Agenda pack
North Lanarkshire Council · 21 February 2023
Back to Adult Care and Social Work Committee — 21 February 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Our Ref: Your Ref: Contact: Tel: Fax: E-Mail: Date: Clare Louise McDonald 01698302190 mcdonaldcl@northlan.gov.uk 10 Feb 2023 Members of the Adult Care and Social Work Committee Chief Executive’s Office Archie Aitken Chief Officer of Legal & Democratic 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, 21 February 2023 at 2:00 pm which you are requested to attend. The agenda of business is attached. Chief Officer of Legal and Democratic 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 193
Page 2
Page 2 of 193
Page 3
AGENDA (1) Declarations of Interest in terms of the Ethical Standards in Public Life Etc. (Scotland) Act 2000 OPERATIONAL (2) Annual Report of the Chief Social Work Officer 2021/22 (page 5 - 68) Submit report by the Chief Social Work Officer seeking approval of the Annual Report of the Chief Social Work Officer for 2021/22 (copy herewith) (3) Home Assessment Team/Discharge without Delay Programme Update Report (page 69 - 78) Submit report by the Chief Officer of Adult Social Work Services providing an overview of a key development of the work to improve the outcomes for people who may be assessed and supported at home (copy herewith) (4) Equipment and Adaptation Service (page 79 - 92) Submit report by the Chief Officer of Adult Social Work Services informing of the current position of the Equipment and Adaptation Service (EAS) (copy herewith) (5) Adult Support and Protection: Social Work Annual Report 2021-2022 and Adult Protection Committee Biennial Report 2020-2022 (page 93 - 156) Submit report by the Chief Officer of Adult Social Work Services providing an overview of Adult Support and Protection Reports recently published (copy herewith) (6) Maintaining a Positive Balance of Care (page 157 - 164) Submit report by the Head of Planning, Performance and Quality Assurance advising of a range of key metric, which compare the performance in North Lanarkshire across other Scottish Councils, demonstrating the sustained efforts to maintain a positive balance of care (copy herewith) FINANCIAL (7) Revenue and Capital Budget Monitoring Report: Adult Social Care Period 10 01/04/22 to 06/01/23 (page 165 - 178) 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 & Housing) and the financial performance of the Social Work capital programme (copy herewith) PERFORMANCE (8) Adult Social Care Performance Report - Quarter 2 2022/23 (page 179 - 186) 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 July to 30 September 2022 (Quarter 2) (copy herewith) Page 3 of 193
Page 4
2 CONTRACTS (9) Contracts Awarded Below Committee Approval Threshold (page 187 - 193) Submit report by the Chief Officer of Assets and Procurement providing notification of contracts awarded between 1 October and 31 December 2022 with a value below the financial threshold requiring committee approval (copy herewith) Page 4 of 193
Page 5
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☒ Yes ☐ No Ref AG Date 21/02/23 Annual Report of the Chief Social Work Officer 2021/22 From Alison Gordon, Chief Social Work Officer E-mail gordonal@northlan.gov.uk Telephone 01698 332001 Executive Summary The Chief Social Work Officer (CSWO) of each local authority is required to provide an annual report and a standard template for this purpose is issued by the office of the Chief Social Work Advisor to the Scottish Government. The North Lanarkshire CSWO Report 2021/22, which is attached as an appendix to this report, provides information on the delivery of statutory functions, performance and improvement activity across the range of social work services over the last year. In addition, information is provided on the wider governance and planning of social work provision in North Lanarkshire, including its key role in local partnerships, and on both the national and local challenges impacting on the delivery of social work services These challenges include rising demand and complexity of need, reflecting and overlaid by the lasting impact on our communities of the Covid 19 pandemic and the subsequent cost of living crisis The report also reflects social work’s contribution to the Programme of Work underpinning the Plan for North Lanarkshire and Delivering for Communities. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Approve this report (2) Note that approval of the report will also be sought through the Education and Families Committee The Plan for North Lanarkshire Priority All priorities Ambition statement All ambition statements AGENDA ITEM 2 Page 5 of 193
Page 6
1. Background 1.1 The requirement that each local authority appoint a professionally qualified Chief Social Work Officer is contained in Section 45 of the Local government (Scotland) Act 1994. Statutory Guidance on the role of the Chief Social Work Officer was updated in 2016, in particular to reflect the impact of Health and Social Care integration, extending the responsibilities of the role to provide advice to the Integration Joint Board (IJB). In addition to providing advice both to the Local Authority and IJB in relation to the discharge of statutory social work functions the role continues to carry key responsibilities for professional leadership, values, and standards both for directly provided and commissioned services. 1.2 Within North Lanarkshire social work services are now delivered and governed through both the Health and Social Care Partnership (Adult Social Work Services) and the Education and Families Services (Children, Families and Justice Social Work) with the Chief Social Work Officer’s responsibilities for practice and staff governance covering social work functions across both areas. The Chief Social Work Officer role in North Lanarkshire sits within the Education and Families Service with the operational head of Children, Families and Justice Social Work. However, whilst the CSWO role requires to be undertaken by one designated individual, delegation of responsibilities is permitted where required by the scale of business. In North Lanarkshire this means that the Chief Officer Adult Social Work Services, routinely exercises delegated responsibilities for decision-making and professional standards within adult services as well as providing support and cover with respect to the wider functions of the CSWO role. 1.3 As noted above the Annual Chief Social Work Report is intended to provide a key overview of social work service delivery and uses a core template provided by the Scottish Government. The Office of the Chief Social Work Advisor (OCSWA) also produces a national report each year which draws on key themes and messages from CSWO reports across Scotland. 2. Report 2.1 The report provides an update on the governance and partnership arrangements which provide a framework for the delivery of social work services in North Lanarkshire. There have been limited changes to these within 2021/22 although the incorporation of additional services within Education and Families and within the remit of the Chief Social Work Officer has further strengthened opportunities for joint-working and supported the integration of service delivery and support to individuals and families in key areas such as tackling poverty, employability and community connection. Similarly social work services remain fully engaged with the continued embedding of the communities structures associated with Delivering for Communities including the delivery of local outcome and improvement plans (LOIPs) through the Community Boards. Continued coherence of planning and delivery across all areas of social work is supported both by the core council operating model and specific cross-cutting arrangements within social work such as the social work leadership and workforce meetings. This close alignment has been particularly important to ensuring a responsive and effective approach to some of the challenges experienced during this period where both the direct the impacts of the pandemic and the related changes in the needs of our communities have required adjustments in service delivery and flexibility in deployment of resources. Page 6 of 193
Page 7
2.2 A key strength with respect to social work service delivery in North Lanarkshire remains a strong balance of care which has been sustained despite the challenges in service delivery during the pandemic and recovery period. We continue to benchmark well nationally with respect to the proportion of adults and children, including those with complex needs, who continue to receive support, including intensive support, within their own homes and communities. Work across all social work care groups also continues to deliver improvement with respect to effective early support, for example, through the testing of the three conversation model in adult services, enhancements in family support and family group decision making for children and families and a continuing focus on diversion in both adult and youth justice, 2.3 Performance in some areas of the service has however been impacted by the significant demand and workforce pressures outlined within the report and this has at times impacted on responsiveness and our ability to consistently deliver the level of high-quality individualised support which is our aim for all those whom we support. This has meant, for example, some people assessed as having less immediate or critical needs having to wait longer for some aspects of service. Pressures have been particularly acute with respect to the delivery of home support services but are a feature across many areas of the service. In response, and as reflected more fully within the report, a range of actions are ongoing to redesign and enhance services, maximise the benefits of integrated working and to support the recruitment and retention of staff, 2.4 Looking forward the report reflects on the opportunities for improvement in outcomes for people arising both from national policy commitments such as the Promise and the facilitative local context but also notes the risks to delivery of both improvement and key functions arising from key demand, financial and workforce pressures including the level of change capacity required. This is particularly relevant to the uncertainties introduced with respect to proposals for root and branch structural reform through the implementation of a National Care Service (NCS). The recently agreed establishment of a Member Officer Group within the Council will support focus on this issue whilst other issues highlighted within this report will also continue to be reflected through established reporting structures in the year ahead. 3. Measures of success 3.1 N/A – Annual Report to meet reporting requirement. A range of outcome measures, KPIs and specific service standards are applied across social work services. 4. Supporting documentation 4.1 Appendix 1: Annual Report of the Chief Social Work Officer 2021/22 Alison Gordon Chief Social Work Officer Page 7 of 193
Page 8
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? No direct impact though the report provides key evidence that the effective delivery of social work services supports the Council in their delivery of Fairer Scotland Duty. As this is a retrsopective report no EQIA is required. 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 Finance? 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 Resources? 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? 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 Page 8 of 193
Page 9
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? Whilst digital developments are a feature of service improvement and delivery within social work all relevant changes reflected within the report have already been considered through relevant governance processes. Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) 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? Key risks highlighted within the report are incorporated in relevant risk registers. The report itself is part of a wider framework of reporting which supports the scrutiny of social work services and therefore aids the Council in its duties with respect to the delivery of key statutory functions 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Where relevant issues are considered in planning for individual’s support, Where relevant the service will also continue to consider the benefits of enhanced arrangement for groups of service users. An example of this is within our Restorative Justice Service which has both a veteran’s group and has also previously contributed through unpaid work to linked community projects. Page 9 of 193
Page 10
1 ANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2021/22 The Chief Social Work Officer Function The requirement that each local authority appoint a professionally qualified Chief Social Work Officer (CSWO) is contained in Section 46 of the Local Government (Scotland) Act 1994. The CSWO provides professional governance, leadership and accountability in respect of the delivery of social work and social care services, including commissioned Services. A key aspect of the role is to provide the local authority Chief Executive, Elected Members and the Integrated Joint Board with advice on social work service delivery and on cross-cutting issues and in parallel to promote understanding of the complexities involved in delivering the linked statutory responsibilities which require consideration of need and the management of risk and liberties. The then Scottish Office explicitly recognised that the need for the CSWO role was driven by “the particular responsibilities which fall on social services in that they affect personal lives, individual rights and liberties to an extent that other local authority services do not.” (Circular: SWSG2/1995 May 1995). The CSWO also has a direct remit for decisions on a number of statutory matters including in relation to secure accommodation, adoption and welfare guardianship as illustrated below. An additional aspect of the CSWO role is to inform the delivery of wider services which support or impact on social welfare. This is of particular importance in the current period of post-pandemic recovery and the cost of living crisis, both of which have impacted disproportionately on those within our communities who already face a range of adversities. In North Lanarkshire the CSWO role is held by Head of Children, Families and Justice Services closely supported by the Head of Adult Social Work Services who holds delegated responsibilities with respect to adult social work and social care, deputises in other areas as required and works alongside the CSWO in relation to the other functions of the role. Page 10 of 193
Page 11
2 Annual Report The CSWO is required to provide an annual report in accordance with Scottish Government guidance. The format of this report was abridged during the pandemic to reflect a smaller number of priority areas and in the light of associated demands and this approach has been maintained for this reporting period. This report therefore seeks to provide an overview of social work service delivery in North Lanarkshire for the period April 2021 to March 2022 and addresses the following areas: • Governance and accountability arrangements, including partnership working • Service Quality and Performance, including key service developments • Resources • Workforce • Future Priorities The continuing impact of the Covid 19 Pandemic and emerging Cost of Living Crisis have clearly been significant to the landscape of social work service delivery over this period and this is reflected across the report. In this context and that of significant demand and staffing pressures, staff across the service have showed remarkable resilience and a continued commitment to achieving the best possible outcomes to those we support. In presenting this report I would like to thank and pay tribute to all staff involved in the delivery of social work services in North Lanarkshire for their vital work over the past year and the persistence and flexibility shown in the face of a particularly challenging environment. I would also like to thank all internal and external partners, carers, families and communities who have supported us in our work. Alison Gordon Chief Social Work Officer Page 11 of 193
Page 12
3 1. GOVERANCE AND ACCOUNTABILTY ARRANGEMETS Social Work Services in North Lanarkshire continue to play a critical role in supporting and safeguarding our communities. Adult Social Work and Social Care Services are delivered though North Lanarkshire’s Health and Social Care Partnership (HSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service, both arrangements support integration in service delivery with other key services. A range of mechanisms, as reflected below, also ensures strong alignment is maintained across social work in planning, delivery and professional support arrangements. The Social Work Service in North Lanarkshire directly employs around 2,800 staff and in collaboration with commissioned services and partners are involved in providing support to approximately 30, 000 individuals and families at any one time in addition to contributing to wider partnership and community activity. Following previous structural changes, 2021-22 has been a year of relative stability with respect to governance arrangements for social work therefore the core arrangements described below will largely be familiar from previous CSWO reports. I have however highlighted both changes made corporately to continue to strengthen capacity to deliver the wider Plan for North Lanarkshire as to well as to oversight arrangements as services begin to move beyond initial emergency and resilience arrangements put in place during the early period of the pandemic and referenced in my previous report. Moving forward it is clear that proposals for a National Care Service as reflected in the consultation in autumn 2021 and the Bill published in June 2022 are likely to involve radical change in the future governance of social work services. During 2021-22 the Council and HSCP responded to the NCS consultation whilst retaining a focus on continuous improvement within current arrangements, a balance which will is likely to continue to be necessary over the next period. Partnership working at local level remains fundamental to social work and a key aspect of the role of the CSWO involves developing and sustaining effective partnership working and relationships across a range of organisations and structures. In addition to the specific responsibilities of the CSWO to the Council and HSCNL the CSWO holds a key leadership role within a number of local partnerships as well as contributing to the wider national social work community Page 12 of 193
Page 13
4 1.1 North Lanarkshire Council and North Lanarkshire Partnership The Plan for North Lanarkshire continues to set the direction for the council and partners. Its purpose is to communicate the shared priorities and provide a focus for activities and resources around place making with a long-term vision where North Lanarkshire is the place to Live, Learn, Work, Invest, and Visit and of inclusive growth and prosperity. It's a Plan with a shared ambition that aims to ensure the benefits that this brings reach all our communities, and that there is a much fairer distribution of wealth. https://www.northlanarkshire.gov.uk/index.aspx?articleid=1240 It is centred on: • improving economic opportunities and outcomes • supporting all children and young people to realise their full potential • improving the health and wellbeing of communities • enhancing participation, capacity and empowerment across our communities and • improving North Lanarkshire’s resource base The Plan is supported by 25 high level ambition statements and in turn by a Programme of Work: https://mars.northlanarkshire.gov.uk/egenda/images/att90076.pdf att95824.pdf (northlanarkshire.gov.uk) The CSWO, Head of Adult Social Work and Head of Planning, Performance and Quality Assurance have lead responsibility for key areas of this programme but also a role in ensuring connections are made across the wider range of corporate programmes of work, which impact on areas which are important to those who use social work services, for example, employability services. Phased changes in the council’s management structure have been implemented to support the delivery of the Plan and from spring 2022, the CSWO/Head of Children, Family and Justice Services has also had operational responsibility for Tackling Poverty and for Community Learning and Development and Resettlement functions, creating further opportunity for integrated working in areas which have close links with social work. The Programme of Work is shaped and overseen by the Corporate Management Team and through the council committee structure with the Adult Health and Social Care Committee and Education and Families Committee having oversight of the delivery of social work. The overarching framework for partnership working in North Lanarkshire continues to be provided by North Lanarkshire Partnership (NLP) which brings together the major public sector agencies in the area along with Voluntary Action North Lanarkshire (VANL) the third sector interface in the area. The priorities for delivery across the partnership are now included in The Plan for North Lanarkshire. Page 13 of 193
Page 14
5 The Children’s Services Partnership (CSP) continues to provide multi-agency governance and strategic planning and direction for children’s services in North Lanarkshire. Children’s Service Partnership Board membership includes Elected Members and HSCP/NHS Board representation to enhance the coherence of children’s services planning across key governance structures. There is also direct representation of young people on the Board though the Youth Council, Promise Development Team and Champion’s Board links. Our most recent Children’s Services Plan https://www.northlanarkshire.gov.uk/sites/default/files/2021- 08/North%20Lanarkshire%20Childrens%20Services%20Plan%202021-2023.pdf was published in spring 2021 and is framed around the foundations of the Promise and UNCRC. Young people themselves were integral to the development of the plan with the Promise Development team leading on the development of the vision and the Youth Council undertaking a survey focussing on awareness of rights and leading on identification of actions within the plan to promote and embed these rights. The task groups supporting the delivery of the plan have been reconfigured in line with the updated priorities with new groups focusing on Voice and Family Support, the Corporate Parenting Task Group evolving into the Promise Partnership Care and a refreshed Mental, Health, Wellbeing and Resilience Task Group co-ordinating work including the establishment of new supports as part of the Community Mental Health and Wellbeing Framework. Social Work places a key role in each of these strands with Senior Social Work Managers co-chairing 3 of the 4 task groups and the Partnership’s Continuous Improvement Group. The CSWO is lead officer for the CSP and chairs the Improving Children’s Services Group which has oversight of the work of task groups together with the ‘Scaffolding’ and ‘People’ elements of the Children’s Services Plan. The North Lanarkshire Community Justice Partnership (NLCJP) currently also chaired by the CSWO has responsibility for the oversight of Community Justice in North Lanarkshire. The partnership has benefited from the strong participation of partners and published the North Lanarkshire Community Justice Outcome and Improvement Plan (NLCJOIP) in March 2017. https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=20573&p=0. Due firstly to the pandemic and subsequently to ongoing work at national level on a new Community Justice Strategy and revised Outcome Performance and Improvement Framework, this plan initially published as a three-year plan, has since been extended and supplemented by annual action plans to March 2023. Interim planning has been informed by an ongoing process of Strategic Needs and Strengths Assessment. The Community Justice Annual Report 2021/22 NLCJP 2021-22 Annual Report_0.pdf (northlanarkshire.gov.uk) provides an overview of key activity during this period. Page 14 of 193
Page 15
6 During 2020/21 arrangements for the North Lanarkshire Partnership’s Strategic Leadership Board (NLSLB) were revised and new arrangements were agreed for the Community Justice Partnership and Children’s Services Partnership Board to present on an annual basis to enhance visibility and oversight. This has now been implemented leading also to a wider partnership focus on The Promise and commitment to further work to ‘Build a Promise Community’. A similar arrangement is now in place to present the CSWO Annual Report to the NLSLB, with the intention of supporting increased visibility and ownership across the partnership of public protection work (whose multi -agency governance is through the Chief Officer Public Protection Group) as well as the wider work of social work and social care. A key development in North Lanarkshire over the past two years has been the establishment and embedding of nine Community Boards to support community leadership, involvement and capacity building with each area focussing activity through a local outcome and improvement plan (LOIP). Social work services play a part in these supporting local partnership structures with the CSWO undertaking the role of Community Co-ordinator for one of the local boards and the Head of Adult Social Work and Head of Planning Performance and Quality Assurance providing a link to the Health and Social Care Partnership and its strategic commissioning activity across all Community Boards. Senior Social Work Managers also participate in area-based teams and the sub-groups which support the delivery of the LOIPs. 1.2 Health and Social Care North Lanarkshire The Integrated Joint Board and its Performance, Audit and Finance Sub Committee provide the overarching governance structure for the partnership. Both the Head of Children Families and Justice Social Work Services/CSWO and the Head of Adult Services provide professional social work advice to the Board. The Mental Health, Learning Disability and Addictions Partnership Board (chaired by the Head of Adult Social Work Services) and the Frailty and Long Term Conditions Partnership Board (chaired by the Head of Health) have the role of informing and implementing strategic direction on behalf of HSCNL across their respective areas and maximising the opportunities provided by the integration of Health & Social Care to promote best practice and guide the access for individuals to the right support. The Partnership Boards have been in place for a number of years and are currently under review as part of the refresh of the Integration Joint Board’s new Strategic Commissioning Plan 2023-26. The current Strategic Commissioning Plan for the HSCP was published in March 2020 following an extensive engagement process with a wide range of service users, carers and staff the covers the period to 2023: https://www.hscnorthlan.scot/wp- content/uploads/2020/07/Strategic-Comm-Plan-20-23-FINAL.pdf Page 15 of 193
Page 16
7 The Plan identifies three key priorities: 1. People should be in control of the care they receive, and it should meet their needs 2. People are supported to maintain their independence and manage their care needs 3. People are supported and helped to avoid preventable conditions These are also supported by a set of Ambition Statements which guides the work of the partnership going forward: • Do the right thing first time • Provide a range of community support services to live well in connected communities • Focus on what matters to people (outcomes) • Be at the forefront of technical and sustainable solutions • Promote prevention and early intervention • Ensure North Lanarkshire is the best place to work, volunteer and care. The plan is supported by a programme of work which interfaces with the wider Plan for North Lanarkshire and the wider council programme of work Strategic-Comm-Plan-20-23-FINAL.pdf (hscnorthlan.scot) North Lanarkshire Alcohol and Drug Partnership is hosted within HSCNL and has been considerably strengthened over the last two years, co-developing its 2021-2024 strategy around the themes of rights/respect/recovery through engagement with a broad range of stakeholders : https://mars.northlanarkshire.gov.uk/egenda/images/att99221.pdf Five ADP sub-groups have been established to develop actions covering: Prevention, Early Intervention and Education; Treatment Care and Recovery; Whole Family Approach; Public Health Approach in Justice and Reducing Alcohol Harms. In line with the cross-cutting elements within these key areas the interface between the ADP, CSP and CJP has also been strengthened and whilst the lead senior officer for the ADP is the Head of Planning, Performance and Quality Assurance both the CSWO and Head of Adult Social Work Services have a role in the wider ADP structure. 1.3 Support, care, practice and staff governance arrangements The Health and Social Care Partnership’s Support Care and Clinical Governance Committee (SCCGC) continues to meet on a quarterly basis and is chaired on a rotational basis by the CSWO, Medical Director, AHP Director and Nursing Director. The terms of reference for the SCCGC were updated in 2021 to reflect the organisational changes within the partnership and Adult Social Work Services now report via two sector focussed groups. In view of the need to maintain coherence in practice and staff governance across social work functions and care groups the local framework for professional social is supported both by Social Work Leadership meetings, whose frequency was increased to six-weekly in Page 16 of 193
Page 17
8 2022, and by quarterly Social Work Workforce meetings. A brief fortnightly ‘Social Work Solutions’ meeting also provides a forum for social work Heads of Service, Senior Managers and Business Partners to address cross-cutting business issues. As reported in my previous report, a cross care group working group was established in 2021 involving senior and frontline managers, frontline staff and union representatives to address the challenges presented by new ways of working and organisational changes, initiated or escalated during the pandemic, and in particular the impact of more disparate and remote working on social work practice and on practitioner support needs. This group focussed on how to maintain and enhance the delivery of high-quality services and support staff wellbeing within the context of pandemic and in planning for recovery. Notably it took a trauma informed approach focussing on areas of safety, trust, choice, collaboration and empowerment considered what was working well organisationally and in practice and areas for development. An initial action plan to address identified issues was developed in conjunction with the social work leadership team and whilst the group has met less regularly over recent months its work has informed priorities within wider strategic workforce plans and has fed into planning for the new hubs and the linked operating model within North Lanarkshire. A range of other processes are in place to support assurance around practice and service delivery in social work services. The Quality Assurance and Commissioning Team, hosted in Adult Social Work Services, operates across social work and over 2021/22 its capacity has been strengthened, particularly, to support the CSWO and service responsibilities for the monitoring of the delivery of commissioned services. The team which reports to the Head of Planning ,Performance and Quality Assurance also lead on a range of other functions critical to the duties of the Chief Social Work Officer including with respect to regulatory activity, complaints management and overview, risk management and procurement and provider sustainability as reflected in their annual report for 2021/22: https://mars.northlanarkshire.gov.uk/egenda/images/att99223.pdf Additional arrangements for multi-professional oversight of Care Homes and Care at Home established during the pandemic have also been maintained although the frequency of meetings has been reduced as the year has progressed and pandemic pressures have reduced. In addition, a Home Care Board continues to oversee the wider redesign of the service. In addition to the role of the Quality Assurance Team all Senior Managers within social work undertake regular performance reviews with their teams and support additional audit, development and review activity to support practice standards, agreeing priorities with the CSWO and Head of Adult Social Work Services. With respect to staff governance the CSWO and Head of Adult Social Work also maintain an overview of referrals to, and investigations by, Scottish Social Services Council supported by HR Business Partners. With respect to less formal engagement with staff, whilst there has been a return to more site-based working, and alongside this more direct team interactions over the course of the Page 17 of 193
Page 18
9 year, Senior Social Work Leaders have been conscious that their visibility as leaders and the opportunity for less formal but direct face-to-face dialogue with staff has been impacted by pandemic. This has begun to be addressed through visits by the CSWO and other key managers to teams planned over the summer of 2022 and this will remain a priority going forward. 1.4 Public Protection Leadership in the field of Public Protection remains a key responsibility of the CSWO and the Head of Adult Social Work Services who collectively provide support to the Chief Executive of the Council in his role as chair of the Chief Officers’ Public Protection Group (COPPG) to which the MAPPA Strategic Oversight Group (MAPPA SOG), Violence Against Women Strategic Group (VAWSG), Adult Protection Committee (APC) and Child Protection Committee (CPC) report on a quarterly basis. The CSWO chairs the Lead Officers Public Protection Group and is currently vice chair of the CPC and chair of the Violence Against Women Strategic Group whilst the Head of Adult Social Work Services is a key member of the Adult Protection Committee. The MAPPA Strategic Oversight Group operates on a pan Lanarkshire basis with the chair rotating between the Police Scotland Public Protection Superintendent and the CSWOs of North and South Lanarkshire. The prioritisation of public protection remained a key focus both nationally and locally during the pandemic period and recovery period and over the past two years both public awareness raising, and monitoring have given close attention to areas in which the pandemic may have increased vulnerabilities or impeded access to support. Whilst ongoing self-evaluation activity has continued, the pandemic resulted in the temporary suspension of external inspection programmes relating to Adult Protection, Children’s and Justice Services however these were again stood up during 2021/22. Although no external inspection of public protection functions took place during this period notification of a Joint Inspection of Adult Support and Protection has since been announced with related activity scheduled for summer/autumn 2022. By its nature Public Protection is an area of high residual risk and this is reflected on the local authority risk register. It was therefore, as previously reported, included in the Council’s internal audit programme for 2020/21 with a focus on quality assurance mechanisms. The audit report to Audit and Scrutiny Panel in September 2021 concluded that assurance arrangements were generally satisfactory offering ‘reasonable assurance’ to the council and noted the prioritisation of public protection during the pandemic period. Recommendations were made in three areas and included progression of further planned self-evaluation of the Chief Officers Group and the strengthening of multi-agency action plans including through use of SMARTer measures. Action in these areas has been progressed along with a small number of additional actions identified as a result of the subsequent self-evaluation undertaken by the COPPG. In addition, it is proposed to amend the terms of reference for Chief Officers Group to incorporate reporting and oversight responsibilities relating to Drug Deaths and Suicide and associated preventative activity Page 18 of 193
Page 19
10 reflecting both the broader focus of public protection taken during the pandemic period and the additional ask of Chief Officer Groups linked to new national action plans for these areas. The COPPG regularly considers the resourcing of multi-agency public protection activity and following recommendations from the Lead Officers Group agreed in early 2022 also to enhance capacity, for a 12-month period in the first instance, to support the enhancement of MARAC arrangements locally as well as to create additional training and development capacity to support the implementation of new national guidance in child and adult protection. 1.5 Engagement with the people who use support services and the Community and Voluntary Sector Ultimate accountability for social work services is to those who use them, their families and the communities of North Lanarkshire and Social Work Services and the CSWO play a key role in ensuring that the voices of people who use and have experience of social work services are heard, not only in individual planning, but that they inform the design and delivery of the service. This approach is in line with the overall vision for the Council expressed in Delivering for Communities and the importance placed on the role of Community Boards as outlined in section 1.1 above. HSCNL also operates within the framework of its Engagement and Participation Strategy 2021-2024 which is designed to ensure the right systems and supports are in place to enable effective engagement with stakeholders: https://mars.northlanarkshire.gov.uk/egenda/images/att95292.pdf The strategy builds on the strong foundations established to facilitate the involvement and engagement of people who use services, carers, the community and voluntary sector, and the independent sector and its operationalisation is supported by a Stakeholder Engagement and Participation Strategy, Framework and Working Group Care Opinion also continues to be promoted with increased use of the platform to add to the learning possible through complaints analysis. Care Opinion is an independent web- based service where people can share their experience of services which has widened its focus from health to health and social care. Partnership for Change, our local umbrella forum for service user and carer involvement has supported this roll out and monitors and presents on postings to relevant forums to illustrate issues of concern as well as positive stories. Within Children’s Social Work we have continued to develop the use the Mind of My Own App (MOMO) which helps young people communicate their views for meetings, raise concerns or share good news in way that suits them. With Children’s Services partners and colleagues from the Council’s corporate communication team, the service has also supported the innovative Make It Right project, a campaign co-designed with young people Page 19 of 193
Page 20
11 and launched in January 2022 to raise awareness of children’s rights and a key stepping- stone to embed these in practice in North Lanarkshire. With respect to Children’s Services the Partnership Agreement between the CSP and Young People was established in 2018: https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=21857&p=0 and continues to form the basis for engagement with young people who are now represented directly on the Board but with partners also making a parallel commitment through a range of other links with the Youth Council and to the Champion’s Board which has over this period been successful in significantly extending engagement and participation with younger children experiencing care. The Promise Development Team, which has at its heart Development Workers and Assistant Support Workers with lived experience of care, was established in early 2021 and has also been key to ensuring children, families and carers are central to service planning and development both within social work and within wider services. While awareness raising remains part of their remit equally important has been their role in promoting the wider engagement of children and families and direct contribution to practice and system change. Building on this model and previous engagement with those with lived experience, Justice Social Work Services have now also progressed the recruitment of two workers with lived experience to support service development and provide peer support. Engagement with carers in North Lanarkshire remains equally critical to service delivery and development and is undertaken through the framework of the Carers Strategy 2019-24 http://www.carerstogether.org/wp-content/uploads/2020/10/NL-Carers-Strategy.pdf which was developed in partnership with carers with a vision ‘to ensure, in partnership, that North Lanarkshire adult carers and young carers are supported, represented and enabled to build resilience, carry out their caring role and to live healthy independent and fulfilled lives’. North Lanarkshire Carers Together continues to provide an information and advice service but also a network for carers to represent individual and collective issues and to contribute to policy development, service provision and evaluation both locally and nationally, a role which has been particularly valuable and important in ensuring carers voices are heard and challenges understood during the pandemic period. Voluntary Action North Lanarkshire (VANL) continues to provide the key local interface with the community and voluntary sector in North Lanarkshire and participates as equal partners in the partnership structures described above and in a wide range of linked improvement activity. This has included membership of the Children’s Services Partnership Board and the ongoing involvement and facilitation of endorsed third sector networks linked to the Community Justice Partnership. Within Health and Social Care, VANL have also continued to play a central role in developing voluntary and community sector involvement through community capacity and carers support work as reflected within the Community Solutions Strategy and delivery programme, Softening the Lines 2018-23: http://www.voluntaryactionnorthlanarkshire.org/sites/default/files/cs_strategy_2018- 23_softening_the_lines-converted.pdf Page 20 of 193
Page 21
12 Using 9 thematic leads to guide best practice and 6 locality host organisations to ensure a truly community led approach a devolved budget of over 1m is directly invested in organisations and community groups. A supporting commissioning plan and the programme approach have ensured a focus on key outcomes with the budget also supporting the leverage of additional funding and in-kind contributions. The overarching aims of the programme are to prevent isolation and loneliness and to address inequalities using innovative approaches to support people to be more active and to reconnect to their communities. The use of the Community Solutions model has also provided a vehicle within Children’s Services to test out new models of support to address distress and promote positive mental health with a significant portion of new Scottish Government funding targeted at early intervention and community support through the Children and Young People’s Mental Health and Wellbeing Framework allocated to organisations through VANL to develop new supports in partnership with school clusters, children, young people and their families. Of key importance in social work across all care groups however remains the principle that engagement, inclusion and empowerment are not seen as episodic events but also embedded in day-to-day practice with a focus on good conversations and strength-based approaches. 2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE 2.1 Support to Unpaid Carers As referenced in my previous report the ongoing impacts of the COVID-19 pandemic on unpaid carers have been significant. Many carers had to provide more care than usual during the pandemic, and this has continued for some people with staffing and demand pressures across the social care, social work and health sectors, both locally and nationally, further exacerbating the issues faced by unpaid carers. This has resulted in a detrimental impact on overall well-being of many carers in terms of stress and anxiety levels and the need to continue providing care for longer. Despite this, unpaid carers continue to provide support for those who otherwise may require support from social work and health services and are the main source of support for many people. In order to support an increase understanding of carer experience both nationally and locally including where we are making a positive difference, North Lanarkshire noted an interest in participation as a site for more in-depth activity linked to the the Care Inspectorate’s national ‘Inquiry into carer’s experiences of social work and social care service delivery’, with subsequent confirmation that linked survey and focus group activity would take place over the period March to June 2022. In the interim priority has continued to be given to how support to carers can be enhanced: Page 21 of 193
Page 22
