnership Delivery Framework. The first part of the Self-Assessment asks ADPs to assess themselves against the Self-Assessment Criteria and to map themselves again the Criteria using the definitions Maintain, Explore, Develop outlined in the table below. Page 80 of 236
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Definition Maintain We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. To meet this definition, the ADP needs to be confident that it has policies and practice in place. ADP member’s and senior stakeholders support this statement. The ADP has feedback processes in place and is confident that an external process could independently gather similar feedback locally. The ADP is confident in maintaining this standard as core practice. Explore We currently partly demonstrate this standard and may need further development The ADP feels it has some evidence to support the standard but isn’t confident it is consistently maintained. The ADP and stakeholders feel there is room for improvement on some elements of the standard. Develop We do not fully demonstrate this standard currently and need to develop / discuss this further. The ADP is not confident it is achieving the standard. Further work is required to generate support for improvement or progress The self-assessment then asks the ADP to demonstrate their assessment with narrative in line with the headings of: 1. How effective is the ADP in respect of this area? 2. How do you know this? 3. How will you do it and by when? For each of the elements described above, please outline in no more than 250 each what you need to maintain, improve or do differently and provide a timeframe for these to be implemented. Please be open and honest in your response and consider the self-assessment in collaboration with relevant stakeholders, including local communities, children, young people, and families. This will provide opportunities to: Page 81 of 236
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• review what progress has been made and what development and learning has happened • provide assurance about the quality of delivery • highlight areas of good practice for sharing • highlight areas for improvement and levels of priority Those completing the self-assessment are encouraged to use information from different sources to triangulate evidence of the quality-of-service delivery. The completed Self-Assessment should focus on outcomes rather than activities. This could include a description of the impact of changes or improvement activities on the delivery or information on how potential impact is being monitored. Page 82 of 236
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The Self-Assessment Tool ADP area: Please use the box below to highlight relevant contextual and background information about the ADP including: -Population data for context -Outlining Governance and accountability arrangements (particularly in relation to ADP, Community Planning Partnership, Integration Joint Boards and Chief Officer Groups) -Links to other local statutory plans/partnerships (and how they link to local delivery) e.g. what links / role does the ADP have in relation to delivery of outcomes against their Local Outcome Improvement Plan / Children’s Services Plan Page 83 of 236
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Drugs North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 80 people dying from drug-related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire. There were 2,812 drug related crimes in North Lanarkshire in 2019/20 [latest figure available]. This is a rate of 82.4 per 10,000 population share, contrasting with a rate of 64.6 across Scotland. Alcohol In 2020, 101 people died from alcohol-related causes in North Lanarkshire. Alcohol related hospital admissions were 3270 in 2019/20 [latest available figures]. There were 36,135 Alcohol related hospital admissions across Scotland. Age-sex standardised rate per 100,000 for North Lanarkshire in 2019/20 was 982.36 and 673.27 for Scotland. The age-standardised death rates for alcohol-specific deaths in the most deprived 20% of areas in Scotland has been consistently higher than the rest. The death rate in the most deprived areas is 4.3 times the rate in the least deprived areas in 2020 (41 deaths per 100,000 compared to 10). Since 2001 the death rate in the most deprived areas has remained the highest of all five SIMD quintiles although the gap has narrowed slightly. *1 Not from the full sample of 94 deaths as at the time of analysis we did not have the toxicology reports for all 94 deaths therefore this percentage is from the available data set (61 of 94 deaths) SIMD and DRD Across Scotland in 2020, 1339 drug-related deaths occurred. Seven hundred and seven (53%) were in SIMD quintile 1 and three hundred and sixteen were in quintile 2 (24%) therefore 77% in quintiles 1 and 2. This is most significant if we consider the population of North Lanarkshire where 59% (32% SIMD 1; 27% SIMD 2) of the population is in SIMD quintile 1 or 2*. Page 84 of 236
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The strong links between drug and alcohol related harms and poverty1, inequality and trauma are widely acknowledged. Deprivation has been linked as a significant factor2 in drug and alcohol problems developing. 1 Hard Edges Scotland | The Robertson Trust 2 Staying-Alive-in-Scotland-Digital.pdf (sdf.org.uk) * See appendix 1 for fuller data Page 85 of 236
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What we see in North Lanarkshire is not unique and reflects a national picture where data trends are synonymous with the wider evidence base on substance-related harms3 . It is vital we have the most relevant data and evidence available to us to target the response needed to tackle the root causes of problematic substance in a holistic way. This includes using tried and tested approaches and targeting specialist responses across key localities. This will help to improve links to universal services and support the right investment in initiatives that can influence change and prevent deaths at the earliest opportunity. Support for Families In the Scottish Families report ‘Hidden in Plain Sight’ commissioned by NLADP in 2020, the vast majority of community survey respondents (9 in 10 people) felt their community had an issue with alcohol or drug use, with just 7% believing this not to be the case. NLADP strategy does not exist in isolation and is intended to link with other strategic plans focussed on identifying and protecting those at risk of harm from substance use. This includes but is not limited to: ➢ North Lanarkshire Children’s services plan ➢ Mental Health and Wellbeing Strategy ➢ Community Justice Improvement Plan ➢ Strategic Commissioning Plan ➢ VANL strategic plan ➢ North Lanarkshire Town Visions ➢ NL Housing Strategy & Rapid Rehousing Plan 3 Problem drug use in Scotland (parliament.uk) Page 86 of 236
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NLADP Structures ADP Board Prevention Treatment ROSC Whole Family App/FIP Justice & Health Alcohol Harms Finance Sub Group Page 87 of 236
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Section 1: Strategic Planning Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes Maintain Explore Develop We are confident that we are demonstrating this standard; we have evidence to support this, including stakeholder confirmation and need to maintain this focus overtime. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 1.1 Transparency and Effectiveness Further work is required to develop as part of ADP communications plan, web-site and app to share minutes/documents Page 88 of 236
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1.2 Inclusion Confident this is fulfilled via ADP structures/Commissioned services 1.3 Planning Cycle Further work is required – ADP is relatively new in terms of governance.. 1.4 Needs Assessment Confident this is fulfilled via ADP structures/Commissioned services 1.5 Whole System Approach Further work is required – ADP is relatively new in terms of governance. 1.6 Resources and Delivery Further work is required – ADP is relatively new in terms of governance. 1.7 Outcomes Further work is required – ADP is relatively new in terms of governance. Q. How effective is your approach to Quality Standard 1? 1.1 Transparency and Effectiveness The ADP has board representation from statutory and community sector representatives including people with lived and living experience. More work is required to develop as part of ADP communications plan, web-site and app to share key documents and development via minutes’/update documents. Currently all papers from NLADP to the IJB are shared via the North Lanarkshire MARS system. 1.2 Inclusion Page 89 of 236
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Confident this is fulfilled via ADP structures/Commissioned services. NLADP commissioned services regularly support direct feedback from those with lived and living experience, community representatives and the wider workforce. NLADP Board have approved a permanent lived experience project worker post to strengthen and maintain out inclusion focus. Work is ongoing to strengthen and sustain our approach. This currently includes: Barnardos, Phoenix Futures, North Lanarkshire Recovery Community, We Are with you, Equal Say Advocacy, Scottish Drugs Forum, Scottish Families Affected by Alcohol and Drugs, SAMH, Turning Point Scotland, Al-Anon in addition to statutory services engagement. 1.3 Planning Cycle The ADP is still in the process of defining our planning cycle following a great deal of work being carried out this year to finalise a new strategy, establish robust governance structures and formalise delivery and commissioning plans. The current planning cycle will take NLADP up until April 2023 when a new annual planning cycle will be put in place in keeping with the national guidance from the Scottish Government including the following elements: • Assessing needs • Aligning resources • Agreeing delivery plans and priorities • Reporting and learning from outcomes 1.4 Needs Assessment The partnership has undertaken extensive needs assessment via the Scottish Drugs Forum peer research programme; a recent rapid review research project carried out by Iconic Consulting; and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. NLADP Information and Research Officer supports ongoing analysis of NRS data with commissioned services monitoring reports to allow NLADP to assess need and target responses on an ongoing basis. All work carried out is now being drawn on to inform commissioning priorities into 2023. 1.5 Whole System Approach Page 90 of 236
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NLADP Board, finance and 5 sub-groups have broad representation from key stakeholders/partners and people with lived and living experience in taking a whole-systems approach. This includes; Police Scotland/NHS/Education/Housing/Justice/Community sector and a number of community representatives with lived and living experience. More work will be undertaken as part of our workforce development agenda and training needs analysis, launched in September 2022, to strengthen the Whole System Approach. The ADP support team is widely represented via a number of existing partnerships and networks including but not limited to: ➢ Adult protection committee ➢ Child protection committee ➢ Community Justice Partnership ➢ Violence against Women partnership ➢ NL housing partnerships ➢ Mental Health Partnership ➢ Improving Child Services group ➢ NLADP Commissioned services delivery group 1.6 Resources and Delivery Currently under review to inform commissioning priorities and resource allocation into 2023 and beyond. NLADP has a clear understanding of the resource available, the needs that exist and a clear plan. 2022 has been a transitory year for NLADP to review and move towards a more sustainable commissioning model and planning/evaluation cycle. 1.7 Outcomes Page 91 of 236
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NLADP Strategy clearly sets out the ADP priorities. Delivery outcomes to demonstrate progress and impact are currently under review to inform commissioning priorities and resource allocation into 2023. The support team continues to work closely with commissioned services during this transition to ensure local needs are met. The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework. Q. How do you know this? NLADP has undertaken extensive needs assessment via SDF peer research, rapid review research carried out by Iconic Consulting and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. This include the view and experience of those who have used services locally including families. NRS data with Commissioned services monitoring reports also supports NLADP assess need on an ongoing basis. Q. What do you want to maintain, improve or change, how will you do it and by when? April 2023 and beyond – NLADP commissioning plan and delivery plans will be published setting out funding priorities with spend and review arrangements. NLADP will work more closely with community solutions and the community sector via VANL to co-produce more of the responses that are required to tackle the root causes of problem substance use beyond 2023. Page 92 of 236
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Any further comments? Page 93 of 236
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Section 2: Financial Governance Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of its Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 2.1 Investment Confident this is fulfilled via ADP structures/Commissioned services 2.2 Governance Confident this is fulfilled via ADP structures/Commissioned services 2.3 Accountability Confident this is fulfilled via ADP structures/Commissioned services 2.4 Reporting Confident this is fulfilled via ADP structures/Commissioned services 2.5 Financial Planning We currently partly demonstrate this standard and may need further development. Work underway to set out commission plan for 2023. Page 94 of 236
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Q. How effective is your approach to Quality Standard 2? 2.1 Investment NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements. The finance group currently meets every 6 weeks with updates at ADP Board level also on a 6-weekly basis. Investment decisions from each sub-group are reviewed by the finance group before final approval by the NLADP board. 2.2 Governance NLADP has a clear reporting mechanism for monitoring and reviewing the investment arrangements. The finance group currently meets every 6 weeks with updates at ADP Board level on a 6-weekly basis. 2.4 Accountability NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – finance group currently meets every 6 weeks with updates at Board level also on a 6 weekly basis. Accountability beyond the North Lanarkshire ADP Finance Group is to the NHS Lanarkshire Board and to the Council Committees covering Adult Health and Social Care and Education and Families. The Chief Officer of the Health & Social Care Partnerships (North) is accountable for: • The Scottish Government Direct Funding allocation services • The Local Improvement Fund investment in services to reduce problem alcohol and drug • Drug Deaths Taskforce Funding • Additional Funding allocation to NLADP from Scottish Government Page 95 of 236
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2.5 Reporting NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – finance group currently meets every 6 weeks with updates at Board level also on a 6 weekly basis. 2.6 Financial Planning NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – We currently partly demonstrate this standard and may need further development. Work underway to set out commission plan for 2023. Most recently NLADP brought together the board, finance group and key stakeholders for a development day to agree priorities for investment. This will form that basis of the final delivery and commissioning plans. More work is required here to ensure Lived/Living experience panel are established and have a more active role in financial planning review processes. This currently happens at IJB level. Q. How do you know this? NLADP finance group meeting minutes/draft commissioning plan and regular spending/variation review and monitoring at this forum and updates to the NLADP board. Q. What do you want to maintain, improve or change, how will you do it and by when? Page 96 of 236
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Further work required to finalise and publish NLADP delivery and commissioning plan by April 2023. Any further comments? Section 3: Quality Improvement Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. Page 97 of 236
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3.1 Methodology We currently partly demonstrate this standard and may need further development. 3.2 Reporting We currently partly demonstrate this standard and may need further development. 3.3 Sustainability We do not fully demonstrate this standard currently and need to develop / discuss this further. Page 98 of 236
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Q. How effective is your approach to Quality Standard 3? 3.1 Methodology QI methodology applies across all NHSL improvement projects – more work is to be done to train staff and stakeholders to support relevant Test of Change initiatives. Three members of the NLADP support team have undertaken Quality Improvement training which underpins our approach. 3.2 Reporting Currently commissioned services are required to provide regular monitoring reportswith the next 6-month review due in October 2022. From April 2023, all commissioned services will report to the ADP support team on a quarterly basis, with 6 month/Annual reviews taking place. More work is required to offer support and improve performance monitoring processes. NLADP Lead and Information Research Officer carried out a review of data and evidence in 2022 to understand gaps and improve the quality and consistency of data to the ADP. Work continues with Health Improvement/Public Health colleagues to strengthen links and QI data to help inform and target future initiatives. Work of each sub-group is underpinned by QI principles including the Drug Deaths Prevention Group/Reducing Alcohol Harms group and existing test of change initiatives proposed. This includes investment from DTTF and Corra funded initiatives such as prison Link worker, naloxone, Family learning centres and Breakthrough housing support initiatives. 3.3 Sustainability Page 99 of 236
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NLADP has more work to do to support more sustainable quality measures in keeping with planning and commissioning cycles as these are reviewed for implementation beyond 2023. This will be built into future commissioning processes more routinely and robustly via SLAs/ongoing monitoring and performance review processes. Q. How do you know this? NLADP has undertaken extensive needs assessment via SDF peer research, rapid review research carried out by Iconic Consulting and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. PHS/NRS data with Commissioned services monitoring reports also supports NLADP assess need on an ongoing basis. All work carried out is now being drawn on to inform commissioning priorities into 2023. Q. What do you want to maintain, improve or change? NLADP has more work to do to support more routine and sustainable quality measures in keeping with planning and commissioning cycles - these are to be reviewed for implementation beyond 2023. More work is required to support all partners and stakeholders to understand and apply QI principles. New Staff to the ADP support team will complete QI training. Improve access to information and data around alcohol harms working closely with PH and HI colleagues. Any further comments? Page 100 of 236
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Section 4: Governance and Oversight Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 4.1 Oversight We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. 4.2 Governance We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. 4.3 Risk Management We currently partly demonstrate this standard and may need further development. 4.4 Accountability We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. Page 101 of 236
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Q. How effective is your approach to Quality Standard 4? 4.1 Oversight NLADP structures are clearly set out with each group directed with a specific Terms of reference setting out meeting frequency, governance arrangements and review processes. There are clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. The draft ADP strategy was shared with all stakeholders and partners for feedback and review. NLADP hosted a number of consultation meetings as part of the strategy development including an online stakeholder event and a follow up consensus event. 4.2 Governance NLADP structures are clearly set out with clear Terms of reference for each group setting out meeting frequency, governance arrangement and review processes with clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. 4.3 Risk Management Further work is required to define and embed risk management processes and to review arrangements moving forward. 4.4 Accountability Page 102 of 236
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NLADP structures are clearly set out with clear Terms of reference for each group setting out meeting frequency, governance arrangement and review processes with clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. Q. How do you know this? NLADP structure, strategy, draft commissioning plan/delivery plan/Group terms of reference, membership lists, meeting minutes, decision making/action logs. Q. What do you want to maintain, improve or change, how will you do it and by when? Improve the transparency of the processes and decision making arrangement making details more widely available as the ADP website develops to be able to host information. NLADP will establish lived experience panels in 2023 to review and feedback on future proposals/investment as part of our governance and oversight arrangements Page 103 of 236
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Section 5: The relationship between the ADP and the Integration Authority Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 5.1 Alignment and Governance We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. Page 105 of 236
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Q. How effective is your approach to Quality Standard 5? 5.1 Alignment and Governance The ADP Chair is a member of the HSCP Senior Leadership Team and IJB. The progress and performance of the ADP is regularly reviewed at these forums with ongoing feedback. All activities linked to NLADP strategy, delivery and commissioning plans and ongoing performance is scrutinised, reviewed and adjusted via the Integration Joint Board Planning, Performance and Audit (PF&A) committee and approved at IJB level. Q. How do you know this? The integrated authority already has robust mechanisms in place. Full details are open and transparent via NLC with all papers and minutes publically available. The role, function and performance of the ADP is well understood across the HSCP and IJB. Q. What do you want to maintain, improve or change, how will you do it and by when? NLADP will continue to approve spend/adjustments via ADP structures and sub-groups subject to ongoing monitoring at IJB PF&A committee and IJB. Increase the profile and understanding of the ADP and the work we do to encourage more participation achieving our outcomes. This includes ensuring the MAT standards are implemented effectively with the full support of the senior leadership team to influence the change required to fully embed the standards across all localities. Page 106 of 236
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This Self-Assessment of Partnership Delivery Framework is agreed and ratified by: Senior System Stakeholders ADP Lived Experience Stakeholder/s / Representative Kerry Anne Clarke – NL Recovery Chair of the Alcohol and Drug Partnership Morag Dendy Chair of the Community Planning Partnership The Chief Executive of the Local Authority Des Murray The Chief Executive of the NHS Board Heather Knox Director of Public Health Professor Josephine Pravinkumar The Chair of the Integration Joint Board The Chair of the Chief Officers Group Divisional Commander for Police Scotland Stephen Dolan Chief Executive of Third Sector Interface Maddie Halliday The Chief Officer of the Health and Social Care Partnership Ross McGuffie Page 108 of 236
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APPENDIX 1 Self-Assessment Criteria Page 109 of 236
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1 Quality Standard 1 : The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans 1.1 Transparency and Effectiveness X The strategic plan is agreed by the ADP X The strategic plan is published and publically available X The ADP can demonstrate effective strategic linkage with other local partnership groups and local communities X The ADP can demonstrate examples of improvement activities and positive outcomes for the local population X The ADP can demonstrate evidence that Strategic Planning is safe, effective, compassionate and person- centred 1.2 Inclusion X The ADP can describe how they engage with local communities X The ADP can demonstrate how any potential barriers to involvement or engagement are removed X The ADP strategic planning is inclusive of people affected by drug and alcohol harms and their family members, those who use services, those who deliver services, and the local population Page 110 of 236
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X The ADP embeds equality impact assessment processes to understand the diverse needs of local populations and uses this information to inform pathways and provision in its strategic planning and ensure human rights are met X The ADP Strategy effectively aligns to other statutory plans / priorities on delivery in support to families in crisis or at risk of being in crisis as a result of drug / alcohol use (e.g. Child Protection, Adult Protection) 1.3 Planning Cycle X The ADP can demonstrate that it delivers in line with a strategic cycle for planning which includes: needs assessment, delivery, commissioning, review and reporting of outcomes / progress X ADP Strategic Planning is based on population health approaches and includes primary, secondary and tertiary prevention 1.4 Needs Assessment X The ADP has a local assessment of the needs of people who use alcohol / drugs led by NHS Public Health and involving partners 1.5 Whole System Approach X The ADP can demonstrate that their strategic planning is based on national and local priorities, is evidence based and aligns with delivery of local supports and services Page 111 of 236
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X The ADP has representatives of: X Health and Social Care Partnership: mental health, primary care, adult services X Specialist drug / alcohol services X Health (e.g. emergency department, relevant acute wards, health improvement / public health) X Children’s services X Police X Justice services X Housing / accommodation / homelessness services X Employment services X Community X Lived experience X Education X Third Sector Interface X The ADP can demonstrate that other local planning partnerships and services incorporate and complement ADP activity to reduce alcohol and drug harms 1.6 Resources and Delivery The ADP has an annual delivery plan agreed by member organisations that details resources aligned in support of delivery, including the following: direct resource, local financial investments and “in kind” resources. It details Page 112 of 236
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cross-system prioritisation and responsibilities within, for example, Health and Social Care Partnerships, Children’s Services Planning Partnerships, Community Justice Partnerships and Community Planning Partnerships to be deployed to implement the Annual Delivery Plan and the outcomes to be achieved 1.7 Outcomes X The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework X The ADP outcomes are measureable and reportable X The ADP routinely reports on progress against strategic outcomes 2 Quality Standard 2 : The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans 2.1 Investment X The ADP is able to demonstrate that investment in the delivery of outcomes comes from a range of sources, including the Local Authority, Health Board and the Integration Authority, as well as outside of the public sector X The ADP can demonstrate investment is in line with Scottish Government priorities Page 113 of 236
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X The ADP can demonstrate that investment is based on evidence of effectiveness and outcomes X The ADP can demonstrate ability to disinvest based on evidence of effectiveness and outcomes and in line with changing priorities articulated though formal needs assessment 2.2 Governance X The ADP has clear policies and procedures for aligning resources for investment with strategic planning X The ADP seeks authorisation for investment from the Integration Authority and local scheme of delegation X The ADP has a clear policy agreed with members and the Integration Authority on the treatment of underspends / overspends X The ADP can demonstrate effective and transparent governance arrangements are in place X The ADP can relate investments in third sector and public sector to performance and outcomes 2.3 Accountability X The ADP and the Integration Authority can demonstrate all funding allocated to NHS Boards for onward delegation to ADPs is available to the ADP X The ADP has full accountability for the totality of funding allocated for drugs / alcohol from its NHS Board and Local Authority Page 114 of 236
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2.4 Reporting X The Health and Social Care Partnership Chief Finance Officer is a member (or formally represented) on the ADP X There is regular routine financial reporting to the ADP on the total spend on alcohol and drug services The ADP and Integration Authority provide an quarterly and annual financial report to the Scottish Government X The ADP reports to local governance structures on investments 2.5 Financial Planning X The ADP strategy includes investment to increase activity over time in relation to prevention and early intervention aligned with other such preventative spend across local partners / partnerships 3 Quality Standard 3 : The ADP can demonstrate quality improvement in delivery of outcomes 3.1 Methodology X The ADP has or uses an underpinning quality improvement methodology Page 115 of 236
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X ADP staff and members are supported to use improvement methodologies through training and other workforce development activities 3.2 Reporting X The ADP can demonstrate examples of where improvement methods have had a positive impact X The ADP can demonstrate links with outcome reporting, needs assessment and financial investment / disinvestment 3.3 Sustainability The ADP can demonstrate how achieved improvements are embedded and sustained X The ADP benchmarks performance with other areas (e.g. other ADPs, other partnership groups) 4 Quality Standard 4 : The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan 4.1 Oversight X ADP Members can demonstrate effective oversight arrangements are in place to deliver the local strategy Page 116 of 236
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X The ADP can demonstrate processes to ensure oversight, coordination and alignment of ADP activity with other relevant local partnerships and strategies 4.2 Governance X The ADP has published the roles and remit for members setting out how decisions are made, issues and disputes are resolved, conflicts of interest are managed X There is a organogram that sets out the relationship of the ADP with the Integration Authority, with other planning boards (e.g. Children’s Partnership and the Community Justice partnership), and with areas of statutory responsibility (e.g. Child Protection and Adult Protection) X The ADP can demonstrate how they know governance structures provide appropriate assurance of safe, effective, compassionate and person-centred delivery X There are process in place for the ADP Chair to escalate and progress discussions with local partners / responsible officers when a priority is not being delivered and a process in place to ensure ADP contribution to aligned plans is being progressed X The ADP strategic plan forms part of the overall Community Planning Partnership (CPP) offer, is ratified via CPPs, and aligns with the priorities of other key statutory plans 4.3 Risk Management X There is a clear process for identifying and managing risk in relation to delivery of national and local priorities Page 117 of 236
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X There are clear controls in place to reduce impact of identified risks X The ADP can demonstrate how failure is reported, analysed and learning facilitated 4.4 Accountability X The ADP can describe clear accountability to appropriate Chief Officer(s) responsible for the delivery of relevant policy, system or targets X The ADP can demonstrate clear articulation of the relationship with senior accountable officers, and specifically, the relationship between the ADP and Public Protection that sit with the local Chief Officers Group and can demonstrates that processes are in place to ensure learning from drug deaths and responsibility for reducing substance use mortality and harm 5 Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan X The ADP has a clear policy on taking investment plans and business cases to the Integration Authority Joint Board for ratification Page 118 of 236
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X The ADP provides performance and financial reporting to enable support the development of the Integration Authority’s Annual Performance Report X The ADP regularly reports to the Integration Authority on performance X The work of the ADP is reflected in the objectives of the Integration Authority Strategic Plan X Governance and oversight arrangements for ADP business are supported by the Integration Authority X Adult treatment services are delivered in line with ADP strategy X The ADP and the Integration Authority have a clear policy on how decisions and directions are managed for services out-with the scope of the Integration Authority (e.g. children’s services, police, housing will be issued) X The Integration Authority ensures governance arrangements support the deployment of resources at pace to support the Mission Page 119 of 236
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PO82.2 Carers Act Implementation North Lanarkshire Council Report Does this report require to be approved? ☒ Yes ☐ No Ref MD Date 15/11/22 From Morag Dendy, Head of Planning Performance and Quality Assurance E-mail WilliamsonM@northlan.gov.uk Telephone Executive Summary This report is intended to update Committee of the support in place for unpaid Carers across our communities and to seek endorsement of our approach to ensure continuation of support. We recognise that unpaid Carers of all ages play a vital role in the lives of the people they care for and the Council is committed to supporting Carers to ensure they can continue to provide that care for as long as they wish. As previously reported, services were commissioned in March 2019, to undertake the following functions: • Direct support for adult Carers: Lanarkshire Carers • Carer’s campaigning, information and representation services: North Lanarkshire Carers • Together • Young Carers Support Services: Action for Children Young Carers Service • Community Solutions Programme: Voluntary Action North Lanarkshire Support delivered via these commissioned services has enabled us to meet the requirements of the Carers (Scotland) Act 2016. By utilising the allocated ring-fenced funding via Scottish Government to support the implementation of the Act, several initiatives (reported through Committee Nov 2021) were developed to provide additional support to meet some of the priorities set out in the act. Our approach to supporting unpaid Carers is closely aligned with our Self-directed Support transformational programme, details on which are contained on a separate report. Recommendations It is recommended that the Adult Care and Social Work Committee: 1. The content of the Report is noted 2. The approach to supporting unpaid Carers is endorsed. 3. The requested extension to service contracts is approved to ensure a continuation of support is available for unpaid Carers. Adult Care & Social Work Committee AGENDA ITEM 4 Page 121 of 236
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The Plan for North Lanarkshire Priority Enhance participation, capacity, and empowerment across our communities (13) Improve preventative approaches including self-management Ambition statement 1. Background and giving people information and choice over supports and services 1.1 The Carers (Scotland) Act 2016 came into force on 1st April 2018. The Act was built upon existing legal rights for Adult Carers and Young Carers in Scotland as well as introducing new rights. The aim of the Act was to support Carers through offering a personalised approach to any support required in their caring role and to try to minimise the risk of future crisis, both for the Carer and Cared for person. 1.2 Our Strategy for Adult Carers and Young Carers (2019-2024) cites the last Census completed in Scotland from 2011. This highlighted that approximately 10% of North Lanarkshire’s population identified as being in a caring role and early indications are that this number is set to rise when the most recent census information is published. It should be noted that not all Carers are known to services. 1.3 The impact of the pandemic and the ongoing challenges across health and social care has added significant extra pressure to Carers and families. 1.4 Our commissioned Carer Support Organisations were awarded contracts in March 2019, on a 4+2+1 basis and are now nearing the end of the original contract period. 1.5 The Carer Breather pilot over a period of 18 months is due to end in March 23. Early feedback on the success of the pilot has been very positive, particularly from those who were able to have a break together and for those providing care but who did not necessarily wish to identify with a carer’s organisation. 1.6 We participated in the national Care Inspectorate Inquiry into Carers experiences of adult social work and social care. North Lanarkshire were one of the 5 Health & Social Care Partnership areas participating in a more in-depth inquiry. The Inquiry has now been completed and we await feedback on the outcome. 1.7 Carer support is a key factor in our SDS transformational programme, looking at a whole system approach. Details of the SDS transformational programme are contained within a separate report. 2. Report 2.1 We have three (3) commissioned organisations supporting Carers. To compliment these services, regular and locally based support has been achieved by enhancing and extending Support for Carers, utilising the allocation of ring-fenced funding via Scottish Government to further support the implementation of the Carers (2016) Act. 2.2 At the time of procuring the commissioned services, awards were made with the option to extend based on the original contract terms & conditions. Our intention is to exercise Page 122 of 236
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the option to extend these contracts a further 2 years, based on performance, efficacy, and success to date. 2.3 The cost to extend the contract period for all services will be met from recurring ring- fenced funding form Scottish Government and is detailed below: Provision Provider CURRENT 22/23 Budget 23/24 Budget 24/25 Budget Adult Carer Support Plans Lanarkshire Carers Centre £616,097 £646,902 £679,248 Young Carers Statements Action for Children £418,481 £439,405 £461,375 Information & Advice Service North Lanarkshire Carers Together £255,739 £268,525 £281,952 2.4 Over the past year enhanced support for Carers has been made available through a range of initiatives utilising unallocated ring-fenced funding from the Scottish Government. These initiatives included Carer Breather, the Hospital Support Programme and Short Breaks. Our robust partnership approach with commissioned and community-based services, provides assurance that Carers know how and where to access support. 2.5 The Carers (Scotland) Act 2018 highlights that unpaid Carers should be involved in hospital discharge planning. A development aimed at supporting unpaid Carers in hospital discharge planning is already in place and will be operational until September 2024. 2.6 Imminent amendments to the Carers Act will include a legal right for unpaid Carers to have a break from caring. Expansion of Carer Breather and funding for flexible Short Breaks will ultimately assist in meeting legal responsibilities in a cost effective, sustainable and carer valued and informed way. 2.7 The Carer Breather programme is supported by NLCT within Community Solutions, with initiatives developed directly through listening to the views of Carers. Short Breaks support is managed by Lanarkshire Carers. Having this provision in place has helped reduce carer stress and burn out and mitigated against escalation of carer needs. Engagement and participation activity has demonstrated the success of the current programme, as well as highlighting a greater need and demand for this option – as a valued approach to flexible breaks from caring. 2.8 The intention is it continue to support flexible Short Breaks and expand the Carer Breather programme beyond March 23, by offering additional investment to provide Carer support – both geographical and thematic. The additional funding required will come from specific ring-fenced Carer support monies. The proposed operational timescale will fit with the planned extension to our commissioned services contracts. 2.9 The cost to continue and expand this provision will be met from recurring ring-fenced funding from Scottish Government and is detailed below: Provision 2023/24 2024/25 Total Short Breaks £200,000 £200,000 £400,000 Carer Breather £300,000 £300,000 £600,000 Page 123 of 236
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2.10 Carer Breather will continue to utilise the Carer Pathway Toolkit to engage Carers in conversation as part of a light touch early intervention within the local community. 2.11 Our current Carer Strategy runs until 2024. To prepare for reviewing our strategy and implementing any learning from the Care Inspectorate Carers Inquiry, we will refresh the role and function of our Carer Strategy Implementation Group. Members will play a valuable role in our ongoing partnership approach to supporting unpaid Carers. 2.12 The Carers Policy Team are currently developing a National Carers Strategy, which will articulate the Scottish Government’s overall ambitions for unpaid carers and for carer support. The publication of this strategy, the learning from the Care Inspectorate Carer Inquiry and the publication of the Scottish Census information will all inform the refresh of North Lanarkshire’s Carer Strategy. 2.13 A breakdown on how the 2023-2025 funding has been allocated is detailed below: Carer Support Allocation 2023-2024 2024-2025 Provision of Adult Carer Support Plans - commissioned service, which also includes adult carer support £ 646,902 £ 679,248 Provision of Young Carer Statements - commissioned service, which also includes young carer support £ 439,405 £ 461,375 Information and Advice – commissioned service, which also includes Carers Advocacy £ 268,525 £ 81,952 Duty to support adult carers – includes Carer Breather; Community Solutions; SDS including Carer Budgets £ 650,000 £ 800,000 Duty to support young carers – includes PAMIS (provides support to families); SDS including Carer Budgets £ 50,000 £ 50,000 Additional short breaks support £ 200,000 £ 200,000 Local Carer strategies £ 100,000 £ 100,000 Other - Hospital Support £ 145,246 £ 145,246 Unallocated Budget £ 1,032,017 TOTAL £ 3,532,095 £ 2,717,821 2.14 From the expected 2023/24 ring-fenced funding from Scottish Government, the total unallocated £1,032,017 will be utilised to implement any recommendations from the reports (noted at 2.10 above) once published. This approach will ensure that we remain responsive to the needs of Carers across our communities, enabling them to maintain their caring role while leading a full life. Page 124 of 236
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3. Measures of success 3.1 A reduction in the number of unpaid Carers reaching crisis point through improved access to Carer break opportunities. 3.2 Increased number of unpaid Carers involved in support planning, resulting in better outcomes for both the cared for person and the unpaid Carer. 3.3 Improved Anticipatory Planning 3.4 Evidence of the efficacy of our approach through unpaid Carer feedback, through Carer Support Organisations and through the refreshed Carer Strategy Implementation Group. 4. Supporting documentation 4.1 Appendix 1 - Carer Support Update – Nov 2021 https://mars.northlanarkshire.gov.uk/egenda/images/att97211.pdf 4.2 Appendix 2 - NLCT Update 4.3 Appendix 3 - AFC Young Carers Update 4.4 Appendix 4 - GBT - Hospital Support Programme 4.5 Appendix 5 - GBT – Carer Breather Activity 4.6 Appendix 6 - Lanarkshire Carers Update 4.7 Appendix 7 - Lanarkshire Carers Annual Report Morag Dendy Head of Planning, Performance & Quality Assurance Page 125 of 236
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact because of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Scottish Government have allocated ring fenced funding to support the Implementation of the Carers (Scotland) Act 2016. The financial commitment to extend the current commissioned services contracts and expand/extend support for Short Breaks and the Carer Breather programme will be met from the allocation made to North Lanarkshire. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☒ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☒ No ☐ The legal context in which Carer support and Carer Rights operates can be found within the following legislation: The updated Carers (Scotland) Act 2016, Statutory Guidance. Carers (Scotland) Act 2016, Statutory Guidance 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ Page 126 of 236
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If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Improved web - based information should be available to ensure to unpaid Carers understand their rights and can access support. This is currently in development. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? There is a risk that without appropriate supports in place for Carers to continue in their caring role, additional pressure will be on health and social care service. Risk impacts are reflected through the service’s risk register and all commissioned services are managed through our Contracts Monitoring Framework Page 127 of 236
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Appendix 2 North Lanarkshire Carers Together (NLCT) – Update Report Oct 22 North Lanarkshire Carers Together (NLCT) provide a Campaigning and Representation service and are the dedicated Information and Advice service for carers and professionals who come into contact with carers. Information Over the past year the service has provided more than 4,500 pieces of information to more than 1100 carers, of which 625 were newly identified and the service made 623 referrals to a range of services including: • Financial Inclusion team • Young and Adult carer supports • North Lanarkshire Disability Forum • Range of Social Work services A lot of information over the past year still revolved around supports directly related to COVID including PPE and information on where and how to access vaccinations. There is a reliance on the NLCT staff team for emotional support and personalised interventions, particularly with the ongoing social care difficulties for those they care for. A new rebranded Carer Information Pack has been developed outlining what a carer is, carer rights, the range of NLCT services and what supports are available across the local authority. Carer Engagement & Representation Carer engagement and representation is essential to the development of local services and policies and to feed into national and local consultations. This also has to be meaningful, supported, funded and crucially the loop needs to close in that there has to be feedback to carers who give their time to contribute. NLCT frame all consultation with their guiding principle ‘We Asked, You Said, We Did’ and is their promise to those carers who form part of their Carer Forum. The Forum meets in-person, digitally and also has a closed private social media group. It has 48 members. This past year, the Carer Forum led within North Lanarkshire the consultation with carers on the proposed National Care Service and with the development of Carer Breather*. NLCT also led locally on the national Care Inspectorate Inquiry into carers experiences of adult social work and social care which included a ‘deep dive’ into 5 Health & Social Care Partnership areas including North Lanarkshire. Feedback and results are always provided to those carers in an accessible format whom participate in engagement. NLCT also represent carers views and needs in the following networks and fora: • Children, Young People and Families Network • BAME Network • Strategic Commissioning Planning Group • Integrated Joint Board • SDS Network • Mental Health Communications & Reference Group Page 128 of 236
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• 3rd sector Health and Wellbeing Network • Community Solutions Governance subgroup • Community Solutions Carer Support Network Leads • Community Boards • Community & Voluntary Sector Partnership Group Chair / SLB Rep • NL Advice Network • NL Social Enterprise Network • Old Age Psychiatry Programme • Rural Network Campaigning In partnership with the Carer Positive Team at Carers Scotland, the service host 2 events each year identifying and encouraging local partners to become carer positive employers and recently campaigned in support of the private members bill to Westminster for statutory time off for those working alongside a caring role. A key piece of work the service provides is a Carer Aware Programme - delivering training sessions to carers and partners, informing them of the Carers (Scotland) Act 2016, of carer rights, and where and how to access support and services for carers locally. Over the past year they have delivered 17 sessions to 244 carers and partners, which includes 6 sessions to 65 front-line social work staff. The service is currently promoting 1 session per month to Health & Social Care to campaign on the important contribution carers provide to the social care system as Equal Partners. In October this year, a Carer Aware session was delivered to elected members. NLCT has a programme of work with the community partnership team and routinely work in partnership to identify parent carers, inform them of supports available and are currently leading on co-produced cost of living events across the Northern Corridor. NLCT continue to promote Care Opinion to carers and partners and will ensure access to Care Opinion will also be available to carers from the BAME community, with the use of Language Line if necessary. Developments Carer Advocacy NLCT launched an Independent Advocacy Service on 13th September 2021, and it is now operating a waiting list due to demand for the service. Since inception, the Advocacy Worker has supported approximately 50 carers on a range of issues. Family Support The service is also entering into its second year commissioned by North Lanarkshire Council Education & Families to provide a family support service to parent carers who have a child or young person with additional needs. The child’s named person, or the Neuro Developmental team in CAMHS can refer into the service where the family receive support such as psychoeducation on the child’s condition, help with strategies, emotional support, information, advice, signposting to relevant statutory and community supports. Carer Breather Page 129 of 236
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*For many years the idea of a short break was either traditional respite or a cash grant which often have restricted eligibility criteria, such as caring for someone over 18 or with a specific disability. The service led on a consultation with carers, putting them at the heart of service design to consider alternative and creative ways to provide a short break. Carers fed back that service providers needed to think outside the box and address the need for time out that didn’t only take the form of an annual short break, but that was easily accessible in the community, available on a regular basis and more flexible in terms of availability throughout the day. From these insights, the Carer Breather funded projects were set up to offer activities such as art therapy, health and wellness activities, holistic support, and groups supporting people caring for loved ones with learning disabilities or living with long term conditions. This service is now supported by NLCT as Carer Support Network Leads within Community Solutions. Carers can now access new services across North Lanarkshire that provide breaks from their caring roles and allow them to take some quality time out for themselves. The Carer Breather projects and pilot Sitter Services were developed directly through listening to the views of carers, and will be utilising the Carer Pathway Toolkit to engage carers in conversation as part of a light touch early intervention within the local community. Carer Podcast NLCT recently launched their new and novel way of getting information out to carers and those who come into contact with them through the development of a Carer Podcast early in the new year. Actor Jane McCarry agreed to discuss her previous caring roles and the impact the pandemic has had on mental health and wellbeing of carers and the people they care for in the inaugural recording. There are many plans for future episodes including an interview with a local GP and a carer discussing the impact of the cost-of-living crisis. All NLCT activity is dependent and revolves around sound partnership working and trust across the rich and diverse statutory and community and voluntary sectors. Page 130 of 236
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Appendix 3 Action for Children, North Lanarkshire Young Carers – Update Oct 22 NLYC will finally move to the new premises (Enterprise House) in November 2022 after several delays. The new facilities will enhance carer involvement with a new Podcast Suite for young carers as well as a facility for training, educational support, and 1:1 counselling. Enterprise house is a modern, secure and energy efficient building with recently upgraded networking and IT facilities. The new building will also feature a new VR facility for young carers to use for Groupwork and training purposes. (Fire and rescue \ first aid \ medication management and safe lifting & handling.) Upgraded kitchen facilities will allow the service to support young carers to learn new skills in cooking, food preparation and Nutrition. The service has been fully operational since mid – 2021 with a small Covid disruption in Late December 2021. Groupwork supports and individual 1:1 supports have continued since this time. In line with the Carers (Scotland) Act 2016 the service has continued to prioritise identification and support of young carers within North Lanarkshire, including the offering of a Young Carers Statement and review where applicable. A major part of our work has been the continued delivery of a large number of carers led short breaks and residential breaks. Young Carers choose to go to Aberdeen, England, Glasgow, Edinburgh, Dundee, and Ayrshire, as well as attendance at the 2021 Young Carers Festival in Fife. In addition, our young carers have enjoyed a number of concerts, plays and musicals both in Edinburgh, Glasgow and Cumbernauld. Our ability to provide these breaks has been supported by successful applications to funders and also the Lanarkshire Carers Short Breaks Bureau who remain a vital partner and source of support to the service. Through additional funding and support from Action for Children we managed to replace three of our old vehicles with newer, more efficient, models. Supporting Mental Health and well-being remains vital, and the service has continued its successful initiative with counselling services who provided vital emotional supports to a number of young carers. In addition, we have continued our Blues training initiative, and provided training for carers through our partnership with Landed. In addition, we worked with and number of other partners including Reel-time studios, New College Lanarkshire, Lanarkshire Carers and Columba 1400. We also provided a number of specialised ‘sibling’ short breaks with the ‘Over the Wall’ organisation. Our partnership with Motherwell FC community trust remains extremely important and beneficial to our young carers. Recently we held our first ‘post covid’ ‘Fire-reach’ training initiative with Scottish Fire and Rescue in Coatbridge. Raising awareness of young carers existence remains another major piece of our work, and we have developed a whole new suite of traditional and digital materials which are all QR linked to our updated website. The website provides a wealth of information on what we do, supports available for all carers and also a dedicated referral page. We have had a number of features in the papers, including the Scotsman, Daily Record and also on STV. This has been made possible through support from Action for Children’s media and fundraising teams. We have continued with our Facebook page also. Partner support remains vital to the service, and we celebrated a number of important partnerships with third sector supports and also Education, NHS \ CAMHS, social work, third sector Page 131 of 236
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and a number of charity foundations. NLYC continues its partnership with High schools in North Lanarkshire with awareness raising presentations, drop ins and attendance at school events. We are currently piloting a primary school awareness initiative in Bellshill. Ian Sloan Locality Services Manager Action For Children Page 132 of 236