13 A range of supports and services are commissioned to provide Carer support, inclusive of the following key strands: • Lanarkshire Carers – Direct Support for Adult Carers • Action for Children Young Carers Service – Young Carers Support Services • North Lanarkshire Carers Together (NLCT) – Campaigning, information and representation services • VANL – Community Solutions Programme There are also a range of funded organisations who play a part in supporting unpaid carers, including the Disability Forum and other condition specific and\or age-related support organisations. We work in partnership with both commissioned services and funded organisations, all of whom offer a range of supports to Adult Carers and Young Carers. Overall, approximately 11,000 carers are known to the carer support organisations in North Lanarkshire and are in receipt of some form of support. During 2021/22 1040 Adult Carer Support Plans have been progressed by Lanarkshire Carers where assessed need was deemed to be low or moderate. In situations where carer need has been identified as being significant or critical and unable to be met through the range of carer support options described above and below, approximately 50 individual Carer budgets have been agreed. In many instances individual budgets to supported people are also scoped to reflect individual carer circumstances, such as complex care related needs, caring responsibility for more than one person, or the carer’s own health related needs. In addition, over 1,000 carers benefited from small grants distributed through Lanarkshire Carers. Young Carers have been supported through Young Carer Statements, a wide range of carer support and activity groups, training opportunities, resilience aid and support, respite breaks, creative short breaks, carer awareness training and legal advice. A pan Lanarkshire Steering Group focussing on the needs of Young Adult Carers was also established last year. A key ambition is to ensure the needs of carers are integral to wider service planning, an example being that following the success of a Community Link Worker initiative which focussed on support, advice, guidance, and signposting to families whose child may have a neuro-developmental condition, there are plans to extend this in 2022/23. This has been funded through Community Mental Health and Wellbeing Framework budget for children and young people and is now hosted through North Lanarkshire Carers Together and in line with our wider approach focusses on early, whole family support and community connections. There is a well-established short break service, operated by Lanarkshire Carers and this continues to play an important role in supporting unpaid carers in enjoying a break from their caring role. Feedback from carers however has also pointed to the need for more regular, flexible ‘time out’ accessible within their local community. This has informed a range of new initiatives including a ‘Carer Breather’ programme, facilitated through NLCT Page 22 of 193
Page 23
14 and delivered by a range of local organisations and the piloting of a ‘Sitter Service’. These initiatives offer unpaid carers regular and flexible breaks from caring. Positive feedback from unpaid carers regarding this approach will result in an expanded programme in the coming year. Work is also ongoing to meet the requirements of the Carers Act to ensure that unpaid carers are as involved as they want to be in hospital discharge arrangements. This includes involvement in decision making, as well as support at the point of discharge and beyond. Whilst this approach has been welcomed, we are aware through feedback from Carer Support Organisations, Advocacy, and individual carers that further work is required in this area, to ensure that no involved unpaid carers are missed from discharge planning as a result of pressures to work at pace in this area. We remain aware also of the diversity and fluidity of the carer population and that despite our efforts some carers remain less visible to services and supports. We continue to innovate and use a range of methods to ensure information and support is accessible, from the more traditional information packs to the launch of a new podcast for carers and support for digital inclusion. 2.2 Justice Social Work Services During this period criminal justice service activity has continued to be delivered as per our legislative responsibilities, and during periods of restrictions related to the Covid-19 pandemic in accordance with emergency legislation, health and safety, and social distancing measures. In common with all social work disciplines the most significant challenge for Justice Social Work Services throughout the reporting period was the impact of the restrictions and the challenges associated with fulfilling statutory obligations, managing risk, and supporting our most vulnerable service users and their families including those with unstable or chaotic lifestyles. To assist with this a Red/Amber/Green (RAG) risk management system was implemented to ensure that those most in need or at the highest risk were prioritised, and appropriately supported. This was reviewed on a weekly basis by both front line and senior managers ensuring that throughcare licences, drug testing and treatment orders and community payback orders were managed and supervised through a combination of regular home visits and contact via virtual platforms and telephone calls. Community Payback Orders (CPOs) Covid-19 pandemic restrictions necessitated the closure of unpaid work across North Lanarkshire for two periods during 2020/21 and 2021/22. As these restrictions began to ease recovery planning was crucial to support the transition from a partial, to a fully operational service and in the initial stages of recovery service users were able to attend unpaid work in a limited way and in fewer numbers. Part of the approach to recovery has continued to involve increasing the opportunities for unpaid work to be undertaken at home supported by the completion of appropriate risk and Page 23 of 193
Page 24
15 health and safety assessments. This approach has permitted some orders to be completed without the need to submit requests for extensions to an already burdened Court Service. The continuation of this hybrid working model, alongside traditional unpaid work, together with successful partnerships with the third sector has supported the delivery of 53,464 unpaid work hours during 2021/22. This figure is close to twice the 27,600 hours completed in 2020/21 but still substantially less than 85,116 hours delivered pre-pandemic in 2018/19. The number of outstanding unpaid work hours, an area of national concern, has also fluctuated, dropping initially from circa 54k in February 2021 to circa 34k in April 2021 due to one-off commutation of some hours on some CPOs facilitated through emergency legislation and new approaches in service delivery but standing at circa 47k as of May 2022 with the impact of an escalation in orders made as court activity increased counter- balancing innovations in practice to enhance capacity. In recognition of the longer- term impacts of the pandemic on the whole justice system, temporary funding was provided to justice social work by Scottish Government to enhance capacity for both core and commissioned services in 2021/22. This will be continued in 2022/23 although the temporary year on year nature of the funding has created a number of challenges in service planning and recruitment. A fuller report on the delivery of Community Payback Orders over this period is available: att99332.pdf (northlanarkshire.gov.uk) The following examples however illustrate the range of unpaid work opportunities that were made available across North Lanarkshire during this reporting period: • Over 203 bicycles were distributed to North Lanarkshire residents though the Restorative Justice bike workshop at no cost. A by-product of this was the assistance and support it gave to individuals in terms of the potential to maximise their health and wellbeing. In addition, the service has given help to local communities by offering bike maintenance and repairs. This project has particularly assisted those children, young people, and families who are unable to afford the cost of bikes or their repair. Bikes have also been given to victims of bike theft. • The Wood Workshop has enabled the creation of useful items for various community groups, such as outdoor classrooms and activity equipment for schools, and planters for sheltered housing complexes. • The Laundry workshop has helped to ensure that donated clothing such as school uniforms could be repaired, cleaned and ironed prior to distribution to families and individuals in need. • Within our craft activity groups items were made and donated to local organisations or sold at fayres with the money raised being donated to local charities. • Squad placements assisted with the completion of projects in local communities such as landscaping. • Several private placements were maintained in various settings including local churches, allotments, sheltered housing complexes and charity shops Page 24 of 193
Page 25
16 • As previously noted, unpaid work home working for appropriate service users was employed throughout the pandemic. These arrangements benefitted community partners including the Police Scotland Dog Unit, SSPCA, NHS, Wildlife Trust, Housing and Leisure and Recreation colleagues, and the wider community. This resulted in 5,650 hours of home working being completed during this reporting period. Whilst group work to support the ‘other activity’ element of orders was restricted over this period, the additional funding provided by the Scottish Government for recovery purposes permitted the continuation of the delivery of ‘other activity’ from third sector providers through both digital platforms and more limited face-to-face delivery: 1. The Wise Group delivered a group-based programme designed to provide information and awareness on topics such as managing mental health, dealing with negative thoughts and emotions, dietary and physical health benefits, financial inclusion and budgeting, building positive networks, dealing with conflict, support with employment and training possibilities, and alcohol and drug education. 2. Love Learning worked with service users on an individual basis to address literacy, and social isolation difficulties. 3. Street Cones designed a group work activity to support individuals through the maximisation of their skills and potential by involvement in the creative arts. Participants wrote a script which they subsequently performed. The quality of North Lanarkshire Council’s Community Payback Order delivery is continually assessed, and the perspective of service users and community projects supported is regularly sought as reflected in our annual CPO report (link above) Diversion from Prosecution In line with the Vision for Justice in Scotland the service continues to prioritise the promotion of Diversion from Prosecution. To ensure consistency of practice in this area multi agency briefing events have continued to take place with relevant social work staff, police colleagues and the voluntary sector. Diversion from Prosecution referrals in North Lanarkshire continue to be above the Scottish Average, and the numbers have been consistently high throughout the pandemic. Diversion 2021/22 Male Female Total Number of Referrals 255 98 353 Number of Assessments Undertaken 240 93 333 Number of Cases Commenced 134 61 195 Number of Individuals for whom cases commenced 123 61 184 Number of cases successfully completed 117 57 174 Page 25 of 193
Page 26
17 Offence focused interventions People subject to supervision by justice social work are supported to recognise and address wide ranging and often complex personal and family issues as well as undertaking offence related work. Developing a strong professional relationship is a key element of the supervision experience and is fundamental to effective engagement and positive outcomes. Staff utilise Risk Management Authority approved risk assessment tools to assess risk and need and to implement appropriate responses to addressing criminogenic needs. The Justice Outcome Star has been developed over several years to support more meaningful engagement and to contribute to the measurement of both individual outcomes and the impact of interventions at service level within Justice Social Work Services. The aggregated information from this tool is used both to support Strategic Needs Assessment and service planning. Offence focused Interventions take place both on a one-to-one basis and within groupwork settings, although due to pandemic restrictions, the capacity to safely deliver groupwork was severely compromised over this period placing more reliance on 1-1 delivery. The approach is based on “Good Lives” principles and includes general offence focussed work, for example, managing strong feelings, handling conflict, dealing with relationships, anger awareness, managing impulsive behaviour, goal setting and planning. More intensive and targeted interventions encompass MFMC (Moving Forward Making Changes) and our UP2U domestic abuse programme. More detail on these programmes is provided below. UP2U Domestic Abuse Groupwork Programme UP2U ‘Creating Healthy Relationships’ is now fully operational across the Justice service and can be accessed by individuals who are subject to statutory supervision because of their involvement in domestic abuse offences. The programme is delivered by justice social workers in a case management setting on a 1:1 or a 2:1 basis. The service also has a centralised UP2U team to support locality teams with the delivery of the programme to high-risk individuals who are screened using our new UP2U screening panel process. The programme can also be delivered in a group work setting, however, capacity for this has been limited over the pandemic period. Justice Services also utilised a proportion of covid recovery monies during the reporting period to purchase a training programme for 56 staff across children and families. This allowed for the implementation of the ‘UP2U Family Practice’ intervention for non-court mandated individuals. This version of UP2U is designed specifically for child and family practice scenarios where unhealthy domestic abuse relationship behaviours exist. This approach provides a vehicle to respond to the need for domestic abuse behavioural change work across both children, families, and justice services. Moving Forward Making Changes As part of revised and newly implemented Criminal Justice Social Work structure a dedicated Moving Forward Making Changes (MFMC) Team was established in August 2021. Following the easing of Covid-19 health and safety restrictions a steady resumption of face- Page 26 of 193
Page 27
18 to-face MFMC programme delivery during the period 01.04.21 to 31.03.22 has been possible. Other Justice Services: The Women’s Community Justice Service has continued to work holistically to address the specific needs and issues of women within the justice system over this period enhancing the provision of practical support where required including the use of technology to facilitate participation. Justice Throughcare provision has also remained a priority to ensure those leaving custody receive appropriate levels of support to address their risk and facilitate their reintegration from prison to the community. The linked Community Bridges Project was maintained throughout the pandemic period and continued to support people who have difficulties with substance use and who are being released following a short-term prison sentence. The Drug Treatment and Testing Order team maintained its focus on intensive support services to 35 individuals in total during the reporting period. The specific challenge in this area of work was associated with the withdrawal of drug testing provision during the period of Covid restrictions, and its limited reintroduction thereafter. It is anticipated that this service will be fully restored during the coming year. Finally, the Prison Social Work Team based at HMP Shotts has maintained site-based provision, continuing to work closely with SPS colleagues to assess and support prisoners and their families. In addition to statutory work the team delivered child protection awareness sessions to SPS staff resulting in an increase in child welfare referrals. Tackling Poverty and Exclusion In addition to a focus on the above work the team have continued to integrate actions to address poverty and exclusion within day-to-day practice recognising the corrosive impact of both on both those involved with the service and our communities. This has included: • Income maximisation, generating £58k in monies for over one hundred adults and families • Working with the Connecting Scotland Scheme to address digital exclusion and secure devices/solutions for a number of service users • Prioritising recovery of access to the Keep Well nursing service to support address the health inequalities and poor mental and physical health often experienced by justice service users, and with respect to community support: • Staff and service users supported foodbanks in Coatbridge and Airdrie by collecting food and distributing food parcels 2 to 3 times per week. • 491 gifts for younger children and 343 gifts for older children were given out over the festive season. Christmas and New Year meals were also provided for vulnerable adults and families by local restaurants, and Restorative Justice staff distributed these. • Working in partnership with local charities the service has laundered donated school uniforms and assisted in their distribution to the families that required them. Page 27 of 193
Page 28
19 2.3 Children and Families Social Work Services Keeping The Promise Following publication of The Promise by the Independent Care Review in February 2020, cross-party commitment to support delivery was made by North Lanarkshire Council in August 2020, thereafter with the intent of working across council services and with the Scottish Government, partners and care providers to deliver the necessary changes. Children and Families Social Work has a key leadership role in this and is uniquely placed to drive and connect the key strands of work required to support the ambitions of the Promise and the required transformation of systems, outcomes and experience for children and families. This is due to the key statutory role social work plays in supporting children and young people and their families both for ‘children in need’ and those experiencing or who have experienced care and the underpinning values of inclusion and empowerment alongside a culture of partnership working. Social work therefore has a key role to play in transforming both family support and care. Following a reduction in demand in 2019/20, primarily in the initial stages of the pandemic referrals to children and families social work services have grown over the past two years and in 2021/22 were 15% higher than in 2018/19. This appears to reflect increased need for support from children and families within our community. Although further work is needed to fully understand the picture which sits behind this, the change is perhaps unsurprising given the evidence that the pandemic impacted disproportionately on those who already faced the greatest adversities, including on children’s early development and wider wellbeing, and that families are now also adversely affected by the emerging cost of living crisis. Year Number of Referrals 2021/22 10858 2020/21 10253 2019/20 9077 2018/19 9519 2017/18 9654 Balance of Care Placement Type 31 March 2019 31 March 2020 31 March 2021 31 March 2022 Foster care (NLC) 119 100 112 94 Foster care (Independent) 47 67 61 53 Home Supervision 294 298 227 188 Formal Kinship Care 296 355 321 307 Informal Kinship Care 150 153 170 183 Residential (NLC) 27 28 27 33 Residential (Independent) 12 13 11 11 Secure* 4 0 2 1 Continuing Care 39 45 53 73 Page 28 of 193
Page 29
20 Overall, the above table shows that the number of children and young people experiencing formal care has fallen over the past year. A focus on family support, strengths-based practice and integrated working has enabled North Lanarkshire to continue to achieve fewer children looked after per head of population than the national average. We also used residential care proportionality less than the national average. Despite this, there was an increase in young people in our children’s houses for three main reasons: our commitment to providing support to unaccompanied children seeking asylum in a nurturing and safe environment, our openness to taking older young people back into care when they need and ask for it and the growth in continuing care. Following a drop of a third in numbers of children and young people supported in external residential placements over 2018-21 the number has plateauedespite a longer-term commitment to providing support Close to Home. This is due to a number of factors relating both to demand, complexity of need and the long-term nature and supporting relationships associated with some of these placements. Nonetheless it remains a key priority of the education and families service to ensure increased capacity to support young people with complex needs within the North Lanarkshire community. This also drives efforts to recruit more ‘in-house’ foster carers. While there were slightly fewer in children in foster care, our focus on supporting and encouraging young people remain with their carers for as long as they need meant a continued and sustained increase in the use of continuing care with the effect that some of our foster and kinship carers are now ‘continuing carers’. The COVID-19 pandemic coincided with a significant decrease in the number of children looked after at home and this trend has continued. The reasons for this continue to be monitored as it is not yet clear if this is the result of preventative support and early help or a continued disruption to processes following the pandemic. Involving Young People A key development led by Today Not Tomorrow (part of our Champions Board Structure) has been the production of an online resource to support managers and practitioners on how to improve record keeping with a focus on the impact of language. Awareness raising sessions by the Promise Development Workers took place with some managers and practitioners, with further role out planned. Several young people were also involved in scoping and framing the key qualities required of mental health support for Care Experienced Young People, work they had the opportunity to showcase at a national event, Tending the Light, which formed part of the festival of care in February 2022. This work led on to young people codesigning and taking part in the council procurement process for a new bespoke service. A helpful by-product of this, is our corporate commissioning and corporate staff asking for specific training on The Promise so they can support meet the ambitions of the council and our children and young people. Our Promise Development Workers were also involved shaping the development of our services in response to young people in conflict with the law and contextual safeguarding. Page 29 of 193
Page 30
21 A Good Childhood Achieving a loving and caring home: Children and young people experiencing care The positive role children’s houses play in providing care and love to children and young people continued to develop over the year as the culture changes associated with keeping The Promise became more established. In particular, the service facilitated 3 young people returning to the houses as younger adults, because of trauma and crisis in their lives, in line with the aspirations of young people’s right to ‘return to care’ if necessary. The Promise Plan 21-24 sets out clear expectations in reducing the use the use of the restraint and our children’s houses were and the serviced participated in a pilot project funded via the Promise Partnership Fund, on partnership with Aberlour and Kibble, to help us achieve this ambition. A core group of 8 staff were identified to take the work forward and the first step in the project plan is to remove the use of the Prone hold by the 31st of January 2023. A significant development over the year has been the introduction of the National Transfer Scheme requiring all local authorities to accept transfers of children into their care, providing crucial placements to unaccompanied asylum-seeking children. To this end our children’s houses played a critical role in providing care to 14 unaccompanied children to ensure that their individual support needs were more fully assessed, and they received wrap around support whilst they settled in Scotland, starting their recovery from trauma. Another 4 young people went straight into supported care placements with 3 progressing from children’s houses to supported care placements. While this has placed increased demand on our children’s houses and supported care, the service has taken the view that this has been a child centred approach to supporting children who have come to the UK unaccompanied. We also appointed a social worker to specialise in working with and supporting this group of young people. Achieving a loving and caring home: Support to family-based carers The Children’s Carers’ Service provides support to kinship carers, supported carers of young adults, as well as to adopters and foster carers to achieve permanent loving homes for children and young people into adulthood. Over the course of the year the team received 120 initial enquiries about fostering or adopting and of these, 63 progressed to initial interview. 21 enquirers progressed to preparatory groups and of these 14 went on to submit an application to foster or adopt. This represents a 38% decrease on previous years, reflecting national trends. To meet this challenge the team established a new and creative recruitment strategy. This has a particular focus on new and changing needs, including the council’s commitment to find homes for unaccompanied asylum-seeking young people, and young people with complex needs to allow them to remain in North Lanarkshire. The team also worked with North Lanarkshire’s resettlement team to undertake initial assessments and support for Ukrainian host families. Page 30 of 193
Page 31
22 The engagement and participation of care experienced young people continued to be highly valued in the delivery of the service and young people supported and actively contributed to the recruitment and preparation groups for prospective adopters and foster carers. Brothers and Sisters Development in this area is not without challenge and over the year 65% of children in care were separated from at least one brother and sister. In response to this analysis, the team developed a new strategy, co-led by the Promise Development workers and involving carers, to support brothers and sisters stay together when they need to be cared for away from home. This comprised specific support to carers as well as a focus on recruiting carers with the capacity to look after brothers and sisters together. In addition, a revised framework for assessing family time was implemented, with the voice of children and parents central to more creative approaches to family time, while keeping children safe. Adoption This service provided a range of support and advice to 60 adoptive families. This comprised individually tailored post adoption support as well as support groups and training specific to adoption. The team experienced an increase in demand for post adoption support services, leading to a planned review of the whole service that has now commenced to ensure it meets all needs and offers timely support to avoid families reaching crises, providing the scaffolding required as outlined in the key messages of The Promise. This review will include consideration of an apparent increase in the small but significant number of adopted teenagers required to move to alternative arrangements over the past year, often residential care. As part of the team’s commitment to learning and development, the service participated in national research including researching the impact of Dyadic Developmental Psychotherapy (therapeutic support to adoptive and permanent fostering families) led by Oxford and Glasgow Universities. Permanence Planning The service continued to play an active role in leading developments in permanence planning for children to avoid drift in care planning. A number of new initiatives were started or refreshed including: • Senior practitioners within the Children’s Carers team supporting locality social workers to increase capacity and progress permanence planning. • New Permanence Planning Training was developed and launched to reflect new legislation and research and as part of North Lanarkshire’s commitment to relational practice in line with The Promise. Kinship Team In response to growing need, the kinship care team continued to expand to comprise 1 senior social worker, 3 social workers, 1 support worker and 1 support work assistant. The Page 31 of 193
Page 32
23 team had a busy and successful year with 106 new kinship carers approved, and ongoing dedicated emotional and practical support provided to 170 kinship carers. In addition, the team co-facilitated 7 kinship carer groups across North Lanarkshire in partnership with Nurture Scotland and CLD. Whole Family Support Family Group Decision Making & Lifelong Links Family Group Decision Making (FGDM) is a strength-based way of working which takes a structured approach to involving wider family and support network in decision making and planning for children and families. It is rights-based and aligned with the principles of UNCRC. Research in Scotland has found very good outcomes associated with this approach in reducing the risk of accommodation (Mitchell et al, 2018). As such FGDM is a key component of North Lanarkshire’s commitment to keep The Promise by supporting and nurturing relationships within families and preventing the accommodation of children wherever possible. Over the year April 2021 to end of March 2022, the FGDM service made considerable progress in successfully supporting children remain within, or return to, their families. Over period the service had two full time FGDM Co-ordinators. Family meetings achieved the following outcomes: • Based on referral dates for the year April 2021 to March 2022, 23 meeting were held and family plans were made for 32 young people, involving their family networks of support. • All 32 young people were supported to reduce the risk of them being accommodated, part of a rehabilitation plan, support new babies stay at home with their family or to support kinship placements. • 12 children referred as at risk of coming into residential or foster care, 11 have successfully remained living with parents or family members. One child was supported with family and friends but unfortunately this wasn’t sustainable and is now supported in a children’s house with family support. • 6 babies whose names were placed on the Child Protection Register pre-birth as at potential risk of significant harm, 5 have been supported to remain safely in the care of their parents post birth and one in a kinship placement. Family meetings avoided significant placement costs to the service but most importantly family meetings have enabled children to benefit from loving and safe relationships within their families. In January 2022, the service was successful in securing funds for two additional coordinators from the Promise Partnership fund to implement and approach to family group decision making called ‘Lifelong Links’. Lifelong Links seeks to create life-long social networks for children and young people in care and aftercare, providing them with practical and emotional support. Lifelong Links uses tools and techniques to identify family members and other adults, such as former foster carers or teachers, who care about the child or young person. These individuals can then be brought together in a lifelong links meeting to Page 32 of 193
Page 33
24 develop a life-long support plan for the young person. This outcomes of this will be presented in next year’s report. Intensive Services Intensive family support that is available to families when they need it, including out of hours and at weekends, is provided by our intensive service. The primary objective of the service is to ensure that children and young people are able to remain in or move to family where they feel they belong and are safe. During this year work in the team was concluded with 202 children and young people, of which this objective was achieved for 153 children and partially for 20 children and young people. There were 18 children and young people where this outcome was not a focus of intervention and 11 children and young people where this outcome was not achieved. To promote the involvement of the children, young people and their families in the development of the service, some young people coproduced a set of service standards with staff so that families are clear what can expect and have a right to from the service. With the easing of COVID restrictions, intensive services also stood back up group work and other activities to promote the wellbeing and resilience of children and young people. For example, through the provision of intensive support some young people achieved their Duke of Edinburgh Bronze Award and are now able to progress their DofE awards through North Lanarkshire’s universal offer. Some young people were involved in singing coaching and playing instruments and others produced their own DJ set whilst learning the skills to use the associated technology. The service also delivered parenting support delivered on a 1-1 and groupwork basis and learn to cook family participation sessions. During school holiday periods the team has assisted families with access to activities in the local community and further afield to ensure positive experiences for children and young people. This included a sports day, walking group, swimming group and supported family outings. Young People in Conflict with the law Support from custody As part of our Intensive Service, the Youth Bridges team supported 58 young people under the age of 21 who had experienced custody. 21 were new admissions to Polmont within this period. This is consistent with the downward trend in admissions to Polmont from North Lanarkshire although may have also been affected by Court restrictions through Covid. Youth Bridges staff ensured that 72-hour reviews were held within the prison to discuss vulnerabilities and support for these young people. Five (24%) young people were care experienced, a significant reduction from the past two years (56% in 2019/20 and 50% in 2020/21). Youth Bridges uses the Outcome Star to identify areas requiring support and to measure outcomes. Over the year ten domains of the Outcome Star showed improved outcomes of at least 65% for the young people closed to the service, with reduced offending for 88% and reduction in drug / alcohol use for 69%. Page 33 of 193
Page 34
25 As part of the commitment to meet the requirements of The Promise Plan 21-24, the service reviewed its approach to young people in conflict with the law. We found that 182 children were referred to the Reporter on offence grounds - a higher rate than the national average. However, SCRA only referred 7 of these children to a Hearing on offence grounds, reflecting the strong partnership commitment to the welfare principles of Kilbrandon. We still have work to do, however, to maximise the use of the Children’s Hearings and diversion rather than the court: In 2021/22 only 4 young people (under the age of 18) were remitted to the Hearing by the Sheriff court for a disposal, 5 young people were remanded or sentenced to custody and 7 were made subject to a Community Payback Order. This resulted in the development of a small team to work in partnership SCRA to use hearings more effectively to support relational working and robust alternatives to custody, remand and court disposals. Moving on: Supporting Care Experienced young people who have left care In response to our recognition of our need to provide more intensive and integrated support to care experience young people, the newly established team of three support workers and two social workers within intensive services has proactively reached out to young people and responded to young people returning for support to provide the care they need. As at March 2022, 141 young people were receiving support representing an increase of more than a third since the start of the pandemic. 66 care experienced young people were supported directly from Intensive Services, many of whom have reconnected with the service over the past year. A key area of improvement has focused on a ‘hub’ approach delivered from the Intensive Services building to ensure awareness of the rights and entitlements of care leavers and promote a ‘no wrong door’ approach across the multi-agency partnership. The building is used by many care leavers to receive support from the service or other agencies. A new protocol with housing was also agreed to ensure housing support was arranged around the needs of young people. Each locality in North Lanarkshire now has a housing champion advocating for care experienced young people. Tackling poverty has been a key priority and the council did not reduce payments to care experienced young people in line with the UK Government’s decision to end the temporary uplift to Universal Credit. A Right to Education: The Virtual School North Lanarkshire has continued to strengthen its commitment to care experienced children and young people to access education and close the attainment gap through the Virtual School. The Virtual School is a small multi-professional team, which supports the improvements in capacity and responses across the education system as well as co- ordinating and providing direct bespoke support for children and young people. The Virtual School maintains an overview of education planning and support for all care experienced learners. The Virtual School works in an integrated way and has formed productive relationships with community learning and development, local businesses and many other relevant partners in addition to strong connections with schools and other education and social work services. Page 34 of 193
Page 35
26 During the 2021/2022 school session, the Virtual School received 89 new requests for direct support and worked with 242 learners. The Virtual School supports young people through a wide range of activities including well-being programmes – improving physical and mental health, vocational learning opportunities, outdoor learning, literacy and numeracy programmes including direct support for SQA qualifications, volunteering/mentoring opportunities, individual learning engagement projects, transition supports and access to specialised resources e.g., counselling. Support interventions are delivered in a setting specific to the needs of the young people involved with intensive staffing provided to increase confidence levels and ensure any barriers to engagement are addressed. The Virtual School seeks to accredit young people for their learning undertaken during these activities through wider achievement awards including for example, John Muir, Young STEM Leader and Saltire or additional qualifications such as Forest and Outdoor Learning Award (SCQF 2 and 3), Cosmetology (SCQF Level 4) and City & Guilds Introduction to Automotive Engineering (Level 1). In session 2021-22, 108 such awards were achieved. Through Virtual School, teachers also deliver 1-1 or small group teaching sessions, with a specific focus on S4 pupils at risk of leaving education without any formal qualifications and learners at significant risk of disengagement with education. The direct impact of the former being the achievement of 81 SQA national 3 or 4 qualifications achieved by 32 young people. The Virtual School coordinates an intensive support offer for a number of vulnerable families across school holidays. Over summer 2021, the intensive offer was aimed at care experienced families including kinship groups and other targeted groups. Offers made were wide-ranging and included a variety of activities for young people and their families to enjoy, for example, leisure passes, access to summer activity camps, family days out (including cinema and bowling trips), Cooking Together sessions and bespoke health and wellbeing interventions. In total, 1339 individual offers at the intensive level were accepted by 402 children and young people. In addition, 74 families were supported with a direct payment to facilitate a bespoke package of support in circumstances of particular need. Removing exclusions of care experienced learners from school, aligning with the ambition of the Promise Plan 2021-24 is a target for Virtual School. Staff work in collaboration with schools and wider services to support the development of trauma informed practice and to seek alternatives to exclusion. For care experienced learners over three sessions (August 2019 to June 2022), data gathered demonstrates a 48% reduction in exclusion episodes, a 59% reduction in school days lost due to exclusion, and a 39% reduction in the number of care experienced learners excluded from school. Education within Intensive Services Within the intensive services base in Coatbridge, bespoke education was provided to 18 young people in need of enhanced support. Four were school leavers and achieved various qualifications in National 3 and 4s. The young people in the school were supported by intensive services support assistants to engage in their education programme and with some practical skills and activities. As part of our intensive service offer, we have an operational garage, The 7 Day Centre, that offers experiential learning in automotives and Page 35 of 193
Page 36
27 mechanics. Over the year the centre offered 9 young people vocational placements. One young person was supported to access a college course for mechanics, and this commenced in August 22. One young person evidenced the skills and ability to pursue mechanic but was not ready to undertake other available routes to further their training or employment. The young person has been supported to maintain their placement at the 7 Day Centre through NL Roots: Opportunity for Growth programme, which is placement and learning programme for young people who are or have experienced care. The young person is being supported to continue their learning in automotives and mechanic whilst increasing skills, options and readiness to pursue further careers options. To ensure the young people within these settings benefit from more robust pathways and the full range of educational opportunities, the 7 Day Centre and intensive service education base are being integrated into the We Aspire Academy. 2.4 Adult Social Work Services In common with other social work care groups there have been a number of challenges to the delivery of Adult Social Work Services over the year due to the impact of the pandemic and both associated and underlying demand pressures as well as recruitment challenges in key areas. Significant work has been undertaken, both to reinstate support services that had been reduced due to the pandemic and to continue to redesign services. This report therefore reflects the challenges experienced in maintaining high-quality care in line with statutory and regulatory requirements as well as ongoing work to redesign and improve services to support improved outcomes for individuals. Investment in Adult Social Work and Social Care through the Winter Planning and Enhanced Support funding stream from the Scottish Government was introduced during the course of 2021/22 to increase capacity in direct provision as well as to improve assessment capacity, nonetheless the volume and complexity of demand profile alongside workforce challenges have resulted in significant operational and capacity pressures across the whole of health and social care provision and we have seen this in particular with respect to Support at Home, Mental Health Officer activity and also in adult protection where the resourcing of large scale investigations has been required against a background of existing high demand. The narrative below provides further detail on service activity, performance, innovation and improvement as well as areas of challenge. Early and preventative interventions – Right Support, Right Time First Point of Contact A major focus for the Health and Social Care Partnership is to ensure that when people contact health or social work services the response is rapid and appropriate. There should be a focus on assisting people to be independent and getting things right first time. The core of which is a strength-based approach, transferring the balance of care to prevention, early intervention and self-management. Page 36 of 193
Page 37
28 In order to explore a whole system change a pilot project was undertaken in Motherwell in 2021 using the Three Conversation Model. Partners 4 Change who led on the delivery of the model have experience of working with 75 council areas in the UK in relation to reform, redesign, financial sustainability, and personalisation. Of the 75 councils, 35 councils were judged to have used this to support whole system change. Here the evaluation of the Motherwell innovation site in 2022 deemed it to be a success with much learning. The aim was to build a whole system, multi-disciplinary team approach embodying coordination, collaboration focusing on communities and person-centred practice. The new way of working was found to have reduced barriers and with simplified recording sufficient to meet legislative needs. It was found that early links with the community and voluntary sector was important for quality outcomes and supporting people with better lives. The quality of engagement with people was strong and there was reduced need to access services for longer term supports. Ongoing development work through the First Point of Contact Group is considering how to scale the learning from the innovation site and addressing how to bridge the gap between the voluntary and statutory services, creating trusted pathways. Making Life Easier Making Life Easier (MLE) is an online resource offering information, professional advice and direct access to support and services for all residents of North Lanarkshire. Making Life Easier gives people the tools to look after their own health and wellbeing. It allows earlier interventions for people and prevents deterioration. The system has reduced waiting lists for Occupational Therapy services with the consequent increase in capacity allowing for services to be directed to the people that need them most. Making Life Easier supports the national policy shift in Scotland to give people the tools to help them to stay well, live independently, promote their social engagement, live active and healthy lives and can, where possible, self-manage. In the year 2021/2022 8,089 people in North Lanarkshire used MLE, a 24.9 % increase on the previous year and an increase of 63% increase on the 2019 usage. Of these users, 86.7% were new visitors and 1,102 people completed a self-assessment. Figures show through the Covid 19 pandemic, Making Life Easier remained a reliable source of information, advice, and support for the people of North Lanarkshire with users increasing year on year. Technology in Health and Social Care We continue to invest in the implementation of technology enable care and have established a dedicated Technology Team within Health and Social Care which provides support and guidance on the implementation of technology, through the development of standards, processes and training. A key focus is on embedding technology into the Page 37 of 193
Page 38