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Appendix 4 Getting Better Together Hospital Discharge Support Programme (HDSP) CARER SUPPORT ACTIVITY REPORT Report activity period: October 21 to September 22 Following on from a discharge to assess test of change with D2A, the service successfully secured additional D2A funding in September 21. This additional funding increased the capacity of the service to meet the increased need for supporting unpaid carers of North Lanarkshire patients age 16+ across Lanarkshire’s NHS sites. To meet this need, the service recruited new additional community liaison officers during the last quarter of 2021. HDSP now has four full-time liaison officers whose main bases are University Hospitals Monklands and Wishaw. Although these sites are our main bases, the carers of North Lanarkshire patients at University Hospital Hairmyres and other NHS sites are visited or contacted when a referral is received. This expansion to four liaison officers increases the service capacity to: • Provide information to more unpaid carers about their rights and potential supports available to them. • Directly refer into local carer support organisations as well as wider community supports. • Expand direct practical and direct support provision to both carers and cared for. • Provide more indirect support to carers by arranging supports for more patients which promote carer breaks and help make caring role more manageable (anticipated low level carer support). • Liaise with Health and Social care professionals on behalf of carers when required. • Provide emotional/listening ear support to carers when appropriate. • Raise awareness of carers rights with our Health and Social Care colleagues and teams. Shortly after receiving D2A additional funding, D2A was replaced with new programmes within the acute sites, namely Home First and Home Assessment Teams. These have the same ethos as D2A and HDSP offered it’s support to carers engaged within these programmes. Areas of focus for HDSP with carers has been: • Increasing engagement with both carers and professionals. • Early discharge planning and support intervention. • Reducing admissions by providing quick response supports to carers/cared for. The service continues to be very flexible in its engagement with carers. Although referrals are made to HDSP by our health & social care teams and community and voluntary sector partners, carers are welcome to self-refer. Our liaison officers meet with carers both within wards and during home visits to provide tailored information, advice and practical support. During the past year, the service received 202 enquiries in which direct contact was made with carers by the team. Page 133 of 236
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Following our personal outcome conversations with carers, information about available supports is provided and the service provided 127 carers with information about their rights and the support available to them. This signposting information was provided to carers either in our discharge information packs or by post or email. If consent is granted, onward referrals are made to local carer support organisations such as North Lanarkshire Carer Together, Lanarkshire Carers and North Lanarkshire Young Carers. This promotes access to the wide range of service available to carers from North Lanarkshire’s carer support organisations including Creative Breaks and access to Adult Carers Support Plans and Young Carer Statements. These are anticipated to promote carers health and wellbeing and the right to a life outside of caring. 108 carers responded that they feel more aware of supports available to them following input from the service. In addition to this, information and onward referrals are also made on behalf of carers to a wide range of other supports such as Carer Breather supports which HDSP was a panel member via our membership of the Carers Network. Information provided to carers covers areas such as Local Authority services (such as Social Work, Leisure and Culture) and health promotion literature. • Social opportunities. • Leisure and physical activities. • Future planning. • Support to self-manage specific health conditions. • Welfare rights. • Provide meaningful feedback on the services received and how to become involved in shaping future services. The service submitted 133 direct referrals on behalf of carers to both carer support organisations and wider community, voluntary and statutory supports during the past year. By working in tandem with both carers and patients, the service also indirectly supports carers by either arranging community supports on behalf of patients or by providing practical supports directly to patients. HDSP assisted 406 patients which resulted in 194 direct referrals or supports being made. Many of these indirectly support carers in a wide variety of ways whether this be reducing carers need to provide transport to appointments, requesting community alerts to provide more peace of mind or a social activity that provides a regular break for carers. HDSP also provides an important point of contact for Health and Social Care professionals looking for information and advice regarding support for unpaid carers. The service highlights available carer support and carers rights to colleagues when enquiries are received. Support available to carers and carers rights are also highlighted by HDSP during awareness raising sessions with teams including hospital social work, physiotherapy, and occupational therapy amongst others. During the past year, HDSP has been involved in numerous awareness raising meetings with newly qualified social workers to highlight carer support and EPIC principles. Other awareness raising sessions include presenting to the Monklands Physiotherapy team. HDSP’s Wishaw team recently distributed carer information to NHS staff during a recent stall, Page 134 of 236
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recognising that many of our acute colleagues have unpaid caring roles also. Community based stalls have also now resumed as we learn to live with Covid and HDSP have provided carer information at these also. Expanding our range of practical support provision has been a priority for HDSP during the past year. The service expanded home visits so these can be completed pre discharge, on day of discharge and post discharge. Our pre discharge home visits align closely with the early discharge planning though DWD with which the service has been actively supporting. The range of hands-on practical supports that can be provided expanded to include: • Collecting essential items from home and bring to ward. • Move furniture to accommodate equipment (if possible). • Complete a common-sense assessment of any potential issues and feedback to hospital. • Check heating/utilities are working and assist with gas/electricity top up. • Ensure essential groceries are in place when required. Clear fridges. • Test community alert. These supports are offered to both carers and patients when need is identified. These supports benefit carers in several situations such as when the carer had difficulties due to their own health and mobility or alternatively when the carer lives some distance away or has other responsibilities that make it difficult to take on these tasks. The service has expanded these supports to include a settling in service for the cared for on the day of discharge. This involves HDSP meeting recently discharged patients at their home at the point of discharge, making sure they are comfortable, preparing a light snack and spending a few hours at this initial stage to make sure all is well. To facilitate our settling in service, HDSP attended food hygiene and safer handling training to ensure that we can safely meet recently discharged patients at their home and provide this assistance. Again, this settling in service at point of discharge benefits carers who have difficulty being with their loved one, friend or neighbour at the point of discharge and provides reassurance. In addition to these practical supports, the service provides other direct supports to carers. These are wide ranging, from completing application forms for carers, assisting with making arrangements for cleaning services or for equipment but crucially can include obtaining information and clarifying issues on behalf of carers and raising carer concerns with Health and Social care teams. This communication role supports the Carers (Scotland) Act 2016 – Section 28 regarding keeping carer informed and taking on board carers views. The need to liaise with other professionals on carers behalf in a low-level advocacy role is particularly beneficial in complex discharges at reducing carer stress quickly and preventing need for formal advocacy. In the period covered by this report, the service provided 42 carers with practical or direct supports. Making the discharge process clear and manageable for carers is a key outcome for carers and our service. 97 carers responded that following the input from the service, the discharge process was made more manageable. Page 135 of 236
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HDSP was actively involved throughout the Planned Date of Discharge (PDoD) engagement group. This helped identify a need for a NHS Lanarkshire discharge policy which stated that carers should be informed, involved, and supported in discharge planning. HDSP also conducted carer surveys to obtain carer feedback on their discharge experiences as part of PDoD. HDSP’s input has continued in this area as PDoD evolved into a nationwide programme Discharge Without Delay (DwD). HDSP are currently members of: • DwD steering group. • Pan-Lanarkshire Discharge Survey group • Discharge Passport Group. In each of these, HDSP along with partners are promoting carer engagement during early discharge planning, so carers feel more informed, included, and aware of where to access support. HDSP has also participated in the recent DwD learning webinars, highlighting how the 3rd sector can help support discharge for carers. This has also included a presentation at both the national discharge without delay webinar and the Lothian webinar event showcasing what the 3rd sector currently does to support carers within North Lanarkshire. This is ongoing with HDSP being invited to highlight 3rd sector discharge support with Glasgow and Greater Clyde in October. Out with DwD, HDSP are currently also involved in a Medicine Management and Discharge group to help identify carer issues with medication at the point of discharge. Although at an early stage, the service is currently obtaining carer issues in this area and will be involved obtaining direct feedback from carers on their experiences of assisting with medication when a survey is ready. Aim being to improve carer experiences in this area. Alongside earlier discharge planning, HDSP has also been working alongside the Home Assessment Teams (HAT) to prevent and reduce admissions. HDSP receive referrals from HAT for people who are either presenting emergency departments or are in the community but at risk from being admitted. This involves quick response from HDSP to provide support which can include supporting carers in tandem with patient. Like our pre discharge visits for inpatients, HDSP can visit people we assist in their homes to provide support either independently or as part of a join visit with our Health and Social care colleagues. The service is keen to strengthen our partnership working with our colleagues to assist both unpaid carers and our colleagues as we approach the winter pressures within the acute sites. Page 136 of 236
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Appendix 5 Getting Better Together Carer Breather Fund CARER SUPPORT ACTIVITY REPORT In Dec 2021 funding was granted to conduct a localised test of change with regards to the wider introduction of a sitter service in the locality. The Sitting Service has been able to provide peace of mind to carers with a volunteer visiting the home to keep the cared for company while the carer is able to have a break from their caring role. The sitting service is not able to provide domiciliary care but can provide company to those who do not like to be on their own while the carer tends to their own health and/or social needs, allowing for a meaningful scheduled break where plans can made. Having the opportunity of a break is welcomed but for some isolated carers this can present other barriers, such as anxieties about reengaging with the community. The Carer Breather funding has allowed us to develop a Carer Connector post, who can support carers to identify and access other supports in their community. This additional capacity allows a staff member to work one to one with carers supporting them to identify and access activities and supports in their own community. This could be training, volunteering, leisure activities, hobbies etc. As a Healthy Living Centre, we already have a varied activity programme, be we understand that carers who have been isolated for long periods of time can feel anxious. Our Carer Connector can accompany them to offer support and help them to settle in. Opportunities range from physical activities such as guided walks or exercise classes to general social activities. Although all the above can decrease isolation and loneliness, we hope that our carer connector can also provide a preventative service. We have over 30 staff members and many visitors we have into our centre daily, spanning all age groups. A carer can often be in plain sight but has not recognised their role themselves. Our carer connector is visible within the organisation and centre and can identify hidden carers and offer information, advice and signposting if needed. As a Healthy Living Centre, we can identify and offer additional light touch supports that may benefit the carer and the cared for. We have a wide-ranging programme of activities that we can tap into, especially for those carers who have been isolated for long periods of time and unsure of how to move forward. Caring Matters is a peer support group we facilitate to support unpaid carers. The group allows the carer, and cared for, the opportunity for socialisation and time to talk to others in the same situation in a safe supportive environment. Our members can chat and enjoy a light breakfast followed by easy chair exercises. We also provide relaxing raki treatment to reduce any feelings of stress. We have now partnered with North Lanarkshire Council who are delivering meditation music sessions where our members can relax by listening via headphones as they are guided through a meditation session. We also provided transport to and from these groups, which is vital for carers, or cared for, with mobility issues. Page 137 of 236
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April 2022 – Sept 2022 48 Individual Carers Supported 81 Hours Sitter Service provided 18 Carers supported to access or increase benefit income Page 138 of 236
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Appendix 6 Update from Lanarkshire Carers for North Lanarkshire Committee Paper - October 2022 Lanarkshire Carers is commissioned by Health and Social Care North Lanarkshire (HSCNL) to provide an information, advice and direct support services to unpaid carers. The organisation is also commissioned by South Lanarkshire Health and Social Care Partnership (SLHSCP) and therefore provides Lanarkshire wide services across each locality in Lanarkshire. Lanarkshire Carers support service delivers personalised, and case managed, emotional and practical help through meaningful, outcome focussed conversations with trusted, skilled and experienced professionals. Services include telephone and drop in/appointment based daily duty service, along with access to NHS attend anywhere and video conference call facilities. Lanarkshire Carers Short Breaks Bureau supports with a range of activities including individual carer grant funding. Lanarkshire Carers Group Work activities include a comprehensive Carer Training Programme which is carer-led and shaped. Carer Wellbeing Calls support a journey route tiered approach to case management and outgoing/ongoing carer contact. The service also delivers a Lanarkshire Carers Card scheme and independent services in partnership with others, including legal services and carers counselling support, as well as a range of other services available at no cost to carers. Part of this commissioned service includes delegated responsibility for Lanarkshire Carers to discharge some of the duties of HSCNL to deliver Adult Carer Support Plans, a partnership agreement sets out the respective and shared responsibilities for this and collaborative working arrangements that support the approach. Lanarkshire Carers works with and for carers to develop and deliver services that make a positive difference to their lives. They place carers at the heart of their organisation to ensure the services they offer are effective and accessible regardless of personal circumstances or caring situations. Carer self-refer to the organisation and this is the contact most frequently used. Facilities are also in place for professionals from any organisation to make direct referrals. A personal outcomes approach to carers support is integral to the work. They have adopted the language of the Carers Act, providing the 'right information at the right time'. In every interaction with a carer they discuss the impact of their caring role (using the national wellbeing indicators as their guide) and support carers to think about what matters to them – developing personal outcomes which forms an Adult Carer Support Plan. This is underpinned by anticipatory and preventative measures and has a focus on providing tailored support to empower the carer. This plan is agreed in partnership with the carer. Rather than focus on paperwork being completed, the emphasis is on the professional relationship and the conversation. This is recorded in a purpose build client relationship management system. Carers do not have to repeat their story as they are already using the outcomes of their conversations to co-produce their Adult Carer Support Plan. The information is all in one place, and all the toolkits and conversations are linked together. Lanarkshire Carers Key Carer figures for North Lanarkshire (from April 2021 to March 2022): • 854 new carers in contact with Lanarkshire Carers • 5,863 Carers are known to Lanarkshire Carers • 3,167 Carers accessed Lanarkshire Carers services in reporting period • 23,282 services access by carers from Lanarkshire Carers • 166 Young Adult Carers known to Lanarkshire Carers • 45 New carers from Black, Asian minority ethnic (BAME) communities, 345 BAME Carers known to Lanarkshire Carers • 1,040 Adult Carer Support Plans progressed by Lanarkshire Carers More information around these key highlights, figures and impact can be found in Lanarkshire Carers latest annual report: https://lanarkshirecarers.org.uk/assets/uploads/documents/2021/12/lanarkshire-carers-annual-report-21-22.pdf Adult Carer Support Plan Partnership Statement: This agreement, between Lanarkshire Carers, HSCNL and SLHSCP was developed to maintain a mutual understanding and expectations between key partners in relation to the delivery of Adult Carer Support Plans (ACSP’s). The roles, responsibilities and boundaries of all partners have been defined and agreed. The agreement provides staff with an information and awareness raising tool and ensures that carers have access to accurate information and are signposted and referred appropriately. It was 1 Page 139 of 236
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agreed and launched in May 2021 and has been supported through shared communications and staff awareness raising development workshops. A link to the ACSP Partnership Statement can be found here: https://lanarkshirecarers.org.uk/information-and-resources/professionals/lanarkshire-carers-adult-carer-support- plans-partnership-statement Lanarkshire Carers Hospital Linked Project: Lanarkshire Carers has a well-established system for partnership working across the three acute hospital sites in Lanarkshire. The team includes four Carer Support Workers specifically linked to the three NHS Lanarkshire hospital sites and to cottage/community hospitals. Part of a larger locality-based team, the dedicated hospital linked staff are well resourced to support carers involved in hospital admission, treatment and discharge for themselves or the person they care for. Lanarkshire Carers dedicated BAME carer support services is part of the wider team and enhances the hospital linked activity, including through multilingual staff who can communicate in different languages. Lanarkshire Carers is building on this established work through the Discharge without Delay phased programme. Developments are underway to work more proactively with partners in acute settings including co-location to help further establish good relationships and to build trust and understanding of Lanarkshire Carers and their role. The Hospital Linked Carer Support Workers already work closely with professionals and partners within these hospital sites, and work continues to further support collaborative working and to make referring to Lanarkshire Carers even more streamlined. Lanarkshire Carers Partnership, Collaboration and Co-location: Local and national partnerships provide opportunities to share good practice, inform, learn and influence. All staff in the organisation actively participate in collaborative activity to raise awareness of carers and their services and to meet the needs of carers more effectively. Lanarkshire Carers have good links with VANL, the community solutions programme and wider third sector along with locality planning groups in North Lanarkshire. The service works with the commissioned provider of NL Young Carers service to develop cross provider referral, collaborative transitional support, access to short break grant funding for young carers and to develop Lanarkshire Carers Young Adult Carer activities. 1575 carers were signposted, referred, or informed about the role of partner organisations (2021-2022) Lanarkshire Carers partnership work and referral pathways are vital within all journey routes with carers. Their staff are actively encouraged to scope the landscape and form relationships with Health and Social Care and third sector organisations to enable carers to be referred/signposted to the right support at the right time. Pre-pandemic, Carer Support Workers were co-located within all social work locality offices throughout North Lanarkshire. This promoted a valuable and effective partnership and helped to build strong working relations. Throughout the pandemic, this arrangement continued virtually and their staff have arrangements to recommence physical co-location from September 2022. Care Inspectorate ‘Understanding carer’s experiences of social work and social care service delivery’ Inquiry: The Care Inspectorate carried out an inquiry in Scotland from 28 March 2022. The purpose of this was to learn how the future support of carers can be developed and improved. North Lanarkshire was selected for a closer inquiry. As the commissioned service for Direct Adult Carer Support and Adult Carer Support Plans, Lanarkshire Carers involvement and contribution supported North Lanarkshire Health and Social Care Partnership with the Care inspectorate inquiry. Lanarkshire Carers identified a lead officer for their organisation and Care Inspectorate short-term working group. • 10 Carers attended a focus group (the maximum requested by the Care Inspectorate). • 10 Carers took part in individual telephone conversations conducted by the Care Inspectorate • The unpaid carers national survey was launched on 18 April 2022 and open to 3 June 2022. This was distributed electronically to all carers known to Lanarkshire Carers and wider through their social media channels to ensure maximum engagement and response. Sessions were held with their staff team to inform them of support carers may require completing this. • 196 carers (Lanarkshire wide) were supported by Lanarkshire Carers to complete the unpaid carers survey Lanarkshire Carers included an additional BAME carer focus group with interpretation for speakers of other languages. Telephone conversations were also supported through other language interpretation services which they organised. Lanarkshire Carers Black, Asian and Minority Ethnic (BAME) Carer Support and Equalities Service: This is a well-established and recognised service, integral to the work of the broader team. It is one of very few 2 Page 140 of 236
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dedicated BAME services in Scotland. It is recognised nationally for good practice, innovation and effectiveness. Their multilingual BAME staff work across Lanarkshire to identify, engage, inform, advise and support carers. Information is available in languages including Urdu, Polish, Arabic, Chinese, large print and Braille. This work has recently been highlighted as best practice and is part of Carers Trust Inclusive Communication Guide. Lanarkshire Carers refreshed website has access to many online services, information and forms and the recently installed software ReachDeck ensures this is available in any language required. Lanarkshire Carers identified the need for specialised and targeted support for LGBT+ carers and secured funding from Carers Trust, Making Carers Count, for a project to research LGBT+ awareness and identify challenges faced by LGBT+ carers in Lanarkshire. This project will inform organisational change and enhance inclusive and proactive service provision. The collaborative focus of this work will ensure partners will also benefit from increased recognition, understanding and ability to support carers from under-represented groups. Carers Week 2022: Lanarkshire Carers celebrate Carers week annually helping to make carers valued and visible with a range of activities and events as part of the national focus in June each year. Several online courses and face-to-face activities were held throughout the week. Highlights included a Ready, Steady, Cook workshop hosted by North Lanarkshire Community Food and Health Partnership, Carers Rights and Services sessions held in Polish and Urdu and a Bollywood Dance workshop. The closing event was held in Chatelherault Park and included outdoor mindfulness, outdoor Tai Chi and a drop-in session, where many carers got involved, took part and accessed support about their caring role. This event was attended and acknowledged by a number of elected representatives and parties. Carer Involvement, Participation and Feedback: Lanarkshire Carers is a carer-led organisation and carer feedback, evaluation and influence is used to plan, adapt, learn and develop. Carers are encouraged to provide feedback on services accessed and carers representatives are involved in a number of work streams, including the Short Break Bureau grant panels. Lanarkshire Carers training programme is carer-led, with topics and suggestions gathered from conversations and carer feedback used to shape future programmes. Lanarkshire Carers proactively plan training courses that have been identified as of interest to carers through extensive partnership, outreach and community-based work. Extensive focus group, evaluation and carer satisfaction activity supports Lanarkshire Carers service development and has recently informed for example, CarersSpace, pampering, group work, counselling, anticipatory care planning and keep well provision. The organisation actively supports and encourages carers participation in national research and activities including the Carers Parliament, Coalition and Cross Party Working Group. Lanarkshire Carers continues to raise awareness of Care Opinion as a way for people to share their experiences of health and care services. Lanarkshire Carers quarterly contract monitoring arrangements for the organisation includes the submission of regular case study examples of outcomes achieved, carers quotes and comments. A minimum of 24 case studies are submitted each year along with ad hoc reports as requested/required. The impact of their work is evidenced through both statistical and narrative evidence. Lanarkshire Carers have also introduced #feedbackfriday shared via social media channels to highlight the personal outcomes achieved through their work and individual carer experiences of accessing their services and the difference this made to their lives. Short Breaks Bureau: An integral part of the commissioned service, Lanarkshire Carers Short Breaks Bureau (SBB) provides information, advice, support and activities which highlight and focus on short break opportunities for carers. The team help raise awareness of carers rights, opportunities and the variety of ways short breaks can be supported and accessed. The SBB staff support the wider team and work directly with carers to complement outcome focused conversations in relation to short breaks. In addition to short break grant funding the SBB also has information and access to other support for those in financial hardship and can access help to reduce isolation and exclusion. This includes grant funding which may assist carers through help with the cost of repair/replacement of white goods, equipment, essential items. The SBB also works with partners and professionals, locally and nationally to develop this work. Information is available for statutory, third and private sector organisation’s to raise awareness of the service and the opportunities available for carers to take a short break. 1,054 carers in North Lanarkshire benefitted from grant funding distributed by Lanarkshire Carers in 2021-2022: • Creative Breaks Time to Live Fund - £128,203 awarded • Carer Flexible Support Fund - £50,475 awarded • ScotSpirit Holiday Voucher Scheme - £66,170 awarded • Other sources of grant funding - £109,429 awarded Lanarkshire Carers Short Break Bureau secured and distributed substantial amounts of funding in individual grants to carers. The Short Break Bureau, within the commissioned service, are experts in this field and have built the infrastructure and processes required to deliver a streamlined and effective grant application process 3 Page 141 of 236