29 assessment, planning and implementation of care to provide service users further choice in how care can be provided. The ‘tech flat’ within North Lanarkshire has been set up to demonstrate technology in situ to professionals as well as those who use services and their carers’. Having closed during 2020/21 due to pandemic restrictions it has now reopened and continues to be a well-used resource with around 60 visitors per month. The flat supports consideration of the use of technology within support plans for individuals and continues to be upgraded with new and innovative technology, something that the team will be looking to further evolve. We also continue to be involved in shaping the NHS Lanarkshire Digital Strategy to ensure a person-centred focus is maintained is this fast-developing area of practice. Work has been carried out alongside our NHS partners in developing guidance around the use of technology within rehabilitation. The team has also had involvement in shaping national policy and learning around TEC, telecare and the analogue to digital transition through partnerships with the Digital Office for Local Government, NSS TEC and the Scottish Government. The analogue to digital telecare transition is a major change project with considerable associated challenges for our Community Alarm Service through the transition. This continues to be progressed through the technology team with the aim to conclude with a fully digital community alarm and telecare service by the end of 2025. Locality Support Services The Locality Support Services (LSS), registered with the Care Inspectorate, offer self-directed support to adults with disabilities and /or long-term health conditions. Support is flexible over seven days and evenings connecting people with their local communities and interests. The service takes a human-rights and asset-based approach, promoting independence and personal responsibility, supporting people to consider their natural connections, friendships and paid support where it is required to achieve positive individual outcomes and better lives. The locality support service adapted its delivery model throughout the pandemic and into recovery, offering a blended service of direct support and online/distant support to the people and their families and where required making use of a temp variation to registration to offer support and care in and from people’s homes. Some service users have opted to continue having support on-line and benefit from our broader portfolio of communication methods. Some young people have been particularly enthusiastic about using technology to communicate including a preference for using this for reviews rather than traditional building-based meetings although limits on organisational access to social media platforms can be an issue. The pandemic has also necessitated a more place-based approach changing the needs profile of people being referred into locality support services, with more people requiring support who have mental ill health, self-neglect and addictions as their main issue. This has highlighted new training needs with steps taken to source development opportunities for workers. Page 38 of 193
Page 39
30 The service is also very conscious of the wider health inequalities which often impact on those with disabilities and long-term conditions and continue as core practice to support people to identify at least one health outcome and to promote general healthy lives. This is underpinned by an approach which places value on developing a progressive assessment process, communicating well and working with partners will improve access to health and other services. Integrated Day Services Integrated Day Services for Older Adults have continued to work with an aim to support people with complex support needs to continue to live in their own homes safely, often preventing admissions to hospital. During the initial period of the pandemic the service changed its delivery model in line with restrictions to work on an outreach basis however the have now returned to working as a building-based service implementing a recovery plan whilst adapting to the increased pressures across health and social care services. This has temporarily reduced the availability of some on-site interventions from health professionals however operational arrangements will continued be reviewed as full recovery of the service is progressed. Support at Home North Lanarkshire has, for many years, had a positive balance of care, which means that the considerable investment in community-based supports over time has resulted in a high proportion of people with long-term and complex needs being able to continue to live in their own homes. The metric used for benchmarking across Scottish Health & Social Care Partnerships and reported in the Annual Performance Reports (APRs) reflects very positively the long-term efforts in North Lanarkshire to create and sustain the range of supports which minimise long term residential, nursing or hospital care. In Adult Services, support at home is offered through internal home support, independent sector provision and direct payment. Home Assessment Team To complement existing measures around Planned Date of Discharge (PDD), Discharge to Assess (D2A) and Discharge without Delay (DwD) a multi-disciplinary Home Assessment Team has been established with the aim of supporting people to be cared for at home (or as close to home as possible), preventing avoidable admissions to hospital and, where hospital admission is necessary, supporting timely discharge. During 1st April 2021 and 31 March 2022 the referral rates demonstrate the pressure on Home Support with 73.1% of referrals coming from the hospital. The Home Assessment Team (HAT) soft launch took place in Wishaw in late April taking referrals from University Hospital Wishaw/ Monklands and in August the Cumbernauld soft Page 39 of 193
Page 40
31 launch was implemented taking referrals from UH Monklands/Wishaw with plans now underway to accelerate full implementation at UHW. HAT work collaboratively with hospital discharge hubs and clinical teams to support timely discharge from hospital to enable an assessment of each person’s immediate and longer- term needs in their own home. This can include anything from signposting to support from a statutory service and community care assessment. The Home Assessment Team has a multi-disciplinary approach to person centred care and consists of Home Support staff, AHP’s, Clinical Responders and Social Work staff facilitating ‘Home First’ principles enabling people to be supported to return home for a period of assessment. This also reduces the pressures associated with having to make life-changing decisions around longer-term care from a hospital setting. The initial implementation stage has demonstrated multiple benefits in supporting early intervention, reducing deconditioning, supporting and maintaining independence though better tailored support, reducing also the ‘over-prescribing’ of support and levels of ongoing care required from the home support service. Home Support Service The Home Support Services supports up to 3,000 people at home in any one day (over 5,500 people over the year), providing over 22.5k hours of support each week. 74% of home support service is provided by in house services, the remainder provided by the independent sector. However, maintaining responsive, high-quality support at home for those who require this has presented as substantial challenge over the past year due to significant workforce and demand pressures within the sector, a pattern which has been common across the country. An underlying increase in the level of need and national and local drive to relieve pressure on acute health services are significant factors and within home support resource has been drawn to the high level of referrals from hospitals impacting also on the responsiveness to emerging need within the community, As reflected above the HSCP have continued to focus on early intervention and prevention and the delivery of person-centred care through self- directed support with the introduction of the HAT team, described above, designed to improve the experience and outcomes for individuals, in particular on their pathway from hospital, as well as improving allocation of home support resource to those who need ongoing support. As noted in previous CSWO reports immediately prior to the pandemic plans were put in place for a redesign of the service with the centralisation management and support functions and new roles to maximise the capacity and quality of the service, to embed reablement and to support a move away from a time and task model to more personalised self-directed support for those with more stable longer-term needs. The pandemic, wider demand and system changes have required these plans to be adapted. There has since been considerable work to implement a new structure within Home Support Service to ensure that assessment and planning through reablement is re-introduced and that the Page 40 of 193
Page 41
32 wider options for independent living can be developed. A Home Support Redesign programme has been established to progress the implementation to improve pathways and service user experience, and address workforce challenges to maximise capacity and responsiveness. Additional resource has been invested in the service supported through partnership and new Scottish Government funding, with additional management and administrative support put in place, alongside the additional recruitment of 140 frontline home support workers based in Home Assessment Team and Home Support Service. The service now employs approximately 950 FTE Home Support Workers. A reassessment of the implementation to inform further redesign is taking place to allow the service to reflect and review changes to meet current and new priorities. This includes our Out of Hours Service to address call waiting times for both staff and service users. To ensure the delivery of a safe and high-quality service to support positive outcomes, consultation with staff, service users and their carers and stakeholders will inform the continued redesign of the service. The key areas that will be addressed to include; 1. Recruitment and retention of Home Support Workers, administration and Management 2. Training, to ensure staff are competent and confident across all aspects of Home Support provision 3. Roles: evaluating the hard-to-recruit posts 4. Quality of care and support being providd 5. Efficiency/ scheduling 6. Increased demand needs to be managed through efficient pathways Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. In addition to Home Support Worker roles, Support Officer and Service Delivery Coordinators are difficult to recruit and retain. These new roles were introduced just prior to the pandemic, and it was not possible to establish them fully due to changes in working arrangements and the difficulties of delivering training during this period, contributing to staff feedback suggesting the posts are too challenging. The tasks and skill sets required for a number of posts, including administration and management roles which are critical to supporting our staff will therefore be reviewed as part of our planned work. In the interim the rolling recruitment of Home Support Workers continues in order to meet demand, with plans now in place to ensure all learning and development requirements are informed by a fully inclusive development plan and robust curriculum to support key priorities. A further key element of the planned redesign of Home Support was the development and implementation of a dynamic scheduling tool both to benefit home support workforce in the field and for those who schedule and plan work. Initial development work has been undertaken but identified a number of design complexities however this will be taken forward as a priority given its criticality to service efficiency and improvement. In response to the challenges outlined the service has been working closely with colleagues from the Care Inspectorate, both strategically in relation to service improvement as well as operationally at local level. Page 41 of 193
Page 42
33 Promoting choice through Self-Directed Support Transformational SDS Agenda Our transformational SDS agenda has an emphasis on building greater community capacity to support earlier preventative approaches and proactive planning alongside the continued use of individual budgets for those with substantial and ongoing need. Two new temporary Service Manager posts have been created to further develop and shape our strategy around Self Directed Support across the Partnership supported by two resource worker posts. These posts are part funded through Scottish Government monies to enhance SDS. Key priorities include enhancing partnership working across the spectrum of community solutions, universal services, third and voluntary sectors and statutory sector, linking also with the Tec team on assistive technology so that people can be supported at home as independently as possible, for as long as is appropriate, whilst minimising risk and reducing reliance on statutory services. SDS Budgets The number of people receiving an individual budget within the 21/22 year was 1520. The graph below shows the number of individual budgets per locality. This numbers reflect all people receiving funding via an SDS budget across children, adults, and carers. There are currently 148 individuals who have an individual budget to provide 24-hour support. Part of the transformational work going forward will be around robust reviews of these support arrangements considering the potential use of technology enabled care solutions where these are appropriate to support better lives and increased independence. Page 42 of 193
Page 43
34 In the year 21/22 year we had a total of 317 Direct Payments (Option 1) and as with SDS budgets overall these figures include all children, adults and carers. To support the increase in people choosing a Direct Payment arrangement, and the anticipated need going forward a new DP support service was specified and procured. As of October 2021, Take Control North Lanarkshire commenced work in North Lanarkshire replacing SPAEN. Take Control NL are part of the well-established user led organisation Glasgow Centre for Inclusive Living (GCIL). GCIL have a track record of effectively meeting the needs of people wishing to employ their own support staff using a DP. 23 21 18 39 17 30 0 5 10 15 20 25 30 35 40 45 Individuals receiving 24/7 Support per Locality Page 43 of 193
Page 44
35 Community Living Change Fund/Coming Home Report In line with Scottish Government recommendations made within the Coming Home Implementation Report, and more recently the allocation to North Lanarkshire Health and Social Care Partnership of £1,298,332 from the Community Living Change fund, over a three-year period (2021-2024), a programme of work is being undertaken to support the strategic objectives of: • Reducing delayed discharges of people with complex needs. • Repatriating those people inappropriately placed outside of Scotland. • Redesigning the way services are provided for people with complex needs. This initiative will build on the work already well established in North Lanarkshire and evidenced through our balance of care data. A significant amount of work has been undertaken to ensure people are supported at home in their local community. North Lanarkshire has the highest proportion of people aged 18 and over with long term needs who receive personal care at home in mainland Scotland and has the lowest placement rate for all adults aged over 18 in Scotland, which is over 30% lower than the Scottish average The addition investment will provide an opportunity to review the current situation post- pandemic and compliment the national work being undertaken to develop a dynamic discharge register. A multi-agency team lead by Health and Social Care Partnership was proposed to be established and will identify individuals with Complex Care Needs who are out of area or whose discharge is delayed and review and develop protocols to address this. This will include robust planning arrangements across a widen number of agencies to reduce the length of time people need to wait to be discharged. A key outcome is to establish a new register of individuals affected and the introduction of an appropriate assessment tool which will facilitate review of all cases. From this individual outcome plans will be developed to assist each person back home addressing and resolving the key obstacles faced such as housing, funding, care equipment etc. For those individuals identified as being repatriated and following appropriate assessment including risk assessments, planning will facilitate appropriate interventions to ensure individuals can come home safely. Additional protocols will be developed to support interactions with other authorities which may be involved in such areas. Statutory Interventions Mental Health Officers Service and Adults with Incapacity Act (Scotland) 2000 Mental Health Officers (MHO) are social workers with a minimum of two years post qualifying experience who have gained Mental Health Officer Award (MHO award) which is a postgraduate certificate at SCQF level 11. Statutory duties for MHO’s are set out in the Adults with Incapacity (Scotland) Act, 2000; the Mental Health (Care and Treatment) (Scotland) Act, 2003 [MHCTA]; the Criminal Justice (Scotland) Act, 1995; Criminal Justice (Scotland) Act 2016 and the Adult Support and Protection (Scotland) Act, 2007. The implications of emergent court judgements emphasising the significance of both the Page 44 of 193
Page 45
36 European Convention of Human Rights and the United Nations Convention on the Rights of Persons with Disabilities in statutory decision making, combine to place heavy demands on the current resource. Additionally, new duties for mental health officers were introduced in the implementation of the Mental Health (Scotland) Act, 2015. The Chief Social Work Officer holds overall statutory responsibility for the governance and the management of welfare guardianship orders that have been granted to the local authority, and for overseeing the supervision of private guardians in their role and function as welfare guardians. The day-to-day management of these statutory responsibilities are delegated to Mental Health Officers and Social Workers and overseen by managers within adult social work. Adults with Incapacity Act (Scotland) 2000 The above chart shows the monthly running total of private and local authority welfare/financial guardianship orders held for individuals in North Lanarkshire over the period April 2021 until March 2022. The total number of guardianship orders in place in the North Lanarkshire Council area at the end of March 2022 was 986. This is a 1.6 % decrease from the period 2020-21. On 31 March 2022, the number of individuals on a guardianship order in Scotland overall was 17,101. The North Lanarkshire total figure constitutes 5.8 % of the national total. The local authority has a statutory responsibility to provide supervision and support to all Private Guardians and undertake reviews of how the powers are being used on a regular basis, unless it is formally agreed that this is not required. In relation to local authority welfare guardianship powers, these are also reviewed regularly either by a Designated Mental Health Officer or Social Worker. Page 45 of 193
Page 46
37 Within North Lanarkshire Council there are several private residential and nursing care homes which offer accommodation for adults with complex care requirements. Local Authorities, from across Scotland, place Adults in these establishments. number of these Adults require the use of Mental Health, Adults with Incapacity and/or Adult Support and Protection legislation to ensure lawful decision making and protection of human rights. The statutory responsibility for undertaking statutory duties as relevant to individual residents is carried out by North Lanarkshire Council staff. During this period, as noted in section 2.5 below two Large Scale Investigations were undertaken under Adult Protection processes with respect to this type of establishment. The co-ordination of these investigations and associated statutory activity, in liaison with home local authorities, to ensure individuals rights were safeguarded and needs appropriately supported placed substantial additional demands on North Lanarkshire MHO and social work resources. Over the period April 2021 to March 2022, 135 requests were received for Mental Health Officer reports to accompany new guardianship applications. In comparison with the previous year this shows a 5.5 Increase. Of these applications 77 were for renewals of welfare guardianship orders, which is a 157 % Increase in renewal applications since the previous year. It should be noted that the ‘stop the clock’ put in force by the Coronavirus (Scotland) Act 2020 ended on 30th September 2021, therefore the increase in renewals this year would be expected as a direct consequence of demand effectively being held over from the previous year. Page 46 of 193
Page 47
38 Younger Adults with intellectual disabilities and/or neurodevelopmental causes and older Adults with cognitive impairment remain the main categories of diagnosis in respect of guardianship applications granted between April 2021 and March 2022. Mental Health (Care and Treatment) Act 2003 and Mental Health (Scotland Act 2015 Statutory interventions to safeguard and support individuals through mental health legislation is noted in the table below. National trends for civil detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 have continued to rise. In North Lanarkshire there has been a reduction in the number of Emergency Detention Certificates (down 10%) and Short-Term Detention Certificates (7.9%), whilst the number of Compulsory Treatment Orders has increased (22%) since the previous year. The total number of supervised Forensic orders continues to increase in North Lanarkshire Council. We continue to maintain a higher than the national average rate of consent to Emergency Detention Certificates. This year, MHO’s have however refused consent to 38 Short Term Detentions, which is 25 more than the previous year. Quality Assurance, Continuous Improvement and involving Lived Experience North Lanarkshire Council recognise that, MHO involvement in the social work and care management role of adults with complex needs in relation to decision making capacity and/or experience severe and enduring mental health difficulties, can offers much better outcomes for individuals as a result of the knowledge and skill base MHOs retain whilst ensuing human rights are central to intervention. Page 47 of 193
Page 48
39 Our plan is to promote quality assurance by gathering feedback from people with lived experience who are involved in the service, in addition to continuing to work collaboratively with partnership colleagues and other stakeholders. We are developing our links with Integrated Addiction Services in recognition that many individuals we work with experience mental health and addiction issues which require a whole systems approach. We are also introducing self-evaluation and auditing processes for statutory MHO reports and have undertaken a trauma informed walk through of the service to ensure best practice and continuous improvement. Service Recovery As discussed in last year’s report, the impact of the pandemic, required rapid development of remote working and centralising processes across the MHO service. Whilst there has been a return to face-to-face assessments, meetings and MHO forums we have also continued to benefit from the flexibility remote ways of working can offer service users and staff alike with MS TEAMS and ‘Near Me’ service. The centralisation of key functions has created many benefits to managing pressures across the service in relation to staffing, workload and sharing knowledge and experience. A centralised priority allocation process is now in place as a way of addressing the pressures across the service. Appropriate Adults Services In January 2020, Appropriate Adults (AA) Services across Scotland became a statutory function via part implementation of the Criminal Justice (Scotland) Act 2016. This now means that a statutory duty is placed upon Police Scotland to request an Appropriate Adult, while the Council have a statutory duty to provide Appropriate Adult Services, and the training of AA’s. The Care Inspectorate have the duty to assess the quality of AA Services. During 2021-22, national developments have continued to take place to assist with the ongoing implementation of the national statutory framework e.g. Scottish Government AA Oversight Group, national training group, and the requirement to complete a service-based questionnaire on North Lanarkshire AA Services, for the Care Inspectorate. The Council is currently working in partnership with the Care Inspectorate and other partners to design a self-evaluation model for ongoing quality assurance purposes for AA Services. Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with 12 employees trained to perform AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In line with statutory guidance produced by Scottish Government, work is underway to develop a local Appropriate Adult Oversight Group. This multi-agency group will have responsibilities for policy and practice development in this area eg. recruitment, training, confidentiality, health and safety and service complaints. Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year, in line with other local authority areas who have also experienced reductions in referral rates. This is being monitored by a National Oversight Group, Scottish Appropriate Adult Page 48 of 193
Page 49
40 Network and Police Scotland. While there was a decrease, there were increases in the number of times AA’s are being asked to attend police stations (for the same offence) and are spending an increased amount of time supporting vulnerable adults whilst there. As Council employees perform the AA role in addition to professional social work roles, this continues to contribute to resource pressures however an Appropriate Adult Development Officer post has been agreed and funded through new monies following statutory implementation and it is hoped to recruit to this shortly. 2.5 Public Protection Whilst all public protection activity is undertaken in partnership, the social work service has a lead role and associated statutory responsibilities, particularly with respect to adult and child protection and the management of high-risk offenders. The information below provides an overview and analysis of that activity. Child Protection The number of children whose names were placed on the child protection register decreased by 20% from 2020 to 2021, consistent with an emerging national trend during the initial period of the pandemic. Historically, proportionately fewer children’s names have been placed on the children protection register in North Lanarkshire than the Scottish average and this remains the case, although the gap is narrowing as illustrated below. Despite this decrease, 2021/22 saw a continuing trend of increased child protection activity overall. The table below illustrates an increase of 66% in child protection referrals over the past 5 years but proportionality fewer children (a 33% decrease) being referred to a Child Protection Case Conference. This indicates that more children were referred into the child protection system than was perhaps necessary. The development in North Lanarkshire of planning for the wellbeing of children through our Empowering Clusters, is designed, in part, to address this, with local supports and services in place to respond to need at an early stage. These trends will be monitored. Page 49 of 193
Page 50
41 Year Number of Child Protection Referrals Number of referrals that proceeded to Case Conference Percentage of Investigations Proceeding to Case Conference Percentage of Conferences resulting in Registration 2021/22 1714 229 30% 73% 2020/21 1482 261 31% 76% 2019/20 1617 339 42% 74% 2018/19 1150 329 51% 76% 2017/18 1030 340 49% 74% Adult Support and Protection During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. Police Scotland remain one of the highest referring agencies, submitting 16% (380) of all ASP referrals received; this is a 39% decrease from last year (from 598 to 380). In addition to the 380 ASP referrals made by Police Scotland, there were a total of 4,004 Police ‘Adult Concern’ Reports received. Since the same reporting period last year there has been a 13% increase in police ‘Adult Concern’ reports (from 3,552 to 4,004). This is the third year running when significant increases have occurred; this work continues to generate significant resource pressures. For the fourth year running, there was an increase in the number of referrals received from NHS L personnel (from 426 to 473, up 11%). Referrals from Social Work Services staff decreased by 10% (from 411 to 371). For this period, ASP referrals from Care Homes demonstrated a 9% increase (from 416 to 455). Information from inquiry and Investigation processes suggest possible causes of this include, the increasing complexity of people placed in care homes, many of whom have significant levels of cognitive impairment and/or dementia, and behaviour which requires intensive support. Monitoring and support in this area is provided by colleagues in Quality Assurance and, in line with the increased focus on Care Homes during the pandemic this area of activity has also been monitored through regular review of ASP referrals for care homes and multi- professional Care Home Oversight arrangements. Adults with mental health issues were represented in 35% (858) of the total ASP referrals received, being the main primary user group referred. Referrals for this group have decreased since the same time last year but remain high in overall percentage terms (from 939 to 858). This only reinforces the importance of key service developments such as Distress Brief Intervention (DBI) and social work investment in delivering ASP training for those organisations who deliver services at home to our most vulnerable service users. Page 50 of 193
Page 51
42 ASP Investigations /Case Conferences and Statutory Orders/Functions During 2021-22 there were 434 ASP Investigations carried out, a 18% conversion rate from inquiry to investigation and a 16% increase from the previous year. There were 111 ASP Initial Case Conferences held; this measures a 29% decrease from last year. Anecdotal information from localities suggest that some cases have moved from investigation to case conference sooner in the process. For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire also sought and implemented thirteen ASP Protection orders, broken down as; six Removal Orders, three Banning Orders and four temporary Banning Orders, all with power of arrest. During the period from April 2021 to March 2022, two Large Scale Investigations (LSI) under Adult Support and Protection (Scotland) Act 2007 (ASPA) were carried out at care homes. Both investigations highlighted a lack of legal safeguarding for many adults in relation to welfare and financial decision-making with necessary actions progressed to address this in conjunction with the Care Inspectorate, placing authorities, providers, individuals and families. The nature of these investigations required dedicated staff teams to be set up for a period to progress this and whilst this was critical in ensuring the effectiveness of investigations and supporting actions, this did have an impact on staff resource for other activity. MAPPA (Multi-Agency Public Protection Arrangements) In addition to their in public protection though the management of offenders, as described in 2.2 above, justice social work services have a key role in respect to MAPPA arrangements as lead agency for offenders subject to statutory supervision. As such the service works closely with the council’s housing service and other responsible authorities including, Police Scotland, NHS and the Scottish Prison Service to assess and manage the risk posed by sexual, violent and other risk of serious harm offenders. As noted in 1.4 above whilst activity is operationally managed within relevant agencies. multi-agency oversight and co-ordination is supported by a small pan-Lanarkshire team and Strategic Oversight Group (SOG). An annual MAPPA report provides information on the ongoing local implementation of MAPPA arrangements, key priorities and activity statistics: MAPPA Annual Report 2022 | North Lanarkshire Council Of the 699 individuals in custody or in the community in Lanarkshire subject to MAPPA as of 31/3/22, 56% (394) were the responsibility of North Lanarkshire authorities. Overall, the number of individuals managed under MAPPA have grown significantly since arrangements were established 15 years ago however this increase has slowed in recent years. In both North Lanarkshire and pan-Lanarkshire there was again a small increase between 20/21 and 21/22 however as in other areas of the justice system it difficult to clearly separate underlying trends from the impact of the pandemic on the justice system. MAPPA related activity is however a key aspect of justice social work workloads. Whilst the statutory activity above is categorised in distinct strands there is a clear interface across the different areas of public protection requiring joint-working across both social work Page 51 of 193
Page 52
43 care groups and partnership arrangements. There is for example an increasing number of older individuals and those with substantial care needs who are managed under MAPPA requiring close working between adult and justice services and there is also a strong interface with child protection whilst domestic abuse and violence against women may also link strongly to wider public protection processes. All social work staff are therefore expected and trained to have core knowledge of of the range protection procedures and responsibilities. Statutory public protection interventions and processes are also part of a wider continuum of safeguarding and community safety activity in which social workers are involved, some of which are reflected in earlier sections of this report. Additional examples of key priority areas for social work and partners where practice is evolving and innovating to strengthen the protection and wellbeing of our communities are set out below: Contextual Safeguarding and Missing Young People Contextual Safeguarding is an approach to protecting young people who are at risk of extra familial abuse (harm outside of the home), such as criminal or sexual abuse or violence within peer groups. North Lanarkshire is one of the first local authorities in Scotland to adopt this approach and a multiagency steering group was established in 2021 and an audit of practice comprising a review of processes and consultation with staff was completed. In addition, the Promise Development Team with the support of Who Cares Scotland provision in North Lanarkshire, held consultations and engagement with young people in relation to their experience of service responses to risk of harm outside the family. To ensure interventions and resources are put in place to reduce risks in contexts, a Young Person’s Safeguarding Panel was established in November 2021. It has representation from across council services (CLD, education, community safety, housing) as well as from partners to ensure a holistic response. The panel considers young people at significant risk of harm outside the home and is co-chaired by Police Scotland and Social Work and with each panel there has been a complex mix of risks. Risks are discussed alongside strengths, and there is a clear focus on the young person/people’s wellbeing. The panel adds value to case planning with young people by agreeing actions to address risks in locations or contexts for young people. There continued to be a weekly Missing Persons’ meeting that discussed all young people who were reported to the Police as being missing from the community or a residential home. The missing person meeting notes any risks to the child or young person when they were missing for further action and support and monitors the outcome of this. A comparison of those young people reported as missing in 2021/22 with the previous year shows a decrease in the number of total missing episodes (603 as opposed to 663) but an increase in the number of individual young people reported as missing (287 as opposed to 185). As a result of ongoing work with children’s house staff in their approach to nurturing and supporting young people, there was a significant reduction in young people reported missing from North Lanarkshire’s children’s houses as illustrated below. In 2020/21 nearly half the missing episodes related to care experienced young people missing from children’s houses whereas this reduced to a quarter in 2021/22. However, it also reflects an increase in young people missing from their own families, 65% of whom were not known to the social work service at the point of being reported missing. Page 52 of 193
Page 53
44 20/21 21/22 All young people reported as missing continued to be offered a Return Discussion from a contracted service through Barnardo’s Scotland. This enabled young people to raise any issue that may be affecting them with an independent person rather than a parent, police officer, teacher or social worker. This led to a number of young people being referred onto additional supports and the disclosure of harm that would not necessarily have occurred if this independent service had not been available. All young people reported as missing continued to be offered a Return Discussion from a contracted service through Barnardo’s Scotland. This enabled young people to raise any issue that may be affecting them with an independent person rather than a parent, police officer, teacher or social worker. This led to a number of young people being referred onto additional supports and the disclosure of harm that would not necessarily have occurred if this independent service had not been available. Suicide Prevention The Suicide Prevention Partnership Group is a collective of multi-agency staff which aims to collaborate in the promotion of the national and local suicide prevention strategies. This takes place via a range of activities including awareness raising and training across services and local communities. The process of gathering data on suicide locally has developed since the winter of 2019. More comprehensive information is now available from Police Scotland; which includes more contextual information about the deceased person’s life, employment and relationships. This information support the targeting of prevention activity. As noted in the table below from 2018 until 31st December 2021, North Lanarkshire has lost 171 people to completed suicides. There continues to be an increase in deaths of younger people under the age of 39: these have mostly been young males. Suicide rates did not significantly vary throughout the lockdown period (2020/2021) however as we continue to recover from the emotional and fiscal effects of the pandemic there is a Page 53 of 193
Page 54
45 concern that the cost-of-living crisis may impact an increasing number of individuals mental health and wellbeing with an associated risk of a rise in suicide rates. In this context continuing to review and enhance the local action plan is clearly essential (taken from National Records of Scotland suicide data for North Lanarkshire on an annual basis from 2018 until 2021) YEAR Completed number of suicides in NLC 2018 58 2019 57 2020 62 2021 52 Up to 31 March 2022 13 The local action plan delivered by the Suicide Prevention Partnership Group is framed around the following aims: 1. Reducing the risk of suicide in high-risk groups. 2. Tailoring approaches to improve mental and physical health in specific groups. 3. Reducing access to means of suicide, including identified Locations of Concern 4. Learning from investigations and reviews into unexpected deaths. 5. Providing better information and support to those bereaved or affected by suicide. 6. Supporting research, data collection and monitoring. 7. Building community capacity to help reduce the stigma and taboo associated with suicide. There is extensive peer support available across the authority with suicide awareness and prevention training being delivered across health, education, third sector and voluntary organisations. The partnership now embedded participation, initially as a pilot area in rolling out Distress Brief Intervention is also supportive of this work. A Senior Officer Adult Service Leads on the Suicide Prevention work. A proposal is being progressed to recruit a Suicide review Officer pan Lanarkshire, initially on a temporary basis, to continue to take forward this important work. Drug Related Deaths 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. Page 54 of 193
Page 55
46 Measures associated with targeting drug related deaths locally and nationally have been implemented via MAT Standards, Drug related Death task force workstreams and ADP funded projects. 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. 3. RESOURCES For financial year 2021/22 North Lanarkshire Council had gross annual social work budget, inclusive of Covid & winter planning funding, in excess of £266m. This was allocated as £220m for Adult Social Care and £46m for Children, Families & Justice. The equivalent funding for the previous financial year was £252m. The ongoing impact of Covid-19 resulted in spend in excess of £8M which included the costs of PPE, the provision of additional home support hours and partner sustainability payments. This expenditure was fully funded by the Scottish Government. New recurring investment of £300m was announced by the Scottish Government at the end of 2021 to protect health and social care services over the winter period and to provide longer term improvement in service capacity across health and social care systems. North Lanarkshire’s share of this funding was £6.4m and a full business case was approved on how Page 55 of 193
Page 56
47 this would be utilised over the forthcoming 12-month period: https://mars.northlanarkshire.gov.uk/egenda/images/att97950.pdf There are however ongoing difficulties across the sector in recruiting for the required posts delaying spend against these funds. In aggregate Social Work had a savings target of £1.768M, 78% of which was achieved during the year. Plans are in place to fully achieve the savings in future years. Whilst the totality of Social Work activity during 2021/22 was undertaken within the overall budget resource and resulted in an underspend position this outturn underspend is projected to be on a non-recurring basis and therefore financial pressures are expected in specific areas as follows: - a. Home Support b. Independent Care Homes c. Self-Directed Services d. Integrated Equipment and Adaptation Service e. Family Placements f. Children’s Houses The underspend in Children’s Services Social Work was mainly due to savings in employee costs, which were largely as a result of recruitment issues and savings in external payments both to individuals and external agencies. There remain however significant ongoing cost pressures particularly in relation to placements costs which were alleviated by temporary additional funding allocated by the council which ended in 2021/22. Pressures relate primarily to growth in placements and costs within kinship care and external fostering. There are also ongoing cost pressures in relation to the management of internal Children’s Houses and the rise in costs for external residential placements, although as noted previously there has been a reduction in the use of external residential resource over recent years. Previous pressures with respect to continuing care costs have been mitigated by the additional recurring local investment in this area of service. Within the Justice budget the Scottish Government allocated additional funds to all 32 authorities to support the Justice recovery from the pandemic. North Lanarkshire received £0.943m of which £0.164m was earmarked specifically for the Third Sector. NLC were able to utilise £0.632 in year which included the full utilisation of the Third Sector monies. The main obstacle to fully spending the additional funds was in relation to recruiting to temporary posts. This was exacerbated by the relatively late confirmation of this funding which meant an automatic lag in recruitment as a direct consequence. In view of demand pressures and the criticality of frontline social work provision to both the delivery of statutory responsibilities and wider national and local policy ambitions the council and HSCP have taken no savings from main grade social worker posts over this period or recent years however wider savings have impacted within the service and the overall financial climate clearly remains challenging. Page 56 of 193
Page 57
48 Additional national funding for adult health and social care, of which local spend is reflected in the business case link above, has supported address some pressure points in Adult Services, however as noted elsewhere in this report recruitment challenges remain. Further recurring national investment in Adult Social Work from 2022/23, equating to 1.278m for North Lanarkshire announced in early 2022 is also welcome. Additional funding for Justice Social Work Services to support address the pandemic related backlog in demand will also continue into 2022/23 however the position beyond this is unclear. In contrast there has been no earmarked national investment in Children’s Social Work Services beyond the short- term winter support plan monies allocated at the end of 2020 with the impact that a number of the developments reflected in section 2.3 above have been supported by a range of short-term or non-recurring partnership funding and are therefore vulnerable to any changes within this. Financial Modelling for Service Delivery Financial Planning and monitoring continue to be a key responsibility for the management team. The Council’s financial strategy includes Service input to four key processes. These are: a. Preparation of detailed single year budget b. In–year budget monitoring and projections c. Preparation of rolling 3-year budgets d. Preparation of a Medium-Term Financial Plan Alongside these the Council Finance Team work closely with the IJB Chief Finance Officer to prepare a medium-term financial plan for the Health and Social Care Partnership. In terms of financial modelling the Management Team increasingly take a whole systems approach to delivering new and more efficient operating models which often requires joint working with other Council services and key external partners. The Management Team have also had to undertake significant work to prepare projections, plans and models which estimate the operational and cost impact of Covid on service delivery. This information is shared with officers in the Council, IJB key external partners and with the Scottish Government. In addition to the wider financial modelling described above work has also been undertaken to support the business plan for Adult Health and Social Care. With respect to Children’s Services the council and local partnership is one of three areas who have committed to working with the Promise team nationally on ‘Human and Economic Cost Modelling’, work which is intended to support longer term change both nationally and locally by identifying how money is currently spent and the system changes required to move the balance of spend toward early intervention and family support in line with the aspirations of Christie. Page 57 of 193