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and award system for carers throughout North Lanarkshire. Their robust procedures support audit trails and due diligence prevents duplication of funding and ensures as many carers as possible can benefit from the limited amount of funding available. Grant awards are linked to and recorded in ACSP’s with Lanarkshire Carers outcome-based approach to grant funding having a positive impact on carers lives. This approach is referenced as good practice with Shared Care Scotland’s Rethinking Personalised Short Breaks paper. Carer Support Workers endorse and submit applications on behalf of carers, following a person-centered conversation with the carer to better understand their support needs, the outcomes they want to achieve and how they could achieve them. Taking a conversation-based approach with carers is a more effective way of understanding, helping and supporting carers. Lanarkshire Carers staff team is experienced and capable of having effective conversations with carers, exploring alternative and creative ways that carers can benefit from a short break tailored to their individual circumstances. The Carer Flexible Support Fund was initially established through winter support funding from the Scottish Government, matched and then a further contribution received from Health and Social Care North Lanarkshire. This has been a lifeline for many carers in financial hardship. This funding supports carers in crisis in lots of different ways. Applications are linked to Adult Carer Support Plan conversations and outcomes, enabling Lanarkshire Carers staff to work with carers to address longer term need whilst using funding to support them in the short term. Examples of this are referenced in Lanarkshire Carers Winter Funding Impact Report. Lanarkshire Carers Carer Card Scheme and Respitality Initiatives are also vital for ensuring carers access short breaks from caring when they need it. Additional national funding has been awarded by Shared Care Scotland to develop opportunities such as these, as well as other new initiatives, and to increase capacity of the Short Breaks Bureau. Lanarkshire Carers are involved in the national Promoting Variety Initiative – Helping local commissioning services to better understand and develop a marketplace of short break opportunities for the benefit of carers and those they care for. Scottish Government Winter Funding Package for Unpaid Carers: Following the Scottish Government announcement in January 2022 about additional funding for local carers centres during the winter period, £367,390 of funding was allocated to Lanarkshire Carers for the benefit of carers across Lanarkshire. Lanarkshire Carers was allocated a proportion of funding (in line with Carer Population Equation) to expand and enhance a range of existing support services for carers during the winter period (to be spent by end of March 2022). This included: • Introducing wellbeing and counselling services for carers • Acquiring IT equipment and assistive technology for carers • Providing funded legal services for carers • Increasing the amount of grant funding available to carers through the Creative Breaks Time to Live Fund and Carer Flexible Support Fund • Enhancing opportunities available for carers through the carer training programme • Providing discounted podiatry services for carers • Purchasing hybrid and other equipment for Lanarkshire Carers to better engage with carers A comprehensive report has been produced that outlines the impact this funding has made to carers in Lanarkshire: https://lanarkshirecarers.org.uk/assets/uploads/lanarkshire-carers-winter-funding-impact-report-2022.pdf Lanarkshire Carers Digital Development • 32,435 unique visits to Lanarkshire Carers website • 3,494 followers on Facebook • 1657 followers on twitter • 506 Instagram subscribers • 9,626 signed up to Lanarkshire Carers mailing list Lanarkshire Carers has a strong digital presence and audience. They have invested in the development of online/virtual services for carers. A new website has been developed with accessibility and translation tools to be more inclusive and to reach as many new and existing carers as possible. Lanarkshire Carers launched CarerSpace – an online carer conversation toolkit and single point of access for carers to record and share information about their caring circumstances, helping to start or continue a conversation about their caring roles and their support needs. A key benefit of this is that carers are able to log on to CarerSpace independently and can start to consider their caring role by themselves, or with friends, family and other trusted professionals beside them. The tool can be accessed day or night and is therefore available 4 Page 142 of 236
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whenever the carer finds the time, energy and focus to think. The responses can be submitted to Lanarkshire Carers, and a Carer Support Worker will then contact the carer to discuss further and look at ways to help address any of the unmet support needs they have identified. Once the conversation with Lanarkshire Carers has progressed, and an Adult Carer Support Plan agreed, carers can also access a copy of their ACSP via the portal too. This can be useful to refer to at any point, to share with professionals/friends/family that they wish, or to let Lanarkshire Carers know if their circumstances have changed. This single point of access for the carer means they are not confused by additional or disjointed paperwork, terminology or barriers in the way of them accessing good conversations to lead to decisions about their support. Virtual/online engagement continues to be a popular and preferred method of communication with many carers in North Lanarkshire. Lanarkshire Carers has invested in new equipment and resources (predominantly funded by external sources) that will enable them to continue engaging with carers in this way, including Video Conferencing equipment for use in one to one or group settings using a range of platforms including Teams, Zoom and NHS Near Me. They invested in new portable equipment for staff, creating a more flexible and agile workforce that can co-locate across the community. They have also invested in software to develop more engaging content for carers and partners. The organisation recognises and values the unique and vital place for and impact of in-person services and also recognises the opportunities that digital services offer to further enhance their offer and make best use of limited resources. The extensive service delivery model ensures that carers can be supported in ways which best meet their individual needs and preferences. Governance and Membership: Lanarkshire Carers is run by carers for carers. Their Board of Directors meet regularly throughout the year to oversee the work of the organisation; providing strategic direction and ensuring their legal responsibilities and duties are met. The Strategic Framework – Journey Route to 2025 – is agreed and in place. Their new membership structure helps to identify those members who want to support the board with their governance role and get more involved in consultation and engagement activities. Lanarkshire Carers recognises that carers are experts by experience and that they are equal partners who need to be at the heart of their work and involved at every stage. They aim to ensure that carers can contribute to all parts of their organisation, to help shape responsive services. Their new membership structure supports new approaches and meaningful carer involvement and participation, recognising that the changing needs and dynamics of caring and a membership level between full and/or affiliate can be changed at any time. Staff Health, wellbeing and development: Lanarkshire Carers is committed to ensuring that health, wellbeing and development of their staff remains a key priority for their organisation, ensuring their diverse workforce is highly skilled and able to meet the needs of carers. Development activities throughout the year have included a focus on the future of the organisation and how each member of staff contributes to its success and the delivery and development of services for the benefit of carers through their sustainable future strategy. Protected learning sessions with staff focus on key areas such as Adult Support and Protection, Adult Carer Support Planning, Data Protection and Information Security as well as other topics to ensure their staff team are prepared, informed and knowledgeable. These sessions provided staff with opportunities for confidence building, practicing of skills, involvement and engagement with all areas of their organisation. Increased digital capacity has meant that Lanarkshire Carers have been able to accelerate the pace of learning and development, coming together more frequently in larger groups, without this impacting on service delivery to carers. Digital learning is now facilitated in a regular planned way with ‘Protected Learning Sessions’, as well as having ‘on-demand’ training that can be accessed from a library whenever suitable. Their staff benefits package has been reviewed and enhanced to promote staff wellbeing and improve employee retention and attraction. Their Employee Assistance Programme (EAP) provides information and resources for general wellbeing with access to courses, discounts and perks, fitness programmes, and articles about prioritising mental health. Lanarkshire Carers is a Carer Positive employer, Healthy Working Lives accredited, Volunteer friendly and a Living Wage Foundation accredited employer. Carers Census Data: Lanarkshire Carers contributes to the requirement of Carer Census Data returns for North Lanarkshire, shared annually with Scottish Government to measure the impact of the implementation of the Carers (Scotland) Act 2016. They have developed systems to capture and report data on carers who access support through their service. For 2021-2022 reporting period, Lanarkshire Carers included 3,122 carer records in their return to Scottish Government, detailing the types of support carers required and the how Lanarkshire Carers supported these carers to meet their needs. They carry out regular data cleansing activity to ensure the data they record and report on is as accurate as possible. Sustainable Future: Lanarkshire Carers is a local employer of 41 people who mainly all live and work within Lanarkshire, many of whom are carers themselves. The organisation provided an immediate and comprehensive pandemic response, made possible through their business continuity planning activity, that enabled them to deliver 5 Page 143 of 236
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a continuous and flexible service for carers. Moving to the next phase of their response to the pandemic, Lanarkshire Carers focus continues to be on developing a leading service for the benefit of carers. The key to achieving this is continued longer term funding which has supported development, improved service provision and enabling the organisation to plan and develop services accordingly. Authors: David McCord, Francine O’Donnell and Barbara McAuley 11 October 2022 Tel: 01236 755550 / 01698 428090 6 Page 144 of 236
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Appendix 7 Annual Report 2021-2022 A Caring Culture Page 145 of 236
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Introduction Barbara McAuley Chief Executive Officer Samar Sheikh Chairperson Lanarkshire Carers works with and for carers to develop and deliver services that make a positive difference to their lives. This vision has provided the foundations for our organisation for many years and remains the purpose of our work. The past two years have seen unprecedented change in all aspects of our lives, with many of these changes affecting our working lives. Doing things differently is a recurring theme. Lanarkshire Carers is a pioneering organisation, using every challenge to adapt, learn and develop. We know that trusted relationships lead to effective carer support. We have taken care of our staff, helping them to look after themselves and making sure they have the skills, confidence and resources needed to support carers throughout an extremely demanding period. Daily feedback from carers, about their experiences and the difference our services make, gives our work meaning. It inspires and motivates everyone involved at Lanarkshire Carers. We recognise and value the contribution of carers, everything they do and the impact that caring has. This annual report begins with a thank you to every carer in every community in Lanarkshire. Carers are crucial to the wellbeing of others and many more people have taken on caring roles for family and friends. Caring for someone can have far reaching effects, meaning access to the right support at the right time is important and necessary. Lanarkshire Carers mission is to ensure that carers in Lanarkshire are identified, engaged, well informed, involved, supported and empowered. The Carers Act (Scotland) 2016 extends and enhances the rights of carers. Beginning a conversation at the earliest opportunity helps carers to feel informed, prepared and supported. Lanarkshire Carers is a value-based organisation; our values guide our behaviour and conduct, which are reflected in everything we do. This annual report, for the period April 2021 to March 2022, provides an overview of activities, how we have developed and innovated and the results we have achieved. 2 GOVERNANCE Page 146 of 236
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Governance Lanarkshire Carers is run by carers for carers. The Board of Directors have met throughout the year to oversee the work of the organisation; providing strategic direction and ensuring their legal responsibilities and duties are met. Our new membership structure helps to identify those members who want to support the board with their governance role. Lanarkshire Carers recognises that carers are experts by experience and that they are equal partners who need to be at the heart of our work and involved at every stage. We aim to ensure that carers are able to contribute to all parts of the organisation, to help shape responsive services. Our new membership structure supports new approaches and meaningful carer involvement and participation. We recognise the changing needs and dynamics of caring and a membership level, between full and/or affiliate, can be changed at any time. Engaging with full members is a priority for the Board of Directors. Strategic Framework Lanarkshire Carers published our Strategic Framework in August 2021. ‘Celebrating 25 Years in Lanarkshire’ sets out our journey route, plans and work streams to 2025. Actions for each work stream and how our progress will be measured are detailed in relation to: Plans, Provision, Practice, Partnership, People and Performance. 3 2,089 Lanarkshire Carers Members (up to 31 Mar 2022) (190 Full Members, 1,899 Affiliate Members) 45,545 Services accessed by carers (23,282 North Lanarkshire, 22,263 South Lanarkshire) 6,507 Carers accessing our services (3,167 North Lanarkshire, 3,340 South Lanarkshire) 11,308 Carers known to Lanarkshire Carers (5,863 North Lanarkshire, 5,445 South Lanarkshire) 1,766 New carers in contact with Lanarkshire Carers (854 North Lanarkshire, 912 South Lanarkshire) GOVERNANCE Page 147 of 236
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We have ambitious plans The numbers of people caring is increasing and more of them are contacting Lanarkshire Carers for support. We are preparing for the future, building capacity and growing our organisation in response to this. Recovering from COVID-19 and responding to the long-term implication for carers will remain central to our work. The emerging cost of living crisis and the impact this is having on carers presents new challenges. Our emergency and flexible support funds for carers helps with our response to this. The willingness of our staff team to embrace and contribute to change has been crucial, particularly over this reporting year. Returning to working together as a staff team and seeing carers in person has been a priority in our planning for this year. Staff described our work over the past year as: We moved our premises in South Lanarkshire, staying within the Princes Gate facility but moving to a larger unit. This has created space to develop the carers areas needed and also to provide our staff team with suitable accommodation to return to working from the office. We have equipment, technology and resources that support the delivery of our hybrid service delivery model and the flexibility this offers has further enhanced our accessibility. It has been great to bring staff back together and to start seeing carers in person again. Our premises in North Lanarkshire are in the final stages of refurbishment and we are looking forward to returning, again with better spaces for carers and staff. 4 PLANS Page 148 of 236
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We identified the need for specialised and targeted support for LGBT+ carers and secured funding from Carers Trust, Making Carers Count, for a project to research LGBT+ awareness and identify challenges faced by LGBT+ carers in Lanarkshire. We want to understand the barriers experienced in relation to accessing local and national information and services. This project will inform organisational change and enhance inclusive and proactive service provision. The collaborative focus of this work will ensure our partners will also benefit from an increased recognition, understanding and ability to support carers from under-represented groups. The Scottish Government provided an additional winter support funding package for carers in January 2022. This funding was to be managed locally through Lanarkshire Carers Short Break Bureau and enabled the delivery of a range of additional support for carers. Planning and delivery of this work was a huge undertaking for the organisation within tight timescales and we are extremely proud of our response. We published a separate impact report of this work and have participated in national research to measure success and inform future practice. This year we have reviewed our approach to group work activities. The research has highlighted the changes in approach needed to effectively meet the needs of carers, and how best to make use of our resources to benefit the most carers possible. Our website has a new look and functionality, making it easier to navigate. Our social media platforms support extensive engagement and connections. Across the organisation digital development is helping to streamline our practice and processes. Communication systems enhance agile working and make it easier to handle the large volume of calls we receive. Video conferencing equipment has supported a hybrid approach. A grant management system has made it possible to administer substantially increased and varied grant funding for carers, with due diligence and speed. Our recording and reporting systems support all aspects of our work and planning. 5 PLANS Page 149 of 236
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Information, advice and support for people who care Lanarkshire Carers delivers direct and dedicated information, advice and support for people who care. Early and preventative support and a wide range of flexible service delivery methods, underpinned by our journey route model, offers choice and control for carers to access the right support at the right time. Lanarkshire Carers provides individual emotional and practical support, group work activities, adult carer support plans, emergency and future planning, a carer training programme, a short breaks bureau, grant funding, a carer wellbeing call service, carer card scheme, legal clinics, counselling, bereavement, negotiation and representation support and signposting/referral to other agencies. All our services are provided at no cost to carers across Lanarkshire. Not all carers require or choose to access all of our services, choosing to opt for those that best meet their needs and circumstances at any given time. 6 “I have never accessed any support before and called yesterday, spoke with a Carer Support Worker and when I came off the phone, I felt so good, as if a huge weight has been lifted" “I was blown away by your kindness today. I really appreciate it. I didn't expect that. I am looking forward to the yoga and mindfulness. Sounds great” "I phoned in a terrible state. The Carer Support Worker I spoke to made such a difference by listening to me and encouraging me to apply for a break. 3 weeks later I feel so much better and have been awarded the break and can’t wait to get away. They will never understand how much they saved me that night on the phone. Thank you for making me see I’m important too. This had allowed me to feel better and also continue my role as a carer“ “You helped me when no one else would. You were patient, kind and super helpful" "It’s an excellent resource that I didn’t even know was available. It is a support that I know I can access when required. But most importantly I do not feel alone“ 625 Carers attended one or more training courses (327 North Lanarkshire, 298 South Lanarkshire) 3,244 Carers signposted. referred or informed about the role of partner organisations (1,575 North Lanarkshire, 1,669 South Lanarkshire) 32,435 Unique visits to Lanarkshire Carers website PROVISION Page 150 of 236
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Our generic services are complemented through a targeted approach towards the needs of specific groups such as young adult carers and seldom heard/isolated carers. We raise awareness of and respond to communication, capacity, cultural and language barriers and/or reluctance to engage with services that inhibits identification, self-identification and service uptake.. Lanarkshire Carers Black, Asian and Minority Ethnic (BAME) Carer Support and Equalities Service is a well- established service and is one of very few BAME dedicated services in Scotland. It is recognised nationally for good practice. Our multilingual BAME staff work across Lanarkshire to identify, engage, inform, advise and support carers. Information is available in community languages including Urdu, Polish, Arabic, Chinese, large print and Braille. This work has been highlighted as best practice and is part of Carers Trust Inclusive Communication Guide. Our refreshed website has access to many online services, information and forms and the recently installed software Reachdeck ensures this is available in any language required. 7 “When you care for your loved one you forget to look after yourself. The support I have received has been fantastic. Thank you for the incredible mindfulness and relaxation sessions. I have truly managed to relax” 2,153 Carer Card holders (1,100 North Lanarkshire, 1,053 South Lanarkshire) 555 BAME carers known to Lanarkshire Carers (345 North Lanarkshire, 210 South Lanarkshire) 69 New carers from Black, Asian and Ethnic Minority (BAME) communities (45 North Lanarkshire, 24 South Lanarkshire) 299 Young Adult Carers known to Lanarkshire Carers (166 North Lanarkshire, 133 South Lanarkshire) PROVISION Page 151 of 236
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Identified, Engaged, Involved, Informed, Supported, and Empowered Staff consistently report that the support that often has the most significant impact on carers starts through contact established with someone who is able to listen. The trust and confidence carers have in the skilled and experienced staff at Lanarkshire Carers is evident and we are often their only form of support. Spending time building a valued relationship early on is key to the good conversations that lead to positive outcomes. Lanarkshire Carers personal outcome-based approach, resources and conversation toolkit were developed with carers for carers. This enables carers to explore various aspects of their lives and focus on what matters to them. Conversations centre around seven wellbeing areas: 88 Lanarkshire Carers has also developed CarerSpace: an online portal that can be accessed at any time by carers to start or continue their conversation with us about their caring role and support needs. Carers can use CarerSpace to note outcomes they have identified themselves or through conversations with families, friends or other supportive helpers They can also access a copy of their Adult Carer Support Plan via the portal once the conversation has progressed to a point where this can be shared. Responsibility lies with the Local Authority to offer and produce Adult Carer Support Plans (ACSP), however both North Lanarkshire and South Lanarkshire Health and Social Care partnerships have commissioned Lanarkshire Carers to deliver direct support services for carers. Part of this commissioned service is to deliver Adult Carer Support Plans for carers, working in partnership with social work depending on the support needs identified. PRACTICE Page 152 of 236
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Our service delivery model and practice considers all aspects of life in order to understand what is important to each carer and to agree personal outcomes. Carers are encouraged and helped to reflect on what they can do themselves, what support might come from other community and family resources and how the services we offer might help. We work collaboratively with partners from all sectors and signpost/refer carers to other providers and community organisations. Lanarkshire Carers services include direct early and preventative practical and emotional support, utilising a wide range of flexible delivery methods. We offer choice and control for carers to access the right support at the right time to enable them to continue care, to have a life alongside caring and maintain their own health and wellbeing. Lanarkshire Carers personal outcomes toolkit is useful for talking to carers about their support needs, any personal outcomes they want to achieve and how they could achieve these. The responses provided by the carer can be used to progress their conversation with us. Carers have access to individual support and ongoing contact to develop an Adult Carer Support Plan that details a personalised, outcome-based support package. De-escalation and risk management outcomes are always a key priority and when the need is greatest we work collaboratively with social work to establish an effective plan. Our co-location helps build the professional relationships that make a positive difference to this work. We have reviewed and built upon our approach to keeping everyone safe and our contribution to public protection matters. 9 "I was incredibly impressed with the professional and personal introduction I received. Whilst the member of staff advised they had only recently joined the team, and given the acute complex facets to my case, they did advise that they may have to stop and ask questions. The staff member's ability to both control and guide the call holistically was impressive. Their recall ability was also exceptional, and I expect that this will only grow with confidence and experience. They evidenced both relatable and personal qualities which underpin the delivery of core principles of social care provision. Perfect example of frontline call handling and understanding of your service in particular! After this call and such a torrid and difficult time, I felt more hopeful, positive and such enabled to meet the challenges ahead. Without your service, that would not have been possible so thank you!“ 1,725 Wellbeing calls made to carers (842 North Lanarkshire, 883 South Lanarkshire) 1,952 Adult Carer Support Plans progressed (1,040 North Lanarkshire, 912 South Lanarkshire) PRACTICE Page 153 of 236
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Our Partnership Approach This year we have expanded our work with hospital discharge teams and community liaison activities. We now have staff linked to each hospital, providing additional and recognised points-of-contact for both professionals and carers. This work is pivotal to providing continuous care and ensuring that carers voices are heard and their lived experience valued. Our Lanarkshire wide approach increases choice and control for carers and aligns with NHS Lanarkshire’s delivery model that sees people attend hospitals based on need, not location. It also supports the many carers and cared for situations which cross between the two local authorities, acute and community hospital sites. pita We supported a new partnership with the hospitality and tourism sector in Scotland. The ScotSpirit Holiday Voucher p Scheme focused on supporting individuals and families who have been particularly adversely affected by the impact of the pandemic, while at the same time providing financial support to the Scottish tourism sector. Lanarkshire Carers are the delivery partner for this Local and national partnerships provide opportunities to share good practice, inform, learn and influence. All staff in the organisation actively participate in collaborative activity to raise awareness of carers and our services and to meet the needs of carers more effectively. Staff are linked to every locality in Lanarkshire, co-located in social work teams and work in partnership with other third sector and community organisations. We also work closely with community health colleagues and in partnership with the three hospital sites in Lanarkshire. scheme in Lanarkshire. 10 Lanarkshire Carers providing specialist dedicated and commissioned direct support to carers Working with and for carers, member led and involved Engaging and working with national partners Working collaboratively with Statutory Services Links with local community resources, voluntary support services and local businesses PARTNERSHIP Page 154 of 236
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250 Carers attended one or more Carers Week events hosted by Lanarkshire Carers (Lanarkshire wide) To involve carers effectively they need to feel listened to, supported and respected. Their contribution must be valued and have an impact. We aim to encourage and empower carers and increase their confidence to use their voices and influence in our organisation and also in wider activities locally and nationally. As a member led organisation, delivering direct support we have a unique insight into lives of carers and the impact of caring. We have facilitated carer involvement in a variety of local and national research activities, including responding to the National Care Service review and the Carer Allowance Supplement Bill consultation. A carer, supported by our organisation, gave evidence to the Social Justice and Social Security Committee regarding this Bill. Both consultation responses are on our website. In South Lanarkshire, our Carers Connected consultative forum also brings together carers from our organisation as well as carers involved in partner organisations to engage in discussion regarding a range of topics including the strategic commissioning plan, home care, accessibility and safety. Partnership and collaboration is an integral part of our work. Throughout the reporting year this has supported carers to access a diverse range of support and services including for example; PPE, anticipatory care plans, attend anywhere/near me appointments, carer card recognition/discounts, legal services and specialist services from other organisations. Lanarkshire Carers is a committed contributor in delivering joined up, non- duplicating services Lanarkshire Carers has strong links with both Third Sector Interface Organisations in Lanarkshire. Working closely with the VASLan, the Chief Officers Group and locality forums/groups in South Lanarkshire and also with VANL, the Community Solutions Programme and locality planning groups in North Lanarkshire. We work closely with organisations across Lanarkshire’s diverse third sector. Every year our organisation recognises and highlights Carers week; a national campaign bringing people together to help Make Caring Visible and Valued. Carers across the country continue to face new challenges as a result of the pandemic, with many people taking on more caring responsibilities for their relatives and friends who are disabled, ill or older and who need support. They need to be recognised for the difficulties they are experiencing, respected for all they are doing, and provided with information, support and understanding. 11 PARTNERSHIP Page 155 of 236
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The performance monitoring of the organisation includes quarterly contract compliance reports, six monthly staff learning and development reports and a variety of other reports throughout the year. All reports highlight the numbers and narrative along with details of carers experiences of the work we do. Carer comments and case studies provide powerful evidence, highlighting the impact of caring and what helps carers to continue to care. Lanarkshire Carers Short Break Bureau must be given particular recognition this year. Established in 2014 Lanarkshire Carers Short Break Bureau has secured and distributed substantial amounts of funding in individual grants to carers. This project has built the infrastructure and processes required to deliver a streamlined and effective grant award system for carers throughout Lanarkshire. There have been many challenges as a result of Covid-19. The restrictions and barriers imposed meant that carers experienced increase stress and many were unable to take a short break from caring, away from their normal routines. Our staff team is experienced and capable of having effective conversations with carers, exploring alternative and creative ways that carers can benefit from a short break tailored to their individual circumstances. As Time to Live Delivery Partner for North and South Lanarkshire, Lanarkshire Carers is awarded one of the largest amounts of funding from the Scottish Government through Shared Care Scotland. Lanarkshire Carers Short Breaks Bureau have many years’ experience delivering large amounts of funding to carers, some of this within a very short timeframe. We have also introduced a management system to cope with the increasing volumes of carers getting in touch with us for funding. 12 1,970 Carers benefitted from grant funding (1,054 North Lanarkshire, 916 South Lanarkshire) £204,359 Other grant funding awarded (£109,429 North Lanarkshire, £94,930 South Lanarkshire) £101,920 Carer Flexible Support Funding awarded (£50,475 North Lanarkshire, £51,445 South Lanarkshire) £117,796 ScotSpirit Holiday Voucher Scheme allocated (£66,170 North Lanarkshire, £51,626 South Lanarkshire) £222,302 Creative Breaks Time to Live funding awarded (£128,203 North Lanarkshire, £94,099 South Lanarkshire) PERFORMANCE Page 156 of 236
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Staff Highlights Nickie Murphy (Carer Support Worker) The key highlight for me was the introduction of our counselling and bereavement support service. Whilst a range of support services exist in Lanarkshire, there was a gap in provision of dedicated counselling services for carers and a demand from carers for this type of service. The feedback from carers who accessed this service has been fantastic. It’s great to see us helping carers in new and different ways and being able to meet their needs. Laura Jamieson (Carer Support Worker) As a new member of staff at Lanarkshire Carers, to learn how much support was offered to the carers in Lanarkshire was amazing. One particular highlight of my year has been supporting a carer who was struggling to manage work with her caring role. As an organisation we were able to award the carer funding through the Lanarkshire Carers Flexible Support Fund which helped the carer pay for food and energy bills for 3 months whilst benefit applications were processed. This made a huge difference to the carer as it meant that she didn’t have to worry about missing a day or two of work if her caring role meant that she couldn’t attend. Isbah Khan (Black, Asian and Minority Ethnic (BAME) Carers Services and Equalities Co-ordinator) As Co-ordinator for the BAME Carer Services and Equalities team I have been involved with LGBTQ+ research, engagement, collaboration and recruitment activity throughout the year. I am delighted that we now have a dedicated resource to support carers from the LGBTQ+ community. Changes have been made to our Client Management system to meet the data processing requirements of this project and we have adapted our systems to capture relevant information. I am very much looking forward to seeing this project evolve in the year ahead and beyond. 13 PERFORMANCE Page 157 of 236
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Lanarkshire Carers delivers personalised support. We champion carers rights and are committed to making caring a positive experience. Staff health and wellbeing is very important within our organisation. We continue to offer learning, development and employee benefits opportunities to promote a positive working environment. Like many organisations, this year we have seen a number of staff move on to new opportunities and different stages of their lives. We have welcomed new staff into our growing and diverse staff team. The wealth of experience and enthusiasm they bring is motivational and exciting. 14 635 Volunteer hours logged 13 Volunteers supporting our work 8 Board Members 39 Staff Team PEOPLE Page 158 of 236
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Moving to the next phase of our response to the pandemic, our focus continues to be on working together. The key to achieving a sustainable organisation will be involving everyone at Lanarkshire Carers in creating a sustainable organisation. We will achieve a sustainable future by: • Having everyone in the same boat, with two oars, rowing in the same direction • Having the right people in the right roles, doing the right things at the right times and in the right way, all working together • Recognising all paid staff, board members and other volunteers have a role to play Partnership with carers is central to this work and we look forward to working with you all in the coming year. Thank You 15 SUSTAINABLE FUTURE Page 159 of 236
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Financial Summary 2021-2022 This year a new treasurer was elected and operational staff appointed with new roles in relation to finance. We are reviewing our procedures in response to the changing business needs. We have restructured our staff team to reflect current responsibilities and more effectively deliver our services. The contracts we have from both Health and Social Carer North Lanarkshire (HSCPNL) and South Lanarkshire Health and Social Care Partnership (SLHSCP) meet the majority of salary and operating costs. Our thanks go to both Health and Social Care Partnerships as our main funding partners for their continued support along with Shared Care Scotland, Scottish Council for Voluntary Organisations (SCVO), Carers Trust and the individuals who donate to the organisation. Lanarkshire Carers role distributing small grants to carers continues to be a growing area of our work. The organisation has reported remarkable achievements in relation to this activity. The impact that grants have on carers lives is evidenced through our evaluation and the feedback received. The links between good conversations supporting grant distribution and further support for carers are well established. A copy of the Statement of Financial Activities for the year ended 31 March 2022 from the audited accounts has been provided for reference. A full copy of the detailed audited accounts is available on our website. This year we seek approval of the proposal to appoint a new auditor, Robb Ferguson and thank our outgoing auditor for working with us over recent years. Our Funders Linda Craig Treasurer and Director 16 FINANCIAL REPORT Page 160 of 236
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Statement of Financial Activities For the year ended 31 March 2022 17 FINANCIAL REPORT Page 161 of 236
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Registered Office Ground Floor Left, Princes Gate 60 Castle Street, Hamilton ML3 6BU Company Number: SC209296 Charity Number: SC029160 Centres Lanarkshire Carers Centre; Hamilton Ground Floor Left, Princes Gate 60 Castle Street, Hamilton ML3 6BU Lanarkshire Carers Centre; Airdrie Airdrie Locality Support Service 92 Hallcraig Street, Airdrie ML6 6AW Board of Directors Samar Sheikh | Chairperson Linda Craig | Treasurer and Director Liz Beattie | Director Kevin McGoldrick | Director Phil Hughes | Director Lynn O’Hara | Director Colin Toal | Co-opted Director Gordon Lennox | Director Bill Craig | Director Auditors Ken Tait & Co Chartered Accountants 16 Haddow Street, Hamilton ML3 7HX lanarkshirecarers.org.uk South Lanarkshire: 01698 428090 North Lanarkshire: 01236 755550 Email: info@lanarkshirecarers.org.uk Information, advice and support for people who care © 2022 Lanarkshire Carers Centre Ltd Registered Office: Ground Floor Left, Princes Gate, 60 Castle Street, Hamilton, ML3 6BU Charity No: SC029160 | Company No: SC209296 CARER TRAINING PROGRAMME SHORT BREAKS BUREAU ADULT CARER SUPPORT PLAN BAME CARER SUPPORT LEGAL CLINICS LANARKSHIRE CARERS CALL VIRTUAL DROP-IN SERVICE CARER WELLBEING CARER ACTIVITIES AND EVENTS CARER CARD CARERSPACE YOUNG ADULT CARERS Page 162 of 236
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref MD/MW Date 15/11/22 Quality Assurance Annual Report From Morag Dendy, Head of Planning, Performance & Quality Assurance E-mail WilliamsonM@northlan.gov.uk Telephone 01698 332093 1. Background 1.1 This report highlights Quality Assurance activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. Full detail of these activities is included in Appendix One. Executive Summary The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. Our commitment is to provide an annual report on activity carried out in the preceding year. The purpose of this report is to update Committee on our Quality Assurance activity over the annual period of 1 April 21 to 31 March 22. Recommendations It is recommended that the Adult Care and Social Work Committee: 1) note and endorse the contents of the report. 2) Remit the report for information to the Integration Joint Board 3) Remit the report for information to the Audit and Scrutiny Panel 4) Remit the report for information to the Education, Children and Families Committee The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (24) Review and design services around people, communities, and shared resources AGENDA ITEM 5 Page 163 of 236
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2. Report 2.1 Contracts - In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. 2.2 Contract Management - A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous, and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. 2.2.1 This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. 2.2.2 The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up-to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. 2.3 Regulatory Activity - During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. 2.4 Provider sustainability - Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. 2.5 Procurement - A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement. Page 164 of 236
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2.6 Children, Families and Justice - Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. 2.7 Complaints - Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. 3. Measures of success 3.1 Measures of success are contained within Appendix One of this report. 4. Supporting documentation 4.1 Appendix 1: Quality Assurance Annual Report 2021/22. Morag Dendy Head of Planning, Performance & Quality Assurance Page 165 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Conformance with Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 and organisational duty (Duty of Candour) on health, care, and social work services. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Page 166 of 236
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Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☒ If Yes, please provide a brief summary of the impact? Requirement to publish an annual Duty of Candour Report 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Risks are identified and reported on via the relevant risk register. Page 167 of 236
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2021/22 Quality Assurance Annual Report 2021/22 APPENDIX 1 Page 168 of 236
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1. Introduction The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. The team support the development and/or maintenance of robust practices that assist in achieving better outcomes for those who access services. Our cycle of monitoring and review ensures services meet the strategic aims of both the Council and the Health and Social Care Partnership. Our commitment is to provide an annual report on activity carried out in the preceding year. This report outlines activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. 2. Contracts In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. Tables 1a and 1b below illustrate graphically the extent of the work that has been carried out in engaging with the independent sector in a proportionate and balanced way to ensure service provision has a legal basis, is provided safely and is of a high quality through our contracting arrangements. As of 31 March 22, 93% of all social work spend had the provision of a formal contracting arrangement, the remaining 7% will be reviewed and prioritised in the coming year and contracts agreed as appropriate. Table 1a Page 169 of 236
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Table 1b 3. Contract Management Framework (CMF) A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. In addition, this approach moves the emphasis of the Quality Assurance Team from a service improvement focus to a contract management arrangement to enhance the principles of consistency, efficiency and effectiveness at the heart of Best Value. The CMF was developed to align with contract development and this process will continue as contracts and procurement exercises change to reflect new models of provision and procurement. It is a whole systems approach which links commissioning, contracting, monitoring, reviewing and re/de- commissioning. The CMF is a redesign of previous and existing monitoring practice in parallel with the development of the Council’s digital systems to securely exchange and make available information to improve decision making at individual, practitioner and strategic level. For individuals using commissioned services it supports them to: • be confident their views are listened to, respected and used to influence service quality. • be confident that their best interests/outcomes are at the heart of the approach • be able to make informed choice Page 170 of 236
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The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up- to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. The processes of monitoring and the accompanying reporting build a body of real time and accessible information regarding the quality-of-service provision, its performance and outcomes over the life of a contract/framework. Table 2 STATUS INDICATED MONITORING LEVEL Red Significant concerns in relation to service performance, contract compliance. TIER 4 Amber (high) Moderate concerns in relation to service performance, contract compliance TIER 3 Amber (low) Minor concerns identified in relation to service performance and contract compliance TIER 2 Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Each Tier suggests a minimum monitoring frequency (Table 3). The basis of monitoring will be the commitments made by the contractor as part of their contractual agreement with the Council including, but not limited to, Standard Terms and Conditions, Data Protection Terms and Conditions, Special Terms and Conditions, commitments made in relation to Fair Work Practices and Community Benefits and relevant national standards. Table 3 Tier 1 Contract monitoring visit frequency – annually in most cases. Tier 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly. Tier 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Tier 4 Contract monitoring visit frequency – 1 to 4 weekly. Page 171 of 236
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For the 2021/22 reporting period, monitoring activity was undertaken on 300+ contractor organisations. Despite a challenging environment in relation to the pandemic response, 72% of contractors had a Tier 1 monitoring status, with Tier 2 at 16%, Tier 3 at 8% and only 3% of contractors at Tier 4 (as of 31 March 22) indicating the value of having close and robust relationships with contractors. Table 4 4. Regulatory Activity During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. Care Homes in NL: 22 Care Homes were inspected in relation to 1 or more quality indicators in the year to 31 March 22. Key question 7 – ‘How good is our care and support during the Covid 19 pandemic?’ was applied to all inspections. The remaining care homes will receive a fuller inspection in 2022/23. It is worth noting that 2 care homes were the subject of Large-Scale Investigations, under Adult Support and Protection legislation, with significant support provided by the Care Inspectorate and Senior Council Officers to address and improve quality improvement measures. One of these care homes has subsequently closed with Care Inspection registration being removed. 221 49 22 11 Contractors Tier 1 Tier 2 Tier 3 Tier 4 Page 172 of 236
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Table 5 Table 5 above illustrates the challenging environment care homes were operating in during the pandemic with 14 of the 22 homes assessed as ‘Adequate’ for the category relating to care and support during the pandemic. Care Homes in Scotland (excluding NL): North Lanarkshire Council currently has people placed within 141 care homes that are located elsewhere in Scotland. North Lanarkshire Council retains care management responsibilities for the people living in out of authority care homes. The host authority where the care home is located is responsible for care home contract monitoring, however, not all 32 local authorities operate in the same way. The Quality Assurance Team receives regular updates from host authority contacts in relation to out of authority care homes. Table 6 Table 6 above illustrates the position noted in North Lanarkshire care home settings is similar to the national picture of a sector struggling to meet the challenges posed by a pandemic. 46 of the 83 care homes inspected were assessed as ‘Adequate’. Page 173 of 236
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The Quality Assurance Team have worked in close partnership with colleagues from NHS Lanarkshire, the Care Inspectorate and the care homes themselves to support care homes to pursue an improvement agenda. This has included: - • Initially weekly meetings with Care Home Managers to provide a means of communication, to discuss issues arising, for example the developing guidance from the Scottish Government, and to seek solutions to local problems through discussion. The meetings are now monthly. • The Quality Assurance Team administered the Sustainability Payments Scheme for the care home sector (See Section 5). • A series of Collaborative Visits to care homes by Quality Assurance Senior Officers, NHS Lanarkshire Care Home Liaison and Infection, Prevention and Control staff took place to provide support and guidance to care home management and staff. Self-Directed Support (SDS) including Care at Home: Prior to the pandemic, the Care Inspectorate changed their quality inspection themes for registered services. This was fully implemented for Care Homes and some self-directed support contractors. However, 40 of these SDS contractors were still to be inspected using the new themes as of 31 March 22. As previously mentioned, Care Inspection activity has been predominately focused on Care Homes, however, there have been 10 inspections of SDS contractors because of increased notifications to the Care Inspectorate. There are also 10 SDS contractors that were still awaiting an initial inspection as their services have been registered within the past 2 years. Table 7 Table 7 above is primarily based on inspections carried out pre pandemic. However, for the 10 services inspected under the pandemic regime the majority were categorised as ‘Good’ or ‘Very Good’. It is interesting to note, that despite the inspections being because of notification to the Care Inspectorate, 6 out of the 10 inspected were classed as good or very good. Page 174 of 236
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5. Provider sustainability Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. The payments to care homes for underoccupancy have been the biggest proportion of the additional financial support provided through the principles. However, occupancy levels are increasing to pre pandemic levels except for some homes that have been more significantly impacted by outbreaks. For other community-based activity and provision, there has been less of an impact on service delivery, with most providers returning to normal (pre-pandemic) delivery levels. Table 8 6. Procurement A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. As mentioned above, in the 2021/22 reporting period, we have managed to expedite a significant number of procurement exercises that have resulted in 93% of the spend on social care services being covered by some form of formal agreement, ranging from large scale contractual frameworks to individual agreements. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement, none more so than the internal procedure established for the Council’s lower threshold, but regulated, procurement of various Health and Social Care contracts (value range £50-£552k), which in conformance with the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016, permits the Council to consider and award relevant contracts without the need for competition. This has helped immensely in terms of efficiency at a time when there are significant pressures on our resources. It’s also useful to note that Quality Assurance leads on procurement for all social work services including those focussed on children, families, justice services and adults. Table 9 describes a sample of procurement activity undertaken. PROVIDER SUMMARY NCHC Care Homes Other Total Total Number of Providers 28 45 73 Number in contact for support 26 31 57 Providers Supported to date 26 31 57 Page 175 of 236
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Table 9 Contract Comments and Benefits Flexible Framework for Self- Directed Support and Care at Home Services + £900M value, 10 years, will result in less frequent re-tenders + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Annual entry and exit points for Contractors + Secured an increase in the number of contracted providers, improving the choice and control for supported people Direct Payment Support Service + £400k, 3 years, competitively tendered using new toolkit + Improved specification and implemented tighter controls supported by the new terms and conditions Befriending Services + £360k, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Advocacy Services + £1.8M, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Mental Health Services + £3M, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Provision of Taxi Hire and Private Hire Services to the Council throughout North Lanarkshire + £3.2M, 4 years, competitively tendered using new toolkit + Improved specification and tighter controls Flexible Framework for Non- Traditional Respite + £4M, 10-year agreement, will result in less frequent re- tenders + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Covers an existing gap within National ‘Respite’ Frameworks + Annual entry and exit points for Contractors + Secured an increase in the number of contracted providers, improving the choice and control for supported people Fair Work The Scottish Government’s Fair Work First policy initiative focuses on encouraging and supporting employers to create more diverse and inclusive workplaces where workers have security of pay and contract, can develop and utilise their skills and have an effective voice in the workplace. As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. Potential contractors have committed to provision of community benefits within their tenders, which includes offering employment to people in the local community, youth training and training for people from disadvantaged groups, traineeships and apprenticeships, volunteering opportunities, supporting local supply chain and local community resources. All contractors have indicated they are either already accredited as or are willing to become Scottish Living Wage employers. Work is underway in determining how established contract monitoring processes can incorporate Scottish Living Wage compliance and progress in implementing community benefits commitments. Page 176 of 236
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7. Children, Families and Justice Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. Quality Assurance has supported Justice Services with Scottish Government funding to secure services to support rehabilitation. Over the reporting period, links have been established with our colleagues in HQ within Education and Families to ensure that we monitor contracts with external service providers and incrementally develop and apply a quality assured approach. Links are well established with Scotland Excel where their Frameworks Agreements have been effective in ensuring optimum service delivery, under difficult financial pressures. Improvements are required to be made in respect of joint working with the council to ensure Children and YP placements are conveyed to the appropriate teams. Quality Assurance will continue to work with each locality to ensure this information is shared. 8. Complaints Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The detail below provides an annual summary and analysis of complaints received over the period 2021/22. • Overall, 123 complaints were made in the reporting period, a decrease of 21% from 2020/21. 41% were Children and Families complaints, 59% were Adult Social Work/Community Care complaints. • 76% of Children and Families complaints were handled at Stage 1, 24% at Stage 2. • 21% of Stage 1 complaints failed to meet target timeframes for closure. Average time for closing Stage 1 complaints was 5.3 days. • 17% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 17.3 days. • 79% of Adult/Community Care complaints were handled at Stage 1, 21% at Stage 2. • 21% of Stage 1 complaints failed to meet target timeframe for closure. Average time for closing Stage 1 complaints was 5.5 days. • 7% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 15 days. Overall, there was a slight improvement on performance levels from the previous reporting period. The complexity of the issues at hand, new processes, GDPR, staffing, IT systems and very tight time frames for resolution were some of the contributory factors for failure to close all complaints within the stipulated timescale. Table 10 highlights the cause of complaints about NLC Social Work throughout the reporting period. • 30% of all adult service complaints related to quality of the service, a further 27% were in respect to conduct of staff members. Page 177 of 236