Page 58
49 4. WORKFORCE 4.1 Workforce Planning Workforce planning within social work is integrated thought the social workforce group but informed by the Council’s corporate ‘Workforce for the Future Strategy’, https://mars.northlanarkshire.gov.uk/egenda/images/att96241.pdf which was updated and approved in June 2021 and interfaces also with the wider HSCP workplan. As reflected in other parts of this report the direct and indirect impacts of the pandemic and cost of living crisis along with underlying demand pressures have significantly impacted on the ask of the social work workforce over this period. Changes in the labour market as the country moves into the recovery phase have also impacted on recruitment and retention of staff and have together exposed some of the underlying vulnerabilities with respect to the capacity, valuing and development of the social work and social care workforce. North Lanarkshire is not immune to these challenges and whilst many of these also require action at national level, there is substantial work ongoing locally to address key issues and support workforce resilience. Social Worker Recruitment and Retention The service has previously adopted a mixed model with respect to social worker recruitment bur in response to financial constraints the services’ internal social worker trainee programme was paused in 2018/19 and since this time social worker recruitment has been predominantly external. Whilst staff turnover in many areas was supressed during the initial stages of the pandemic this has increased over the last 18 months. This is in part due to more internal movement to promoted, developmental and specialist posts within all care groups, including those created through service redesign and temporary funding streams, with such opportunities also supporting positive career pathways and staff retention. There has also been movement across care groups due to the creation of additional posts in justice and adult services with some ‘churn’ emerging particularly in children and families alongside an emerging increase in movement to other local authorities, in particular Glasgow where pay rates for main grade social work staff are higher. This is in a context of national recruitment challenges for social work with no overarching-system of bursaries/employment whilst training as well as increased demand for staff and the disruptive impact of the pandemic on social worker qualifying training. Whilst North Lanarkshire continues to successfully recruit including attracting students who have has positive placement experiences with the authority, this has also impacted on experience levels and stability at the frontline, for example in Children, Families and Justice alone 36 external appointments were made to the role of social worker over this period, 29 of whom were newly qualified. Whilst these staff bring skills, creativity and commitment to the service, the impact of the pandemic on pre-qualifying opportunities has impacted on learning needs and the changing balance between newly qualified and more experienced workers, alongside an increasing complexity in the demand profile, has created clear pressures with respect to the allocation of work within localities with a requirement to provide more support across teams. Page 58 of 193
Page 59
50 Frontline managers continue to monitor caseloads and assist their workers in the prioritisation of their statutory responsibilities. In Justice Social Work a revised structure has allowed for a more flexible approach to the deployment of staff across the authority to support the teams who are dealing with the most urgent and pressing demands and authority wide teams continue to support localities across all care groups. Whilst not favoured as a core element of our ongoing workforce strategy, where necessary limited use of agency social workers has also been employed under the auspices of Covid-19 recovery monies in Adult and Justice services. There is a productive partnership approach between the service and our HR colleagues in terms of ongoing recruitment strategies. Advertising frequency and dates have been reviewed to streamline the process and quicken the employee onboarding experience to and the service also maximises opportunities to recruit on a permanent basis (temp location) against temporary vacancies on the basis that normal levels of turnover mitigate any associated. financial risk. As outlined in 4.2 below, a commitment to capacity to support Practice Learning, the new Supported Year in Practice and to both Continuous Professional Development and Health and Wellbeing Support are all critical to longer-term recruitment and retention strategies but in the current context and it is likely that supporting actions will need to continue to be updated and reviewed. Our Senior Practitioner Scheme continues to contribute to retention and the building of a skilled workforce. It allows social workers and occupational therapists to progress to an enhanced salary scale on completion of relevant post qualifying training and commitment to undertake additional responsibilities and remains a key component of our model, with over 60 practitioners within the service carrying the status alongside tailored work plans identifying their additional contribution to the service. The Senior Practitioner qualification has been extended to include the Diploma in Autism and the National Joint Investigative Programme Training and new social workers who meet the criteria have immediate access to temporary Senior Practitioner status, pending a process to confirm status. Our strong commitment to the provision of Practice Learning as part of Learning Network West has been maintained and despite some of the challenges involved in providing quality learning experiences in the context of hybrid working, we have by the end of 2021/22 been able to restore placement provision to pre-pandemic levels. The service has benefitted significantly from the input of the students and as noted above this also supports recruitment. Following a ‘test of change’ in autumn 2021 provision of opportunities through traditional dispersed placements has been supplemented by the development of two student hubs base in the north and south of the authority. Each hub has the capacity to support around 9 students with a co-located practice teacher and with all placement opportunities overseen by a dedicated Senior Officer in our Training and Organisational Development team. Our experience to date suggests this model is highly valued by students whilst also providing flexibility of deployment to support service needs. Page 59 of 193
Page 60
51 Recruitment and retention of Mental Health Officers North Lanarkshire Council remain committed to training social workers to become MHO’s and since 2018 have successfully supported nine individuals through their MHO award. An MHO Traineeship Scheme was introduced during the pandemic, ensuring the MHO Trainees are located within the MHO Service during the course. We received positive feedback from the Trainees that being based within the service, provided quality learning and practice opportunities, despite a significant reduction in face-to-face contact with colleagues and service users. The scheme will continue, and a self-evaluation process is currently being undertaken. Colleagues across Education and Families and Social Work Emergency Services have shown an interest in being considered for the Award. Mental Health Officer forums continue every 6 weeks, offering discussion on practice issues, case studies, national reports/guidance and providing feedback to Scottish Mental Health Law Review. North Lanarkshire continue to offer MHO’s the opportunity to obtain, and maintain, Senior Practitioner status and to share their knowledge and experience with MHO and social work colleagues in relation to various aspects of AWI and MH legislation as well as Self Directed Support. We recognise the breadth of knowledge, experience, and skill across the MHO service and plan to restart consultation sessions regarding human rights, AWI and MH Act as well as establishing MHO champions who have areas of practice interest, in relation to neurodiversity, forensic work, and complex trauma. Remote external training and development opportunities continue to be available to MHO’s, for example via the Scottish Forensic Network, Mental Welfare Commission and MHO community of practice (SASW). Despite these measures in common with other local authorities, North Lanarkshire continues to be under-resourced in this area and this poses a considerable challenge for responding to statutory duties and timelines. Recruitment, retention and succession planning for MHOs are high level priorities and are under constant review. The service has recently been augmented by three newly qualified Mental Health Officers and an experienced MHO from another social work team. We also continue to have a core group of sessional MHOs who are involved in supporting AWI processes to support adults assessed as lacking capacity for making decisions with respect to hospital discharge processes this is proven to be beneficial and will continue to be funded. Grant aided funding from the Scottish Government to support Mental Health Officer training, is supporting the recruitment of a stand-alone Practice Assessor with we anticipate the post be filled by September 2022. We are also in the process of recruiting social worker posts to be based in the Mental Health Officer Service and an additional Mental Health Officer post for complex discharge planning is also currently under development. Page 60 of 193
Page 61
52 Social Care As reflected in Section 2.4 above there remain significant recruitment, retention and capacity challenges with respect to the home support workforce and whilst recruitment planning for the in-house service has always had to be balanced to avoid a simple transfer of capacity from the local independent sector the need to retain critical service delivery has necessitated an upscaling of recruitment to our in-house service over the last year. Challenges in recruitment and retention in this sector are not confined to the roles of home support workers providing direct care but also to management and support functions, as reflected earlier in this report, requiring further review of roles, the creation of additional posts and ongoing consideration of support arrangements to aid retention. Other areas in which there are recruitment challenges include locality support services and some roles within residential childcare, significant factors being wider labour market changes and comparative pay. In addition to wider strategic actions, service areas are themselves active in seeking solutions, for example, locality support services have continued to build links with education, encourage apprenticeship schemes and promote the idea to young people that a career in social care is rewarding and full of possibilities for promotion, further education and development. A group has been set up with a focus on promoting succession planning and preparedness of workers interested in promotion, staff development and the introduction of the principles of creating a working environment that is trauma informed Administration/Business Support Administrative and support staff within social work play an invaluable role in supporting service delivery and increasing challenges with respect to recruitment and retention in respect of key administrative and support roles have over the past year also impacted significantly on the service with high vacancy and turnover rates particularly in main grade roles with loss of staff to other services in the local authority, the health service and private sector an issue, again with comparative pay issues a significant factor. A wider review of administrative support across the wider education and families and social work service is planned with an ambition that a redesigned business support model will support efficiency and offer roles which both reflect the specific needs of the current service and which are more attractive and offer improved career pathways for staff. Care Academy A important vehicle to support workforce planning in social work and a key element of Workforce for the Future is the Health & Social Care Academy a much long-standing piece of work, with mature partnership model and based on a key joint venture with NHS Lanarkshire. Recently, existing work has been deepened by establishing 3 priority sub- groups focused on 1) the young workforce, with further development of the in school vocational offering for Health and Social Care; 2) adult recruitment and employability, with a focus on both short- and longer-term workforce demands in the sector, 3) building capacity and resilience by supporting wellbeing, training, and development across the existing workforce. A clear plan of action has been developed for each of the subgroups who will take forward this work in the next 6 to 12 months with regular reporting to the Workforce for the Future Steering Group. Work will also be taken forward in the next Page 61 of 193
Page 62
53 phase to develop a framework of outcome measures which can be used to track the overall progress of the programme and its impact. 4.2 Workforce Development and Staff Support There are a wide range of learning and development opportunities open to staff supported and planned both corporately and at service, team and individual levels with a focus on alignment to service and corporate ambitions and redesign but also on more specific team and individual development needs the latter through our PRD processes. Prior to the pandemic the council invested in LearnNL a cloud-based learning management system designed to support a more inclusive and accessible approach to learning whilst improving digital literacy, and this was a key support in sustaining training and development during the pandemic period during which more training was adapted for online delivery however as the year has progressed there have been some opportunities to re-stablish face- to-face team development, with the hope that wider opportunities will be available over the coming year. A summary of key activity over the period with respect to Learn NL, Assessment Centre and training activity to supporting registration and the social care workforce and Post-qualifying Awards is noted below: LearnNL Total number of activities undertaken on LearnNL including mandatory learning – 10,718 Leadership Development – 87 activities Fundamental Leadership – 2 Influential Leadership – 9 Assessment Centre and Registration The Assessment Centre continues to support SVQ, and PDA qualifications required to meet registration, role and CPD requirements. This is achieved through both in house assessment and access to SVQs through external providers. The North Lanarkshire Assessment Centre was subject to an external verification visit in August 2022. A number of activities were undertaken in this visit to ensure we continue to meet the requirements set out by SQA. All areas sampled in the visit were rated green (High Confidence) by the external verifier, an excellent achievement, sustaining high standards of delivery throughout challenging times. Awards completed (2021 – present) SCQF Level 6 (SVQ2) – 8 SCQF Level 7 (SVQ3) – 5 SCQF Level 9 (SVQ4) – 2 PDA Level 9 – 4 Page 62 of 193
Page 63
54 Active Candidates – External Programmes (2021 – present) New College Lanarkshire – 17 West Lothian College – 4 A tender has recently been issued for the provision of SVQ Level 2 in Social Services in Health Care which will provide up to 30 places over the next two years Active Candidates – Internal Programmes (2021 – present) SCQF Level 7 (SVQ3) – 4 SCQF Level 9 (SVQ4) – 5 PDA Leadership and Care (SCQF Level 9) – 3 Post Graduate Opportunities Advanced Practice skills – 1 completed 2022 Postgraduate in Child Welfare and Protection @ Stirling University – 4 started in 2021 and completed June 2022. A further 5 will commence September 2022 due to finish June 2023. Postgraduate in Adult Support and Protection – 2 Postgraduate in Contemporary Drug and Alcohol Studies – 2 Part funding of final year of PHD qualification – 1 Postgraduate in Management and Leadership – 1 Exploring the Theory and Practice of Psychological Trauma – 1 MSc In Leading People Centred Care – 1 Children in Conflict with the law – 2 places funded for 2022 with a further 4 places funded for 2023 Professional development award in practice learning (PDA PL) Four social workers qualified as practice teachers this year with a further two due to finish by December 2022. This is supported by a practice learning pathway for social workers to become link workers and practice teachers. Over the past 4 years we have promoted practice learning and successfully built a strong cohort of competent and confident link workers and currently have waiting list to become a practice teacher. Social Worker Training Whilst our secondee scheme is currently suspended as noted above we continue to have staff studying on their own time with the Open University which they self-fund. We have 6 support workers who are all at a stage they now only require to be sponsored by NLC for their 2 practice placements to qualify as social workers. We have committed to this funding and all 6 will start their first assessed placement February 2023 and will qualify September 2024. Newly Qualified Social Workers (NQSWs), Supported Year in Practice In view of the workforce profile describe in 4.1 above, the service has been delighted to receive funding support for a Practice Learning Officer as and early implementer of a supported year for NQSW’s. Knowing that North Lanarkshire Council (NLC) is a part of the Page 63 of 193
Page 64
55 early implementation has also been a key factor for NQSW applying for posts in the local authority. There are currently 21 NQSW who are registered with SSSC as part of the supported year with others sue to join this group shortly whilst 4 NQSW who were employed by NLC prior to the supported year starting are receiving support through Early Professional Development Programme, training and development opportunities being shared and 1:1 support as required. An initial face-to-face inductions day for NQSWs has taken place with others to be scheduled as further staff join backed with a 12-session programme to runover the year and engagement with line managers. The CSWO and Head of Adult Social Work met with NQSWs as part of their initial induction programme, and it is planned that further ‘touch in’ contact will take place in future induction days and later in the programme. Other key training and development: A broad range of other core training and development activity has continued including with respect to Public Protection using online and blended models. For example, ASP Council Officer Training (Day2) and investigative Interview Training (Day3) were reviewed and redesigned to support remote delivery and were delivered to 30 staff during April and May 2021. The Getting it Right in Child Protection blended course has run throughout the pandemic ensuring that multi-agency staff are knowledgeable and confident within child protection practice. A range of service specific and partnership training has supported key areas of organisational, service and practice development described elsewhere in this report in a number of instances using a ‘train the trainer’ model which is supporting the expansion in the use of the Outcome Star as a tool from justice services across education and families and plans to embed Safe and Together within Children’s Services Team based learning is also common across the service. One example being locality support services who developed an on-line platform using Yammer to share good practise and develop a quality assurance space insuring services across the six localities were learning from one another and providing quality services. Six weekly ‘best practice’ meetings have been established locally to recognise and celebrate good stories, meeting one of the needs expressed by workers in one of our feedback exercises. Trauma Informed Practice A key priority across the social work service is the embedding of trauma informed approaches across both organisational systems and service delivery and to ensure an appropriately skilled workforce in line with the National Trauma Training Plan. Trauma Informed Practice is already embedded in areas of training and service delivery, for example, as integral to the Scottish Child Interview Model which forms the basis for the pan- lanarkshire Joint Investigative Interviewing Team. One of our childcare teams was involved in the national piloting of social work specific training and trauma informed systems and practice are also integral to our work on contextual safeguarding and the subject of a research partnership with the Innovate national research project as well as to the work of Page 64 of 193
Page 65
56 the services’ health and wellbeing group. Senior Social Work Managers are Trauma Champions for the Council and HSCP respectively along with our Principal Educational Psychologist, developing the local steering group and associated plan. Lived Experience As reflected elsewhere in this report the service has benefited significantly from the increased involvement of those with lived experience in training and development activity and from the opportunities created for targeted employment of those with lived experience. Further work is planned to ensure appropriate pathways are available both to this type of role and others within the service and to ensure appropriate support is available for staff with respect to these roles and future career development. a number of Reflective Learning: The Scottish Child Abuse Inquiry/Historical Abuse Reflective learning remains central to continuous professional development and service quality within social work and social care whether through 1-1 supervision or sharing learning from case audits and reviews. One area of focus over the past year has been local learning from work undertaken with respect to the Scottish Abuse Inquiry which has also dovetailed with work around the Promise. Lead officers involved in supporting the inquiry have prepared presentations around key learning which have been delivered to the social work management team and to a range of children and families staff with further inputs planned to adult services and the child protection committee. This is also influencing service improvement in areas as diverse as the planned review of our foster care handbook and management of access to records requests. Support for Staff Wellbeing As reflected across this report demands on staff remain significant and whilst there has been huge resilience within the workforce the level of demand alongside a significant change agenda and the residual impacts of the pandemic are still impacting on the wellbeing of many staff. A range of specific supports have been made available but there is also increasingly within the service a clear need to focus on the support staff need within day-to-day practice and working arrangements to manage and thrive and this clearly links with work around a trauma informed organisation. 5.1 Looking Forward - Priorities for 2022/23 and beyond It is clear from the reflection on delivery of social work and social care contained in this report that the context is likely to remain both complex and challenging over the coming year as both the service and the communities we support continue to be impacted by the legacy of the pandemic and the increasingly significant cost of living crisis. There are clear indications in the demand on all areas of the social work service during 2021/22 of a significant increase in both the volume and complexity of need, which will not be simply transitional, but will carry forward into 2022/23 and beyond, and that challenges in other parts of the public sector, particularly with respect to acute health services, will also continue to impact hugely. Page 65 of 193
Page 66
57 In this context it is sometimes difficult to focus on the strong starting position within North Lanarkshire with respect to our balance of care and the embedding of integrated working across Health and Social Care, the Education and Families Service and the wider Council and Partnership. Whilst this position is likely to be tested by immediate demand pressures it is important that these do not draw focus from a whole system approach and the opportunities to further strengthen this, for example, through the embedding of the Empowering Cluster’s model within Education and Families and of the 3 Conversations Model in Adult Services. Equally, whilst income maximisation and tackling poverty actions have always been a feature of the delivery of social work and social care in North Lanarkshire, it will be more important than ever that these are both broader and fully integrated into day-to-day practice and service delivery given the challenges faced by those we support and the close association between poverty, health inequalities and statutory interventions across all social work care groups and the disproportionate experience of poverty also impacting on unpaid carers. Workforce pressures and issues in social work and social care will require serious and continued attention at both national and local level, both to reduce the risk to the delivery of key statutory responsibilities and the quality of care and support, and to ensure capacity for the continuous improvement and service redesign necessary to improve outcomes. Whilst digital developments will continue to be essential, and create opportunities for wider engagement, as reflected at the start of this report, the visibility of senior managers and opportunities for more informal engagement with staff have been compromised over the last two years and a range of visits and events are planned for early 22/23 which will also provide an important vehicle for staff to come together. A continued focus on working to build trauma informed systems and organisation as well as to strengthen practice in this area will also be fundamental to creating a healthy service which supports staff to deliver well for our communities In addition to the continued opportunities presented by digital and tech solutions within service redesign and improvement, it is anticipated that the conclusion of a tender for a new social work case management system will be completed early in 2022/23. Whilst the transition to this will be complex, take some time and require the support of a robust implementation plan, a new system will be a key support to staff as well as improving service user experience and the measurement of performance/impact. Equally important, for the home support service in particular, will be work to finally secure a strong dynamic scheduling system. External scrutiny, specifically with respect to public protection is likely to feature for the service in the coming year with some inspection programmes previously paused during the pandemic. An adult support and protection inspection is scheduled during the first part of the year and there is the possibility also of an inspection of services to children and young people at risk of harm in the relatively near future. Whilst welcome this will require to be factored into planning given the associated stretch on organisational resource requirements. Similarly, 2022/23 will be a year when significant work will be required around strategic needs assessment and other preparatory work to support the the renewal of key statutory plans due in 2023 including the HSCP’s Strategic Commissioning Plan and Page 66 of 193
Page 67
58 the Children’s Services and Community Justice Plan whilst the Council will also refresh its Programme of Work. Undoubtedly the financial context for service delivery, as for the wider public sector, will also remain challenging and its impact is exacerbated by the growth in demand across all social work care groups. Whilst, as reflected in the resources section of this report, there is considerable focus on financial planning, there remain specific challenges around the short- term nature of additional funding specifically in justice and children’s services and in realising a route to support the aspiration to move a higher proportion of resource upstream. We will however continue to engage in work on this. The context for the delivery of social work services will also clearly continue to be impacted by key national policy drivers including the Promise, the yet to be finalised incorporation of UNRC into Scots Law, the Vision and Strategic Priorities for Justice, and perhaps most significantly by the planning and legislative process for the proposed National Care Service alongside a raft of additional national policy drivers and planned changes in guidance and legislation. Additionally wider and emerging demands on social work services include the now mandatory National Transfer Scheme for Unaccompanied Asylum-Seeking Children and, with the resettlement support needs arising from the tragic war in Ukraine. The overall the scale of change, some of it potentially significantly disruptive, alongside the demand and workforce pressures likely for social work will undoubtedly continue to challenge capacity and in moving forward there will be a need to maintain the benefits of local best practice and partnership working whilst progressing the system transformation required to address longstanding problems and to support better outcomes. Continued strong leadership will be required to avoid staff being overwhelmed and to balance immediate pressures with respect to core service delivery, and the associated risk to those we support, with the change and improvement capacity required for the scale of envisaged over the coming years. As noted in my report last year, and equally true a year on, ‘Social work has the potential to play a key role in shaping system transformation nationally and locally and in ensuring a focus on rights, inclusion and social justice however it is also important that the complexities inherent in the social work task are recognised and that context supports best practice’ Page 67 of 193
Page 68
Page 68 of 193
Page 69
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☒ Yes ☐ No Ref DF/MF Date 21/02/23 Home Assessment Team/Discharge without Delay Programme update report From Diane Fraser, Chief Officer of Adult Social Work Services E-mail FlavellM@northlan.gov.uk Telephone 07939284700 Executive Summary The delivery of high-quality support is critical to support individuals who are at risk of admission to a hospital or who have complex discharge needs. The improvement work to progress this is critical to the strategic plan for North Lanarkshire and the Integrated Joint Board as well as central to Home First a national commitment through the Discharge without Delay programme. NHS Lanarkshire was an initial pathfinder site for the national Discharge Without Delay programme, and NL HSCP is a key partner in delivering this work. This report provides an overview of a key development of the work to improve the outcomes for people who can be assessed and supported at home. There are a range of service redesign which is outlined in the report approved by the IJB on 16th February 2022, Winter Planning and Enhanced Supports. It will highlight the Home Assessment Team (HAT) in North Lanarkshire, which includes background, progress to date, plans, recruitment update, successes and risks. The fundamental difference and priority is assessment at home with a focus of complementing established practice and supporting service redesign and streamlining of other key areas of work: First Point of Contact (FPOC), Access Social Work, Home Support and Reablement, Hospital Social Work and locality responses. This includes the longer-term vision of the creation of an enabling hub. Recommendations It is recommended that the Committee: 1. Acknowledge the report. 2. Endorse the strategic direction of HAT and the rollout of HAT across North Lanarkshire. 3. Endorse the plans for the rollout of HAT across North Lanarkshire 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 3 Page 69 of 193
Page 70
1. Background 1.1 In September 2021 the IJB approved the establishment of a Change Fund to support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire Health and Social Care Partnership, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan: 1. Do the right thing first time. 2. Provide a range of community services and supports to people to live well in connected communities. 3. Focus on what matters to people. 4. Be at the forefront of technical and sustainable solutions. 5. Promote prevention and early intervention. 6. Ensure North Lanarkshire is the best place to work, volunteer and care. 1.2 At that time, the monies established into a Change Fund totalled £6.076m of non- recurring funding to support new ways of working, create additional capacity and continue to address the impact of Covid-19. 1.3 Priorities for the use of the Change Fund were identified as: • Prevention and early intervention, targeting spending on helping people to live healthier and safer lives and maintaining their independence at home or in the community. This means less spending is required on hospital or specialist care later. • Empower individuals and communities, involving them in service design and delivery. This should result in services that match what people need and want. • Improve efficiency by adopting a whole system approach to improve and deliver services. 1.4 Further investment to support winter planning for health and social care was announced by the Scottish Government in October 2021 in respect of the range of measures to support and protect health and social care services over the winter period and to provide longer term improvement in service capacity. This announcement was supported by new investment funding of £300 million nationally. 1.5 A Winter Planning & Increased Capacity Business Case was developed, and this sets out a total recurring investment of £6.759m in three main categories: 1. Assessment and planning capacity. 2. Direct provision of services and supports. 3. Infrastructure capacity. 1.6 Home Assessment within the first of these categories and is the approach that North Lanarkshire Health and Social Care Partnership is taking to implement what is known nationally as Home First. The Business Case set out a total recurring investment of £6.759m to address the above three categories and to establish/embed Home Assessment across North Lanarkshire. 1.7 In October 2022, in response to the significant pressures across health and social care, in hospitals, the Cabinet Secretary for Health and Social Care advised NHS Boards, Health and Social Care Partnerships and Local Authorities to prioritise Home First initiatives and progress at pace. Page 70 of 193
Page 71
1.8 To address these demands and prepare for winter it was necessary to accelerate the provision of Home Assessment and it was agreed that University Hospital Wishaw would be prioritised given the pressures at this site. This requires close working between Acute and community staff to develop a model to support assessment at home. 1.9 The Home Assessment Team is a multi-disciplinary approach to embed Home First principles and the key difference is staff supporting people to return home from hospital for a period of assessment. The initial implementation stage has evidence of redirecting or reducing the level of support people need following discharge. To develop this at scale it will be necessary to redirect substantial resource to the Home Assessment Team. In addition, there is a need to work closely with all Home Care providers across the sector to create the capacity required to release this resource. 1.10 The objectives are: • A whole system approach on prevention and early intervention through good early conversations and robust assessment and planning which meets quality outcomes for people in encouraging self-management. • A designated workforce in enabling discharge and maximising function in the home environment by increasing the number of timely post-discharge assessments and providing a rapid community response to prevent hospital admission. • A robust discharge pathway for those who require home assessment and rehabilitation following discharge from both hospital front door and wards. • Flexibility to deploy the workforce across the sectors. • Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?). • Clear leadership and presence within discharge arrangements services. • An approach to avoiding admission to be developed with the Integrated Rehabilitation Teams (IRT) and locality teams. • Close links with individuals involved in the Planned Date of Discharge process to identify appropriate patients for the HAT pathway. • Close working relationships with IRT, District Nurses, Acute, Allied Health Professionals, Hospital at Home and Hospital Discharge Support Programme (3rd sector) with access to the equipment store to support hospital admission avoidance and discharge arrangements. 2. Report 2.1 The pressures within the health and social care system have been sustained in the community and acute hospital sites as a consequence a range of improvements have been implemented. Across Lanarkshire there has been a level of success with the introduction of the home first philosophy, planned date of discharge, and development and implementation of a discharge policy. This will be further enhanced by home assessment/ home first teams which are expanding across Lanarkshire. There has been several challenges for NL HSCP, particularly due to capacity and recruitment and will be fully imbedded by March. 2.2 There has been a concerted approach to seeking to embed Discharge without Delay and maximising the concept of Planned Date of Discharge (PDD). This is in addition to hospital transition teams (home first/home assessment teams), and investment in discharge teams in emergency departments. Page 71 of 193
Page 72
2.3 There is a robust organisational structure where DWD improvement projects are monitored and scrutinised through a dedicated DWD lead and DWD steering group. This group then reports to the unscheduled care board for Lanarkshire. 2.4 Progress made against the work plans • Home Assessment Team soft launch in Wishaw in late April taking referrals from University Hospitals Monklands and Wishaw. • Cumbernauld soft launch in August, taking referrals from University Hospitals Monklands and Wishaw. • Cumbernauld and Wishaw Home Assessment Teams operating at reduced capacity whilst recruitment is ongoing. • Governance agreed. • Standard Operating Procedure drafted. • Workshops held in October 2022 to map pathways, review and agree pan- Lanarkshire referral criteria with all key stakeholders in the MDT including transfers of care into reablement, mainstream /longer term home support and rehab services. • HAT staff accommodation secured in university hospitals and community. • Induction programme established. • Data spreadsheet developed and continuing to be revised according to activity and developments. • As of 20th January, 314 patients in total had been referred to and supported by the Home Assessment Team. The growth in the referral rate to the Home Assessment Team has shown a sustained growth, particularly since the beginning of November 2022. Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw Total 35 5 5 86 55 128 314 11% 2% 2% 27% 18% 41% • The chart below outlines the proportion of individuals who have required further service or no service following their time with the Home Assessment Team. A sizable majority of individuals (63%) have required no further support, with 20% requiring ongoing support. Of those requiring ongoing support, 26% required support through the reablement service, 26% required further support through the Integrated Rehabilitation Team (IRT) and 23% required a mainstream home support service, Page 72 of 193
Page 73
• Approximately half of the individuals who have had an assessment completed with the Home Assessment Team, were discharged from the team within 10 days. The table below illustrates the average number of days from initial referral through key milestones such as commencing the home assessment and completion of the home assessment. On average, hospital patients are discharged 1,2 days after a referral to the Home Assessment Team; and following discharge from hospital, it takes, on average, 0.2 days to commence the assessment at home. Average No. of Days Referral - Hospital Discharge 1.2 Referral - HAT Assessment Start 1.4 Referral - HAT Completion 11.5 Hospital Discharge. - HAT Assessment Start 0.2 HAT Assessment Start - HAT Completion 10.3 • The service will continue to develop its performance dashboard to monitor demand and the service’s capacity to respond. Metrics in relation to individuals’ outcomes and the responsiveness of the service will also continue to be monitored and reported. There are also wider measures of success which will be evident beyond the immediate footprint of the team. For example, the success of the service is dependent on its ability to divert and avoid potential demand on other care at home services - by ensuring individuals, through support from HAT, require no further support or a reduced level of ongoing support as a result of effective assessment. Similarly, it is anticipated that the team’s ability to support individuals’ timeous discharge from hospital will, in future and along with the wider Discharge Without Delay programme, deliver improvements to the partnership’s overall performance in relation to delayed discharge. 2.3 Recruitment update 2.3.1 Recruitment to HAT ongoing to build capacity and roll out across other NL localities. The pressures within the system regarding workforce are widely acknowledged. These pressures have been impacted by the competitive employment market with staff leaving for better pay and conditions, training and career opportunities. The social care sector is facing significant challenges, as a regulated workforce, the number of people leaving to seek alternative careers is at its highest. Additionally, the cost of living and fuel costs are impacting directly on the workforce. Page 73 of 193
Page 74
2.3.2 A number of recruitment campaigns have been progressed across health and social care to recruit across the team including Home Support, Physiotherapy and Occupational Therapy staff. This is with the intention that the Wishaw and Cumbernauld Team will be fully operational by mid-February. 2.4 Risks and challenges 2.4.1 The implementation of Home Assessment does present with a number of risks. Risk Mitigation The release of a substantial number of Home Support Workers from the mainstream/longer term service will impact on the delivery of long- term home support including disruption of existing care packages and potential increase in unmet need. Working closely with independent home care providers across the sector to create the capacity required to release this resource. People are not supported as required due to the need for effective, efficient and consistent reablement activity. Ringfenced reablement teams to progress to meet needs. Lack of engagement with staff on Older Adult wards. Targeted engagement activities between HAT and ward staff. The lack of downstream flow h may cause a bottleneck at the hospital front door impacting on patient safety. In addition, patients’ outcomes may be poorer due to deconditioning in the hospital setting which ultimately leads to increased dependency on formal supports or transfer to long term care home placement. Engagement activities to support communication and promote earlier discharge from hospital. Planned Date of Discharge (PDD) is not fully embraced. It is critical that a specific date of discharge from hospital is identified at the earliest opportunity with plans made to agree a safe and appropriate transition back home. Engagement/support with refreshed communication across hospital sites and across localities. Also testing a new rota for PDD daily meetings incorporating HAT data. Low referral rate to HAT. HAT utilising NHSL relevant discharge patient information, focussed communications to increase referral, relevant discharge patient information access for NL staff. Recruitment challenges. Planned, phased and strategic recruitment. Low Pharmacy input. Currently under discussion to improve and develop to support HAT. Page 74 of 193
Page 75
Limited access to pool cars. Under discussion. Lack of capacity on acute sites to support HAT. Engagement with University Hospital Monklands and University Hospital Wishaw to review accommodation and provide space for staff. 2.4.2 Other challenges: • Timely movement of people into services, if required, including Reablement, IRT, long-term home support. • Funding for non- cost pays to be agreed and sourced as not included in initial business plan. 2.5 Next steps 2.5.1 As HAT as developed further synergies have been identified with other key programmes of work to improve our prevention and early intervention response. This includes the Frailty Strategy and Home Support Redesign. The interface with other parts of the persons journey is critical, whilst some individuals will not require any statutory support, there will be those who would benefit from further intervention. Therefore, while we ensure FLOW through the acute hospital sites, this is also required within community settings and timely access to reablement, and rehabilitation will be critical. It is our intention for the majority of people to receive reablement to maximise their potential and ensure that they receive the right support. Reablement provision had been significantly impacted during the pandemic and due to capacity and workforce issues it has been challenging to fully recover. As a consequence there will be changes to within the Home Support Service to ensure that Reablement can be fully operational. To do this it will be necessary to prioritise this area of work. This may have a short-term impact on those who will receive longer term Home Support. To mitigate this we will be implementing the new ways of working incrementally and by locality. There will be a range of options available to individuals requiring longer term support following reablement. 2.6 Future actions: • Development of service model to support HAT across North Lanarkshire. • Continue to support an accelerated HAT response with initial priority of Cumbernauld and Wishaw. • Rollout to implement HAT in other remaining localities throughout 2023. • Communication and engagement activities continue including staff briefing sessions. • Finalise Lanarkshire wide referral criteria. • Finalise HAT process and patient/service-user pathways. • Include HAT patients/service users in daily Planned Date of Discharge (PDD) call • HAT rota for daily PDD call. Establish key linkages within the Health & Social Care Whole System Dashboard and track wider impacts of the service on Delayed Discharge performance, and capacity of the home support service. Page 75 of 193