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• 32% of all children, families and justice complaints related to quality of service, whereas 26% were in respect to conduct of staff members. Table 10 A significant number of complaints did not comment on expected learning outcomes and/or service improvements expected, therefore suggesting that there were no further actions to be considered. Comments that we did receive, in relation to learning outcomes, included improved communication, recording and staff training. To ensure compliance, further training related to complaint handling will be rolled out over the coming year. This will promote competency by enabling all staff managing complaints to comply with the process and capture learning and/or service improvement. Within the reporting period, eight social work complaints were sent to the Scottish Public Services Ombudsman for consideration, none of which were upheld. Those that were investigated found that the Council had acted reasonably. Duty of Candour The Organisational Duty of Candour is a statutory duty on Scottish organisations providing health and social care to be open and honest when something goes wrong that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is a requirement of the Council. Appendix 1 provides a report for 2021/22. 9. To conclude The Covid pandemic challenged all services both in-house and commissioned to a degree not experienced before. Despite this, the Quality Assurance Team have been part of several developments, which have improved the operation of the social work service and the performance of independent social care contractors including: - • Procurement processes refined • Newsletter established for staff • Senior Officer links to Locality teams • Senior Officer link to Adult Support and Protection activity • Business Continuity • Sustainability payments 16 13 8 6 5 2 22 20 12 9 9 2 0 5 10 15 20 25 Quality of Service Conduct of staff members Dealt unfairly or wrong Didn't provide a service on time Didn't provide a service Unhappy with policy/procedure Complaint Cause Adults CFJ Page 178 of 236
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• Individual PA process • RaciQ developed for procurement process • Contract Monitoring Framework • Collaborative work with NHS Lanarkshire, Care Inspectorate, Scottish Care • Carer Developments, Partnership Agreement • Complaint sprint • Operational Risk Register • Involvement in LSIs • Council Website • Data Governance, FOIs/SARs and guidance • Development of market facilitation plan Planned developments for 2022/23 include: - • Further development of market facilitation plan • Further development of participation and engagement strategy • Plan for in-house service monitoring • Commercial pipeline refinement • Contract Management Framework development • HSCP website This report has covered Quality Assurance activity undertaken during the period 1 April 21 to 31 March 22. The pandemic has had a significant impact on the sector and over the coming year several developments to support and provide assurance will continue. It is expected that future annual reports will continue to update on Quality Assurance measures implemented across the service. Page 179 of 236
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Appendix 1 North Lanarkshire Health and Social Care Partnership Duty of Candour Report: 2021/2022 Introduction North Lanarkshire Health and Social Care Partnership recognises that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental. The duty of candour arrangements, which we have implemented reflect the Scottish Government’s commitment to place people at the heart of health and social care services in Scotland. When harm occurs the focus must be on personal contact with those affected; support, and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 was implemented on 1st April 2018 placing an organisational duty (Duty of Candour) on health, care, and social work services to be open and honest with people in their care. The overall purpose of this duty is to ensure organisations are open, honest, and supportive when there is an unexpected or unintended incident resulting in death or harm as defined in the Act. All health and social care services in Scotland have a duty of candour, a legal requirement which means that when things go wrong and mistakes happen, the people affected understand what has happened, receive an apology, and that organisations learn how to improve for the future. A key part of this duty is that Health and Social Care publish an annual report about the duty of candour in our services. This short report describes how the services we commission, and our own services have operated the duty of candour during the time between 1 April 2021 and 31 March 2022. Information about policies and procedures All social care organisations have a Duty of Candour policy. All staff who are employed in the sector should be aware that all instances that necessitate implementation of Duty of Candour must immediately be reported. In such instances, a manager will then take the appropriate action, ensuring relevant bodies [depending on the sector] such as Social Work and Care Inspectorate are notified of the event. Where an incident occurs that triggers the duty of candour, managers have responsibility for ensuring that the duty of candour procedure is followed. Information on Duty of Candour and reportable incidents is described in detail within Appendix 1. 82 commissioned organisations were asked to provide information in relation to Duty of Candour activity in the reporting period. Of the 37 [45%] that responded, there were five reported incidents. All North Lanarkshire Council social work in-house services - home support, integrated day services, locality support services and children services were also asked to provide information. There were no Duty of Candour incidents reported from any of the council provided services. Duty of Candour incidents are an integral part of our contract management quarterly monitoring returns. How many incidents happened to which the duty of candour applies? In the reporting period, five incidents have been reported to which the duty of candour applied, one in relation to maladministration of medication, and four where a person fell and sustained physical harm. All incidents reported were from either care at home support or care home services. No Duty of Candour incidents were reported by North Lanarkshire Council in-house social work services. Page 180 of 236
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Details of incidents where Duty of Candour applied Nature of incident: Incorrect medication was administered to a service user, resulting in admission to Accident and Emergency. No permanent harm occurred. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. Procedures and training have been revised as a result. Nature of incident: Person fell and fractured hip – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (R) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (L) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell – sustained a laceration to the head – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Conclusion There were no Duty of Candour incidents from in-house social work services within the reporting period and only five from care home and care at home services, none of which had lasting consequences for the person to whom the duty applied. Appropriate actions were taken, lessons were learned, procedures and training were revised, and where applicable, families were informed, and were invited to meet to discuss in more detail. If in the future, if any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify any lessons learned and the result of any such review will be shared with the relevant person/persons. This approach will minimise the impact on the organisation and the vulnerable people we strive to support. Page 181 of 236
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Appendix A – Definition of Harm and appropriate level of response Grading of Harm Definition of Harm Level of Response No harm, incident prevented Any service user safety incident that had the potential to cause harm but was prevented. These incidents are outside of the scope of the duty of candour. Social work professionals may however feel it is appropriate to inform the person involved if it is in their best interest. No harm, incident not prevented Any service user safety incident that occurred but no harm was caused to the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Low Harm Any service user safety incident that led to the extra observation or minor treatment such as first aid or additional medication for the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Moderate Harm A level of harm that is not permanent but has led to a moderate increase in treatment or prolonged psychological harm of more than 28 days. For example, a return to theatre, an unplanned readmission to hospital, unexpected admission to critical care, a prolonged hospital stay or additional out service user visits. Duty of candour is a statutory requirement. Notification should be given to the person affected or their representative in person including an explanation of the incident, the process for investigation and an apology. This will be followed up in writing and on conclusion of the investigation the findings and outcome will be available to the service user of their representative. Serious Harm Any service user safety incident that has resulted in permanent harm that is directly related to the incident and not the natural course of an illness or the underlying condition of the person affected. Examples of severe harm are permanent lessening of bodily functions, sensory, motor, physiological or intellectual function, removal of the wrong organ or limb or brain damage. Duty of candour is a statutory requirement – see above. Death Any service user safety incident that directly resulted in the death of a person and is not related to their illness or underlying condition. Duty of candour is a statutory requirement – see above. Page 182 of 236
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Appendix B Organisations who provided a response: Aspire Invercare Love Crossreach Keane Premier Support Services Beechwood Care Home Support for Ordinary Living Quarriers PHEW Care One Professional Leonard Cheshire HK Care Angels Key Housing Local Lanarkshire Care Partners in Play All New Beginnings Lanarkshire Association for Mental Health Thera Care Wheatley Care The Richmond Fellowship Scotland HRM Potential Living Capability Scotland Cornerstone Care Solutions Lanarkshire Care Partners Inclusion Scotland C-Change Scottish Autism Cera Care Turning Point Scotland Potential Living Enable Scotland Enhance Supported Living Services Lochside Manor Deanston Care Home Page 183 of 236
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PO51.1 Self-Directed Support North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref DF/KM Date 15/11/22 From Diane Fraser, Head of Adult Social Work Services E-mail murdochk@northlan.gov.uk. Telephone Executive Summary This report sets out our approach to Self -Directed Support (SDS) locally and provides an update to committee on our SDS Transformational agenda. Promoting choice through Self-Directed Support (SDS) continues to be the national and local approach to ensuring that people who require support can exercise maximum choice and control around how they are supported. Locally, our approach to SDS starts with the person and their personal resources, wider family and friends, community resources and community solutions, as well as targeted supports or services. This approach reflects that SDS is everything that is available that helps someone live their life. Our approach means that people can choose and arrange some or all of their own support instead of having it chosen and arranged by other people. For many people who come into contact with our services locally, information, advice and signposting may be all that is required. For others with more significant ongoing complex need, an individual budget may be required. Our Social Work Information System currently reflects approximately 14,000 people open to Social Work with 1,600 people currently in receipt of an individual budget. It has been almost ten years since the passing of the Social Care (Self-Directed Support) (Scotland) Act 2013. The Independent Review of Adult Social Care was published in 2021, and with the ongoing developments with a National Care Service there is likely to be ongoing substantial changes to Scotland’s Social Care landscape. North Lanarkshire’s strategic direction will continue to be informed by developments at National level including the revised SDS Strategy. The improvements to implementing SDS is a local priority which will influence the way in which people will receive care and support. Our transformational SDS agenda is being developed to reflect the current landscape and to allow us to evolve as we move forward. Economic conditions mean that public sector budgets will always feel constrained while the need for services is likely to continue to grow. Therefore, it is important that we look to anticipate and, where possible, prevent need before it arises. Adult Care and Social Work Committee AGENDA ITEM 6 Page 185 of 236
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Our transformational SDS agenda incorporates our approach to support for unpaid carers and this update will be provided via a separate report. Recommendations It is recommended that the Adult Care and Social Work Committee: i. Note the content of the Report ii. That an update is provided as the Transformational SDS Strategy is developed and implemented. The Plan for North Lanarkshire Priority Enhance participation, capacity, and empowerment across our communities (13) Improve preventative approaches including self-management Ambition statement and giving people information and choice over supports and services 1. Background 1.1 The Social Care (Self-Directed Support) (Scotland) Act 2013 was implemented on 1 April 2014. The Act aims to ensure that care and support is delivered in a way that promotes people’s choice and control over the support they receive whilst respecting the person’s right to participate in society. 1.2 The Strategic Commissioning Plan identifies three key priorities: • People should be in control of the care they receive, and it should meet their needs • People are supported to maintain their independence and manage their care needs • People are supported and helped to avoid preventable conditions. 1.3 The Independent Review of Adult Social Care was published in 2021, and with the ongoing developments with a National Care Service there is likely to be ongoing substantial changes to Scotland’s Social Care landscape. At a national level the SDS Strategy is being refreshed. 1.4 We are committed to retaining and strengthening our approach to Self-Directed Support and further embedding this ethos within our practice and our systems. With the level of change required given the scale of transformation envisaged we will require continued strong leadership and commitment from all staff to develop and embrace a whole system change. Page 186 of 236
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2. Report 2.1 We are developing a transformational agenda within our SDS strategy which will review and reflect on our current approach to SDS and ensure that we have a clear approach directing the way forward. The local strategy is at an early stage of development, and we are seeking membership from a variety of stakeholders. Our strategy will be co-produced and reflect the unique contribution and perspective of our members. 2.2 The local strategy board will facilitate ongoing discussions with service providers, those in receipt of support, carers/families and other stakeholders regarding the future shape of our local social care and support framework which ensures that we remain responsive to the changing needs and aspirations of North Lanarkshire’s residents. 2.3 Our transformational SDS agenda has an emphasis on building greater community capacity to support earlier preventative approaches and proactive planning. We have a number of initial workstreams identified that will link directly into the new strategic board and inform future workstreams that will be developed. Workstreams 2.4 Our approach will involve development and training across Health and Social Care, support organisations, community organisations through the Third Sector Interface and local communities. Our current SDS training and associated materials including our guided self-assessment (resource allocation tool for individual budgets) will be reviewed involving the above stakeholders and the revised training will be co- produced and delivered widely. 2.5 We have commenced staff engagement sessions to ensure that we are fully reflecting the current views, feelings, and concerns of the teams who will be delivering on much of this strategy. The feedback from the sessions will inform future development and training going forward which will be tailored to the needs of the team at this time. To deliver on the strategy Social Workers have to be empowered to practice in creative and innovative ways which allow people to have greater choice and control in their own lives. 2.6 In line with the ambition statements guiding the Partnership an early intervention and prevention approach will have a focus on increasing the awareness of and use of technology enable care. We will be working alongside our own technology leads as well as provider organisations who currently offer bespoke technology enabled care solutions and responder services. 2.7 To ensure that people have access the right information at the right time from our website, public information, and marketing materials we will be undertaking a review of this and updating the information available. 2.8 Our provider framework has grown over the past 2 years meaning that people should be able to choose from a larger number of support organisations who have contractual arrangements with Health and Social Care NL. Page 187 of 236
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2.9 To support the sustainability and continuing growth of providers we will continue to work closely with them whilst developing a more consistent approach to working together, promoting development opportunities, increasing capacity, and supporting investment. In turn this will empower people to have increased choice, control, and flexibility over the supports and services they access. 2.10 The workstreams outlined as well as future developments will inform the strategy. This will be reported on in future updates. 3. Measures of success 3.1 Evidence of new SDS training and materials being delivered across Health and Social Care, support organisations, community organisations through the Third Sector Interface and local communities. 3.2 Increase in the engagement in training and the feedback from this in terms of the impact. 3.3 Evidence of a consistent and understood approach to SDS which will ultimately improve the quality of information, advice, guidance, and support provided to those engaging at any entry point. 3.4 Evidence of increased confidence in social work practice via more creative and innovative support. 3.5 Evidence of reduced number of people planning support in a crisis with more preventative intervention being reflected. 3.6 Increased use of technology enabled care and bespoke technology solutions. 4. Supporting documentation 4.1 Appendix 1 – Terms of Reference SDS Transformation 4.2 Appendix 2 – What is Self-Directed Support Diane Fraser Head of Service Adult Social Work Page 188 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? An equalities impact assessment will be undertaken as the transformational plan progresses. As the implementation and delivery of SDS will be to a range of groups it is important to do determine whether any of these groups will be impacted. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? There is no budget detail contained within this report, However, the SDS budget is regularly monitored and reviewed through a series of meetings with the budget holder and finance . This needs to be monitored closely due to the increased in demand in social care support and the transition from time and task to outcome focussed. However, there are a range of controls in place to ensure robust management related to the allocated costs of support packages. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? The approach set out in this report is in line with the principals set out in The Social Care (Self-Directed Support) (Scotland) Act 2013. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Page 189 of 236
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Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? The programme board and implementation group oversee all aspects of this transformational plan including developing a communication plan. There is a need for communication with key stakeholders in the delivery of Self Directed Support. 5.9 Risk impact Is there a risk impact? Yes ☐ No ☒ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? There is a risk that demand for service become greater than the allocated budget. A robust process has been implemented to ensure effective budget management is in place. Page 190 of 236
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Appendix 1 Terms of Reference – SDS Transformation Note: This Terms of Reference will be kept under regular review. As the workstream progresses this document will continue to be updated on roles, responsibilities, and assurance processes. Purpose The group’s purpose is to ensure the delivery of Self-Directed Support in line with Scottish Government policy. We will do this locally in line with the 5 key priorities which are: 1. Improve economic opportunities and outcomes. 2. Support all children and young people to realise their full potential. 3. Improve the health and wellbeing of our communities. 4. Enhance participation, capacity and empowerment across our communities. 5. Improve North Lanarkshire’s resource base. The group’s remit is to deliver a clear position statement and strategy on Self Directed Support. The group will have a particular focus in identifying, assessing and managing risk. This includes four weekly meetings, that may branch off to small, working groups to support the progress of this agenda. Aims Work stream aims are to: • Explore ways to ensure supported people, carers/family and staff all contribute to ensure effective, safe and outcome focused approaches • Understanding levels of accountability • Managing expectations and dispelling myths. • Identify what resources are available to enable people to live as independently as possible. • Raise awareness and increase the use of Technology which promotes independence and minimise risk. • Develop a culture of self-evaluation; reflection; shared learning; build on best practice • Ensuring practice remains in line with national guidance and local policy. • Source tools that support practice improvement and achieving outcomes • Explore opportunities to measure impact and celebrate success The group will support the development of self-directed support across North Lanarkshire. There will be eight working groups: Working Group Lead 1. Reviewing the guided self-assessment Claire Leslie 2. Carers Morris Howat 3. Public Information and Marketing Lisa Barbour/ Claire Leslie/Kerry Murdoch 4. Performance Information Lisa Barbour/Laura Astrauskas/Kerry Murdoch 5. Training Helen Marie Bolton/ Claire Leslie 6. Commissioned Services Ray McDonald 7. Universal Services Morris Howat/ Linda Rice Page 191 of 236
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8. Complex Care Linda Rice 9. Technology Lisa Barbour/Laura Astrauskas/Kerry Murdoch The standard agenda items on each working group will be: • Risk • Public Protection • Engagement and Participation The facilitator will maintain links with the other work streams across North Lanarkshire and provide feedback to the group as appropriate. Accountability and Reporting Arrangements The group facilitator will be Andrea Breen, Manager, Adult Services and a group member will be cover if required. The group will report progress through the SDS Transformational Programme Board. The members of the group are responsible and expected to: participate in session discussions; review documents shared; carry out assigned tasks between sessions; adopt a solution focused approach; become an agent and champion of change; seek feedback from wider groups; capture examples of good practice, share learning & feedback and support the implementation of solutions required to enhance Self Directed support. The group will provide an update report on progress and any matters that require escalation through the Adult Support and Governance Group. Suggested Membership The Manager, Adult Services will chair the group. Andrea Breen Senior Manager Adult Services Maria Williamson Senior Manager Quality Assurance Lisa Barbour Service Manager Adult Services Morris Howat Service Manager Adult Services Linda Rice Service Manager Adult Services Helen Marie Bolton Service Manager Adult Services Claire Leslie Senior Officer Adult Services Ray McDonald Senior Officer Quality Assurance Kerry Murdoch Resource Worker Adult Services Laura Astrauskas Resource Worker Adult Services Page 192 of 236
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What is Self-Directed Support? Appendix 2 Page 193 of 236
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Self-Directed Support Contents List 1. Introduction 2. Assessment, Planning and Review 3. Universal Services 4. Making Life Easier 5. Technology 5.1 Community Alarms Redesign 5.2 Equipment and Adaptation Service 6. What are Community Solutions? 7. Self Help 8. What are Locality Support Services? 9. Non-Traditional Respite 10. Disability Information Officer 11. Integrated Day Service 12. Carers Engagement and Participation 13. Carers Guided Self Assessment 14. Four Options 15. Transition Planning 16. Advocacy 17. Public Information Page 194 of 236
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1. Introduction The Social Care (Self-Directed Support) (Scotland) Act 2013 was implemented on 1 April 2014. The Act aims to ensure that care and support is delivered in a way that promotes people’s choice and control over the support they receive whilst respecting the person’s right to participate in society. 2. Assessment, Planning and Review Assessment: Your assessment is a conversation about your needs and how these impact on your wellbeing, independence, and daily living. Your assessment is led by you, and it is important that it captures information that is important to you and that reflects you as a person individually as well as part of a family or community. If you have a carer, family member, or loved one who you would like to be involved in contributing to your assessment their views can also be recorded. Your assessment will reflect things you want to achieve- these are referred to as outcomes. The worker undertaking your assessment will engage with you over a period of time to gather this information and this will be recorded, and a copy of the assessment provided to you. To request an assessment, please complete the online contact form or contact your local social work office. Planning: Following your assessment a plan will be complete which will identify what advice, signposting, and/or support is required for you to achieve the outcomes identified in your assessment. Planning is essentially supporting you to think about the things that are important in your life, the things you want to achieve (your outcomes) and the support required for you to achieve your outcomes. Planning will also consider the resources you have available to you including your own strengths and assets, your natural networks like friends, family, neighbours, and community. Review: Reviews are carried out annually however can be convened at any point if there is a change in circumstances or it is felt that there would be benefit in reviewing support prior to the annual review. The purpose of a review is to discuss the progress being made towards your induvial outcomes as identified in your plan. The review will consider if the support plan is enabling you to make the progress towards your outcomes and if not the reasons for this will be explored and changes can be made to your support plan. Reviews are also about acknowledging and celebrating the outcomes you have achieved over the year and reflecting the impact of this success in your support going forward. Within North Lanarkshire there are 3 commissioned Carer Support Organisations: • NL Carers Together (Information, advice, signposting service and carer advocacy) • Lanarkshire Carers (Carer Support, Short breaks service and a range of other carer support options) • Action For Children Young Carers Support Project Lanarkshire Carers provide: A carer training programme Short breaks Bureau Page 195 of 236
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Adult Carer Support Plans BAME Career Support Legal Clinics Lanarkshire Carers Call Virtual Drop in Service Carer Well -Being support Carer Activities and events Carer Card and Carers Space Support to young adult Carers We also fund or support a range of condition specific, age specific, or issue specific carer support organisations, as well as organisations who can support carers as part of their wider remit. As examples, we fund PAMIS, Hope for Autism, Huntington’s Association, Parkinson’s Self-Help Group and many others. We regularly consider further options aimed at enhancing preventative and \ or anticipatory approaches. The NL Disability Forum and Equal Say Advocacy received funding from Scottish Govt through Support in the Right Direction (SIRD Funding) and offer an advice and signposting service (NLDF) and advocacy around SDS (Equal Say) respectively. We have used some of our SDS Transformational Funding, provided by the Scottish Government, to fund two further projects. Bazooka Arts were awarded £10, 000 and on the strength of that, were able to secure significant additional external and further internal funding to deliver a participatory arts project- aimed at promoting health and well-being, including carer health and well -being. We also awarded SOL £20,000 and following that, w SOL secured a further £159,000 of BIG Lottery Funding – for a project aimed at using technology to tackle isolation and loneliness. Whilst the SOL project was initially geared towards supported people, a number of carers have given feedback about how much the project has helped them. SDS Transformational Funding was also used to fund two internal posts, aimed at maximising the impacts of preventative approaches, enhancing our approach to SDS and having a focus on assistive technology, health, well-being and recovery and support to unpaid Carers. All of the above is aimed at anticipatory and \ or preventative approaches to support and maintain unpaid carers. However, where an Adult Carer Support Plan (ACSP) identifies unmet caring related carer need, that cannot be met through the range of supports described above, a Carer GSA can be agreed. In line with the Partnership Statement agreed between Lanarkshire Carers and both South and North Lanarkshire Councils: In situations where there is likely low or moderate carer need – Lanarkshire Carers can progress\ facilitate the ACSP. Likely substantial or critical carer need, and \ or where the cared for person is known to SW, then SW can progress\ facilitate the ACSP. Page 196 of 236
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Should the ACSP identify carer related caring needs that can’t be met through the range of options above, then it’s probable that a Carer Guided Self-Assessment would be agreed. In line with prioritisation, our resource allocation is as follows: Low level needs -unlikely that a budget would be agreed and more likely that ongoing casework, advice, signposting, information and so on would help meet needs. But, if it made sense to agree a carer budget – to stabilise a situation, or as a one off to help prevent the need for greater resourcing being required at a later date, a carer budget could be agreed, at SW discretion. Moderate Level needs – as above. Again at SW discretion, and likely that carer support as described above, rather than a budget would help meet needs. Substantial - caring related priority carer need. Critical - caring related priority carer need. 3. Universal Services Universal Services are those things that are generally available within in the community to everyone. Universal Services are things like libraries, gyms, leisure centres, health centres, information services, volunteer centres, citizens advice centres and so on. All of these can all play a role in supporting health, well-being, citizenship and social inclusion – through meeting personal outcomes and \ or providing opportunities, information, advice or signposting to other forms of support. Information and knowledge are an important part of ensuring that people can exercise choice and control around the issues affecting them. So, part of Self-Directed Support (SDS) is about making sure that people can access the right information. It is important that up to date public information is widely available - so that people can find solutions for themselves. Information can be about how to keep healthy and well, or about opportunities, or social connections. It could also be about sources of help - for things like how to deal with financial difficulties, welfare benefits or how to access social and recreational resources. All of these are needed for a community to support its citizens. Having a wide source of solutions which people can choose to make use of, enhances their personal responsibilities as citizens and is at the heart of self - directed support. 4. Making Life Easier What is Making Life easier? Making Life Easier is an online resource offering information, professional advice and direct access to services and support. Who can use it? Anyone who lives in North Lanarkshire can use the service for themselves or for someone they care about. For more Information If you need further information, support to access the website or you wish to make a general enquiry about our services, please email makinglifeeasier@northlan.gov.uk Page 197 of 236
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Visit the website https://www.makinglifeeasier.org.uk/ 5. Technology Technology Enabled Care (TEC) is the umbrella term that is used to describe how technology can be used to support your health and wellbeing and enable you to live safely and independently at home. Technology enabled care has continued to develop and advance over recent years with new bespoke technology solutions widely accessible. The range of technology available is extensive and varies from alarms, monitors, and sensors, to the use of digital assistants such as Alexa, or an App on a mobile device. Many of the technology options can be easily integrated into your home environment. How can technology help you? For some people using technology replaces the need for support from an individual whilst still increasing independence and reducing risk. Technology can be used in a variety of ways including: • It can alert others if you need support, for example, if you have a fall or feel unwell • allow you to control your home environment, for example to close your blinds, turn your tv on/off, or control your heating/lighting • Prompt or remind you with tasks such as taking your prescribed medication • keep you connected to friends, family, and your community How can we help you access technology to support you at home? We may recommend and provide some assistive technology following a community care assessment . To request an assessment, please complete the online contact form or contact your local social work office. The technology flat In North Lanarkshire we have an innovative project within Allershaw Tower, Gowkthrapple, Wishaw to showcase how technology can promote safety, wellbeing and independence within the home. A team of staff are available by appointment to demonstrate how technology can be used within your home environment and to allow you to see how this could be used in your home or the home of someone you know. For a YouTube demonstration video of the flat please go to: Assistive Technology Flat Demonstration North Lanarkshire - Making Life Easier For more information or to arrange a visit to the flat please contact: assistivetechnology@northlan.gov.uk Page 198 of 236
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5.1 Equipment & Adaptation Service The service provides equipment and adaptations for people living in North Lanarkshire, as well as NHS Lanarkshire equipment to South Lanarkshire residents. The range of equipment and adaptations we provide includes items such as assistive technology, sensory impairment items, commodes, standard walking items, stairlifts, external rails and banisters, ramps and bathroom adaptations. When you no longer need your equipment or your equipment needs repaired Contact the Equipment and Adaptation Service for more information on collection, uplift and repair of equipment. 5.2 Community Alarm Service Redesign North Lanarkshire currently offers a telecare/community alarm service which operates 24/7 365 days per year and provides a response to the most vulnerable within the community. The two aspects of this service are initial telephone response through our alarm receiving centre and if required by one of our responders visiting a person’s home to provide assistance. The telecoms infrastructure used to deliver telecare services in Scotland is changing from analogue to digital. This opens up a range of new possibilities and opportunities for service delivery and gives us an immediate opportunity for the community alarm service to be reviewed. We want to ensure that we continue to deliver a well-rounded service that can be an asset to the organisation and most importantly to the people in our communities. We need to identify if the community alarm service needs to be modernised and we need to know that the call handling, management of alerts and the delivery of response services are all adapted and attuned to the new digital environment. From early September 2022 we will be asking staff from all areas of the organisation to be involved in this exciting opportunity to give input to focus groups. If you would like to be involved or would like to nominate staff please let us know assistivetechnology@northlan.gov.uk. We aim for this work to be completed by Spring 2023 and a business case with findings submitted to the senior leadership team for consideration. 6. What are Community Solutions? Community Solutions is a community led, health and social care programme operating across North Lanarkshire. It is focused on building communities where people can have full, independent lives. The programme has been in place since 2013 and is a partnership between:- • Health and Social Care North Lanarkshire (HSCNL), • Voluntary Action North Lanarkshire (VANL), the local third sector interface; and • the vibrant community and voluntary sector of North Lanarkshire. Page 199 of 236
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What is the aim of Community Solutions? Community Solutions aims to improve people’s quality of life and wellbeing by taking action which: • strengthens social connection and support, helping to reduce isolation and loneliness; • promotes equality and human rights and reduces inequalities. through services and activities developed in partnership and delivered by the community and voluntary sector. How does Community Solutions work? Community Solutions is an effective and active example of co-production: a true partnership between people, communities and services. There are two approaches: • The Locality Approach: where local communities and organisations work together to create development plans and direct funding based on local need; • The Thematic Approach: larger, North Lanarkshire-wide projects focusing on specific and identified needs, such as community transport; physical activity, hospital discharge support 7. Self Help For some people information or advice may be sufficient, others will need signposting to support options and others might require some reablement or enablement intervention, before the level of support they need can be determined. In all instances, the expectation is that people try to fully explore the range of information, advice and signposting options that are readily available through Universal Services, before considering whether there is any need for a greater level of support through statutory support services. 8. What are Locality Support Services The locality support services are part of the community care teams and of North Lanarkshire Council’s SDS portfolio. We offer personalised, self-directed support to adults who have a disability or long-term health condition in their local community. What is the aim of Locality Support Services. • To deliver flexible support that is personalised and self-directed to adults who live in North Lanarkshire who have a disability or long erm health condition • To Support people to have better, safer, independent lives through assessment and planning, and review. We support people to be more independent, access health services, education, employment, technology, be active in their communities and work towards outcomes identified by people themselves. • To deliver regular, planned respite, during the day to unpaid carers; endeavouring to ensure that we meet their needs while providing person centred care and support. Page 200 of 236
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How does Locality support services work? • People who use our service experience high quality professional support and care which is flexible throughout the week, including evenings and weekends. • Our staff are appropriately qualified and experienced with opportunities for career development and progression. • North Lanarkshire’s six locality support services are each registered with the care Inspectorate; each participate in quality assurance reporting that ensures we meet the standards and requirements set by Scottish government, and that we continually look at ways of improving the service experience for our service users and their families. • We are part of HSCP in Lanarkshire and our work is informed by the identified national and local health and social care outcomes • We are involved in local planning groups/consortiums which agree where investment in community is required. 9. Non-Traditional Respite The new NTR framework came into being on 1 December 2021. This resulted in clear contractual arrangements around the provision of respite in the community. Under this framework, respite consists of a ‘short sharp’ period of support for people who continue to live in their own homes, arranged around each person and their carer’s individual needs and outcomes. Flexible support for a period of up to 12 weeks can be arranged quickly and directly by operational teams. The aim here is that the provision of short periods of respite will assist in reducing the impact of crisis or unexpected situations involving carers and will also support assessment processes. In-House Services Home support How we support people to live independently and safely in their own homes One of the ways in which we help people to live independently is through our support at home service. The services provided depend on the individual needs of the person requiring support and take account of all other resources available. These are services that are provided in your home. If you are referred for a home support service you will have an assessment to determine what you need support with. The best way that we can assess you is to work closely with you in your home to explore what you can do for yourself. We will involve your family and other natural supports to help us to assess what you need help with to increase your independence. We use a reablement approach which means that a small team of support workers will support and encourage you to re- learn or re-gain skills and confidence through the provision of a wide range of personal and practical support. The period of time this team will work with you can range from 4 – 6 weeks. At the end of this period of support we will undertake a review to determine whether or not longer-term support is required. Page 201 of 236
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Free personal care Since 1 July 2002, people aged 65 and over have been entitled to free personal care. Nursing care is provided free to nursing home residents of all ages. On 1 April 2019, the Scottish Government introduced 'Frank's Law'. This means adults under the age of 65 may also claim free personal care if they are assessed as needing support. Frank’s Law is so named after the campaign led by footballer Frank Kopel’s widow Amanda. Personal care covers things like bathing and hair washing, assistance with eating or with medication, and help with getting up and going to bed. Support at home - a guide to our services Services that are provided in your home Social work services in North Lanarkshire have three key objectives to improve care and support for all service users. These are- - that more people are supported at home rather than within institutional care - that people receive faster access to services - that people receive better quality of services and have a positive experience. What services are available? • Home support- this service may be available to you if you are assessed as having specific longer-term needs. This support may be delivered by NLC home support service or by an Independent Home Support Provider who are commissioned to deliver services on behalf of Social Work Service. • Reablement service- this service will support you to re-learn or gain new skills and confidence to support yourself. This service will also work with other professionals to assess if you require support longer term. • Intensive support service- this is a service which can provide support to people who are at the end of their life and wish to remain at home. This service can also support you or your carer if you experience crisis and just need some short-term support within your own home. • Integrated rehab team- This is a team of professionals, for example an occupational therapist or physiotherapist, who will visit you at home and provide advice, support or order aids or equipment that will enable you to be independent and be safe within your home. They work closely with Home support providers to ensure that any service you receive is personalised and meets your needs. 10. Disability Information Officers We have two disability information officers who provide a comprehensive information, advice, and support service for disabled people, carers, all staff and the local community. Officers can provide support to owner/occupier applicants who are assessed for grants and eligible under ‘Additional Assistance’ criteria. Eligibility criteria: when the service user, their family or carers are unable to obtain estimates or complete the application themselves. Page 202 of 236
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How is the service accessed? Requests either come from health and social care staff following an assessment or from members of the public who have completed a guided self-assessment for equipment through Making Life Easier website. To request an assessment from Health & Social Care Contact your local Social Work Office 11. Integrated Day Services Integrated day services involve staff from health and social care working together to provide care and support for older people. The service may provide support through our outreach respite at home service or at an integrated day service centre. The service aims to enable people to remain independent in their communities for as long as they are able to do so. We recognise that older people often have complex and overlapping needs that require support, care and treatment from a range of professionals at the same time. We actively encourage carers to be involved in developing and providing support for the person on an individualised basis. There are six integrated day service centres available with support and meal provision at each of them. There is currently a charge, but this will be discussed with you at the assessment stage. How is the service accessed? Access is through a formal assessment of your support needs, carried out by a social work or health professional. For more information Contact your local Social Work Office 12. Carer Engagement and Participation There are a range of ways in which carer interests are represented locally. These include the funded carer agenda and campaigning function from North Lanarkshire Carers Together, as well as direct support through Lanarkshire Carers. There is a Carer Support Network which seeks to meet and address collective, and individual carer related needs locally, offers a shared interest forum and has an overall remit of supporting carer needs. A Carer Strategy Implementation Group also previously met within North Lanarkshire. However, the impact of COVID, the need for a local strategy refresh and imminent legislative changes around supporting carers means that this group will need to be re-established, perhaps with a different role and remit and work is currently underway to progress this. A Carer Forum also meets regularly and is an integral element of engagement and participation processes. Page 203 of 236
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13. Carer Guided Self-Assessment The Carer GSA (Guided Self -Assessment) was introduced in 2018, to offer individual Carer budgets subject to certain priority need and eligibility criteria being met, following the completion of an Adult Carer Support Plan (ACSP) The headings for the Carer GSA were agreed nationally, with discretion on eligibility criteria and budget amounts left to local negotiation and discretion. After consultation with stakeholders, national eligibility criteria were adopted, and the 12 set budget amounts noted above were agreed: Carer Budgets can be used flexibly to meet agreed outcomes, so long as they are used legally, meet agreed outcomes, do not constitute gambling nor bring NLC into disrepute. Any support put in place to meet assessed carer need flowing the completion of an ACSP cannot be charged for – charges must be waived. Any adult Carer Can request an ACSP and Social Work staff have a responsibility to offer an ACSP when assessing a cared for person. Young Carers can request a Young Carer Statement Current Position There are approximately 50 carer budgets in place at present, agreed through a Carer GSA and reviewed annually. Whilst this number of budgets may appear “low” relative to the number of unpaid carers locally (conservatively estimated at around 40,000), the figure can also be viewed as a testament to the range and variety of supports available to unpaid carers locally – through universal services, community solutions, targeted services or supports, carer specific commissioned organisations, and \ or support to the cared for person that also meets the carer’s needs. Planned eventual end point and timescale With an estimated unpaid Carer population of around at least 40,000 carers locally, it is imperative that we support unpaid carers to support the cared for person for as long as is reasonable and appropriate. It is reasonable to anticipate that the number of Carer budgets will increase over time. Ideally the majority, if not all, unpaid carers could complete at least the part of the ACSP relating to Future Planning, as that facilitates detail of the cared for person’s needs, interests and so on, should anything happen to the unpaid Carer. We need to undertake work to progress this, along with mapping \ profiling demography, to better inform future planning and potential financial demand around unpaid Carers. The challenge will be around how we balance supporting a large number of carers a little bit, including preventative approaches as well as support those carers most in need more, whilst seeking to ensure that preventative approaches positively impact on reducing need. 14. Four Options Under the Social Care (Self-directed Support) (Scotland) Act 2013 there is a duty to offer four options to the supported person upon how they use their individual budgets. Offering the options in this way aims to promote choice, personal control, and flexibility. These principles apply across children, adults and carers who are eligible for individual funding. Page 204 of 236
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The four options are: Option 1: A direct payment, this is when the local authority /health and social care partnership (HSCP) gives money to the person for them to arrange their support plan and arrange payment for these themselves. For a child under 16 this will be paid to parents or a carer with parental responsibility. For all adults this will be paid to the person themselves or an attorney or guardian. Direct Payments offer the person the greatest amount of control over their funding. Option 2: This is when the person has full involvement within their support plan and how their funding is arranged without having to take a direct payment. This option enables the person to design and choose support options while having the local authority/ HSCP arrange payment for this for them. Option 2 offers the person a great deal of choice and control over their social work support and funding. Option 3: This is when the person is unable or doesn’t wish to be involved in the arrangement of their support. This option is when local authority/ HSCP develops the support plan and arranges payment for this on behalf of the person. In planning this option, the social work staff will consider any past wishes and knowledge of the person. Option 4: A mix of the first 3 options for different aspects of the person's support. The local authority/HSCP have a duty to discuss the nature and effect of the 4 options provided to the person planning with their funding. This means that social work staff should explain what each of the 4 options will mean for the person. This applies both in terms of the general impact of the options, that is the varying degrees of flexibility and control associated with each option, general guidance and advice on what it means to have your support arranged on your behalf or to direct your support. It also means the specific impact for the supported person, i.e. what the different options might mean for the person given their own circumstances, assets and circles of support. A collaborative approach to discussing the budget and options is essential. 15. Transition Planning Health and Social Care North Lanarkshire (HSCNL) have a dedicated team of social workers whose role it is to co-ordinate support with and for people who are leaving school and have additional support needs and who will need support to plan for leaving school and beyond. The transition planning team are based within the adult headquarters team and work across localities. Their role is to link with all the young people whose needs should be considered in this way aiming to ensure a as smooth a transition from secondary school as possible. Working closely with The Scottish Transitions Forum and ARC Scotland, in their principles into practice work across Scotland, HSCNL work to the ethos that ‘Transition is a critical and formative experience for young people and their parents and carers. It should be viewed as a process that unfolds over several years, and not a single ‘event’ such as leaving school’. Principles-into-Practice- 2021_full-document- (1).pdf. Working with partners in North Lanarkshire education and families and NHS Lanarkshire the aim of the Transition Planning team is to implement the seven principles of good transitions set out by the Page 205 of 236
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principles into practice work for each person with additional needs leaving school in North Lanarkshire: Principle 1: Planning and decision-making should be carried out in a person-centred way We ensure young people are at the centre of their transitions planning. We have a shared understanding and commitment to person-centred approaches across all services. We ensure young people have a single plan. Principle 2: Support should be co-ordinated across all services We have a co-ordinated approach to transitions in our local authority area. Our learning and development opportunities include an understanding of all aspects of transitions. We evaluate transitions in our area. Principle 3: Planning should start early and continue up to age 25 We begin planning from age 14 and it is proportionate to need. We have joint approaches to assessment between children and adult services Our transitions planning and support continues to age 25. Principle 4: All young people should get the support they need We have an understanding of the number of young people who require support and levels of unmet need. We provide support for those who do not meet eligibility criteria for funded social care support. Our planning and decision- making is done in partnership with young people and their carers. Principle 5: Young people, parents and carers must have access to the information they need We provide information that clearly states what young people are entitled to during transitions. We provide information that shows what support is available. We provide information that is inclusive of different communication needs. We provide information that uses common and agreed language. Principle 6: Families and carers need support We support family wellbeing needs. Advocacy is available at the start and throughout transitions. Principle 7: A continued focus on transitions in our area We have a plan in place to support continual improvement. We share our learning and learn from others. 16. Advocacy The role of an advocate in health and social care is to support a vulnerable or disadvantaged person and ensure that their rights are being upheld in a healthcare context. Health and social care advocacy means supporting people who are unable to ensure their best interests are being recognised. Advocacy Support enables individuals to have their views, wishes and opinions heard. In 2021 North Lanarkshire Council Health and Social Care Partnership, alongside colleagues from NHS Lanarkshire, tendered for the provision of advocacy services. The existing age banded, rather than condition specific commissioning model was retained, as it was found that this approach worked well, referral processes were clear, and increasing numbers of people accessed advocacy each year. The advocacy services available in North Lanarkshire are as follows: Page 206 of 236
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• Equals Advocacy Partnership for adults aged 65 and over • The North Lanarkshire Advocacy Project for adults aged 16-65 • Who Cares? Scotland for children and young people The importance of advocacy being available during the transition from child to adult and from adult to older adult services is key to our ambition that the right support at the right time and plasce is available and that when services are required, that these are accessible to all. Advocacy services are flexible to accommodate those within transitional phases of their lives. This delivery model is expected to promote continuity and to best meet the needs of people using advocacy services. In addition to the three core independent advocacy services, the undernoted are also offered: Shelter (Housing Advocacy Service) is a small but valued service, providing third party advice on complex housing issues to advocacy providers, and when necessary, one-to-one professional advocacy. The local worker also participates in and provides guidance to local housing and other relevant forums. North Lanarkshire Carers Together offers advocacy provision for carers. Advocacy is one of the many services that NLCT offer carers across North Lanarkshire. Other care group, condition specific or interest groups may also offer a degree of representation or advocacy in relation to people accessing or using their services. 17. Public Protection A fundamental objective of North Lanarkshire Health and Social Care Partnership is that the people who live in North Lanarkshire are safe. The Partnership along with other public agencies have statutory duties in respect of public protection. This includes the support and protection of both children and adults. This applies to the general population of North Lanarkshire regardless of whether or not someone receives support from or is known to Social Work. For more information on public protection please visit: Public protection | North Lanarkshire Council Page 207 of 236