Page 76
3. Measures of success 3.1 Data collection format agreed and data collection underway including referral numbers, timescales, input services, and outcomes for people. 3.2 Agreed measures so far: 1. Encouraging self-management with a preventative and early intervention approach. 2. Ensure speedy discharge from hospital. 3. Multidisciplinary working across acute and partnership. 4. More people assessed at home. 5. Increased reablement focus. 6. Further developed relationships with 3rd sector. 3.3 KPIs agreed and subject to monitor and review throughout implementation. 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer of Adult Social Work Services Page 76 of 193
Page 77
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 Finance? 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 Resources? 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? 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 77 of 193
Page 78
Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) 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? Risks have been identified within the body of the report and are managed through the project risk register. 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 78 of 193
Page 79
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☒ Yes ☐ No Ref DF/MF Date 21/02/23 Equipment and Adaptation Service From Diane Fraser, Chief Officer of Adult Social Work Services E-mail Flavelm@northlan.gov.uk Telephone 07939284700 Executive Summary This report is to inform Committee of the current position of the Equipment and Adaptation Service (EAS). The EAS provides an essential service through the provision of equipment and adaptations to enable people to live independently and safely at home. It also provides essential supports to discharge planning. Since the pandemic, the service has faced several challenges, and these will be evidenced in this report. Despite these challenges the service continues to prioritise those most at need who are at risk of admission to hospital or care home and are being discharged from hospital. The report will outline the current demand, performance, premises, workforce, and governance arrangements and will highlight the recommendations for change within the service. The main recommendations made in this report aim to ensure that the service continues to meet the growing demands and delivers on key performance indicators and that the service is quality assured to meet the needs of people living in our communities. Recommendations It is recommended that the Adult Care and Social Work Committee: 1. Acknowledge the contents of this EAS report. 2. Endorse refreshed governance arrangements. 3 Acknowledge the change of current electronic stores management system: Managing Integrated Community Equipment Service (MICES) previously approved at the EAGG. 4 Endorse the service review and anticipate future reports seeking approval for recommended changes. 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 4 Page 79 of 193
Page 80
1. Background 1.1 The Equipment and Adaptation Service (EAS) situated in Motherwell, serves the population of North Lanarkshire Council and all of NHS Lanarkshire patients living in North and South Lanarkshire Council area. It is a valued and effective service supporting the whole spectrum of need from prevention and early intervention to end of life care. Timely delivery of equipment and adaptation supports people to live independently in the community whilst avoiding unnecessary admissions to hospital or care settings and supporting timeous discharge. 1.2 The Equipment and Adaptation service (EAS) helps the Partnership support National and Local strategies in prevention and early intervention: - • The AHP Public Health Implementation Plan 2022 focus on prevention and early intervention and planning for the aging process, preventing and delaying or managing crisis. • NCS (Scotland) Bill 2022 which directs partnerships to ensure that people are supported to lead fulfilling, independent lives. • GIRFE 2022 model by which we are guided to support person centred outcomes and promotion of early intervention, joined up working holistic and flexible. • Rehab and recovery A once for Scotland Approach 2022, which provides guidance on rehab delivery. Main themes are that we provide services which are provided at the right time and integrated and are easy to access for all individuals. • The service supports the North Lanarkshire Health and Social Care partnership to achieve 3 of the key ambitions in the Strategic Commissioning Plan 2020 – 2023: o Provide a Range of community services to support people to live well in connected communities. o Promote prevention and early intervention. o Be at the forefront of technical and sustainable solutions. 1.3 The EAS is jointly funded by North Lanarkshire Council and NHS Lanarkshire. The EAS arranges or directly provides all equipment or housing adaptations for people with disabilities in North Lanarkshire. The service also provides equipment to residents in South Lanarkshire on behalf of NHS Lanarkshire. 1.4 Requests for service come from many sources, including occupational therapists, district nurses, social workers, hospital discharge teams, and importantly, from people themselves through on-line self-assessment via the Making Life Easier web site. 1.5 The service plays a vital role in supporting people, often with very complex needs, to be independent, assists with the implementation of reablement, and facilitates early discharge from hospital. It also plays an important role in preventative and early intervention responses which help people themselves and family carers to live full and active lives safely and with dignity. 1.6 The service is also available to children and young people who benefit from equipment solutions and adaptations to increase independence. Page 80 of 193
Page 81
1.7 The service response to ever increasing growth in demand which reflects demographic changes in ageing and prevalence of long-term conditions, has required close monitoring, impacting on the future funding and operational requirements. 1.8 The impact of the pandemic has resulted in fluctuation and changes in demand. Whole system pressures in managing recovery and redesign have more recently resulted in significant areas of pressure, particularly to support hospital discharge and avoid unnecessary hospital admissions. 1.9 This report outlines the current arrangements for the provision of community equipment and adaptations and summarises the strengths and risks associated with the available service provision. 2. Report Service Redesign 2.1 Prior to the pandemic a proposal to review the operating model of the EAS was agreed however progress has been delayed as the service focused on delivery through covid. As the provision of equipment and adaptations has developed, there has been some activity in the last year in supporting the reviewed. A refreshed Governance Board, improved communication strategy and practice, attention to staff recruitment and retention working with Business Partners has been a priority. Furthermore a comprehensive training plan has been devised across all roles within the service working with Talent and Organisational Development and the successful integration of the Assistive Technology section. 2.2 Increased emphasis has been placed on the service to support hospital discharges through the provision of equipment. This correlates with a lesser priority being given to support people living in the community and often these individuals have much longer waits. 2.3 The service redesign needs to incorporate opportunities for career progression and succession planning within the establishment this should impact on staff retention and recruitment into the service. 2.4 The review workstream has been interrupted by the need to respond to the demand pressures through the pandemic but is expected to make recommendations by September 2023. 2.5 The service redesign exercise will take account of: The staffing structure, recruitment and retention, staff training, the logistic model, software, operating hours, premises, and the prioritisation framework. The service is struggling to recruit to vacant positions, the Senior Technician post has been advertised 3 times with no suitable candidates identified. Further discussions have taken place with our Business Partner and agreement reached that current staff and others will be able to apply for this type of post by “working towards” the required qualification in an agreed timescale to encourage internal candidates to apply for this post. This model may be applied to other posts currently vacant and is under discussion. The current staffing levels are contributing significantly to the current reduction in service performance increasing waiting times. Page 81 of 193
Page 82
• Demand modelling, including the steady increase in the number of two person deliveries required with a steady rise in the number of larger pieces of equipment requested as urgent for discharging people from hospital e.g., beds, hoists and riser recliner chairs. • Increased portfolio, including the significant increase in smart technology to support independence, but could also include an increased role in assessing and supporting specialised equipment use, smart tech, but also including moving and assisting equipment. • Service delivery Model- Locality/Sector based response, creating the capacity for same day responses which dovetail with practice developments in relation to discharge to assess, home first and relationship with integrated rehabilitation teams. Refreshing structures around a locality model will improve responses which cover the spectrum of intervention from proactive, preventative supports to complex, and end of life care. It is proposed that the EAS will develop a locality or geographical based response which supports the wider aspirations of the Health and Social Care Partnership to ensure that the six localities of North Lanarkshire and the four of South Lanarkshire are responsive and reactive to communities and neighbourhoods. • Review of operational groupings, to reshape the EAS operation into three distinct groups: o Stores and Logistics. o Equipment delivery and collection. o Service and maintenance. 2.6 Engagement with staff has already commenced, with various large team, and sub team meetings taking place over the last 6 months and the formation of a local Health and Safety Committee to ensure staff inclusion with the review process. An external provider -Think Distinct has met with most of the staff on a one-to-one basis to allow open and honest discussion on how they feel in regard to the service, its current operating model and future developments. 2.7 Extensive work has been undertaken with the Talent and Organisational team in conjunction with all staff to identify both individual and service training needs which will assist with future service redesign and allow staff to achieve their own career progression. An initial service training plan has been completed which has identified and prioritised these requirements and will be progressed. 2.8 Initial meetings with Joint Trade Unions on raised issues and concerns have taken place and these will be continued on a regular basis to ensure any local issues are identified and dealt with as and when they arise. 2.9 Staff and Trade Unions will be fully involved in the service redesign, which will come back before Committee for final approval by September 2023. Page 82 of 193
Page 83
Service demand 2.10 Several key variables have an increasing impact on the demand for and performance of the EAS. a) Increase in the number of people who choose to die at home and require equipment to allow care to be provided. b) Population changes, particularly in people aged over 75 and aged over 85 which has grown by 20% in the last 10 years in North Lanarkshire. c) The rise in the number of single person households, with associated demand for equipment and adaptations as natural supports not being as available which has grown by 20% in the last 10 years in North Lanarkshire. d) Reduction of the length of time people spend in hospital with increased health and social care provided at home. e) There is an increased complexity of health needs at home, multiple long-term conditions, people with very complex health issues are surviving with high needs e.g., ventilation. f) Increase in the number of people who have severe or profound learning disabilities which has grown by 20% in the last 10 years in North Lanarkshire. g) Increase in people who are clinically obese. 2.11 The EAS activity in relation to delivery and uplift of equipment over the past 5 years is provided in the table below, it is expected that 2022/23 activity will be like 2020/21, however this is anticipated to increase as services normalise in 2023/24. The decrease in activity is due to the change in prioritisation during the pandemic when only P1 and P2 requests were being fulfilled. As can be seen in Table 1 the projected demand to April is showing a 17% increase from 2021 and the service now has extended waiting times for Deliveries and Collections across all equipment groups. Waiting lists for referrals into the service are also increasing – currently there are approximately 1000 assessments pending from the Integrated Rehab Teams across the localities. Table 1 Year Equipment Request Collection Request Total activity 2018/19 44102 19646 63748 2019/20 47395 23087 70482 2020/21 30463 15690 46153 2021/22 31528 19962 51490 2022/23 Projection 34921 17076 51977 Page 83 of 193
Page 84
2.12 Whilst demand reduced during the pandemic and in the recovery period by around 30%, expenditure on core equipment only decreased by around 20% from 2019/20 - which is indicative of the cost increases to equipment experienced in the last 18 months. Equipment Spend 2018/19 £2,284,955 2019/20 £2,478,023 2020/21 £2,012,331 2021/22 £1,965,865 2.13 The delivery and collection of beds averages 51 activities per week, representing 24 deliveries, 25 collections and 2 moves There are currently 2447 profiling beds in people’s homes across Lanarkshire, that equates to 371 per 100,000 population compared to Dumfries and Galloway 353, Fife 245, and Edinburgh 200. 2.14 Work is ongoing to ensure that all requests are properly screened to ensure these are appropriate. There are numerous lower-level alternatives to hospital beds, and these must be explored first before referrals are made for profile beds, which can be very disruptive in the service user’s home. This work has resulted in no increase demand in the last 12 months against a background of increasing demands from Hospital discharge Teams for other pieces of equipment and other Partnerships reporting significant increases for this type of equipment. Adaptations 2.15 The EAS also manages the adaptation service for North Lanarkshire. 2.16 Major adaptations include wet floor showers, ramps, specialist toilets, through floor lifts, external stairlifts and bathroom extensions. 2.17 A moderating group operates to provide consistency and equity across the 6 localities. 2.18 Increased cost pressures from contractors have been incurred post pandemic with the average grant awarded increased from £3200 in 2021 to £4231 for this financial year. Service Performance 2.19 The service has a target that 80% of all core equipment deliveries should be being within 7 working days. Overall performance for equipment deliveries from April – Dec 2022 was 68% of all requests delivered within 7 days. Page 84 of 193
Page 85
Deliveries Collections Total Activity SLA Achieved 2017-18 48551 20327 68878 78% 2018-19 44102 19646 63748 79% 2019-20 47395 23087 70482 78% 2020-21 30823 15694 46517 77% 2021-22 31528 19962 51490 68% 2.20 The impact of urgent requests for Hospital Discharge and admission prevention continues to be a significant challenge on the services resources, with over 92% of these requests being completed within 4 days to the detriment of other equipment requests. 2.21 This rise and prioritisation in equipment being required to support people with hospital discharges has had an understandable impact on the store’s ability to provide standard equipment to meet key performance indicators. 2.22 Bed deliveries and collections demand have been increasing this year, with waiting lists increasing - currently 110 beds are waiting for delivery and 150 for uplift with a service capacity of 10 units per day (combined deliveries and collections). Community Beds Deliveries Collections Total Activity SLA Achieved 2017-18 1544 1394 2938 86% 2018-19 1542 1556 3098 91% 2019-20 1454 1440 2894 92% 2020-21 1378 1463 2841 92% 2021-22 1164 1367 2531 92% 2.23 Adaptation referrals are returning to pre-pandemic levels, with 2077 new requests received so far from April - Nov 2022. Average time to complete across all tenures is 125 days. This is mainly due to the availability of external contractors which is proving to be problematic despite extensive work being undertaken to identify additional companies willing to undertake these types of works. NLC properties average 35 days completion for works undertaken by MEARS. 2.24 Key performance indicators are currently being reviewed to refine and improve the reporting on performance and to better reflect the complexities of EAS and inform future service development. Page 85 of 193
Page 86
Adaptation Referrals received - All Tenures 2.25 2.26 The recycling of costly equipment is essential to ensure a sustainable cost model going forward. This activity has been impacted upon due to covid restrictions and social distancing in the building space, these have now been lifted, however uplifting equipment remains challenging with activity having to be balanced to meet service delivery expectations. 2.27 Equipment supply has improved in the last 6 months with most core stock lines now being readily available. Assistive Technology products are still problematic due to worldwide microprocessor supply issues. Governance 2.28 The governance arrangements are being refreshed to increase the routine monitoring of performance and offer increased support to the service across key partners. 2.29 The new Governance arrangements will ensure the alignment of the services activities to support the Strategic Commissioning Plans ambitions particularly on prevention, early intervention and empowering people to live fulfilling lives. 2.30 The refresh takes account specifically of the need to provide assurance to the senior leadership team, IJB and Adult Health and Social Care Committee with analysis of demand impact and on recovery of performance. The refresh is an opportunity to update representation from the health and social care partnership locality teams, realising the benefits of the creation of the two overarching sectors. The interface with the localities creates the dialogue about the practitioner assessment and planning role which impacts directly on the performance of the EAS. South Lanarkshire representation will be secured. 2.31 The EAS Board has been replaced with a Governance Group, chaired by the Senior Manager – Adults Social Work, to include locality managers, acute staff, finance staff from the Council and Health, Performance and data analyst, Nursing representation, Allied Health Professional representation, Business Partners and a Housing representative. There have been initial meetings and discussions to agree membership and the Terms of Reference for this group and this will continue into 2023 alongside a schedule of meetings. 2.32 The Integrated Equipment Review Group has been reinstated to ensure that consistency in nonstandard stock ordering (such as specialist seating and riser recliners). Number of Referrals Received. P1 P2 P3 P4 Rails 2017-18 3520 19 361 896 5 2239 2018-19 3626 14 413 836 0 2363 2019-20 3463 8 393 793 0 2031 2020-21 2306 89 531 628 1 1031 2021-22 3137 10 403 790 2 1918 Page 86 of 193
Page 87
2.33 The Housing Solutions Moderating Group has also reconvened following cessation because of the impact of Covid 19. The Moderating Group ensures robustness over decision making and equity across all localities for adaptation recommendations. 2.34 Both the Integrated Equipment Review Group and the Housing Moderating Group will report to the Governance Group. Premises 2.35 The service is currently located in a 743 Sq. metre (8000 square feet) industrial unit in Motherwell which hosts warehousing, recycling, repairs workshop and office space. 2.36 The current building is not delivering in the context of demand and flow and there is a need to consider relocation. The Service currently has 3 temporary off-site storage locations for collected equipment, PPE, and bulk deliveries this is in addition to the PPE stored at the NLI premises in Wishaw used for Home Support PPE distribution. These premises are not suitable for any long-term storage of equipment, and one of the locations (Albert Street) has almost been fully vacated. The Cook and Indies building will have to be vacated by early summer in 2023, which will require further suitable storage to be identified and discussion is ongoing to source appropriate space. 2.37 The present store space no longer meets the space requirements for recycling and equipment storage. 2.38 The demand modelling being undertaken will inform the potential increase in demand for equipment. It is known, however, that there is an increased need to store bariatric equipment, a continued increase in recycling of stock to minimise spend on new equipment, and the potential for additional areas of work to be added to the EAS portfolio. 2.39 A review of the current premises did not identify any significant opportunities to reconfigure or expand the property. IT System Development 2.40 As noted previously the differencing IT systems used across the partnership can lead to duplication of requests and limited visibility to a services user’s history of equipment provision. CES 360 was identified as a replacement for the current MICES system as the operating system for the EAS. This system was expected to be in place by the end of quarter 1 of 2022 but the vendor has now advised that they will no longer continue any further development of the CES360 system and will not proceed with its implementation but will undertake some minor improvements to the current MICES system, which will not provide any of the benefits previously identified with CES360. 2.41 It is therefore imperative that an alternative solution is identified to improve the current system which will have the noted identified service requirements: • Direct ordering and tracking of orders, but specifically in terms of the operation of the EAS the system will be much more sophisticated in the construction of delivery routes and times, based more on the complexity of work rather than the number of deliveries. Page 87 of 193
Page 88
• A system that will also link directly to the stock control process, reducing administrative functions. • Field staff will be provided with handheld devices which will greatly reduce the reliance on printed paperwork, provide real-time delivery information to the prescribers via email and route management based on current traffic conditions. • Improved monitoring of equipment due for review and maintenance. • Give prescribers direct access to equipment catalogues stock levels and Service Users equipment history. • Interoperability and data sharing with the new social work system being provided by Mosaic and other external service contractors to reduce duplication of input 3. Measures of success 3.1 The service will achieve agreed operating standards as set out by the Governance Group. 3.2 Customer satisfaction and quality outcomes for people. 3.3 Redesigned service to meet partnership ambition 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer of Adult Social Work Services Page 88 of 193
Page 89
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? The main purpose of the EAS is to address the impact of disability through providing equipment or adaptation designed to overcome physical barriers or limitations and increase independence. Through the provision of equipment or adaptation the EAS children, adults and older adults with disability can fulfil their potential. Localising the structure of the service fits better with wider Health and Social Care developments to ensure the right service at the right time for people locally. 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 detailed financial information will be populated through completion of the Service Review. The 2022/23 gross expenditure budget for the Integrated Equipment and Adaptation Service is £5.081m as highlighted in the table below. £m Equipment 2.413 Adaptations 1.152 Employee Costs and other overheads 1.802 Total Gross Expenditure 5.367 In addition to the revenue funding described above the service has historically received an approved Capital budget for aids and adaptations. In the current 5-year approved capital programme the service was initially allocated £11,640k through to 2025/26. However, this has now been reduced by £650,000 to £10,990k. 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? Page 89 of 193
Page 90
Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? Changes to the management and operating structure of the EAS will be subject to detailed discussion with HR Business Partners and the Job Evaluation team. 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? The implementation of the new stores system will allow the service to introduce technology that improves efficiencies in all areas of the service from real-time automatic updates to prescribers through to route management for field staff. The continued development of smart technology to support independence will remain under review and development. 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? Page 90 of 193
Page 91
The increased capacity to manage the full process of recycling existing equipment will have a positive impact on the environment through reduction of waste. A new stores system will introduce route management and improve fuel efficiency. 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? Communication across the Partnership will be required, and a Communication Plan will be agreed and implemented. 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 model proposed will give increased capacity locally to provide equipment timeously to facilitate hospital discharge and prevent admission and support urgent repair requests. Presently EAS sits on the risk register. The routine and regular testing of equipment will ensure compliance with national Health and Safety standards, protecting people in their use including people with a disability, family carers and paid carers 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 91 of 193
Page 92
Page 92 of 193
Page 93
North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref DF/HI Date 21/02/2023 From Diane Fraser, Chief Officer of Adult Social Work Services E-mail FraserDi@northlan.gov.uk Telephone Executive Summary This Paper provides an overview of two key Adult Support and Protection Reports which were recently published: Social Work Annual Report 2021-2022, and Adult Protection Committee Biennial Report 2020-2022. The paper initially provides information on the profile of adult protection in North Lanarkshire, referencing increased referrals to social work and identifying increased numbers of referrals from care homes and health providers. The background and summary points of two core Adult Support and Protection (ASP) Reports, are provided, reflecting recent activity and developments for ASP in North Lanarkshire. The Social Work Annual Report 2021-2022 provides a summary of all adult support and protection activity responding to adult at risk (AAR) referrals in that period. It provides assurance that this statutory function continues to be met on a timely and proportionate basis and provides example of improved scrutiny and monitoring practice. It also reflects some of the complex and skilled work required through both individual statutory and large- scale investigation activities to mitigate risk for adults living in North Lanarkshire. The Adult Protection Committee Biennial Report 2020-2022 provides a summary of the multi-agency partnership activity and reflects how the Committee has continued to discharge its key responsibilities, as outlined in legislation and guidance. Recommendations It is recommended that Adult Care and Social Work Committee; 1) note the content of this report and those attached. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (14) Ensure the highest standards of public protection Adult Care and Social Work Committee Adult Support and Protection: Social Work Annual Report 2021-2022, and Adult Protection Committee Biennial Report 2020-2022 AGENDA ITEM 5 Page 93 of 193
Page 94
1. Background 1.1 This paper provides the Committee with an overview regarding two key reports reflecting adult support and protection activity and governance in North Lanarkshire. 1.2 Adult Support and Protection is a statutory role of Adult Social work services, as defined in the Adult Support and Protection (Scotland) Act (2007). This Act identifies the requirement of local authorities (now delegated to Health and Social Care Partnerships) to make enquiries and mitigate risk where adults are deemed to be ‘at risk’. 1.3 In November 2022, North Lanarkshire Adult Protection Committee (NLAPC) published its latest Biennial Report to the Scottish Government. This is the seventh Biennial Report of NLAPC and covers the period April 2020 to March 2022. The Report explored strategic, operational and governance details of adult support and protection on a multi- agency basis, as reflected through the work of the multi-agency Adult Protection Committee. 1.4 North Lanarkshire Social Work’s Adult Protection Report 2012-22 was published in December 2022 and provides information on adult support and protection (ASP) activity undertaken by Social Work Services in North Lanarkshire during period 2021 - 2022. Social Work remain the statutory lead agency for ASP and as such this report details all referrals received during the year in comparison to previous years, and what stage they reached in the adult protection process. The report also provides some analysis of the information collated regarding performance and wider developments in adult protection across North Lanarkshire. 2. Report Profile of Adult Protection activity in North Lanarkshire 2.1 The Adult Support and Protection (Scotland) Act 2007 stipulates that adult at risk referrals be submitted to local authority adult social work, who must make enquiries into the referral. As such, social work data provides a full profile of adult at risk (AAR) concerns annually. This report provides a summary of two data sets; the social work overview of 2021/22, and the Biennial Report data from 2020/22, which provides a multi-agency overview of ASP to the Scottish Government. 2.2 During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals. This is the third consecutive annual increase. Indeed, 4,860 referrals were received in 2020/22, this being a 9% increase from the previous Biennial Reporting period of 2018/20. 2.3 The data also reflects some changes in the profile of AAR referrals, both in sources of referral, and the types of harm being identified. 2.4 There has been an increase in referrals received from both Care Home and Health settings. In 2021/22 AAR referrals from Care Homes demonstrated a 9% increase (from 416 to 455); with 19% of total ASP referrals coming from this source. Information suggests that this links to both increased complexity and advanced needs of residents, and to increased monitoring, support and scrutiny of care home services, and reflects the additional challenges and profile that Care Homes have faced during the pandemic. 2.5 2012/22 has seen health referrals become the most prevalent (19% of referrals received); overtaking police (16%) as the primary referrer. There has been significant Page 94 of 193
Page 95
decline in police referrals, of 36% from 2020/22 (from 598 to 381). However, there is an increase in police referrals to social work where a person is not viewed as being an adult at risk. These ‘adult concern’ reports received by Social Work, rising 13% in 2021- 22 (from 3552 to 4004). The Report reflects continued active referral activity from many partners, reinforcing a wide-ranging understanding of adult support and protection across partners. North Lanarkshire Social Work Adult Protection Report 2021-22 2.6 This report provides an overview of Social Work ASP activity for 2021/22, including: 2.7 With regard to AAR, referral activity the report reflects that in North Lanarkshire we continue to see a consistent profile of activity. Eighteen percent of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%), however it remains in our long-term trend, which traditionally reflects national average data in this area. Data shows that in 2021/22, 25% (108) of investigations progressed onto an initial case conference, which again is similar to last year. There was however a 32% increase in the number of initial case conferences, to 108 in 2021/22. Additional profile information is provided in the report. 2.8 Throughout the year, regular performance management reports have highlighted increased demand on social work human and service resources and the impacts on resources across partner agencies. The service has continued to be effective in providing a consistent statutory response to referrals, and mitigation of risk. 2.9 Public protection is identified as an area of high risk on the Councils’ risk register. It thus continues to be subject to scrutiny and monitoring activity as a matter of course. A local audit report submitted to the Council’s Audit and Scrutiny Panel in September 2021 concluded that arrangements were satisfactory and offered an opinion of reasonable assurance; it also recognised the prioritisation of public protection during the pandemic. Routine self-evaluation activity of the Chief Officers Group Public Protection has also informed a refresh of multi- agency action plans across all public protection areas to promote consistency of structure. 2.10 The report provides information on developments to monitoring and supporting ASP activity and reviewing AAR referrals from care homes. This has promoted an ‘early intervention’ approach to identify emerging concern/s, specific patterns and/or trends and provides additional scrutiny and assurance for senior managers and the CSWO. 2.11 There were 13 ASP Statutory Orders implemented in 2021/22: • 6 X Removal Orders, • 3 X Banning Orders with Power of Arrest and: • 4 X Temporary Banning Orders with Power of Arrest. 2.12 North Lanarkshire Council commissioned and carried out two ASP Large Scale Investigations (LSI) in 2021/22, including one with national involvement due to the nature of the care home and its subsequent closure. The work associated in carrying out both LSI’s was significant and complex for all professionals involved. 2.13 Statutory duties for Appropriate Adult services are set out via the Criminal Justice (Scotland) Act 2016 and, Appropriate Adults: Guidance for Local Authorities (2020). Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with sixteen employees trained to perform Page 95 of 193
Page 96
AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In 2021/22 Appropriate Adult referrals decreased by 23% (from 92 to 71) in North Lanarkshire. 2.14 The areas of work within the Social Work annual report which sits within the governance of the Adult Protection Committee (APC) is referred to from section 2.12 of this Report. 2.15 The North Lanarkshire Social Work Adult Protection Report 2021-22, summarises the continued increase in ASP activity in North Lanarkshire, provides oversight of improvement and monitoring activity and shares information on services development over the time period. North Lanarkshire Adult Protection Committee (NLAPC) Biennial Report 2020-2022 2.16 The seventh Biennial Report of the North Lanarkshire Adult Protection Committee (APC) was submitted to the Scottish Government in November 2022 and covers the period April 2020 to March 2022. This report focusses on the multi-agency partnership approach to Adult support and protection in North Lanarkshire, which is led by our Adult Protection Committee (APC). A selection of key points are summarised below: 2.17 The report reflects the significant national and local developments in adult support and protection in this period, with a strengthening of national profile and governance processes, which have helped to guide the work of the APC. 2.18 North Lanarkshire’s APC partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. This is reinforced by our aim to drive forward professional and public awareness of harm affecting adults at risk; working in partnership with our members and the wider community to ensure that vulnerable and at risk people in and from North Lanarkshire are safe and protected from harm. 2.19 The report reflects the significant partnership response to addressing ASP concerns during the pandemic, including the increased monitoring, support and scrutiny activity given the demographic links between ASP risks and vulnerable members of our communities. This includes a shift to some virtual activity, revised training provision and operational flexibility to respond to changing risk and need. 2.20 The report reflects the work of the APC and includes positive self-evaluation findings, with well-established arrangements in place across all aspects of partnership working. This activity lead to reinforced APC representation across key agendas, such as care home assurance, acute and the Alcohol and Drug Partnership. This is helping to raise the profile of ASP across relevant agendas. 2.21 The report highlights areas of positive and innovative practice from APC partners. This includes work with the National Missing Persons Project to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. 2.22 The APC has committed to a trauma informed approach to adult protection. All training and policy development has awareness of the impact of trauma embedded in its content and language. This includes a commitment to transitional safeguarding based on a contextual safeguarding approach we share with our Child protection Committee. 2.23 The report reflects the progress of the APC’s Improvement Plan, including ongoing work to improve the quality of chronologies and risk assessments in adult protection cases, and to strengthen information sharing. This also includes development activity such as the development of guidance such as working with Neglect and with financial Page 96 of 193
Page 97
harm. The APC is also working to strengthen representation from people with lived experience within the Committee framework. 2.24 The report also provides an update on the APC’s training learning and development activity of the APC, including the development to online training, with over 1,100 people accessing various training opportunities over the two-year period. This has also included new training provision to address emerging need, such as self-neglect and hoarding, a GP training programme and relaunching our multi-agency forums to share learning and good practice. 2.25 North Lanarkshire Adult Protection Committee’s Biennial Report 2020-2022 provides a comprehensive overview of the priorities, and activity undertaken, over this timescale. Identified improvements have formed the basis of the 2022/23 APC Improvement Plan. 3. Measures of success 3.1 These two reports are indicative of the significant level of ASP activity across partners. A robust programme of social work and multi- agency monitoring, and scrutiny of this activity continues on a quarterly basis and indicates that risk is assessed and addressed on a timely and appropriate basis. 3.2 A suite of self-evaluation activity has given assurance that our strategic and operational frameworks are effective and proportionate. 3.3 Adult Protection partners are aware of the ongoing improvement activity identified as part of the APC Improvement Plan and identified areas for improvement are monitored through the APC and its subcommittee structure. 3.4 We follow a timetable of policy and procedural development and refresh which has led to the establishment of key guidance and policies to support thematic and emerging risk. 4. Supporting documentation 4.1 Appendix 1 - North Lanarkshire Social Work Adult Protection Report 2021/22 4.2 Appendix 2 - North Lanarkshire Adult Protection Committee Biennial Report2020- 2022 Diane Fraser Chief Officer of Adult Social Work Service Page 97 of 193
Page 98
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 Finance? 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 Resources? 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? 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 Page 98 of 193
Page 99
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 significant technology change, has an assessment been carried out (or is scheduled to be carried out) 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? 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in- Service or ex-Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 99 of 193
Page 100
0 Appendix 1 North Lanarkshire Social Work Adult Protection Report 2021/2022 1st April 2021 – 31st March 2022 Page 100 of 193
Page 101
1 North Lanarkshire Adult Protection Committee Report 1st April 2021 – 31st March 2022 Contents Contents ....................................................................................................................... 1 Introduction .................................................................................................................. 2 Definition of an Adult at Risk… ...................................................................................... 2 Last Year’s update ........................................................................................................ 2 National position… ........................................................................................................ 4 Case file audit / review .................................................................................................. 6 Local Profile… .............................................................................................................. 6 ASP Large Scale Investigations… ............................................................................... 14 Additional Elements Supporting Adult Protection ......................................................... 14 North Lanarkshire Adult Protection Committee ............................................................ 16 Case Reviews .............................................................................................................. 16 Local Developments and Events… .............................................................................. 19 ASP Learning and Development .................................................................................. 22 Key Areas of Reflection ................................................................................................ 22 Summary of Adult Protection Activity for 2021/22 ........................................................ 24 Individual Agency Referral Summary… ........................................................................ 26 Page 101 of 193
Page 102
2 Introduction The Adult Support and Protection (Scotland) Act 2007 came into force on the 29th October 2008. Under ‘the Act’, North Lanarkshire Council as lead agency, has a statutory duty to make inquiries about the well-being, property or financial affairs of an individual if they know or believe that the person is an adult at risk and that they might need to intervene. ‘The Act’ provides powers available to Council Officers to carry out investigations as deemed appropriate for the purposes of inquiry into the circumstances of an adult in order to protect them from harm. This report provides information on adult protection activity undertaken by Social Work Services in North Lanarkshire during period 2021 - 2022. It details all recorded referrals received during the year in comparison to previous years, and what stage they reached in the adult protection process. The report also provides some analysis of the information collated regarding performance and wider developments in adult protection across North Lanarkshire. Definition of an Adult at Risk Section 53 of the Act defines an adult at risk as a person aged 16 years or over and who: • is unable to safeguard their own wellbeing, property, rights and other interests; • is at risk of harm; and; • because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult, who is not so affected. It is important to note that simply the existence of a particular condition does not mean that an adult is at risk. A person may have a disability and be able to safeguard their own wellbeing. For the Act to apply all three criteria must apply. Last Year’s Update Public protection is identified as an area of high risk on the Councils’ risk register. The corresponding local audit report submitted to the Council’s Audit and Scrutiny Panel in September 2021 concluded that arrangements were satisfactory and offered an opinion of reasonable assurance; it also recognised the prioritisation of public protection during the pandemic. Recommendations for improvement were promptly acted upon and supported routine self-evaluation activity of the Chief Officers Group Public Protection. Improvement actions have informed a refresh of multi-agency action plans across all public protection areas to promote consistency of structure. Throughout the year, regular performance management reports have been produced on a weekly, four weekly and quarterly basis which review and analyse ASP activity and identify how these impact on sources and funding implications. Quarterly reports continue to highlight increased demand on social work human and service resources and the impacts on resources across partner agencies. The Performance Management Reports are shared across local Partnership Boards, Chief Officer Groups, Social Work Management Teams and the Adult Protection Committee. The service has continued to be effective in providing a consistent statutory response to referrals from all sources e.g. services users, families, members of the public and professionals, throughout the past 12 months. Within each locality, robust arrangements were in place to streamline staffing via rotas to ensure safe coverage of the ASP duty rota. Page 102 of 193
Page 103
3 While home visits to ‘adults at risk’ continued to take place in line with national and local guidance, a number of developments were required to manage the AP meetings process that promoted good communication between Social Work Services and partner agencies to come together, and to share timely information for risk assessment and risk management purposes. Work was undertaken, in collaboration with social work managers and colleagues from Advocacy services, to design and develop a range of templates and supporting guidance to conduct virtual AP meetings. As the pandemic restrictions ease, the ASP response will retain some elements of virtual meetings for professionals however more face to face work with adults at risk is preferred. A forthcoming review of ASP procedures for Social Work Services (required during 2022 -2023 period) will provide opportunity to explore best practice regards technology use in ASP case management. ASP Council Officers (Social Workers) continue to undertake risk assessments on an individual basis for the protection of Adults with lived experience of harm. Since April 2020, the Senior Officer with responsibility for ASP has been working closely with colleagues across localities and NLC Quality Assurance Team to produce weekly (and fortnightly/four weekly) AP data reports. Such reports are required for both internal and external reporting requirements e.g. Senior Social Work Managers, NL CSWO, CHAT and Scottish Government. Initially, it was recognised that while the weekly data reports will provide a basic weekly trend (e.g. whether the data set has increased or reduced), there were broader limitations within the data sets, in terms of identifying more specific trends and patterns. To address this issue, in addition to the weekly data set information, a ten-week analysis of referrals, investigations and case conferences, with a comparison, to the same period last year, is provided. Feedback from Locality Social Work Managers is positive, in that, the information is useful as it is current and provides a detailed account of AP activity for their own locality area, in comparison to other localities. Throughput the period, every ASP referral that has been submitted regarding adults that reside in care homes in NL, has been reviewed. This work has promoted an ‘early intervention’ approach to identify emerging concern/s, specific patterns and/or trends and provides additional scrutiny and assurance for senior managers and the CSWO. Moreover, good practice guidance in ASP risk assessment and risk management is explored in partnership with Senior Social Workers and Council Officers, where required, which contributes to continues improvement activity in ASP. During the year, a number of development activities have taken place to strengthen AP governance and quality assurance systems within Social Work Adult Services. For example, work is ongoing with the development of an AP governance data base that supports the logging and tracking of cases of concern and/or significant events and CSWO case escalation process. The system promotes a ‘reflective learning from practice’ approach and provides additional assurance that each event is analysed carefully to ensure that learning is taken forward with social work and multi-agency practitioners across localities. Another example is the development of the ASP Service Provider Group. This forum provides a platform for communication between senior social managers (e.g. within Headquarters and Localities) to discuss new and emerging risks within services, as they arise. This group also has a key focus upon Large Scale Investigations (LSI) within North Lanarkshire and other Page 103 of 193
Page 104
4 local authority areas, where North Lanarkshire residents may be within the service. Members from this group are involved with the development of updated AP Large Scale Investigation (LSI) policy and procedures; work is ongoing and will capture learning from practice as the Council carried out two AP LSI’s during this period (see LSI below). Finally, to improve information sharing where ASP Protection Orders are being implemented, the Senior Officer Adult Protection, NLC Legal Services and Police Scotland have a local information sharing process regarding ASP Protection Orders in North Lanarkshire. Colleagues from NLC Legal Services inform Police Scotland at the earliest opportunity where they obtain and implement an ASP Banning Order (with power of arrest). This provides timely and accurate information for Police Scotland to ensure those adults who are deemed at serious risk of harm are safeguarded and protected. The Post Graduate Certificate (University of Stirling) in ASP is presented each academic year at University of Stirling. For academic period 2020 – 2021, three experienced social workers were supported to complete the course; this was however delayed due to the pandemic with the social workers graduating in March 2021. For academic year 2021 – 2022, two experienced social workers have been supported to attend the course; both social workers will graduate in December 2022. This is very positive as it provides further evidence of the councils’ commitment to invest in employee development and to build upon staff resources that supports the continuous improvement of ASP practice. While ongoing development work in ASP performance and scrutiny; AP governance structures and employee learning and development will provide evidence of continuous improvement activity here in North Lanarkshire, the Council continues to undertake a range of AP quality assurance and self-evaluation activities in preparation of the forthcoming joint inspection (see Case file audit / review section below). National Position The Scottish Government, via the National Strategic Forum for Adult Support and Protection, published a detailed three year plan covering Assurance, Governance, Data and Information, Policy and Guidance, Practice Improvement and Prevention. This plan confirmed that all adult protection partnerships in Scotland would be jointly inspected over the next two/three-year period. The Care Inspectorate has updated its activity for the Adult Protection Joint Inspection Process, reflecting the ongoing impact of Covid 19 and the pandemic on both services and the community. The Inspection Partnership Briefing Document, which provides partners with the practicalities of inspection requirements, is being updated accordingly. The Scottish Government ASP Improvement Plan can be accessed by clicking here North Lanarkshire’s Inspection Readiness Multi agency group continues to prepare for inspection through a continuous improvement model. Improvements in a number of areas have been highlighted through self-evaluation. Members are encouraged to ensure that their service’s case files continued to be monitored and internally audited, and that their policies and procedures reflect the Adult Support and Protection agenda. There is currently a significant level of activity with regard to legislative and national policy proposals which directly affect Adult Support and Protection. There is a stated commitment Page 104 of 193
Page 105
5 from the Scottish Government Adult Protection Team to ensure connectivity across this activity. This specifically relates to ‘connectivity’ of the consultation responses/findings regarding the Scott Report , Feeley Report and three revised ASP Guidance documents to inform the progress in all of these areas. Summary of recent national activity is provided below: The responses and analysis for the National Adult Protection Code of Practice and for Guidance for Adult Protection Committees consultation were published in March 2022: o Brief summary report of the consultation analysis o The responses A report on the responses to the GP and Primary Care Guidance is already published and should be considered as part of this package of consultations. Adult support and protection - GP and primary care guidance: consultation analysis - gov.scot (www.gov.scot) The National Care Service ( NCS) Bill is due to be presented to Scottish Parliament in coming months. Within this Bill it is intended that amendments be made to the Adult Support and Protection Legislation. With the creation of an NCS, it is likely that, as part of the transfer of adult social services to the NCS, adult support and protection functions and duties in the Adult Support and Protection (Scotland) Act 2007 (the 2007 Act), which Councils and Council Officers hold, will transfer to the NCS and its officers. As part of the NCS Bill, a number of amendments are being considered to the Adult Support and Protection (Scotland) Act 2007. A limited consultation has taken place with regard to changes, with concerns expressed to ensure connectivity to the ongoing work discussed above and the need for robust consideration of the proposed changes. These amendments include: • Council Officers to be known as “Adult Support and Protection Officers” (ASP Officers), with a potential for some amendments to their role. • the duty in section 4 (Council’s duty to make inquiries) to be undertaken by ASP Officers. Currently the duty is on the Council, with Council Officers being required to undertake ASP Investigation. • The proposed changes also included a fundamental change to the legislation through a change of language and thus definition to the three-point criteria of who is an ‘adult at risk’. Given the high level of feedback to the Scottish Government on the challenge to adapt this criteria without wide and robust consultation, verbal updates from Scottish Government advisors indicate this proposal will not be progressed at this point. The latest Scottish Mental Health Legislative Review Consultation was published on 17th March, with the response due on 27th May 2022 https://consult.gov.scot/mental-health-law- secretariat/scottish-mental-health-law-review/ This is a complex Review across different legislation, with the focus for the Council being the references to Adults and Risk and the 2007 ASP (Scotland) Act. There is a continued Page 105 of 193
Page 106
6 concern that the Adult Protection Legislation does not fit well within this Review process and as yet Adult Protection has appeared largely absent in reports and consultations. The Senior Officer Adult Protection and ASP Co-ordinator have worked in partnership to consider and contribute to, wider national developments and how such developments are taken forward locally, in partnership with local partners. Local consultation, involving senior managers and Council Officers was undertaken to provide views upon the updated ASP Code of Practice and National Care Service; feedback from colleagues and partners contributed to a formal response by the council, to both national consultations. Detailed consultation work has also taken place to identify adult protection updates required for the Councils’ new IT case recording system for social work services; this work is ongoing at present. Case file audit / review The ongoing monitoring and review of adult protection operational activity remains a key feature for Social Work Services. A multi-agency inspection readiness group was formed with senior representatives across the public bodies and led by a Senior Social Work Manager. This group has met regularly to support the pre inspection agenda, as well as planning multi-agency case file reading and tidy up work across localities during April and May/June 2021; this activity will identify areas for policy and practice improvement and, will explore remote and virtual file reading methods to help prepare the partnership for future inspection activity. The Council continues to undertake a range of ASP quality assurance activities to support continuous improvement, including: • The production of AP weekly reports which provide ongoing monitoring and assurance via the review of general ASP referrals and for those specifically related to care home services in North Lanarkshire. • The production of quarterly performance management reports which review and analyse ASP activity. These reports are reviewed via the APC, and in partnership with other agencies and services. • Case review process: ASP governance data base that supports the logging and tracking of cases of concern and/or significant events. The system promotes a ‘learning from practice’ approach and provides additional assurance that each event is analysed carefully to ensure that learning is taken forward and disseminated to social work and multi-agency Local Profile During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. Page 106 of 193
Page 107
7 Number of Referrals 800 700 600 500 400 300 200 100 0 Quarter 1 Quarter 2 Quarter 3 Quarter 4 General referrals Police Scotland continue to be one of the main referrers with 16% (381) of all ASP referrals received. Seven years ago Police Scotland replaced their local reporting system with a central “Concern HUB” which covers both North and South Lanarkshire areas. We initially saw a significant increase in the number of adult protection referrals; however, following a review of their screening processes there was a steady decrease however, now a significant decline, with Police referrals down 36% from the same time last year (from 598 to 381). Other 6% Referrals In Period by Referral Source - 2021/22 Social Work Self 0% Police 16% 15% Carer 15% Health 19% Fire Service 4% NLC-Housing 5% Care Home 19% Family/ Public 1% 574 576 649 575 611 600 592 683 2020/21 2021/22 Page 107 of 193
Page 108
8 While there was a reduction in Police Scotland ASP referrals, the data reveals a significant increase in Police ‘Adult Concern’ Reports rising 13% in comparison to the same time last year (from 3552 to 4004). The data below provides a wider context on police ‘adult concern’ report data, over the last few years, as follows: 2017/18 – 3023 2018/19 – 3148 2019/20 – 3027 2020/21 – 3552 2021/22 – 4004 As above, police concern reports have increased by 981 reports (32%) since 2017/18 (from 3023 to 4004). This is the third year running when significant increases have occurred; this work continues to generate significant resource pressures. There were increases in the number of ASP referrals received from both Health (from 426 to 473; up 11%) and Social Work (from 324 to 371; up 15%). Such increases have resulted in Health and Social Work increasing their percentage share of referrals to 19% and 15% respectively. Housing Services measured a 10% decrease (from 139 to 125) while Fire & Rescue Services demonstrated a 9% decrease (from 93 to 85) in ASP referrals submitted compared to the same time last year. In general, despite the reduction in ASP referrals from Police Scotland, it’s very positive that referral rates are increasing - across the public bodies (and partner agencies) - as much work has been undertaken via training, learning and development and pre-inspection work to promote the importance of employee duties and responsibilities to raise concerns for adults at risk of harm. For this period, ASP referrals from Care Homes demonstrated a 9% increase (from 416 to 455); this means that 19% of total ASP referrals come from this source. Information from inquires and investigations processes suggest: • Those Adults that require Care Home provision are now more advanced with complex health conditions when moving into the service e.g. dementia; • Updated Care Inspectorate ASP procedure that ensures Inspectors seek (and log) information from service providers regarding progress and outcomes of ASP referrals; • Internal NLC Quality Assurance systems such as quarterly reporting via the HYVE system and Senior Officer / Collaborate monitoring/scrutiny visits to Care Homes providers; • Ongoing work from NL APC via events to raise awareness and priority of ASP within Care home settings, and; • Increased scrutiny of care home services during the pandemic. Monitoring and support in this area is provided by colleagues in Quality Assurance in Page 108 of 193
Page 109
9 addition to thorough ASP Multi agency training and, in line with the increased focus on Care Homes during the pandemic this area of activity has more recently also been monitored through weekly review of ASP referrals for care homes and multi-professional Care Home Oversight arrangements e.g. Care Home Assurance and Tactical group (CHAT). Lanarkshire’s Care Home Assurance Operational and Oversight Group promotes multi- agency working and provides oversight of activity in care homes. A strengthened structure provides better connection between operational services and strategic leadership, and has enabled closer working between partners, to identify concerns within care homes at an early stage. This development of enhanced scrutiny and assurance processes has supported informed decision making. A collaborative ‘supportive visit’ structure was introduced to support care home providers during the pandemic and reflects the established links between care homes, NLC Quality Assurance, social work localities and senior managers, the Care Inspectorate, and the District Nursing Care Home Liaison Team. For some care homes, the approach has involved monitoring and support from a locality social work department and the NHSL Care Home Assurance Team, to implement an improvement plan without implementing an ASP Large Scale Investigation. Localities In comparison to the same time last year, statistics show that two (2) localities measured increases in referral rates, as follows: • Airdrie up 26% (from 316 to 398), and • Bellshill up 10% (from 311 to 343). In comparison to the same time last year, statistics show that four localities measured decreases in referral rates, as follows: • Coatbridge down 10% (from 403 to 364), • Cumbernauld down 5% (from 298 to 329), • Motherwell down 8% (from 322 to 295), and; • Wishaw down 14% (from 464 to 397); Data reveals that Airdrie (398) and Wishaw (395) localities received the highest amount of ASP referrals for North Lanarkshire for 2021 - 22. ASP referrals progressed by SWES colleagues increased by 1% (from 256 to 258) between yearly periods. Page 109 of 193
Page 110
10 Referrals In Period by Agegroup and Sex 400 350 300 250 200 150 100 50 0 16-24 25-39 40-64 65-69 70-74 75-79 80-84 85+ Gender Consistent with last year, Social Work Services received more referrals for women than men for 2021/22 (e.g. women: 1299 – men: 1136). The data is consistent to last year and represents a 53% (women) - 47% (men) percentage split. Statistics show that both men and women are more likely to be referred for ASP, when above the 65-year age range. This finding remains congruent with last year’s data for both women and men. Referral by category Adults with mental health issues were represented in 35% (858) of the total ASP referrals received, being the main primary user group referred. Referrals for this group have decreased since the same time last year but remain high in overall percentage terms (from 939 to 858). This only reinforces the importance of key service developments such as Distress Brief Intervention (DBI) and social work investment in delivering ASP training for those organisations who deliver services at home to our most vulnerable service users. For the first time, physical harm and psychological / emotional harm are joint highest reason for referral with 35% each of total referrals received. This marks a significant shift from previous years when psychological / emotional harm was the highest; this could be attributed to the high numbers of ASP referrals received for Care homes that involve physical type incidents between residents. The 2018/19 ASP procedural review introduced the new harm term of self-neglect in an attempt to identify and separate those adults that may be at risk of harm due to not caring for themselves, from those at-risk adults who rely upon care from others. It has been recognised in research that self-neglect cases can be some of the most complex to manage for practitioners, as they are fraught with issues that cut across ethical, legal and practical considerations. Raising awareness of such issues, for multi-agency practitioners, has been a key focus within the Multi agency forums and within ASP multi agency training; a locality working group on self-neglect for practitioners, is currently being considered. For this period, there were 241 self-neglect cases which measures 10% of total ASP referrals 374334 231 127 77 75 99 99 69 102 117 151 103 133179 124 Males Females Page 110 of 193
Page 111
11 received. Referrals for self-neglect situations are third highest reason for all referrals and have increased by 4% since last year (from 232 to 241). Referrals for Financial harm (7%), Institutional harm (5%), Sexual harm (3%) and Material harm (1%) continue to have a focus in adult protection and have similar levels to the same time last year. Referral Outcomes There continues to be a high number of referrals that progress to no further action under adult protection legislation (1,644 or 68%). This may be for a number of reasons e.g. the adult may not meet the three point criteria under the 2007 Act and/or the adult may be better supported by another care agency. Despite many ASP referrals progressing to no further action under the legislation, there is still a legal requirement on the council to carry out initial inquiries. This places responsibility on the locality social work teams to respond to every referral received and undertake detailed work to ensure that the right decisions are made. This can often result in lengthy involvement from social work staff as the adults circumstances evolve and risks change. Some of those referrals may require ongoing work to take place over a longer period of time to ensure that the adult’s welfare, finances, rights and/or property is safeguarded, and they are supported to manage the risks they face. Referrals in Period by Primary Reason SEXUAL SELF NEGLECT 10% 3% SELF HARM 4% EMOTIONAL OR PSYCHOLOGICAL 35% PHYSICAL 35% FINANCIAL 7% MATERIA INSTITUTIONAL HARM L 1% 5% Page 111 of 193
Page 112
12 Referrals in Period Leading to Investigations by Primary Reason 127 75 69 76117 135 64 64 8 12 0 1 4 6 25 3 0 7 ASP Investigations There were 434 investigations carried out in 2021 -22 which marks a 17% increase from last year (from 370 to 434). Data reveals that 18% of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%). 160 140 120 100 80 60 40 20 0 0 Similar to last year, 25% (108) of investigations progressed onto an initial case conference with Emotional / Psychological harm (135) being the highest reason for investigation, followed by Physical harm (117), Financial (69), Self-neglect (64), Institutional (25), Sexual (12), Self-harm (8) and Material harm (4) coming next. As the above table illustrates, in comparison to last year, investigations increased for Physical harm, Emotional / Psychological harm, Self-neglect and Institutional harm. The largest increase between yearly periods has been physical harm type investigations. Quarterly reports continue to highlight the increase for referrals in care homes which often include physical type incidents between residents. Increased awareness of self-neglect and the associated impacts for adults continues to take place in localities via practitioner learning and training; this supports an increase in our ability to identify self-neglect type situations and, collaborate with multi agency professionals to consider proportionate and safe interventions, in partnership with the adult. Case Conferences Case conferences often result following an investigation and are always chaired by Locality Social Work Managers (LSWM). Partner agencies are invited under their duty to co-operate and their contribution is vitally important in sharing accurate information in order to produce and implement effective multi agency risk assessments, protection plans and informed outcomes for those at risk of harm. There were 108 ASP initial case conferences and 52 ASP Review case conferences held for 2021 - 22. This measures a 32% increase in comparison to the same period last year (from 82 to 108). 11 2020-21 2021-22 Page 112 of 193
Page 113
13 Referrals in Period Leading to Case Conference by Conference Decision (if known) 70 60 50 57 40 31 30 66 20 10 0 0 9 0 9 9 0 7 1 0 0 1 Ongoing CC Cont NFA Concerns NFA for ASP - Further Proceed under N/A Concerns further Not Passed for Investigation AWI investigation Substantiated Allocation As noted from the above table, the overwhelming majority (66) of case conferences reached a decision that concerns were ongoing; this means that a full or interim protection plan would be implemented in each case situation. Previously, end of year reports have highlighted that there continued to be a number of ASP cases upon the electronic recording system, at different stages in the ASP process, where no decision had been recorded. This year, the data shows that only three cases, one at each stage i.e. Inquiry, Investigation and Case Conferences processes, had no recorded decision. This is impressive and huge progress made; this positive development is testament to the ongoing pre-inspection preparations that include ASP case file auditing and tidy up work being undertaken by many colleagues within and across Social Work Adult Services (SWS Headquarters and Locality staff). Statutory Orders/Functions For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire implemented thirteen (13) ASP Protection Orders, as follows: • 6 X Removal Orders, • 3 X Banning Orders with Power of Arrest and: • 4 X Temporary Banning Orders with Power of Arrest. In addition to ASP work, qualified social workers within community care teams continued to also hold statutory responsibilities under Adults with Incapacity legislation as follows: • Delegated Officer responsibility for 226 Guardianship Orders where the Council acts as Guardian Supervising Officer Responsibility for 760 private Guardianship Orders. 2020-21 2021-22 Page 113 of 193
Page 114
14 Large Scale Investigations North Lanarkshire Council commissioned and carried out two ASP Large Scale Investigations (LSI) during this period. An ASP LSI undertaken in 2021 related to a community-based care at home service. It required a flexible and responsive approach from the Council and a particular focus on domestic environmental and safety risks, as the service being investigated provided care and support for individuals within their own homes. The most significant ASP LSI undertaken relates to a local care home; carried out from November 2021 to February 2022, at which point the care home closed. It required senior leaders from the Council, Health and Social Care Partnership (HSCP), NHSL, and Police Scotland Lanarkshire Division to establish significant resources to ensure the protection of the facility’s 70 residents from across Scotland. North Lanarkshire had one resident within this service. This was a complex LSI, given the number of HSCPs involved as each undertook reviews for those individuals they were responsible for placing. This work was intensive and complex and required strong leadership at all levels. It involved close co-operation with the Scottish Government, the Care Inspectorate, and COSLA. Plans are currently being put in place to ensure learning from this LSI is shared both locally and nationally; the first step in this has been ensuring the report has been considered by the Adult Protection Committee and the Learning Review Executive Group (formerly called the SCR Executive Group). As aforementioned, it has been recognised that the work associated in carrying out both LSI’s was significant and challenging for all professionals involved. Partners remained professional, focused and resilient throughout the investigation process to safeguard and protect adults, at all times. From both experiences, Social Work Services has recognised that carrying out ASP Large Scale Investigations will require flexibility in approach and investigative methodology and good partnership working to ensure a proportionate, targeted and joined up response. The learning from undertaking both investigations is currently being drafted into an updated AP Large Scale Investigation policy and procedure. Local Care homes and other contracted provider’s continue to have access to adult protection training and awareness sessions, which keeps them informed and supports good practice. NLC Quality Assurance Officers provide further support and scrutiny of adult protection issues. North Lanarkshire Guidance for the Protection of Adults within Registered and Contracted Services policy and procedures is currently under review. Additional Elements Supporting Adult Protection: Appropriate Adults Services Appropriate Adults (AA) facilitate communication between vulnerable individuals and the police (and other governmental organisations such as DWP) during investigation processes. People who are eligible for support will be over the age of 16 years who, as a result of a mental disorder, appear to the Police to be unable to understand sufficiently what is Page 114 of 193
Page 115
15 happening or communicate effectively. AA support can be provided for suspects, victims and witnesses. Statutory duties for Appropriate Adult services are set out via Sec 42 and, Sec 98 to 106 of the Criminal Justice (Scotland) Act 2016 and, Appropriate Adults: Guidance for Local Authorities (2020). These confirm that: • The Council has duties to provide AA services in their area and, to provide training for Appropriate Adults; • Police Scotland has a duty to identify whether an adult requires AA support and, to make a request to the Council, and; • The Care Inspectorate has the duty to assess the quality of AA Services. Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with 16 employees trained to perform AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In line with statutory guidance produced by Scottish Government, work is underway to develop a local Appropriate Adult Oversight Group. This multi-agency group will have responsibilities for policy and practice development in this area e.g. recruitment, training, confidentiality, health and safety and service complaints. As below, Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year. North Lanarkshire is similar to other local authority areas who have also experienced reductions in referral rates; this is being monitored by the national Oversight group, Scottish Appropriate Adult Network (SAAN) and Police Scotland. While there was a decrease, there were increases in the number of times AA’s are being asked to attend police stations (for the same offence) and are spending an increased amount of time supporting vulnerable adults whilst there. As Council employees perform the AA role in addition to professional social work roles, this continues to contribute to resource pressures. North Lanarkshire Appropriate Adult Service requests by Year and number 2017/18 2018/19 2019/20 2020/21 2021/22 158 108 114 92 71 During 2021-22, local and national developments have continued to take place to assist with the ongoing implementation of the national statutory framework e.g. review of local AA service duty system, development of Scottish Government AA Oversight Group, AA national training group, and the requirement to complete a service based questionnaire on North Lanarkshire AA Services, for the Care Inspectorate. The Council is currently working in partnership with the Care Inspectorate and other partners to design a self-evaluation model for ongoing quality assurance purposes for AA Services. Distress Brief Intervention (DBI) The Scottish Government announced that Health and Social Care North Lanarkshire were successful in their bid to host the Central Team for the Distress Brief Intervention (DBI) test programme as well as run one of the pilot sites. The test sites became live in the spring of 2017. Page 115 of 193
Page 116
16 Over the last four years, with Scottish Governments support, the vision, collaborative culture and programme infrastructure has enabled the programme to expand and include young people aged between 16 and 17 years. A Distress Brief Intervention is a time limited and supportive problem solving contact with an individual in distress. It is a two-level approach. DBI level 1 is provided by front line staff and involves a compassionate response, signposting and offer of referral to a DBI level 2 service. DBI level 2 is provided by commissioned and trained third sector service Life Link (North Lanarkshire) who will contact the person within 24-hours of referral and provide compassionate community-based problem solving support, wellness and distress management planning, supported connections and signposting for a period of up to 14 days. On the 14th April 2020, the First Minister announced the expansion and development of the Distress Brief Intervention (DBI) programme into a nationwide response for people presenting in distress to the Mental Health HUB at NHS24, during the Covid-19 pandemic period. The council remain one of the key pilot areas delivering the DBI service, with the second highest referral rates across the 5 pilot areas. Referrals are higher for females and age range is predominately 18-59, and, mostly come from hospital emergency departments. Data reveals that 78% of those referred, engaged in support with reported improvements in median distress levels and outcomes. Until this year DBI referrals were for 16 years and over however the service is now being piloted in some North Lanarkshire Council schools. North Lanarkshire Adult Protection Committee North Lanarkshire’s Adult Protection Committee (APC) partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. The APC has statutory duties to promote communication and co-operation within and between the public bodies, to be involved in the development of local adult protection policies, procedures and practice, and to provide adult protection learning and development opportunities for multi-agency employees. Independent APC Chairs have a statutory duty to submit a Biennial Report to the Scottish Government every two years, outlining activity and progress of implementing the 2007 Act in their area. This has been helpful in measuring local performance and how far adult protection has progressed over such a short period. The Biennial Report for 2018 -20 is available by clicking upon the icon below: North Lanarkshire Adult Protection Com Page 116 of 193
Page 117
17 The APC undertook a self-evaluation exercise in 2021-22, based on recommendations from the National Guidance for APCs. This included consideration of key Adult Protection Committee documentation, including terms of reference and induction materials; governance arrangements following changes in the corresponding arrangements of key partner agencies; and the capacity and resources of the Adult Protection Committee. Results from the self-evaluation exercise were positive and identified well-established arrangements in place across all aspects of partnership working by Committee and Sub- committee members but reflected that additional links to newly established governance routes would be beneficial. As the recently formed Care Home Assurance Team (CHAT), is a new body, it does not feature in national ASP codes of practice or guidance and therefore there is no guidance in terms of governance across these bodies. However the Adult Protection Committee self-evaluation recommended increased links in this area and the Lead Nurse for Care Home Liaison is now a member of the APC. Similarly, the Health and Care Partnership Support Care and Clinical Governance Committee, October 2021, agreed on the increased benefits from more explicitly ensuring links across all relevant groups. With the Adult Protection Co-ordinator, now a member of this Committee, this has strengthened governance links with NHS Lanarkshire. The self-evaluation identified the need for representation by acute services on the Adult Protection Committee. This has helped to raise awareness of adult support and protection within acute service of NHSL. Membership of the NHSL Strategic Public Protection Group have been extended to include Pan Lanarkshire Adult and Child Protection Leads, improving the cohesion, clarity of governance and communication routes between the Adult Protection Committee and its strategic partners. There are a number of thematic developments being progressed on a Pan Lanarkshire Basis via North Lanarkshire Adult Protection Committee. Given an increased national focus on Interagency referral Discussion (IRD) for adult protection nationally, a Pan Lanarkshire working group have agreed to a small IRD pilot to inform our position on the implementation of IRDs for ASP in both North and South Lanarkshire. This will take place in May/June 2022 The Pan Lanarkshire Financial Harm Group is now established with a Terms of Reference agreed. An initial focus for the group will be Section 10 information sharing for financial institutions. A Pan Lanarkshire Self Neglect Group has also been established, aiming to develop a multi- agency framework guidance; work is ongoing in this area. A programme of learning and development for the GP Locality Forums has been facilitated by the Adult Protection Committee. An overall session was delivered in December 2021, this Page 117 of 193
Page 118
18 was followed by a Pan Lanarkshire evening event as part of the GPs learning and development programme. This is being followed up by the Adult Protection Coordinator attending all of the Locality Clinical Forums and providing training to Trainee GPs. This work focuses on awareness raising of adult support and protection, understanding of ability to protect, reducing the stigma of adult support and protection, Section 10 of the Act (information sharing), and the national GP and Primary Care guidance. Advocacy providers are active members of the Adult Protection Committee Network, a sub- committee comprising community and third sector organisations, and are active partners in Adult Protection Committee work. Providers report they have positive relationships with social workers and discussions at the Network reflect a well-established referral process involving staff trained in adult support and protection and promote positive partnership working across all agencies. North Lanarkshire Public Protection Partners and the National Missing Persons Project have worked closely together to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. This aims to mitigate the risk to the people who go missing, provide a consistent approach for the relevant agencies when a person is missing, and ensure that the collective response delivers on the achievement of the objectives contained within the National Framework. Police Scotland information on episodes of missing adults is now part of the APC quarterly data reporting. In addition to missing persons, the APC currently also has monitoring and oversight for Appropriate Adult Services, to ensure that these emerging agendas have clear governance within North Lanarkshire. APC Partners have worked to ensure that the workforce responds to adult protection in a way that is trauma informed. The APC signed up to the National ‘Trauma Informed Practice’ Pledge in 2021 and the Adult Protection Coordinator is a member of North Lanarkshire’s Trauma Steering Group. The Committee continues to work with partners across the public protection agenda to embed trauma informed approaches within our training, audit and policy development. Within this approach we are embedding approaches informed by Contextual Safeguarding to inform procedures and practices. We are committed to promoting a shared approach to language, working alongside our Child Protection Committee, the Senior Officer for Contextual safeguarding, and with the national Contextual Safeguarding Network to promote and enable transitional safeguarding approaches in North Lanarkshire. North Lanarkshire is the Scottish representative in a UK wide research programme led by the Contextual Safeguarding to consider systems and practice for older young people and adults. Page 118 of 193
Page 119
19 Improvements implemented over the last two years have focused on addressing known and emerging risks by developing policies to support practice, improving training and guidance for practitioners, creating effective and flexible digital systems in response to the pandemic which have enhanced the ability of partner agencies to safeguard adults in local communities. Case Reviews (now known as Learning Reviews) There was one notification from Social Work Services in regard to case reviews or significant incidents made to the APC, for the year 2021 - 2022. NLC-APC-ICR022, was a case of sexual violence carried out on one resident to another in an independent care home in North Lanarkshire. The initial case review found that the incident could not have been predicted, however, there was clear learning, largely based on how partners responded. An action plan for partners, from the review, was amalgamated into local public protection and single agency workforce development planning. The Adult Protection Committee completed one Significant Case Review over the year 2019 - 20. The Review for ‘Susan’ was endorsed by the Adult Protection Committee on 4th February 2020. The subsequent action plan following from the findings was progressed throughout period 2021/22. Key actions included refreshing our social work adult support and protection procedures and an increased focus on domestic abuse in adult support and protection training. For example, the role of senior social workers (SSW) has been strengthened throughout the ASP process. Assurance regarding the Duty ASP SSW remit has been strengthened to ensure that the SSW screen and allocate all ASP referrals and continues to sign off and provide oversight at each stage. Learning from both reviews has been embedded into training and action planning via the APC subgroup structures and process. This includes work regarding changing sexualised behaviour, chronologies, trauma informed practice and increasing links between domestic abuse and adult protection processes. Local Developments and Events: Public Protection Newsletter – PPN North Lanarkshire Public Protection Newsletter was updated last year and is now produced in an electronic format and is circulated monthly to 4,000 subscribers. As a well-established way of sharing information, it became a weekly briefing during lockdown measures. The Newsletter shares updates on national and local adult support and protection issues, including publications, guidance, consultations, and resources. It is also a way of reiterating links across public protection agendas. Regular positive feedback is received by practitioners, across agencies, as to the type and nature of information being shared. ASP Multi agency Forums The APC delivered the thirteenth series of the multi-agency fora in November/ December 2021. The programme was interrupted by the Pandemic in 2020 to 2021, and these sessions ran as online events given the restriction remaining on face-to-face sessions. Page 119 of 193
Page 120
20 The fora included a recognition of the significant impact of the Covid Pandemic on all services in the last two years and the specific challenges to protecting adults, The aims of the sessions are: 1. To bring together operational staff with a responsibility for adult protection across North Lanarkshire within their locality; 2. To share relevant information, learning and practice developments; 3. To provide opportunities for best practice to be disseminated across localities; 4. To provide opportunities for communication both within and across agencies; 5. To support links with staff across the Partnership and the Adult Protection Committee This year, the multi-agency fora had three main themes, as follows: Updates on National and North Lanarkshire This reflected the significant progress made in developing a national strategic approach to Adult Support and Protection and included an update on the progress of the National ASP Improvement Plan including the developing role of the National Strategic Forum: • IRISS have been commissioned to support the development of a National Data set and consistent framework to the Biennial Report • National Consultations with regard to the statutory Code of Practice, APC Guidance and GP and Primary Care Guidance • National work impacting on protecting adults such as the National Review of Mental Health Legislation, National Care Service Consultation • The National programme of Joint Inspection of Adult Protection Adult support and protection in a changed climate These activities reported in section one illustrate an increased profile for Adult Protection nationally. The session then went onto update on Local developments, with a specific focus on the impact of Covid. This included discussion on the additional focus on ASP during the pandemic, including increased governance, and national guidance Discussion included staff roles, how we support and assessing risk changed, risks from hidden Harm and Reduced support v Increased scrutiny Changes to the profile of risk was also discussed, specifically regarding self-neglect/ neglect Learning from Reviews The largest part of the session focused on sharing learning from reviews. this includes: Page 120 of 193
Page 121
21 • Local & National SCRs • ICRs & Reflective Learning Review • National review of SARs ( England and Wales) 2017 – 19 • Audit • National Inspection Reports Six key themes were explored, with opportunity for discussion and reflection . Each reflects specific learning for Review and a recognised focus for work in North Lanarkshire. All have/ are being taken forward through different public protection activity. Resources and learning were shared, with links made to changes in policy, procedure and training locally: • Role of decision maker and oversight • Chronology • Domestic Abuse • Ability to protect • Responding to changing and sexualised behaviour • Self-Neglect Practitioner discussion promoted a practice-based element to each subject. Evaluation Evaluation forms and feedback received indicate a positive transition from face to face to online facilitation, although face to face remains the chosen format. The forums took place during a time of an increase in Covid infection and restrictions, in addition some localities had specific capacity challenges. Although reduced attendance from some partners and varied attendance from some localities was anticipated, the decision to go ahead with the sessions reflects the need to work as closely to ‘business as usual’ as possible. Again, there is a commitment that face-to-face sessions are resumed as soon as feasible. Two of the six Forums did not take place due to specific capacity issues in those areas, but as the sessions were online some participants were able to attend other locality forums. 70 multi agency professionals participated across the four sessions. Public Awareness Raising Campaign Social Work Services have actively contributed to national awareness raising by liaising with colleagues via Social Work Scotland and committing to raise national and local awareness by holding an annual Adult Protection Day, held on 20th February 2018, 2019, 2020 and 2021. Key partners have a co-ordinated to post and share each other’s information to generate interest. Within North Lanarkshire the APC and their partners contributed to the local campaign by the following: Page 121 of 193