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/MD/GC Date 15/11/22 Adult Social Care Performance Report – Quarter 1 2022/23 From Chief Officer, Health & Social Care E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 858 143 1. Background 1.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. 1.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions. 1.3 Information from these performance reviews has been supplemented with additional performance information below to offer the committee a wider overview of performance across some key areas of adult social care delivery. Executive Summary The purpose of the report is to provide an update to the Committee on the performance of key areas of activity within Adult Health & Social Care for the period 1 April to 30 June 2022 (Quarter 1). Recommendations It is recommended that the Adult Care and Social Work Committee: i) Endorse the improvement actions included within Appendix 2 of the report; and ii) Note the performance of key areas of activity within Appendix 1 of the report. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities AGENDA ITEM 7 Page 209 of 236
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2. Report 2.1 The purpose of the report is to provide an update to the Committee on wider performance of key areas of adult social care delivery, in addition to the performance areas for improvement which have been identified as part of the Chief Executive Quarterly Performance Review for the period 1 April to 30 June 2022 (Quarter 1). 2.2 The performance data for Quarter 1 and associated trend information is included as Appendix 1. 2.3 Areas for improvement and planned actions are agreed and developed on an exception basis (i.e., for those indicators which are amber or red, based on tolerance thresholds). These are detailed as Appendix 2 of this report. 3. Measures of success 3.1 Measures of success are contained within Appendix 1 of this report. 4. Supporting documentation 4.1 Appendix 1: Adult Social Care Dashboard 4.2 Appendix 2: Areas for Improvement (Quarter 1, April - June 2022) Ross McGuffie Chief Officer Health & Social Care North Lanarkshire Page 210 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Page 211 of 236
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Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☐ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Page 212 of 236
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Appendix 1 – Adult Social Care Dashboard PLEASE NOTE FOR ALL INDICATORS UPWARDS ARROWS DENOTE POSITIVE PERFORMANCE Outcome (National Health & Wellbeing) Ref. KPI Target / Indicator 2021/22 2021/22 Q2 2021/22 Q3 2021/22 Q4 2022/23 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance 2. People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community 2.1 Assistive Technology - Number Of People With Technology (0-17 yrs) 39 38 36 34 GREEN Assistive Technology - Number Of People With Technology (18-64yrs) 1452 645 634 631 635 Assistive Technology - Number Of People With Technology (65+) 880 873 866 852 2.2 Reablement - Number Of People Completing Reablement Process (cumulative) 2000 (500 per quarter) 706 916 1170 334 RED 2.3 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 59.9% 67.7% 63.1% 67.1% AMBER 2.4 Reablement - % Of People With No or Reduced Level of Home Support Service At End Of Process 70% 65.5% 53.2% 52.2% 56.2% RED 2.6 Balance Of Care - % Of People (Age 65+) 45% 45.7% 44.3% 45.3% 45.5% GREEN 2.7 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 70.0% 66.3% *DATA INCOMPLETE 66.6% RED 4. Health and social care services are centred on helping to maintain or 4.2 Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 21.4 21.0 21.3 22.0 GREEN 4.3 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 43.7 43.0 44.0 45.5 GREEN 4.4 Care Home - Average Length of Stay 865 852 831 819 828 GREEN Page 213 of 236
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improve the quality of life of people who use those services 4.5 Number Of People With Self Directed Support 1000 1127 1200 1256 1280 GREEN 4.6 Number Of People With A Direct Payment 240 298 308 321 298 GREEN 7. People who use health and social care services are safe from harm 7.1 % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 17.9% 20.3% 18.9% 15.0% 7.2 % Of Adult Protection Investigations Going To Initial Case Conference 20% 16.9% 41.0% 23.9% 19.6% 7.3 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 76.5% 74.1% 79.3% 72.8% GREEN 7.4 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 65.7% 62.7% 66.3% 72.1% Page 214 of 236
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Appendix 2 – Areas for Improvement (Quarter 1, April – June 2022) 1. Reablement & Home Support Capacity within our reablement teams has been limited for a significant period of time during the pandemic, as resources have been prioritised to focus on operational pressures across the Home Support service. This has been particularly acute during periods of significant C-19 infection / isolation amongst staff over the past two years. However, efforts continue to re-establish capacity across all our reablement teams to ensure individuals are offered support to retain and regain their skills and confidence to live independently in their own homes. A Home Support Programme Board was established in 2021 to oversee the redesign of the Home Support Service, and there is a dedicated workstream focusing on our Reablement and Intensive service. Progress to date: • Weekly meetings have been re-established across all teams. • Daily handovers are also being re-established; however, accommodation continues to present difficulties within some teams. • Teams have noted a decrease in referral activity since the introduction of the Enhanced District Nursing Service. Next tasks to be completed: • Review capacity/resources within reablement teams to ensure flow from Home Assessment Team to the reablement service. • Review practice across localities and agree criteria and working model to ensure consistency across the service. • The Reablement / Intensive Workstream will examine and review existing teams’ practice across localities to agree the criteria and working model to ensure consistent practice. 2. Integrated Equipment & Adaptation Service Overall performance for equipment deliveries was 67%% of all requests delivered within 7 days against a target of 80%. The service has continued to prioritise work for supporting hospital discharges and admission prevention, which can often affect its ability to deliver other equipment requests within agreed timescales. Page 215 of 236
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RM/MD/NL/LH Date 15/11/22 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 6: 01/04/2022 to 16/09/2022 From Morag Dendy, Head of Planning, Performance and Quality Assurance E-mail LynchN@northlan.gov.uk Telephone Nicola Lynch, Business Finance Manager, 07581007187 Executive Summary This report provides a summary of the revenue financial performance of the Health & Social Care Partnership (H&SCP) – North Lanarkshire (Adult Social Care & Housing) and the financial performance of the Social Work capital programme. The report incorporates the period 1 April 2022 to 16 September 2022 (Period 6) and includes projected outturn forecasts for the financial year ended 31 March 2023, with major outturn variances highlighted and explained per the approved Financial Regulations. H&SCP – North Lanarkshire (Adult Social Care & Housing) has a gross revenue expenditure budget of £244.192m and is currently projecting an underspend of £8.624m. This represents a movement of £3.790m from the position reported to Committee on the 6 September (Period 4). This movement is mainly in relation to an increase in the projected underspend within employee costs, which is the result of slippage in the recruitment of posts against the winter planning business case. The other significant movement is within payments to other bodies, the increased underspend is related to the Care at Home budget, which is linked to the difficulty in recruiting posts across the sector, leading to delays in care plans being implemented. The Social Work capital programme has a total budget of £2.504m and is currently projecting an underspend of £0.239m. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the revenue financial outturn position, (2) Acknowledge the capital financial outturn position. The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (25) Ensure intelligent use of data and information to support fully evidence based decision making and future planning AGENDA ITEM 8 Page 217 of 236
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1. Background 1.1 The Council approved its General Revenue Fund Budget on 17 February 2022, and the Integration Joint Board (IJB) approved its Financial Plan on 23 March 2022. The approved Gross Expenditure Budget for the H&SCP – NL (Adult Social Care and Housing) is £244.192m. 1.2 2022/23 is the second year of the Council’s five-year capital investment programme. The programme approved funding of £2.200m for Social Work for the current year. Net reprofiling of £0.304m, from 2021/22, has resulted in a revised budget of £2.504m, as demonstrated by Appendix 6. 2. Report Revenue: Analysis of Significant Variances 2.1 Within Employee costs, the Service currently anticipates an underspend of £5.126m. This primarily relates to slippage in relation to the recruitment of posts linked to the “Winter Planning and Enhanced Supports” business case and also delays in recruiting posts against funding received for additional social workers. 2.2 Within Transport costs, the Service is currently anticipating an underspend of £0.132m, mainly due to less than anticipated mileage and vehicle contract hire costs. 2.3 Within Admin costs, the Service is currently anticipating an underspend of £1.329m, mainly as a result of less than anticipated spend within Carers budgets. 2.4 Payments to Other Bodies are detailed in Appendix 2. This expenditure accounts for £144.893m of the annual budget and is forecast to have an in-year underspend of £1.962m. This is primarily in relation to staff shortages within the Care at Home sector who provide services to individuals via the SDS commissioning framework. It is anticipated that this is an in-year underspend and these budgets will be required in full in 2023/24. 2.5 The Service anticipates an over recovery of income of £0.151m. This is a result of unbudgeted contributions from NHS Lanarkshire towards SDS care packages, partially offset by lower than anticipated income from charges for Community Alarms and Integrated Day Services. Revenue: Earmarked Reserves 2.6 The Integration Joint Board have set aside reserves totalling £31.919m for specific Adult Social Care commitments. A report will be presented to the IJB in December providing full details of all the reserves with proposals on how these will be utilised. If approved, it is anticipated that £13.930m of the earmarked reserves will be used during 2022/23, with £15.302m being carried forward to 2023/24, as highlighted in Appendix 3. All expenditure to be met from reserves are excluded from this outturn position. Revenue: 2022/23 Savings 2.7 The Integration Joint Board approved gross savings within the Adult Social Care service of £2.025m. The Service uses a variety of information, records, and processes to monitor achievement of its approved budget savings and as at Period 6 the Service anticipates £0.653m (32%) will be delivered by the financial year-end. 2.8 Appendix 4 provides further analysis of the savings. The budget gap of £1.372m will be funded by IJB reserves. Page 218 of 236
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Revenue: Covid – 19 2.9 During 2022/23 the Scottish Government was in regular discussions with H&SCP’s with respect to in-year IJB Covid costs. The latest forecast included in this report is for in- year gross Covid costs of approximately £2.106m which is fully offset by income received. Appendix 5 provides further analysis of the Covid Costs and funding. Revenue: Provider Uplift 2.10 Funding has been provided by the Scottish Government (£200m nationally) for additional investment in Health & Social Care, including a Scottish Living Wage increase up to £10.50 per hour effective from April 2022. The Scottish Government indicated that if part of the funding was not required to meet the cost of the pay uplift the remainder be retained by the HSCP with no ring-fenced conditions applied. 2.11 In September, Committee were advised that there was capacity within the funding allocated to North to recognise the range of additional cost pressures experienced by independent sector providers and therefore work was undertaken to scope an inflationary uplift for independent sector partners to address funding pressures beyond the hourly rate increase to frontline staff. 2.12 These uplifts are currently being rolled out across the partners; due to the timing of this exercise an in-year underspend may be reported at a future period. At Period 6, however, full spend is projected. Capital: Analysis of Significant Variances 2.13 The Integrated Equipment and Adaptation (IEAS) capital programme budget for 2022/23, is currently forecasting an underspend of £0.239m. This is due to demand levels not returning to pre-pandemic levels. Following on from the pandemic, there are, however, heightened uncertainties in respect of demand and complexity of need. 2.14 Appendices 7 and 8 outline the Service’s total capital budget, outturn position and current contractual commitments. 3. Measures of success 3.1 The Service operates within approved budget resources. 4. Supporting documentation Appendix 1 Revenue – Subjective Analysis Appendix 2 Revenue – Payments to Other Bodies Analysis Appendix 3 Revenue - Earmarked Reserves Analysis Appendix 4 Revenue - 2022/23 Savings Monitoring Report Appendix 5 Revenue - COVID 19 Costs Appendix 6 Capital – Budget Movements 2022/23 Appendix 7 Capital – Summary Expenditure by Thematic Appendix 8 Capital – Summary Expenditure by Division Morag Dendy Head of Planning, Performance and Quality Assurance Page 219 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The Adult Social Care management team will continue to review and implement management action and initiatives, with the aim of remaining within approved budget resources. This action will include vacancy management, curtailment of non-essential expenditure, and maximising income. This report has been prepared by service based Financial Solutions personnel in consultation with budget managers, in accordance with the Financial Regulations. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ Page 220 of 236
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5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? All activities undertaken by the Council are subject to risk, and in acknowledging the Council’s approved Risk Management Strategy, Services manage these as part of their overall corporate and service planning processes. The demands and restrictions resulting from Covid and the current economic climate has the potential to impact upon the Council’s ability to provide quality services within approved budget levels. The Service continues to face increasing demand pressures for provision within the home support, self-directed support and independent care home arenas. To mitigate these pressures the Service reviews and considers data and trends in relation to current and anticipated demand on an ongoing basis to underpin projections of need and cost, and to agree appropriate operational and management action Page 221 of 236
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Appendix 1 CATEGORY BUDGET ACTUAL YEAR TO DATE ANNUAL PROJECTED ANALYSIS TO DATE TO DATE VARIANCE BUDGET OUTTURN VARIANCE % EMPLOYEE COSTS 36,854,503 34,488,823 2,365,681 FAV 88,003,855 82,878,214 5,125,641 FAV 5.8% Slippage in relation to the recruitment of posts linked to the Business Case PROPERTY COSTS 1,220,439 1,239,845 (19,406) ADV 2,515,508 2,557,555 (42,047) ADV -1.7% SUPPLIES & SERVICES 2,162,615 2,155,327 7,288 FAV 4,771,427 4,755,637 15,790 FAV 0.3% TRANSPORT & PLANT 647,345 586,583 60,762 FAV 1,690,897 1,559,244 131,653 FAV 7.8% Lower than anticipated mileage and vehicle contract hire costs ADMINISTRATION COSTS 691,347 77,865 613,482 FAV 2,288,542 959,330 1,329,212 FAV 58.1% Lower than anticipated spend in relation to Carers budgets PAYMENTS TO OTHER BODIES 49,336,424 48,430,980 905,444 FAV 144,893,824 142,932,028 1,961,796 FAV 1.4% Please refer to Appendix 2 for analysis OTHER EXPENDITURE 1,707 1,707 0 28,858 28,858 0 0.0% APPORTIONED EXPENSES 0 0 0 0 0 0 0.0% CFCR 0 0 0 0 0 0 0.0% CAPITAL EXPENDITURE 0 0 0 0 0 0 0.0% TOTAL EXPENDITURE 90,914,380 86,981,130 3,933,251 FAV 244,192,911 235,670,866 8,522,045 FAV 3.5% NLC CONTRIBUTION 85,727,700 85,727,700 0 185,758,836 185,758,836 0 0.0% NLC CONTRIBUTION - HOUSING 883,388 883,388 0 1,870,010 1,870,010 0 0.0% NLC CONTRIBUTION - TRANSPORT 169,458 169,458 0 550,737 550,737 0 0.0% INCOME FROM HEALTH 29,325,827 29,472,044 146,217 FAV 54,191,628 54,508,431 316,803 FAV 0.6% Over recovery in relation to contributions to SDS care packages from NHS Lanarkshire FEES AND CHARGES 631,069 462,095 (168,974) ADV 1,438,167 1,072,056 (366,111) ADV -25.5% Lower than anticipated income in relation to charges for Integrated Day Services and also Community Alarms OTHER LOCAL AUTHORITIES 13,845 13,845 0 30,000 30,000 0 0.0% USE OF IJB RESERVES 0 0 0 0 0 0 0.0% OTHER INCOME 148,456 218,349 69,893 FAV 353,533 504,967 151,434 FAV 42.8% Overrecovery in relation to returned private sector housing grants TOTAL INCOME 116,899,743 116,946,879 47,136 FAV 244,192,911 244,295,037 102,126 FAV 0.0% NET EXPENDITURE (25,985,363) (29,965,749) 3,980,387 FAV 0 (8,624,171) 8,624,171 FAV FAV = Favourable variation, underspend etc ADV = Adverse variation, overspend, income under-recovery etc PROJECTED OUTTURN ADULT SOCIAL CARE & HOUSING - INTEGRATED Revenue Budget Monitoring Report: Subjective Analysis 01 April 2022 - 16 September 2022 Period 6 Page 222 of 236
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Appendix 2 DESCRIPTION BUDGET ACTUAL ANNUAL PROJECTED TO DATE TO DATE BUDGET OUTTURN % (1) (2) (3) (5) (6) (8) (9) 1 SDS Framework 1 & 2 30,655,894 29,941,246 714,647 FAV 94,319,742 92,771,337 1,548,405 FAV 1.6% Demand led activity. 2 Independent Care Homes 15,857,800 15,858,250 (450) ADV 40,983,557 40,984,532 (975) ADV -0.0% Demand led activity. 3 Payments to NHS Lanarkshire 172,414 143,636 28,778 FAV 1,462,489 1,400,136 62,353 FAV 4.3% Position reflects anticipated in year payments 4 Non Traditional Respite 95,776 19,622 76,154 FAV 335,283 170,283 165,000 FAV 49.2% Position reflects anticipated Locality demand 5 Other Local Authorities - General 44,218 6,180 38,038 FAV 125,335 42,920 82,415 FAV 65.8% Position reflects anticipated in-year demand 6 Voluntary Organisations 1,932,596 1,928,143 4,452 FAV 4,662,141 4,652,495 9,646 FAV 0.2% Position reflects anticipated in-year demand 7 Payments to Other Bodies - General 64,219 20,395 43,824 FAV 857,820 762,868 94,952 FAV 11.1% Position reflects anticipated in-year demand 8 Housing Support (RSL's) 190,021 190,021 (0) ADV 654,376 654,376 0 0.0% Position reflects projected contract levels 9 Locality Flexibility 83,690 83,690 0 FAV 218,068 218,068 0 0.0% Position reflects anticipated Locality demand 10 Private Sector Housing Grants 229,849 229,849 0 FAV 1,152,378 1,152,378 0 0.0% Position reflects level of demand for private sector 11 Medical Fees 9,947 9,947 0 FAV 122,635 122,635 0 0.0% Position reflects Service's approach to absence management12 Other 0 0 0 0 0 0 0.0% TOTAL EXPENDITURE 49,336,424 48,430,980 905,444 FAV 144,893,824 142,932,028 1,961,796 FAV 1.4% FAV = Favourable variation, underspend etc ADV = Adverse variation, overspend, income under-recovery etc ADULT SOCIAL CARE & HOUSING - INTEGRATED Revenue Budget Monitoring Report: PTOB Analysis 01 April 2022 - 16 September 2022 Period 6 (4) (7) ANALYSIS OF VARIATIONS YEAR TO DATE PROJECTED OUTTURN VARIANCES VARIANCE Page 223 of 236
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Appendix 3 Description of Earmarked Reserve 2022/23 Reserve Total 2022/23 2023/24 Balance no longer required Total Comments Carers Support 1,431,747 1,431,747 0 1,431,747 Winter Planning & Enhanced Support - Business Case 5,601,110 2,263,793 3,337,317 5,601,110 Unmet savings 3,543,717 1,732,270 1,811,447 3,543,717 Covid Support 3,000,000 3,000,000 0 3,000,000 Digital Improvements 2,960,400 1,197,000 1,763,400 2,960,400 Social Care Demand Risk 14,004,240 3,000,000 11,004,240 14,004,240 Programmes for Change 1,378,156 1,305,605 72,551 1,378,156 Totals 31,919,370 13,930,415 17,988,955 0 31,919,370 ADULT SOCIAL CARE & HOUSING - INTEGRATED Revenue Budget Monitoring Report: PROPOSED Earmarked Reserves Analysis 2022/2023 Period 6 Page 224 of 236
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Appendix 4 £000 £000 £000 £000 £000 LA Service changes - Muirpark 1,372 0 1,372 Agreement to delay and fund from IJB reserves 1,372 0 Inflation increase from NHSL on Resource transfer and Social Care Funding 653 653 0 0 0 Totals 2,025 653 1,372 1,372 0 ADULT SOCIAL CARE & HOUSING - INTEGRATED Value CommentaryBudget GapTarget Value Value Deliverable APPROVED SAVINGS Saving Gap Revenue Budget Monitoring Report: 2022/23 Savings Monitoring Report Description of Approved Saving 01 April 2022 - 16 September 2022 Period 6 REPLACEMENT SAVING/FUNDING Description Page 225 of 236
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Appendix 5 Assumed Budget Projected Outturn Projected Outturn Variance COMMENT £'000 £'000 £'000 Increased Costs Partner Payments 0 2,106 (2,106) In line with Scottish Government guidance and principles regarding Occupancy and Sustainablity payments to partners 0 0 0 Service Costs Total 0 2,106 (2,106) Income Scottish Government Covid Funding for IJB's 0 (2,106) 2,106 deferred income via NHSL partner TOTAL NET COSTS 0 0 0 DESCRIPTION OF COVID-19 COSTS ADULT SOCIAL CARE & HOUSING - INTEGRATED Revenue Budget Monitoring Report: COVID-19 Costs 01 April 2022 - 16 September 2022 Period 6 Page 226 of 236
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Appendix 6 APPROVED BUDGET 2,200,000 Movements to budget Period Division Thematic category Theme Reprofiling from 2021/22 400,000 Included in opening budget Social Work Key Ambition Integrated equipment & adaptations Acceleration in 2021/22 (96,000) Included in opening budget Social Work Key Ambition Integrated equipment & adaptations REVISED BUDGET TOTAL 2,504,000 Social Work Capital Programme Capital Budget Monitoring Report: Budget Movements 2022/23 01 April 2022 - 16 September 2022 Period 6 Page 227 of 236
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Appendix 7 Thematic Category Budget £ Actual £ Actual % Committed £ Committed % Uncommitted £ Final Outturn £ Outturn variance £ Key Ambition 2,504,000 693,301 27.69% 815,090 32.55% 1,449,000 2,264,090 239,910 Total 2,504,000 693,301 27.69% 815,090 32.55% 1,449,000 2,264,090 239,910 YTD OUTTURN Social Work Capital Programme Capital Budget Monitoring Report: Summary Expenditure by Thematic Category 01 April 2022 - 16 September 2022 Period 6 Page 228 of 236
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Appendix 8 Theme Budget £ Actual £ Committed £ Uncommitted £ Final Outturn £ Outturn variance £ SOCIAL WORK Integrated equipment & adaptations 2,504,000 693,301 815,090 1,449,000 2,264,090 239,910 TOTAL SOCIAL WORK 2,504,000 693,301 815,090 1,449,000 2,264,090 239,910 OUTTURN Social Work Capital Programme Capital Budget Monitoring Report: Summary Expenditure by Division 01 April 2022 - 16 September 2022 Period 6 YTD Page 229 of 236
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref CG/JMcK Date 15/11/22 Contracts awarded below Committee approval threshold From Head of Asset and Procurement Solutions E-mail mckinstryj@northlan.gov.uk Telephone James McKinstry 07939281102 1. Background 1.1 The Councils General Contract Standing Orders (the ‘GCSOs’) outline financial approval thresholds for contracts for goods, works and services. Contract awards above £500,000 for Supplies and Services and above £2,000,000 for Works require approval by the Committee. These contract awards are considered by the Committee on a case-by-case basis. 1.2 Where the value of a contract award is between £50,000 and £500,000 for Supplies and Services and between £500,000 and £2,000,000 for Works, GCSOs require that the Head of Asset and Procurement Solutions award these contracts on behalf of the appropriate Chief Officer. Executive Summary This report notifies the Committee of the contracts awarded between 1 July 2022 and 30 September 2022. It sets out those contracts awarded with a value below the financial threshold requiring Committee approval. Recommendations It is recommended that the Adult Care and Social Work Committee are: • advised of the Contracts awarded below Committee approval threshold between 1 July 2022 to 30 September 2022 as per the process within the Council’s General Contract Standing Orders. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (13) Improve preventative approaches including self-management and giving people information and choice over supports and services AGENDA ITEM 9 Page 231 of 236
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1.3 The Head of Asset and Procurement Solutions is required to notify Committee on a regular basis of any such contracts awarded on behalf of Procuring Service Areas. 2. Report 2.1 The GCSOs require that contracts in excess of £500,000 for supplies and services and £2,000,000 for works are approved, on a case-by-case basis, by the Committee before award. 2.2 The GCSOs require that contracts with a value above £50,000 but less than £500,000 for Supplies and Services and above £500,000 but less than £2,000,000 for Works are awarded by the Head of Asset and Procurement Solutions on behalf of the appropriate Chief Officer. 2.3 The contracts awarded by the Head of Asset and Procurement Solutions that are under the £500,000 Committee financial approval threshold for Supplies and Services and £2,000,000 for Works in the period from 1 July 2022 to 30 September 2022 are detailed in Appendix 1. 3. Measures of success 3.1 Contracts support the delivery of Council and service priorities. 3.2 Appointment of contractors who have suitable experience and capability to deliver the required supplies, services or works. 3.3 Contracts awarded by the Council are compliant with GCSOs and procurement legislation. 3.4 The Council’s Contract Register is kept updated by services and management information is comprehensive and accurate. 3.5 Best Value is both demonstrable and achieved. 4. Supporting documentation 4.1 Appendix 1 – Summary of contracts awarded. James McKinstry Head of Asset and Procurement Solutions Page 232 of 236
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Where Financial impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. The Council’s Procurement Strategy proposes methods of maximising the delivery of procurement benefits that could bring improved financial return to the Council and the areas wider economy. Certain benefits have a monetary value attached and these will be monitored on a project-by-project basis. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Where HR impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. Contracts awarded by the Council are compliant with GCSOs and procurement legislation. 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☒ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Where Legal impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. Page 233 of 236
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Contracts awarded by the Council are compliant with GCSOs and procurement legislation. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☒ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☒ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☒ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Sustainable procurement is one of the key objectives of the Council’s Procurement Strategy and will have a positive impact, including, embedding sustainable procurement as business as usual and incorporating community benefits into the Councils contracts. Supporting local businesses and SMEs through closer working with colleagues in the Council’s Enterprise department and by making our processes more streamlined and accessible. Where Environmental/Carbon impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Page 234 of 236
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Where Risk impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. Contract award procedures may be susceptible to legal challenge if they are not discharged in accordance with GCSO and procurement legislation. Page 235 of 236
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APPENDIX 1 Contract Description Contract Award Date Contract Start Date Contract End Date Contract Extension Contract Value (inc extension) (£s) Pre- Procurement Estimate (£’s) Successful Tenderer Supplies Services Works No of Tenders Received Route* Supply & Delivery of Personal Protective Equipment 22/07/2022 02/08/2022 31/03/2023 31/03/2023 £240,510.00 £250,000.00 Unico Ltd Supplies 15 FMC3 Key – Procurement Route CO - Contract Open Procedure CR - Contract Restricted Procedure FO - Framework Open Procedure FR - Framework Restricted Procedures FMCC - Mini Comp Council Framework FMC3 - Mini Comp 3rd Party Framework DAFC - Direct Award Council Framework DAF3 - Direct Award 3rd Party Framework DAH&SC - Direct Award Health & Social Care Related Services N - Negotiated Contract EXT - Extension to Contract/Framework Page 236 of 236