Page 122
22 • Press releases across North Lanarkshire; • Regular posts on Face book and Twitter across the partners; • Newsletters were shared across the voluntary and public agencies. ASP Learning and Development In line with continued national restrictions and the inability to deliver classroom-based learning, the AP Co-ordinator and members of the APC Learning and Development subgroup reviewed and updated all ASP Multi agency training materials to support remote learning/delivery approaches; training materials now also include trauma informed awareness and approaches for staff to reflect upon and consider. During the period, nine Level 1 courses (3 hours) and seventeen level 2 courses (4 hours) were delivered for multi-agency partners to maintain learning and development momentum in adult support and protection. This year, twenty-four (24) social work staff attended Level 2 training with most social workers progressing onto the full ASP Council Officer Training programme. ASP Council Officer Training (Day 2) and Investigative Interviewing Training (Day 3) materials were reviewed and updated by the Senior Officer, Adult Protection, to deliver via remote based learning due to the inability to provide face to face learning. Two separate deliveries of the training programmes were required during period March 2021 to May/June 2021 where 30 social workers completed the training in order to perform ASP Council Officer roles; please note, this training is a legal requirement for social workers who undertake investigative functions under the 2007 Act. The updated training materials now include Trauma Informed Practice as part of the wider training delivery. One ASP Council Officer Development session was delivered in February 2022 to four Social Workers. This session was held to capture those social workers recently appointed by the Council, and have previous experience of assessing and manging risk in other disciplines e.g. Child Protection and/or MAPPA. As aforementioned, for academic year 2021 – 2022, two experienced social workers have been supported to attend the Postgraduate Certificate in ASP course; both social workers will graduate in December 2022. Key Areas for Reflection • During the period 2021 - 22, Social Work Services received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. The Council additionally received 4,004 Police ‘Adult Concern’ Reports, an increase of 15% from last year (from 3,552 to 4004); therefore the total number of adult protection activities undertaken to keep adults safe across North Lanarkshire for 2021 - 22 was 6,437. • Police Scotland ASP referrals reduced by 36% however they still remain one of the main referring groups. While Police referrals reduced, there were significant increases in referrals being submitted by Health (from 426 to 473; up 11%)) and Social Work Page 122 of 193
Page 123
23 Services (from 324 to 371; up 15%). It’s very positive that referral rates are increasing - across the public bodies (and partner agencies) - as much work has been undertaken via training, learning and development to promote the importance of employee duties and responsibilities to identify and report concerns for adults at risk of harm. • For this reporting period, Social Work Services received more referrals for women than men for 2021/22 (e.g. women: 1299 – men: 1136); the data is consistent to last year and represents a 53% (women) - 47% (men) percentage split. Statistics show that both men and women are more likely to be referred for ASP, when above the 65-year age range. This finding remains congruent with last year’s data for both women and men. • For the first time, physical harm and psychological / emotional harm are joint highest reason for referral with 35% each of total referrals received. This marks a significant shift from previous years when psychological / emotional harm was the highest; this could be attributed to the high numbers of ASP referrals received for Care homes that involve physical type incidents between residents. • The 2018/19 ASP procedural review introduced the new harm term of self-neglect in an attempt to identify and separate those adults that may be at risk of harm due to not caring for themselves, from those at-risk adults who rely upon care from others. For this period, there were 241 self-neglect cases which measures 10% of total ASP referrals received. Referrals for self-neglect situations are third highest reason for all referrals and have increased by 4% since last year (from 232 to 241). • There were 434 investigations carried out in 2021 -22 which marks a 17% increase from last year (from 370 to 434). Data reveals that 18% of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%). In comparison to last year, investigations increased for Physical harm, Emotional / Psychological harm, Self- neglect and Institutional harm. The largest increase between yearly periods has been physical harm type investigations. • For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire implemented thirteen (13) ASP Protection Orders, broken down as follows: 6 X Removal Orders; 3 X Banning Orders with Power of Arrest and, 4 X Temporary Banning Orders with Power of Arrest. • North Lanarkshire Council commissioned and carried out two (2) ASP Large Scale Investigations (LSI) during this period. Social Work Services has recognised that carrying out ASP Large Scale Investigations will require flexibility in approach and investigative methodology and good partnership working to ensure a proportionate, targeted and joined up response. The learning from undertaking both investigations is currently being drafted into an updated AP Large Scale Investigation policy and procedure. • The Scottish Government, via the National Strategic Forum for Adult Support and Protection, published a detailed three year plan covering Assurance, Governance, Data and Information, Policy and Guidance, Practice Improvement and Prevention. This plan confirmed that all adult protection partnerships in Scotland would be jointly inspected Page 123 of 193
Page 124
24 over the next two/three-year period. The Care Inspectorate has updated its activity for the Adult Protection Joint Inspection Process, reflecting the ongoing impact of Covid 19 and the pandemic on both services and the community. The Council and partners, continue to meet and to undertake a range of AP quality assurance activities, including file audits and case file reading, in preparation of the forthcoming joint inspection. • North Lanarkshire Social Work Services continues to work in partnership with other agencies and the APC to ensure adults who may be at risk of harm are supported to keep themselves safe. Regular audits and reviews are undertaken with the results of this activity used to shape and influence policy, practice and employee learning to help retain a focused approach to adult protection and ensure staff and services are suitably trained to deliver positive outcomes for those who may be subject to harm. • Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year. North Lanarkshire is similar to other local authority areas who have also experienced reductions in referral rates; this is being monitored by the national Oversight group, Scottish Appropriate Adult Network (SAAN) and Police Scotland. Local and national developments continue to take place to implement the national statutory framework. Summary of Adult Protection Activity for 2021/22 Total Referrals 2435 Investigation 434 18% Ongoing Work 8 0.3% NFA - Other Service 342 14% NFA 1644 68% Not Recorded 7 0.3% Investigations 434 Initial Case Conference 108 25% Application to Court 0 0% Ongoing Work 4 1% NFA - Other Service 64 15% NFA 257 59% Not Recorded 1 0% Initial Case Conferences 108 Application to Court 0 0% Ongoing Concerns 66 61% Ongoing Work 0 0% NFA - Other Service/Legis. 10 9% NFA 31 29% Not Recorded 1 1% Cases Reviewed (at least once) 52 Ongoing AP Concerns 11 21% No Further AP Concerns 40 77% Review Conference Continued 1 2% Active At End Of Period 203 Page 124 of 193
Page 125
25 Individual Agency Referral Summary (Main Referring Agencies) The following table shows referral data from the four main referring agencies, as recorded on the social work management information system (MIS), hence the total referrals shown is less than the actual total received in the year. This shows the number and proportion of referrals reaching different stages within the ASP process, and the numbers went on to receive service from other areas of social work. The differences between agencies cannot easily be explained, as they are due to a combination of factors, such as individual’s refusal to engage in the process, individual’s backgrounds and previous involvement with services, reasons for and circumstances of referral, the capacity of individuals at the time of referral, and other individual factors. A graphical summary of each agency’s referral data is shown in appendices 3 to 6, along with a table showing the number of referrals each agency recorded as making on their own MIS, if available. Differences between the two systems are due to the possibility that referrals can go through more than one source before reaching social work, so may be recorded against another source. Page 125 of 193
Page 126
Social Work Police Health Housing Fire Service Care Home No. % No. % No. % No. % No. % No. % Total Referrals 1890 Investigation 159 43% 33 9% 85 18% 21 17% 7 8% 21 5% Ongoing Work 1 0% 1 0% 0 0% 1 1% 0 0% 2 0% NFA - Other Service 36 10% 101 27% 83 18% 16 13% 17 20% 37 8% NFA 175 47% 245 64% 304 64% 85 68% 61 72% 394 87% N/A 0 0% 1 0% 1 0% 2 2% 0 0% 1 0% Total 371 100% 381 100% 437 100% 125 100% 85 100% 455 100% Investigations 326 Initial Case Conference 51 32% 7 21% 22 26% 3 14% 0 0% 4 19% Planning Meeting 1 1% 0 0% 0 0% 0 0% 0 0% 2 10% NFA – Ap proc in place 1 1% 0 0% 0 0% 0 0% 0 0% 1 5% NFA – Other services 25 16% 10 30% 17 20% 6 29% 2 29% 0 0% NFA 80 50% 16 48% 46 54% 12 57% 5 71% 14 67% App. Temp banning order 0% 0 0% 0 0% 0 0% 0 0% 0 0% N/A 1 1% 0 0% 0 0% 0 0% 0 0% 0 0% Total 159 100% 33 100% 85 100% 21 100% 7 100% 21 100% Initial Case Conferences 87 Ongoing Concerns 32 64% 5 71% 15 68% 3 100% 0 0% 2 50% CC cont further investigation 0 0% 0 0% 0% 0 0% 0 0% 0 0% NFA concerns not substantiated 14 28% 2 29% 5 23% 0 0% 0 0% 1 25% NFA for ASP – passed for allocation 3 6% 0 0% 2 9% 0 0% 0 0% 1 25% N/A 1 2% 0 0% 0% 0 0% 0 0% 0 0% Total 50 100% 7 100% 22 100% 3 100% 0 0% 4 100% 27 Page 126 of 193
Page 127
1 Appendix 2 North Lanarkshire Adult Protection Committee Biennial Report 2020- 2022 Marian Martin Interim Independent Chair October 2022 Page 127 of 193
Page 128
2 Contents Preface Introduction .…………………………………………………………………….. page 2 1. Covid 19 …………………………………………………………………………. page 5 2. Data Analysis of Harm ...............................................page 7 3. Outcomes, achievements and service improvements.......page 11 4. Training, Learning and Development ………………………………page 17 5. Engagement, involvement and communication .............page 22 6. Challenges and areas for improvement ........................page 24 7. Looking Forward …………………………………………………………………page 26 8. Appendix One : ASP Data 2020 / 2022………………………………page 27 Page 128 of 193
Page 129
3 PREFACE This is the seventh Biennial Report of the North Lanarkshire Adult Protection Committee (APC) and covers the period April 2020 to March 2022.These have been exceptional years - covering the onset of the Covid- 19 (Covid) pandemic in the UK, several periods of lockdown and work towards service recovery and stabilisation. The word ‘unprecedented’ has become very familiar as we began to realise the far-reaching effects of the impact on communities, individuals and services during this period. We experienced and appreciated a continued commitment from partners during this time to meet both new and additional demand and emerging issues for public protection. The focus of this report reflects how the Committee has continued to discharge its key responsibilities, as outlined in legislation and guidance. We welcome the development of new Guidance by IRISS to support our preparation of this report and acknowledge the enhanced national strategic oversight and support for adult support and protection over the period of this report. There has been considerable national change in the period of this report, with the strengthening of the role of the national Adult Protection Oversight Group, the commissioning of IRISS to provide Adult Support and Protection support on a national basis, including the ongoing development of the national dataset for adult protection. These developments have helped guide the work of the Committee and our partners, with a focus on national and local priorities, as outlined in this Biennial Report. Our committee staff have remained in place during this period, providing consistency during a time of dynamic and changing risk and need. In common with other areas of Scotland we have a joint chair of our Adult and Child Protection Committees, with Marian Martin, being the Convenor for the APC since January 2019. Heather Irving has been the APC Coordinator since January 2020. Marian Martin, Heather Irving Independent Convenor Adult Protection Coordinator Page 129 of 193
Page 130
4 We have seen a number of changes to the Committee membership over the period of this report, however enthusiasm and commitment from new members and partner organisations remains high and a culture of collaboration and shared governance has been maintained. We have strengthened our induction processes for new members and consolidated governance arrangements with the APC, reflecting both developments linked to Covid and integrated services. North Lanarkshire’s APC partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. This is reinforced by our aim: ‘to drive forward professional and public awareness of harm affecting adults at risk; working in partnership with our members and the wider community to ensure that vulnerable and at risk people in and from North Lanarkshire are safe and protected from harm.’ This report reflects how Adult Support and Protection (ASP) activity has sustained, and adapted in this difficult period, with a commitment and dedication from partners to addressing change. This includes consideration of how risk and harm are identified, how services mitigate and address risk. The innovation and commitment of staff in such difficult circumstances has been outstanding and we are grateful to all individual staff for their work in continuing to safeguard and protect our most vulnerable members of the community. This report includes information of the impact of Covid restrictions in some areas of the Committee work and also how we have planned our recovery moving forward. Supporting information for this biennial report can be accessed on the North Lanarkshire Adult Protection Committee website at www.northlanarkshire.gov.uk/adultprotection/ Marian Martin Interim Independent Convenor North Lanarkshire Adult Protection Committee 2022 Page 130 of 193
Page 131
5 Adult Protection Committee North Lanarkshire Covid-19 In North Lanarkshire, the impact of Covid has impacted Adult Support and Protection services and activity, in respect of both our strategic response and the increase of risk in the community. Close collaboration between key partners to identify changing trends and patterns of harm has been used to proactively disrupt this. With exception of the first few weeks of lockdown, throughout the pandemic North Lanarkshire consistently experienced high prevalence rates for Covid infection. The period under review covers a time when the impact of Covid created sustained challenges for all public services, including acute and community-based health and social work services. In response, the Council worked with partners to promote guidance to assist staff working on the front line to identify adult risk or harm and to report this in a timely manner. This work required collaboration with Police Scotland to identify changing trends and patterns of harm and the use of such information to proactively disrupt emerging issues. The response to adult support and protection referrals was maintained throughout the pandemic, with staff being supported to continue to meet their safeguarding and investigative responsibilities. The local authority area continues to have significant periods of high demand, as evident on continued pressures on NHSL services. Despite this, public protection has remained a priority, with services operating flexibly and remaining adaptable to ensure adults who may be at risk receive the best care and support. In the first phase of the 2020 Lockdown, our Chief Officers’ Group for Public Protection (COGPP) met on an weekly basis, combining with the South Lanarkshire Chief Officers Group on a rotational basis to reflect our shared NHS Board and Police Division. The focus of the meetings was to interrogate both local and SOLACE data and put in place effective responses to any emerging risks. The Adult Protection Committee (APC) also convened a weekly Adult Protection Operational Group drawn from the APC membership to receive assurance that services continued to prioritise Adults at Risk while considering the fast moving national and regional situation. These meetings addressed practical challenges, emerging risk and shared strategic decision making and the development of local guidance. The return to substantive COGPP and APC arrangements was gradual, with the ability to ‘stand up’ additional provision as required. The response to adult support and protection referrals was maintained throughout the Page 131 of 193
Page 132
6 pandemic, with staff being supported to continue to meet their safeguarding and investigative responsibilities while following guidance on social distancing and infection control. Statutory services continued to operate around the clock to meet public protection duties. Third sector partners were quick to respond to providing support during lockdown to the most vulnerable individuals in local communities. Some examples include welfare calls which reduced isolation for those living alone or shielding, as well as delivering medication, providing transport to medical appointments, and collecting shopping. We have also seen opportunities for improvement changes created by our experience of the pandemic. Significant developments within Monitoring and Assurance, Learning and Development and responding to emerging thematic risks are explored in different sections of this report. A shift to some services being delivered virtually, led quickly to additional guidance on identifying potential risk, given the different skills and knowledge this may require. North Lanarkshire circulated new guidance to staff with regard to Covid and Protection, with our Talent and Organisational Development section providing training and support for staff to develop new skills and confidence. Local Guidance was reinforced and revised to reflect national guidance once this was issued. Public protection has remained a priority, with services operating flexibly and remaining adaptable to ensure adults who may be at risk receive the best care and support. Gold, silver, and bronze command structures have provided strategic oversight, direction and response to rapid changes throughout the pandemic. North Lanarkshire Health and Social Care Partnership (NHSCP) Chief Officer held SLT meetings weekly to provide oversight of service delivery, challenges, and risks. All localities established daily huddles with all agencies participating including GPs, Social work and Health, to ensure robust communication was in place, including reporting and analysis of ongoing and emerging risks. Staff health & wellbeing strategies were recognised as critical and various strategies, for example wellbeing rooms in health centres were implemented to support staff. Communication to all staff was prioritised in our response. Additional National Adult Support and Protection Guidance for Chief Officers and Adult Protection Committees was communicated widely to staff through enhanced routes such as the Public Protection newsletter; as was the Public Protection Governance and Escalation Process Covid-19 Communication update. Written support tools, such as the ABC of Adult Support & Protection and Covid, and aids to be trauma informed and ASP aware when communicating on the phone, reiterated the commitment to prioritise public protection during the pandemic. Page 132 of 193
Page 133
7 Our Adult Protection Covid Recovery Matrix was developed in June 2020 and reviewed in 2021. However it became clear that the sustained pressures of the pandemic continued to impact the delivery of public services not least in the areas of staff capacity during the timeframe of the report What your data tells you Summary of Adult Support and Protection activity 2020-2022 In 2021/22 Social Work received 2,441 adult at risk (AAR) referrals, relatively unchanged from 2020/21 (2,442), meaning 4,883 AAR referrals were received over this reporting period of 2020/22. This is a 9% increase of 450 from the previous Biennial Reporting period. Figures for the last two years are the highest recorded in North Lanarkshire. Trends are being monitored and analysed to understand this increase There are positive signs that referrals across some partners have risen due to increased awareness of ASP, such as increased awareness across NHS Lanarkshire (NHSL) ; however, there are also concerns that the prolonged pandemic and cost of living concerns are impacting on risk. Types of Harm and Presentation The primary harm recorded in AAR referrals in 2020/22 identified a prevalence of emotional and psychological harm (252). Physical harm is then identified as the second highest category with 188 cases, financial harm with 141, and neglect with 120. Work is ongoing to ensure consistency across health and social care localities in this area. Our number of sexual harm referrals remains low; with sexual harm also sometimes identified through secondary or physical harm. Our work to promote practice in this area is discussed later in this report. Our Learning Review (022) identified learning needs regarding identifying and addressing increased risk of sexualised harm perpetrated by some adults as an impact of dementia or delirium. Additions to Multi agency ASP training now explicitly cover this area. Source of Adult at Risk Referrals We continue to see a wide range of ASP referral sources, reflecting awareness of adult protection across all partners. This information is monitored through our Monitoring, Reporting and Improvement APC Sub Committee, and reflects the ongoing investment of partners in both training and procedures. 956 referrals from Health and GP practices were submitted over this period, which narrowly exceeds Police Scotland AAR referrals (955) for the first time. Both agencies account for Page 133 of 193
Page 134
8 20% of all AAR referrals. This reflects an increased awareness and activity from NHSL partners with regard to clinical concerns. We have seen an increased focus on risk in care home settings. While we have seen a continued reduction in Police Scotland AAR referrals, we have seen increased activity in Adult Concern reports. Police ‘Adult Concern’ reports are deemed not to meet the adult protection threshold and are not subject to the same legislative requirements. Social workers have received a rising number of these concerns, with up to 1,000 now received quarterly. All concerns are considered by the social work team, with some ‘upgraded’ to adult at risk status when assessed . Partners are working closely to monitor and understand this increased activity, including a focus on thresholds and consistency. ASP referrals from care homes rose by 13% over the reporting period to 864, 18% of overall referrals. The scrutiny role of the social work quality assurance team has supported development across care homes. As indicated in Appendix One, we continue to see appropriate referral rates from partners such as Housing Services and Scottish Fire & Rescue (SF&R). We have seen a rise in referrals arising from these areas in relation to self-neglect, squalor and hoarding issues. SF&R have also are specifically active with regard to risks identified through their timely responses to home fire safety activity. A recent amalgamation of North and South Lanarkshire SF&R has led to current work to create a joint approach to ASP Pan Lanarkshire. Adult Protection activity 2020-22 As per the legislation and our procedures, all AAR referrals received by Adult Social Work services see an inquiry, as per our Social Work Procedures. 787 adult protection investigations were carried out in 2020-22, with 17% of the total number of ASP referrals received progressing to investigation. This is broadly consistent with the national average and North Lanarkshire’s historical practice. This provides us with some level of assurance that during the pandemic thresholds and assessment remained consistent. The profile of adults involved in adult protection investigations saw 204 (26%) identified as having a physical disability. This was followed by mental health (172 - 22%) and infirmity linked to old age (92 - 12%). Case Conference and Reviews There were 455 adult protection case conferences during 2020-22, which includes 269 initial case conferences and 186 review conferences. This is a 14% increase from the previous reporting period, with 37% of investigations leading to initial case conferences. We have Page 134 of 193
Page 135
9 also seen an increase in recorded review case conferences, specifically in 2021-22, which saw consistently high numbers and 136 Review conferences took place. Statutory Orders In 2020/22, the Council sought and implemented 20 protection orders: • 7 Removal Orders, • 9 Banning Orders, and • 4 temporary Banning Orders (all of which progressed to full Orders and all with a power of arrest). The 6 Removal orders in 2022 were linked to supporting the move of residents from one Care Home to interim or permanent placements at the point of the homes closure. Significant and Initial Case Reviews Two initial case reviews have taken place in this period. Both were deemed not to meet the criteria for a Significant case review (SCR) but led to recommendations for reflective learning reviews. Learning from these reviews has been embedded into training and process. This includes work regarding changing sexualised behaviour, trauma informed practice and increasing links between domestic abuse and adult protection processes. Improvement work following a previous SCR, led to updated North Lanarkshire ASP Operational Procedures strengthening the role of senior social workers (SSW) throughout the ASP process. Assurance regarding the Duty SSW remit has been strengthened to ensure that the SSW screen and allocate all ASP referrals and continues to sign off and provide oversight at each stage. Our SWES (Social Work Emergency Service) also receive and process referrals out of hours. An APC learning review in 2021 identified improvement work was required in terms of refreshing the service model. This is being progressed by adult social work services. An action plan following from the findings from an SCR completed in January 2020 has been progressed. Key actions included refreshing our social work adult support and protection procedures and an increased focus on domestic abuse in adult support and protection training. Large Scale Investigations Notification and updates of LSIs are standing items on both the Adult Protection Committee and Chief Officer Group Public Protection agendas. We have had three LSIs in North Lanarkshire in this period. An LSI undertaken in 2021 related to a community-based care at home service. It required a flexible and responsive approach from the Council and a particular focus on domestic environmental and safety risks, as the service being investigated provided care and support Page 135 of 193
Page 136
10 for individuals within their own homes. A robust improvement plan identified improvements moving forward. The most significant LSI in this time related to a Care Home and was carried out from November 2021 to February 2022,at which point the care home closed. This activity required Public Protection partners to establish significant resources to ensure the protection of the facility’s residents, who were placed in the facility from across Scotland. This work culminated in all residents moving to alternative placements, often closer to their original home, which better met their individual needs. This work was intensive and complex and required strong leadership at all levels. It involved close co-operation with the Scottish Government, the Care Inspectorate, COSLA and other national partners. The practical tools and documentation developed during this LSI, have helped to inform the approach established and processes undertaken to manage a third LSI, again for a specialist Care Home provider which has recently concluded. A new LSI procedure and tool kit has been drafted which uses the learning from these varied LSIs to produce a robust and flexible procedure moving forward. Page 136 of 193
Page 137
11 Outcomes, achievements, and service improvements The Adult Protection Committee undertook a self-evaluation exercise in 2021-22, based on recommendations from the National Guidance for APCs. This included consideration of key Adult Protection Committee documentation, including terms of reference and induction materials; governance arrangements following changes in the corresponding arrangements of key partner agencies; and the capacity and resources of the Adult Protection Committee. Results from the self-evaluation exercise were positive and identified well-established arrangements in place across all aspects of partnership working by Committee and Sub- committee members but reflected that additional links to newly established governance routes would be beneficial. As the recently formed Care Home Assurance Team (CHAT), is a new body, it does not feature in national ASP codes of practice or guidance and therefore there is no guidance in terms of governance across these bodies. However the Adult Protection Committee self-evaluation recommended increased links in this area and the Lead Nurse for Care Home Liaison is now a member of the APC. Similarly, the Health and Care Partnership Support Care and Clinical Governance Committee, October 2021, agreed on the increased benefits from more explicitly ensuring links across all relevant groups. With the Adult Protection Co-ordinator, now a member of this Committee, this has strengthened governance links with NHS Lanarkshire. The self-evaluation identified the need for representation by acute services on the Adult Protection Committee. This has helped to raise awareness of adult support and protection within acute service of NHSL. Membership of the NHSL Strategic Public Protection Group have been extended to include Pan Lanarkshire Adult and Child Protection Leads, improving the cohesion, clarity of governance and communication routes between the Adult Protection Committee and its strategic partners. The APC currently also has monitoring and oversight for adult missing persons and appropriate adults, to ensure that these emerging agendas have clear governance within North Lanarkshire. Improvements implemented over the last two years have focused on addressing known and emerging risks by developing policies to support practice, improving training and guidance for practitioners, creating effective and flexible digital systems in response to the pandemic which have enhanced the ability of partner agencies to safeguard adults in local communities. Page 137 of 193
Page 138
12 Covid Pandemic Given the challenge faced through the pandemic and lockdown, maintaining our adult protection processes to a high level has been a identified as a positive outcome. We have maintained timely responses to adult protection referrals and responded in person wherever possible. In addition, a suite of improvements and achievements have responded to known and emerging risks. The implementation of national public protection reporting during the pandemic helped to strengthen our internal monitoring systems. It led to the development of a weekly Chief Social Work Officer (CSWO) report to focus specifically on ASP activity in care homes. All AAR referrals received from care homes are now individually reviewed and reported in this way. This is further supported by a detailed monthly CSWO report on all adult protection activity in that period. Highlight reports are shared with CHAT, partnership governance groups, and the APC to support consistency. Trauma informed practice APC Partners have worked to ensure that the workforce responds to adult protection in a way that is trauma informed. The APC signed up to the National ‘Trauma Informed Practice’ Pledge in 2021 and the Adult Protection Coordinator is a member of North Lanarkshire’s Trauma Steering Group. The Committee continues to work with partners across the public protection agenda to embed trauma informed approaches within our training, audit and policy development. Within this approach we are embedding approaches informed by Contextual Safeguarding to inform procedures and practices. We are committed to promoting a shared approach to language, working alongside our Child Protection Committee, the Senior Officer for Contextual safeguarding, and with the national Contextual Safeguarding Network to promote and enable transitional safeguarding approaches in North Lanarkshire. North Lanarkshire is the Scottish representative in a UK wide research programme led by the Contextual Safeguarding to consider systems and practice for older young people and adults. Neglect Emerging concerns about self neglect and neglect in the community have been identified through various routes. Members of the APC Network, our community and voluntary sector APC subcommittee reported increased concerns about known and newly referred adults which indicated a rise in self neglect, potentially linked to increased isolation due to the pandemic. APC monitoring and reporting also identified that the risk of self-neglect escalated during the pandemic. Page 138 of 193
Page 139
13 As a result, a multi-agency Pan Lanarkshire Neglect group has been established. Guidance on Working with Neglect and Resistance was agreed by the APCs in August 2022 with a launch event planned for later in the year. This guidance aims to support practitioners and managers working across all agencies within Lanarkshire whose work includes concerns of neglect and/or managing resistance with adults and/or their carers This includes those adults and/or their carers who present as hostile when an adult is subject to adult protection concerns. A programme of training on working with self neglect, resistance and hoarding has also been well received, with around 400 multiagency staff trained to date. Financial harm The refreshed Pan Lanarkshire Multi-agency Financial Harm Group was reconvened in 2021. The group has refreshed our Pan Lanarkshire Financial Harm Guidance booklet and enhanced the reach of adult support and protection to partners working with at risk adults. Monitoring and Reporting improvements 2020-22 has seen various mechanisms enhanced and developed to ensure effective use of data in adult protection processes. These includes data submitted quarterly to the Adult Protection Committee by its partners. This submission to the APC Monitoring, Reporting, and Improvement Sub-committee provides an insight into current performance and supports our understanding? of the profile of ASP in our area. This approach also promotes consistency across partners in, for example, identifying thresholds for referral. Weekly statistical reports to the Chief Social Work Officer with regard to both the SOLACE dataset and local data on all care home and ASP activity include a review of each ASP received from care homes. This has significantly enhanced our understanding of emerging issues and work with care homes. Care Homes All Care Homes in North Lanarkshire are managed by independent providers. North Lanarkshire was an early adopter of a multi-disciplinary team approach to supporting Care Home and Care at Home providers at the outset of the pandemic. This has served to strengthen collaboration between agencies. It also ensured that guidance on adult support and protection was followed consistently across a broad range of services. We have a robust framework of scrutiny and support across the operational and strategic agenda of care home provision. Recently established scrutiny and support systems have enabled enhanced monitoring of duty to inquire processes. In 2021, the Health and Social Care Partnership developed systems to monitor real time trends and themes in adult protection activity. This weekly report to the Chief Social Work Officer includes trend data Page 139 of 193
Page 140
14 and a focus on key areas of adult support and protection, for example AAR referrals received from care homes. Adult support and protection referrals received from care homes are reviewed in addition to the section 4 inquiry process. Themes and outcomes are reported weekly, and a four weekly report is produced for the CSWO and the strategic meeting of the Pan Lanarkshire Care Home Assurance Team (CHAT). The CHAT is a group led by senior managers including the NHS, Social Work, and the Care Inspectorate, which provides high level scrutiny, monitoring and leadership to support a collaborative approach to support and scrutiny for all care home providers across North Lanarkshire and has oversight of the activity described below. Partnership working also promotes a preventative and early intervention approach to safeguarding, identifying emerging risks for services and adults, providing scope for focused improvement work, and increasing assurance across localities, which resulted in five focused quality improvement groups. The Council’s Quality Assurance team has implemented a quarterly reporting system for contractors that includes adult protection data. Quality Assurance officers are linked specifically to individual services and provide timely relationship-based support and advice, guiding services around risk and adult protection activity. Our Care Home Service Provider Group provides a platform for communication between senior social managers (e.g. within social work headquarters and localities) to discuss new and emerging risks within services, as they arise. This support intensified through the Covid period, with daily phone contact/ huddles, weekly meetings and ongoing support from quality assurance, and learning from this is being embedded in locality based. Lanarkshire’s Care Home Assurance Operational and Oversight Group promotes multi- agency working and provides oversight of activity in care homes. A strengthened structure provides better connection between operational services and strategic leadership, and has enabled closer working between partners, to identify concerns within care homes at an early stage. This development of enhanced scrutiny and assurance processes has supported informed decision making. A collaborative ‘supportive visit’ structure was introduced to support care home providers during the pandemic and reflects the established links between care homes, social work localities and senior managers, the Care Inspectorate, and the District Nursing Care Home Liaison Team. For some care homes, the approach has involved monitoring and support from a locality social work department and the NHSL Care Home Assurance Team, to implement an improvement plan without implementing an LSI. Page 140 of 193
Page 141
15 The social work recording tool was enhanced after a significant case review noted the need for professionals to carry out summative risk assessments to a higher standard. Developing a digital approach to adult protection In 2021, the implementation of an online referral in NHSL systems led to the introduction of electronic AP1 submissions from NHSL to the relevant locality duty social work team, with a copy automatically emailed to the NHSL Public Protection Team’s ASP email box. The NHSL ASP Advisor quality assures these referrals, considering the application of the three-point criteria and thematic analysis and may contact staff to offer advice and support if required. Risk, including ASP, is considered as part of Health based assessments, for example, all new patients admitted to District Nursing caseloads will have a comprehensive nursing assessment completed which includes assessment of all risks including any adult protection issues. MAPPA Multi Agency Public Protection Arrangements (MAPPA) and Adult Support and Protection (ASP) have existing operating protocols and information sharing protocols which will be enhanced by the development of this joint protocol. The aim of this protocol is to establish a framework for MAPPA and ASP to work together to enhance public protection and the reduction of reoffending and the risk of harm to adults, whilst recognising the principal differences between MAPPA and ASP. Missing persons North Lanarkshire Public Protection Partners and the National Missing Persons Project have worked closely together to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. This aims to mitigate the risk to the people who go missing, provide a consistent approach for the relevant agencies when a person is missing, and ensure that the collective response delivers on the achievement of the objectives contained within the National Framework. Police Scotland information on episodes of missing adults is now part of the APC quarterly data reporting. Case auditing We have established virtual case auditing methodology, supported by a digital collation and analysis. There have been two substantive audits in this period. A multi-agency case file audit in 2021 identified that risk assessment and management should be more explicitly recorded through investigatory activity. Work is ongoing to ensure consistent recording across the six localities and ensure visibility of risk assessments. Page 141 of 193
Page 142
16 Internal audit indicates that while there are examples of comprehensive chronologies, there is a need to ensure that these are consistently in place and of good quality. As such, the development of risk management plans for vulnerable adults begins at the first point of contact-irrespective of whether this is with police officers, health and care staff, or other referrers. This approach is reinforced through our multi and single agency training which reinforces the importance of recording, defensible decision making, and professional curiosity. Advocacy The programme of procurement activity has continued over the period to ensure ongoing access to quality service provision is available across North Lanarkshire; this included renewed Advocacy contracts and the establishment of advocacy for carers. North Lanarkshire has strong and effective advocacy provision for adults involved in adult support and protection. Close and robust partnership work between social work and advocacy providers sees high levels of uptake and involvement with advocacy services. Audit identifies that advocates regularly attend case conferences with adults and work flexibly with adults to reflect their needs and choices. This has included support to adults whose services were subject to Large Scale Investigations. Thresholds In 2020, both Social Workers and police noted that reporting of police concerns was an area where improvements required to be made. A Police Scotland / APC audit identified that some police concern forms required to be upgraded to AAR by Social Work. Various learning needs were identified relating to police triage processes. These have been addressed through peer learning and further attendance at multi-agency training. Additional training for Community Police has been agreed and plans are being progressed to facilitate this across Lanarkshire in Q3 of 2022. Information systems A range of improvements have been progressed in terms of information systems and processes, for example: An update to the Adult Support and Protection Operational Procedures in 2019 strengthened the process to record information, analyse risk, and improve the use of the 3-point criteria in terms of social work case recording. This change has explicitly added the inclusion of relevant questions in the client information record. A new approach to recording options within SWIS (the Social Work Information System)was implemented, after it was identified by Social Work and NHSL staff that care records and patient records did not always accurately reflect both interventions and the outcomes achieved. Page 142 of 193
Page 143
17 Records management will be further enhanced through the introduction of a new information management system for social work. The tendering process for this has been completed and the contract will be implemented in 2023. Comprehensive scoping work ensured requirements for recording statutory adult support and protection processes and practice are reflected appropriately in the tender. Within NHSL, the Morse information management system has been rolled out. This allows information sharing across all health services more timeously and helps manage risk across multiple services. IRD In 2022 North Lanarkshire undertook the initial phase of a Pan Lanarkshire Adult Protection Interagency Referral Discussion pilot, supported by COGPP and relevant services. This ‘proof of concept activity saw IRDs facilitated as part of the inquiry stage across one locality. Early outcomes have been positive in terms of more timely and proportionate information sharing. A further pilot is being developed to provide wider evidence to fully progress this work which in the longer term aims to result in even more collaborative risk assessments. Chronologies A practitioner's survey (January 2022) on the use of chronologies was targeted at health and social work staff who work with adults at risk. This found a good understanding of the need for chronologies when risk is identified, although this was reduced for adults at a lower threshold. Adult Protection Committee audits indicate that some chronologies are of a good quality, but work is ongoing to ensure high quality chronologies are consistently in place across the Social Work Information System and other agency information systems. NHSL has made progress on this through the roll out of Morse and this has been actioned as part of the tender for the Council’s new information management system. A specific action on improving chronologies is identified in the Learning and Development Sub-committee improvement plan. This is an area that has been impacted by the pandemic and is a priority for the APC Learning and Development Officer when recruited. Training has been strengthened regarding consideration of ability to protect and there is now an increased focus on trauma informed approaches, analysis of unwillingness and working with resistance, and the adult’s ability to execute choice. This has supported the development of our new practitioner guidance on Working with Neglect and Resistance. Following a reflective learning review (022) in 2021, work has been undertaken to increase professional understanding of the relationship between adult support and protection and capacity. Lanarkshire Police Division issued fresh internal guidance on Section 47 certificates which includes progressing to criminal investigation and the need to ascertain the views of adults. Page 143 of 193
Page 144
18 The Adult Support and Protection Operational Policy includes specific guidance for staff who work in mental health and addiction recovery teams (ART). Risk assessments, which are completed and reviewed in partnership with adults who use mental health services, inform the adult’s care and risk management plans. Recent audit work has reinforced the need to ensure that information is shared and made available across agencies and systems. The addition of e-Care information in SWiS provides shared health and social work information within the one system. To improve information sharing where Protection Orders are being instigated, the Senior Officer Adult Protection, NLC Legal Services and Police Scotland have a local information sharing process regarding ASP Protection Orders in North Lanarkshire. Colleagues from NLC Legal Services inform Police Scotland at the earliest opportunity where they obtain and implement an ASP Banning Order (with power of arrest). This provides timely and accurate information for Police Scotland to ensure those adults who are deemed at serious risk of harm are safeguarded and protected. Training, learning and development The Learning and Development Sub-committee workplan details the breadth of single and multi-agency training provision and learning opportunities for the Adult Protection Committee partners in order to maintain and support skills and knowledge. In 2020, the APC Pandemic Recovery Plan recognised the impact of, and challenges arising from the pandemic. A priority was to ensure staff remained skilled and confident in an evolving environment. Multi and single agency adult protection training provision has been redesigned and developed as a virtual model. Despite the challenges, significant adult protection training activity was facilitated during 2020/21 with a total of 476 workers receiving core adult protection training. This increased to over 700 in 2021/22. ASP training and resources have been developed to reflect the different way in which people were accessing services and to ensure the issues which the lockdown exacerbated (such as hidden harm and carer needs) were able to be addressed. New workforce development models were also created, which included rewriting and designing training programmes. Initially this focused on developing training based on the telephone based and virtual activity necessitated by lockdown. Our Social Work and Council Officer training was redesigned into a blended model and within the Health and Social Care Partnership an online and facilitated training provision is available as part of the induction training process. Page 144 of 193
Page 145
19 Training provision has now moved to a mixture of online and blended learning with bespoke face to face sessions provided as required to specific organisations, for example the North Lanarkshire Deaf Club. The APC’s multi-agency training was adapted to reflect national and local learning, strengthening input on sexualised behaviour, domestic abuse, defensible decision making, and ability to protect. We evaluate all courses and consistently receive excellent evaluation from attendees of 88 to 100% rating. We adapt the course in direct response to comments, for example, in response to comments that the course was not long enough we increased the allocated time. We ask participants to identify how they will change their practice following training. The responses below reflect common comments: “I Encourage my team and I to explore case reviews more regular than just at annual development sessions” “Be more assertive in my judgement and more confident in highlighting my concerns and fo procedure” “I would not think twice about raising any fears with my Line Manager” “I won’t be judging people by their appearance and looking at the bigger picture”. The Adult Protection Committee Newsletter is circulated monthly to around 4,000 subscribers. As a well-established way of sharing information, it became a weekly briefing during lockdown in 20020 gradually returning to a monthly edition in 2022. The Newsletter shares updates on national and local adult support and protection issues, including publications, guidance, consultations, and resources. It is also a way of reiterating links across public protection agendas. Pan Lanarkshire Neglect and Hoarding training has proved to be of particular value. This reflects the significant profile of harm currently identified across Lanarkshire. Over 400 people have now attended this virtual training, with ongoing sessions remaining fully subscribed. The training is provided to reflect identified need in this area and is identified as helpful through evaluation. This also supports awareness of the Pan Lanarkshire ‘Working with neglect and managing resistance’ multi-agency guidance 2022. Our FGM and Forced Marriage training has been refreshed and is facilitated by the Violence Against Women and APC Co-ordinators. This popular course is facilitated four monthly to a capacity attendance. Forced marriage is also included in the multi-agency ASP training. Following learning from an ICR, we have embedded learning with regards to developing sexually inappropriate behaviour or challenging behaviour by adults. Multi-agency training Page 145 of 193
Page 146
20 has updated learning content in this area, and it now underlines the requirement for close working relationships between legal, mental health, and other key services. The APC’s well-subscribed multi-agency locality forums were re -established as virtual events during 2022. These share national and local learning at a locality level and give practitioners the opportunity to discuss adult support and protection practice. North and South APCs co-hosted our recent Care Home World Café, at which care home managers, deputy managers, clinical service managers and supporting agencies heard presentations from key agencies which explored their roles within Care Homes and adult protection. Presentations from The Care Inspectorate, Police Scotland, Care Home Liaison Nursing, MAPPA leads, and North Lanarkshire Social workers considered issues arising in care homes and explored statutory roles and responsibilities. The event saw Police Scotland referencing learning regarding capacity and ASP, where they shared their position regarding capacity, criminality, and the rights of individuals. This multi-agency discussion and learning model is crucial to our approach. Some service and agency specific training and awareness raising highlights have included: Each year, NLC supports qualified social workers to attend the Post Graduate Certificate at University of Stirling. In 2022, the council has supported two, and NHSL one, place. This annual commitment means that a significant number of social workers and senior practitioners can cascade expertise within their locality teams and are also part of a tutor pool to support multi-agency training. The newly qualified social worker training programme in NLC includes all areas of public protection, including level 2 Multi-agency ASP training and trauma informed practice. Compulsory adult support and protection training is also in place for all NHS Lanarkshire (NHSL) staff , for example, the adult support and protection Learn Pro module is available to all NHS staff, with 5,310 staff completing modules during 2021/22. Dissemination of the NHSL Public Protection Learning and Development Programme has been rolled out to community mental health team leaders to promote public protection awareness and training for all community mental health staff. The NHSL Care Home Liaison team carry out collaborative visits to care homes with social work colleagues and deliver specific training to staff as and when required. Adult support and protection training within the Scottish Fire and Rescue Service has been redeveloped in the last two years and community officers continue to participate in Adult Page 146 of 193
Page 147
21 Protection Committee multi-agency training. Community and voluntary sector involvement in multi-agency training continues to be widespread, with ongoing commitment from partners to ensure a wide range of practitioners are trained. Appropriate Adults North Lanarkshire’s Appropriate Adults service is well developed during both daytime and out of hours. A training programme is under development to recruit and support the training of additional staff to this role. Appropriate Adult services are fully operated, funded and delivered through Social Work with 30 employees trained to perform roles during business hours and Social Work Emergency Services staff providing support out of hours. Governance and reporting for Appropriate Adults are incorporated in the remit of the Adult Protection Committee and are a standing item on the Monitoring, Reporting, and Improvement Sub-committee. General Practitioners Training Programme: The APC has facilitated specific training across a number of partners in this period. A programme of learning and development for our GP Locality Forums was facilitated by the Adult Protection Coordinator. A session, delivered in December 2021 to the NHSL Lead Clinical Locality forum, identified the benefit to GPs of increased awareness of ASP. This was followed by a Pan Lanarkshire session as part of GPs’ learning and development programme. North Lanarkshire Adult Protection Co-Ordinator then attended the GP Locality Clinical Forums to provide bespoke sessions and also provided training to Trainee GPs. This comprehensive programme of work focused on awareness raising of adult support and protection legislation and practice, an understanding of the three point criteria, Section 10 of the Act, and the national GP and Primary Care guidance. Data relating to GP referrals is considered within our data collation. Adult Protection: Senior Officer, Learning and Development COGPP have jointly funded a temporary Learning and Development post for the Adult Protection Committee. Recruitment for this is underway, with the focus of this post being to support continuous improvement activity outlined in the APC Improvement Plan. Page 147 of 193
Page 148
22 Engagement, involvement, and communication Processes to ensure meaningful engagement with adults and their carers and family are embedded in the Adult Support and Protection Operational Procedures. We are committed to consistent access to and effective use of independent advocacy throughout adult support and protection activity. Strong links between advocacy and adult support and protection services have been demonstrated in a number of areas over this reporting period. In 2021, Independent advocacy services in North Lanarkshire went through a retendering process, and two providers successfully maintained their contracts. Current contracts for both advocacy and carers services focus on the protection of children and adults at risk. This stipulates those services must adhere to local procedures and work in accordance with inter-agency guidelines. Adult protection concerns are included in their quarterly contract management framework return, and all activity is discussed at quarterly meetings between the Advocacy provider and the Council’s Quality Assurance team. Advocacy providers are active members of the Adult Protection Committee Network, a sub- committee comprising of third sector organisations. Providers report they have positive relationships with social workers and discussions at the Network reflect a well-established referral process involving staff trained in adult support and protection, supporting positive partnership working across all agencies. In April 2022, the Network held the first face to face event in two years which focused on debunking myths and stereotypes in adult support and protection and making more effective use of legislative powers. This highly successful event saw people with lived experience, carers and practitioners come together to explore difficult but vital subjects. The event aimed to demystify and destigmatise adult support and protection. The event was evaluated as excellent, with specific praise for the positive tone and language used. As reflected in the Lanarkshire’s Carer Plan 2020-25,carers with responsibility for adults (where adult support and protection is a concern) are provided with a Carers’ Assessment and additional support. The Adult Protection Committee Network has active membership from all the main local carer organisations, as reflected in the statement prepared by these members in evidence for inspection. Large numbers of carer support staff attend our multi- agency training and work closely with other agencies to support adults and their carers. Page 148 of 193
Page 149
23 Lived Experience The APC is actively considering how we sustain and develop representation of the voice of those with lived experience within the APC itself. The Network partners already actively influence the direction of the committee. However, given the current national progress been made with regard, for example, to the Promise, the APC plans to review our current arrangements. Public Protection Communication and Information Sharing Subcommittee In 2020 the four pillars of public protection in North Lanarkshire agreed to merge their Communication and Information Governance Subcommittees, reflecting the joint agendas and shared membership. This meeting has an annually rotated Chair, shared across the Public Protection; the Adult Protection Coordinator performed this role in 2021-22, with the Domestic Abuse Coordinator now in post. Page 149 of 193
Page 150
24 Challenges and areas for improvement Involvement and representation of people with lived experience on the Adult Protection Committee is referenced above in this report. Work is ongoing with the Network to take this forward on a planned basis. Information Management Systems The Council’s information management system has been through a retender process, with the Senior Officer for Adult Protection an active member of the retender group. The successful provide, MOSAIC, will be working closely with the organisation to ensure that the new information management system will support required improvements in recording and information sharing across services and agencies. This will be used to support progress in other identified areas of improvement, including chronologies and risk assessment. Chronologies Work to improve our Chronologies is a priority for the APC, as reflected in our Improvement Plan. It is an identified priority for the Learning and Development Officer currently being recruited. Our audits demonstrate good progress in that most files now contain a chronology, and we see some chronologies being developed before a trigger thresholds of risk are met. The quality of chronologies is still variable. This work will be supported through the new information management system. Risk Assessment As part of the planned review and refresh of NLC Adult Protection Procedures, consideration will be given to improving our risk assessment tools. This will be supported through the implementation of the newly commissioned MOSAIC systems and reinforced through the implementation of the new national Code of Practice from Adult Support and Protection. The APC has a number of actions linked to strengthening our established learning and development programme. This will be supported by the appointment of an APC Learning and Development officer, and will include: Chronologies training Chronologies training, linked to wider development in this area, will be a priority in the next two years. We have made some progress in the use of chronologies, and this will focus on the consistency, language and content of these. Second Worker Training Page 150 of 193
Page 151
25 The APC Learning and Development Group has committed to developing and facilitating a programme of work for ASP second worker training and development. Police training Police and a wide range of partners continue to participate in APC multi-agency training. Pan Lanarkshire training for locality based operational police is planned for winter 2022, to be facilitated by the two APC Leads in conjunction with Police Scotland Risk and Concern Hub staff. Page 151 of 193
Page 152
26 Looking forward Looking forward, North Lanarkshire recognises the national and local challenges and opportunities over the next two years. We anticipate considerable activity linked to implementing and embedding national developments linked to recently refreshed Guidance. Adult protection procedures and policies will be adapted and refreshed to comply with the new Code of Practice, Learning Review Guidance and GP and Primary Care Guidance. The APC will also ensure compliance with the 2022 Guidance for Adult Protection Committees. We have an opportunity with the development of the National Data Set to develop data analysis systems within the new social work information management systems, to enhance our data set to meet both national and partnership best practice. Work on this is being progressed through the APC Monitoring and Reporting Group. We are aware of the continued impact of national challenges on our services, specifically the current cost of living challenges and the ongoing impact of the pandemic on our community and services. The NHS continue to address the impact on long waiting lists for medical treatment on a frail elderly population, thus presenting challenges of managing increased risk. The local authority capacity to offer support is being affected by inflation and budget provision. Planning to address this, in addition to responding to individuals being affected now, are already key priorities for the council. We are already seeing the individual impact of fuel and food poverty in the community and an increased prevalence of impact on people living with neglect and self-neglect has been referenced, along with our response to address this. North Lanarkshire was subject to a Joint Inspection of Adult Support and Protection in July - November 2022, which is shortly to be concluded. The improvement plan from this will be amalgamated to our APC’s current workplan, which is based on the activity and improvements noted in this report. These will then form the basis of the APC’s Improvement Plan moving into 2022-24. We began the report by reflecting on one over-used word and we conclude by using another ‘Permacrisis’. At the time of writing the Scottish and UK governments have both announced sobering statements in respect of public finances which will result in severe financial cuts to public services. Structural change is in prospect with the introduction of the National Care Service Bill. In continuing to protect the most vulnerable sections of society public services will require further resilience and resourcefulness in the future. Page 152 of 193
Page 153
27 Page 153 of 193
Page 154
28 Appendix One Summary of Adult Support and Protection Activity 2020-2022 1. Summary Of North Lanarkshire Adult Protection activity 2020/22 2. Summary of North Lanarkshire Adult Protection referral activity 2020/22 955 referrals from Police Scotland 635 referrals for unpaid carers 174 Referrals from Scottish Fire and Rescue 320 referrals from other council dept.s 2022-22 4862 Adult Protection Referrals 956 referrals from Health professionals and GPs 41 Referrals from family and public 712 referrals from Social work self referrals 4863 Adult Protection referrals Police Adult Concerns 807 Adult protection Investigations North 75% Inquiry decisions within 5 working days Lanarkshire Adult Support and Protection 2020- 22 455 Care Conferences 0 SCRs 20 Protection Orders 3 Large Scale investigations Page 154 of 193
Page 155
29 4863 Inquiries 2. Summary breakdown of North Lanarkshire Adult Protection decisions 2020/22 455 Conference 787 Investigation Page 155 of 193
Page 156
Page 156 of 193
Page 157
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref MD/GC Date 21/02/23 Maintaining a Positive Balance of Care From Morag Dendy, Head of Planning, Performance & Quality Assurance E-mail DendyM@northlan.gov.uk Telephone 01698 332068 1. Background 1.1 The Health and Social Care Partnership is fully committed to ensuring that people are supported to live full and active lives in their own homes and localities, minimising the use of hospital settings. This purpose of this report is to update Committee on the positive balance of care within North Lanarkshire, in comparison with other partnerships across Scotland, and to provide committee with an overview of the supports and services in place to help people live as independently as possible in their own homes for as long as possible. Executive Summary The Health and Social Care Partnership is fully committed to ensuring that people are supported to live full and active lives in their own homes and localities, minimising the use of hospital and other care settings. This report is to advise Committee of a range of key metric which compare the performance in North Lanarkshire across other Scottish councils which demonstrate the sustained efforts to maintain a positive balance of care. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Endorse and support the balance of care within North Lanarkshire; and (2) Note the contents 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 6 Page 157 of 193
Page 158
2. Report 2.1 Balance of care 2.1.1 The provision of social care and support in North Lanarkshire is spread across a range of organisations and settings and much of it is co-designed to meet a diverse and complex range of individuals’ needs across North Lanarkshire’s communities. 2.1.2 The balance of care is a term commonly used to refer to the balance of support and care available within community-based settings (e.g., home care, self-directed support, day services, voluntary sector supports, support for carers), when compared with the support and care available within residential settings (e.g. care homes, NHS continuing care provision, etc.). 2.1.3 North Lanarkshire has, for many years, had a positive balance of care, which means that the considerable investment in community-based supports over time has resulted in a high proportion of individuals with long-term and complex needs being able to continue to live as independently as possible within their own homes. 2.1.4 In order to allow comparison across different partnership areas, there is a standard performance metric which looks at the proportion of individuals aged 18 and over who have long term needs and who receive personal care at home. This metric has been used for benchmarking purposes through Health & Social Care Partnerships’ Annual Performance Reports (APRs) and is key metric within the National Indicator Set designed to measure the overall impact of health and social care integration. This particular metric reflects very positively the long-term efforts in North Lanarkshire to create and sustain the range of supports outlined above. As the chart below illustrates, North Lanarkshire has the second highest proportion of individuals aged 18 and over with long terms needs who receive personal care at home in Scotland. This has remained consistent over recent years with approximately 75% of people aged 18 and over with long term care needs receiving personal care at home. Chart 1: Percentage of people aged 18+ with long term needs receiving personal care at home (2021) Source: Insights in social care: statistics for Scotland 2020/21 Page 158 of 193
Page 159
2.1.5 It is also helpful to consider an additional metric for benchmarking with other partnership areas, namely the percentage of individuals over the age of 65 who have long term care needs and receive 10 or more hours of home care per week. This again reflects positively on the balance of care within North Lanarkshire, with over 50% of individuals over the age of 65 with long term needs receiving 10 or more hours of home care per week. This is the second highest percentage in Scotland. Chart 2: Percentage of people aged 65 and over with long term care needs receiving 10+ hours of home care Source: Insights in social care: statistics for Scotland 2020/21 Page 159 of 193
Page 160
2.2 Care Home Stays 2.2.1 As outlined in the previous section, the balance of care in North Lanarkshire tips favourably towards community-based supports compared with most other Health & Social Care Partnerships. Perhaps it is therefore unsurprising to note that the overall number of registered places in care homes within North Lanarkshire is lower than the Scottish average and lower than the majority of other partnership areas relative to its overall size of population. The chart below illustrates the number of registered places in care homes for older people (aged 65 and over). Chart 3: Rate of registered places in care homes for older people per 1,000 population aged 65 and over (2022) Source: Care home census for adults in Scotland, Statistics on Care Homes and Residents for Years 2011 to 2022 Page 160 of 193
Page 161
2.3 Social Work Expenditure 2.3.1 The overall balance of care within North Lanarkshire should also be seen within a financial context, and in terms of the overall resources available to the service and its partners. The importance we have placed in ensuring individuals, particularly those with complex and long term needs, are supported to live independently within their own home and within their own communities is reflected in the profile of the service’s expenditure. Also, when comparing overall gross social work spend on those aged 18 and over, North Lanarkshire’s overall spend per capita is lower than the Scottish average and lower than the vast majority of other partnership areas which is perhaps even more noteworthy given the pattern of social and economic deprivation across North Lanarkshire. Chart 4: Gross social work spend per head of population (aged 18+) Source: Local Government Benchmarking Framework 2020/21 3. Measures of success 3.1 The partnership continues to monitor progress across all service areas through its performance framework and quarterly Chief Executive Performance Reviews and balance of care metrics are included within the National Indicator set, reported via Annual Performance Reports. Page 161 of 193
Page 162
4. Supporting documentation 4.1 None Morag Dendy Head of Performance, Planning & Quality Assurance Health & Social Care North Lanarkshire Page 162 of 193
Page 163
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 Finance? 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 Resources? 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? 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 163 of 193
Page 164
Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) 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? 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 164 of 193
Page 165
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 21/02/23 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 9: 01/04/2022 to 09/12/2022 From Morag Dendy, Head of Planning, Performance and Quality Assurance E-mail LynchN@northlan.gov.uk Telephone Nicola Lynch, Business Finance Manager, 07581007187 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 £244.158m. 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 9 December 2022 (Period 9) 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 £244.158m and is currently projecting an underspend of £8.472m. The Social Work capital programme has a total budget of £2.504m and is currently projecting an underspend of £0.255m. 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 7 Page 165 of 193
Page 166
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 £4.229m. 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. This is partially offset by costs associated with the 2022/23 pay agreement. 2.2 Property costs are currently anticipating an overspend of £0.201m, mainly due to utilities and one-off property repair costs. 2.3 Supplies and Services are expected to be overspent by £0.335m. This is mainly in relation to higher than anticipated spend in equipment and adaptations. 2.4 Within Transport costs, the Service is currently anticipating an underspend of £0.024m, mainly due to less than anticipated vehicle contract hire costs, partially offset by projected overspend in staff mileage. 2.5 Within Admin costs, the Service is currently anticipating an underspend of £1.862m, mainly as a result of less than anticipated spend within Carers budgets. 2.6 Payments to Other Bodies are detailed in Appendix 2. This expenditure accounts for £144.856m of the annual budget and is forecast to have an in-year underspend of £2.636m. 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. 2.7 The Service anticipates an over recovery of income of £0.253m. 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 2.8 The Integration Joint Board have set aside reserves totalling £31.919m for specific Adult Social Care commitments. It is anticipated that £7.023m of the earmarked reserves will be used during 2022/23, with £24.896m being carried forward to 2023/24, as highlighted in Appendix 3. All expenditure to be met from reserves are excluded from the outturn position. Revenue: 2022/23 Savings 2.9 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 9 the Service anticipates £0.653m (32%) will be delivered by the financial year-end. Page 166 of 193
Page 167
2.10 Appendix 4 provides further analysis of the savings. The budget gap of £1.372m will be funded by IJB reserves. Revenue: Covid – 19 2.11 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 2.12 As advised at the previous Committee, work is underway on the exercise to provide an inflationary uplift for independent sector partners to address funding pressures beyond the hourly rate increase to frontline staff. These uplifts are currently being rolled out across the Partners, the costs of which are included within these projections. Revenue: Request to Earmark 2.13 As outlined in sections 2.1 and 2.5 the service is currently projecting underspends against funding received for the winter planning business case, additional social workers and carers. It is therefore the intention of the service to earmark these underspends at the financial year end and carry forward as a reserve into 2023/24. This will ensure these funds can be appropriately allocated to the appropriate areas into next financial year. Capital: Analysis of Significant Variances 2.14 The Integrated Equipment and Adaptation (IEAS) capital programme budget for 2022/23, is currently forecasting an underspend of £0.255m. 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. 2.15 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 167 of 193
Page 168
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 168 of 193
Page 169
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. 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 169 of 193
Page 170
Appendix 1 CATEGORY BUDGET ACTUAL YEAR TO DATE ANNUAL PROJECTED ANALYSIS TO DATE TO DATE VARIANCE BUDGET OUTTURN VARIANCE % EMPLOYEE COSTS 59,571,555 56,643,738 2,927,818 FAV 87,969,739 83,740,668 4,229,071 FAV 4.8% Slippage in relation to the recruitment of posts linked to the Business Case PROPERTY COSTS 1,777,552 1,917,106 (139,554) ADV 2,515,508 2,717,087 (201,579) ADV -8.0% Expenditure in relation to utilities and one-off property repairs SUPPLIES & SERVICES 4,305,096 4,537,447 (232,351) ADV 4,771,427 5,107,045 (335,618) ADV -7.0% Higher than anticipated spend in relation to the Equipment & Adaptations service, uniforms and protective clothing TRANSPORT & PLANT 870,202 853,554 16,648 FAV 1,690,897 1,666,851 24,046 FAV 1.4% Lower than anticipated vehicle contract hire costs, partially offset by projected overspend in staff mileage ADMINISTRATION COSTS 1,441,659 152,355 1,289,304 FAV 2,325,542 463,214 1,862,328 FAV 80.1% Lower than anticipated spend in relation to Carers budgets PAYMENTS TO OTHER BODIES 91,183,555 89,358,552 1,825,003 FAV 144,856,824 142,220,708 2,636,116 FAV 1.8% Please refer to Appendix 2 for analysis OTHER EXPENDITURE 15,132 11,585 3,547 FAV 28,858 23,734 5,124 FAV 17.8% Minor underspend in "other expenditure" 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 159,164,751 153,474,337 5,690,415 FAV 244,158,795 235,939,307 8,219,488 FAV 3.4% NLC CONTRIBUTION 128,600,838 128,600,838 0 185,758,836 185,758,836 0 0.0% NLC CONTRIBUTION - HOUSING 1,325,147 1,325,147 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 30,146,480 30,405,850 259,370 FAV 54,149,386 54,524,031 374,645 FAV 0.7% Over recovery in relation to contributions to SDS care packages from NHS Lanarkshire FEES AND CHARGES 954,061 758,102 (195,959) ADV 1,438,167 1,155,115 (283,052) ADV -19.7% Lower than anticipated income in relation to charges for Integrated Day Services and Community Alarms OTHER LOCAL AUTHORITIES 20,769 24,042 3,273 FAV 30,000 34,728 4,728 FAV 15.8% USE OF IJB RESERVES 0 0 0 0 0 0 0.0% OTHER INCOME 354,772 463,301 108,529 FAV 361,659 518,423 156,764 FAV 43.3% Overrecovery in relation to returned private sector housing grants and unbudgeted funding for fire safety equipment (EAS). TOTAL INCOME 161,571,525 161,746,738 175,213 FAV 244,158,795 244,411,880 253,085 FAV 0.1% NET EXPENDITURE (2,406,774) (8,272,401) 5,865,628 FAV 0 (8,472,573) 8,472,573 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 - 09 December 2022 Period 9 Page 170 of 193
Page 171
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 57,885,967 56,027,778 1,858,189 FAV 94,319,742 91,635,691 2,684,051 FAV 2.8% Demand led activity. 2 Independent Care Homes 28,550,783 28,844,896 (294,113) ADV 40,983,557 41,408,387 (424,830) ADV -1.0% Demand led activity. 3 Payments to NHS Lanarkshire 171,690 170,448 1,242 FAV 1,462,489 1,460,694 1,795 FAV 0.1% Position reflects anticipated in year payments 4 Non Traditional Respite 192,541 44,052 148,489 FAV 335,283 120,799 214,484 FAV 64.0% Position reflects anticipated Locality demand 5 Other Local Authorities - General 77,181 20,124 57,057 FAV 125,335 42,920 82,415 FAV 65.8% Position reflects anticipated in-year demand 6 Voluntary Organisations 2,930,761 2,938,194 (7,433) ADV 4,625,141 4,635,878 (10,737) ADV -0.2% Position reflects anticipated in-year demand 7 Payments to Other Bodies - General 280,990 197,399 83,591 FAV 857,820 737,078 120,742 FAV 14.1% Position reflects anticipated in-year demand 8 Housing Support (RSL's) 316,478 366,127 (49,649) ADV 654,376 726,092 (71,716) ADV -11.0% Position reflects projected contract levels 9 Locality Flexibility 128,591 116,356 12,235 FAV 218,068 200,395 17,673 FAV 8.1% Position reflects anticipated Locality demand 10 Private Sector Housing Grants 617,521 521,930 95,591 FAV 1,152,378 1,014,302 138,076 FAV 12.0% Position reflects level of demand for private sector adaptations 11 Medical Fees 31,052 15,265 15,787 FAV 122,635 99,831 22,804 FAV 18.6% Position reflects Service's approach to absence management 12 Agency Fees 0 95,983 (95,983) ADV 0 138,642 (138,642) ADV 0.0% Position reflects anticipated in year payments 13 Other 0 0 0 0 0 0 0.0% TOTAL EXPENDITURE 91,183,555 89,358,552 1,825,003 FAV 144,856,824 142,220,708 2,636,116 FAV 1.8% 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 - 09 December 2022 Period 9 (4) (7) ANALYSIS OF VARIATIONS YEAR TO DATE PROJECTED OUTTURN VARIANCES VARIANCE Page 171 of 193
Page 172
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 0 1,431,747 1,431,747 Winter Planning & Enhanced Support - Business Case 5,918,000 2,804,451 3,113,549 5,918,000 Unmet savings 3,058,534 1,893,276 1,165,258 3,058,534 Covid Support 3,000,000 1,050,502 1,949,498 3,000,000 Digital Improvements 5,826,144 432,000 5,394,144 5,826,144 Social Care Demand Risk 5,504,666 100,000 5,404,666 5,504,666 Financial & Strategic Planning 5,416,000 0 5,416,000 5,416,000 Programmes for Change 1,764,279 742,978 1,021,301 1,764,279 Totals 31,919,370 7,023,207 24,896,163 0 31,919,370 ADULT SOCIAL CARE & HOUSING - INTEGRATED Revenue Budget Monitoring Report: Earmarked Reserves Analysis 2022/2023 Period 9 Page 172 of 193
Page 173
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 - 09 December 2022 Period 9 REPLACEMENT SAVING/FUNDING Description Page 173 of 193
Page 174
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 - 09 December 2022 Period 9 Page 174 of 193
Page 175
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 - 09 December 2022 Period 9 Page 175 of 193
Page 176
Appendix 7 Thematic Category Budget £ Actual £ Actual % Committed £ Committed % Uncommitted £ Final Outturn £ Outturn variance £ Key Ambition 2,504,000 1,035,479 41.35% 1,482,694 59.21% 766,165 2,248,859 255,141 Total 2,504,000 1,035,479 41.35% 1,482,694 59.21% 766,165 2,248,859 255,141 YTD OUTTURN Social Work Capital Programme Capital Budget Monitoring Report: Summary Expenditure by Thematic Category 01 April 2022 - 09 December 2022 Period 9 Page 176 of 193
Page 177
Appendix 8 Theme Budget £ Actual £ Committed £ Uncommitted £ Final Outturn £ Outturn variance £ SOCIAL WORK Integrated equipment & adaptations 2,504,000 1,035,479 1,482,694 766,165 2,248,859 255,141 TOTAL SOCIAL WORK 2,504,000 1,035,479 1,482,694 766,165 2,248,859 255,141 OUTTURN Social Work Capital Programme Capital Budget Monitoring Report: Summary Expenditure by Division 01 April 2022 - 09 December 2022 Period 9 YTD Page 177 of 193
Page 178
Page 178 of 193
Page 179
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/MD/GC Date 21/02/23 Adult Social Care Performance Report – Quarter 2 2022/23 From Ross McGuffie, Chief Officer, Health & Social Care E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 858 143 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 July to 30 September 2022 (Quarter 2). Recommendations It is recommended that the Adult Care and Social Work Committee: 1. Endorse the improvement actions included within Appendix 2 of the report; and 2. 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 8 Page 179 of 193
Page 180
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. 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 July to 30 September 2022 (Quarter 2). 2.2 The performance data for Quarter 2 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 2, July – September 2022) Ross McGuffie Chief Officer Health & Social Care North Lanarkshire Page 180 of 193
Page 181
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 Finance? 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 Resources? 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? 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 181 of 193
Page 182
Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) 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? The associated risks for Home Support are identified and managed in accordance with the agreed corporate project risk management and methodology and monitored through the Home Support programme board and wider corporate groups where appropriate. 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 182 of 193
Page 183
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 Q3 2021/22 Q4 2022/23 Q1 2022/23 Q2 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) 38 36 34 34 GREEN Assistive Technology - Number Of People With Technology (18-64yrs) 1452 634 631 635 629 Assistive Technology - Number Of People With Technology (65+) 873 866 852 853 2.2 Reablement - Number Of People Completing Reablement Process (cumulative) 2000 (500 per quarter) 916 1170 354 678 RED 2.3 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 67.7% 63.1% 67.1% 60.6% AMBER 2.4 Reablement - % Of People With No or Reduced Level of Home Support Service At End Of Process 70% 53.2% 52.2% 56.2% 50.2% RED 2.6 Balance Of Care - % Of People (Age 65+) 45% 44.3% 45.3% 45.5% 45.4% GREEN 2.7 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 66.3% 61.7% 66.6% 75.1% AMBER 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 21.0 21.3 22.0 22.2 GREEN 4.3 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 43.0 44.0 45.5 46.3 GREEN 4.4 Care Home - Average Length of Stay 865 831 819 828 939 AMBER Page 183 of 193
Page 184
improve the quality of life of people who use those services 4.5 Number Of People With Self Directed Support 1000 1200 1256 1280 1322 GREEN 4.6 Number Of People With A Direct Payment 240 308 321 298 328 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% 20.3% 18.9% 15.0% 17.5% 7.2 % Of Adult Protection Investigations Going To Initial Case Conference 20% 41.0% 23.9% 19.6% 16.3% 7.3 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 74.1% 79.3% 72.8% 76.3% GREEN 7.4 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 62.7% 66.3% 72.1% 67.4% Page 184 of 193
Page 185
Appendix 2 – Areas for Improvement (Quarter 2, July – September 2022) 1. Reablement & Home Support NLC in-house Home Support provision has increased over the last 28 months with pressures in the system caused by a number of factors including reduced availability of alternatives to in-house home support, pressures from hospital referrals/ discharges, staff absence, skills, training, increased acuity and complexity. Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. In particular Home Support Worker, Support Officer and Service Delivery Coordinators are difficult to recruit and retain. These new roles were introduced just prior to the pandemic, and it was not possible to establish them fully due to changes in working arrangements and the difficulties of delivering training. The feedback from staff is that the roles are challenging and therefore it has not been possible to sustain staff in post. The tasks and skill set needs to be reviewed for a number of posts, including administration and management roles which are critical to supporting our staff. The current Home Support operational model needs to be reviewed to embed Home Support provision, assessment and planning and longer-term care and support provision for North Lanarkshire. To facilitate this, it will be necessary to ensure that the model reflects the pathway which will ensure that: • All individuals will have an opportunity to be assessed at home when they are being discharged from hospital, or when their health is deteriorating to the point that they may need hospital • Community supports will be considered, and individuals will be signposted • Reablement and rehabilitation will be integral to supporting people and will be offered to everyone unless there is no reablement potential due to complex health and/or palliative care needs. The Home Support element of the Reablement provision will have dedicated management team. • During the period of assessment, a lead worker will be allocated to identify personal outcomes and develop a support plan to meet those outcomes. Capacity within the reablement service has reduced significantly since the onset of the C-19 pandemic, as a result of the pressures and demands outlined above. Efforts continue to ensure reablement capacity within the service is protected with reablement and rehabilitation key priorities for the future of the operating model. 324 people completed the reablement process in quarter 2, which was 31 fewer than the previous quarter and significantly below the target of 500 people per quarter. It is crucial that the Reablement Service is supported to fully recover to ensure consistent practice across all 6 localities in supporting people’s rehabilitation or reablement needs. 258 people have completed the reablement process in October and November 2022, suggesting an increase in flow through the service Page 185 of 193
Page 186
2. Integrated Equipment & Adaptation Service Overall performance for equipment deliveries within seven working days was 75.1% for Quarter 2, an improvement from 66.6% for Quarter 1. The service continues 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 186 of 193
Page 187
North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref CG/JMcK Date 21/02/23 Contracts awarded below Committee approval threshold From Chief Officer of Assets and Procurement E-mail mckinstryj@northlan.gov.uk Telephone James McKinstry 07939 281102 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 October 2022 and 31 December 2022. It sets out those contracts awarded with a value below the financial threshold requiring Committee approval. Recommendations The Adult Care and Social Work Committee are: • advised of the Contracts awarded below Committee approval threshold between 1 October 2022 to 31 December 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 187 of 193
Page 188
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 October 2022 to 31 December 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 Chief Officer of Assets and Procurement Page 188 of 193
Page 189
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. Contracts awarded by the Council are compliant with GCSOs and procurement Page 189 of 193
Page 190
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? Where Risk impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. Page 190 of 193
Page 191
Contract award procedures may be susceptible to legal challenge if they are not discharged in accordance with GCSO and procurement legislation. 5.1 0 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. Page 191 of 193
Page 192
APPENDIX 1 Contract Description Contract Award Date Contract Start Date Contract End Date Contract Extension Contract Value (incl extension) (£s) Successful Tenderer Supplies Services Works No of Tenders Received Route * Hosted Job Manager & Dynamic Scheduling Software Solution 2022- 23 18/11/2022 01/11/2022 31/10/2023 N/A £224,680.67 Advanced Business Software & Solutions Ltd Services 1 *EXT Supply & Delivery of Telecare Equipment 30/11/2022 01/12/2022 31/03/2023 N/A £420,480.00 Careium UK Ltd (formerly Doro UK Ltd) Supplies 1 **DAF3 *EXT – Contract Extension to contracted provider delivering best value **DAF3 – Direct Award via a Scotland Excel 3rd Party Framework 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 Page 192 of 193
Page 193
DAF3 - Direct Award 3rd Party Framework DAH&SC - Direct Award Health & Social Care Related Services N - Negotiated Contract EXT - Extension to Contract/Framework Page 193 of 193