Agenda Document Pack - Adult Care and Social Work Committee - 05/09/2023
North Lanarkshire Council · 5 September 2023
Back to Adult Care and Social Work Committee — 5 September 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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8th of September Members of the Adult Care and Social Work Committee Chief Executive’s Office Archie Aitken Chief Officer (Legal & Democratic) Civic Centre, Windmillhill Street, Motherwell ML1 1AB www.northlanarkshire.gov.uk Notice is given that a Meeting of the Adult Care and Social Work Committee is to be held in the Council Chamber, Civic Centre, Windmillhill Street, Motherwell, ML1 1AB on Tuesday, 05 September 2023 at 14:00 PM which you are requested to attend. The agenda of business is attached. Archie Aitken Chief Officer (Legal & Democratic) Members : Clerk Name: Clare Louise McDonald Clerk Telephone: 01698 302190 Clerk Email: mcdonaldcl@northlan.gov.uk M McCulloch, M Boyd, D Ashraf, C Barclay, B Baudo, G Brennan, B Burgess, A Bustard, J Cairns, K Docherty, W Goldie, L Jarvie, J Jones, J Keltie, M McBride, A McCrory, B McCulloch, R McKendrick, A McVey, N Shevlin, R Sullivan, J Toner, C Williams, N Wilson, G Woods. Page 1 of 164
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Agenda 1 Declarations of Interest In Terms of the Ethical Standards In Public Life Etc. (Scotland) Act 2000 Operational 2 Implementation of the National Trauma Framework for North Lanarkshire Submit report by the Chief Social Work Officer (Children, Families, Justice and Integrated Practice) setting out the approach to the implementation of the Transforming Psychological Trauma: Knowledge and Skills Framework within North Lanarkshire (copy herewith) 5 - 18 3 Delayed Discharge and Hospital Occupancy Action Plan Submit report by the Chief Officer (North Lanarkshire Health and Social Care Partnership) informing of the Scottish Government's Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan (copy herewith) 19 - 48 4 Resilience Response Submit report by the Chief Officer (Health and Social Care Partnership) providing an update on the actions being taken in response to the current whole system health and social care service pressures (copy herewith) 49 - 58 5 Winter Plan Business Case Progress Report Submit report by the Chief Officer (Health and Social Care Partnership) providing an update on the Health and Social Care Winter Plan Business Case (copy herewith) 59 - 70 6 Quality Assurance Annual Report Submit report by the Acting Chief Officer (Performance, Planning and Quality Assurance) providing an update on the Quality Assurance activity over the annual period of 1 April 2022 to 31 March 2022 (copy herewith) 71 - 106 Performance 7 Adult Social Care Performance Report - Quarter 4 2022/23 Submit report by the Chief Officer (Health and Social Care Partnership) providing an update on the performance of key areas of activity within Adult Health and Social Care for the period 1 January to 31 March 2023 (copy herewith) 107 - 116 Financial 8 Revenue and Capital Budget Monitoring Report Period 4 01/04/2023 to 21/07/2023 Submit report by the Acting Chief Officer (Planning, Performance and Quality Assurance) providing a summary of the revenue financial performance of the Health and Social Care Partnership - North Lanarkshire (Adult Social Care and Housing) and the performance of the Social Work capital programme for Period 4 from 1 April to 21 July 2023 (copy herewith) 117 - 128 9 Sundry Debt Write Off 2023 Submit report by the Chief Officer (Adult Social Work Services) providing a summary of outstanding debtor accounts deemed uncollectable following all attempts at recovery or are considered uneconomically viable to continue pursuing (copy herewith) 129 - 134 Contracts Page 3 of 164
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10 Contract Award for Administration Support of Engagement and Participation (Supported People) Submit report by the Acting Chief Officer (Planning Performance and Quality Assurance) seeking approval to award a contract for Administration Support of Engagement and Participation (Supported People) to North Lanarkshire Disability Forum (copy herewith) 135 - 144 11 Contract Award for the Supply, Installation, Removal, Servicing and Maintenance of Stairlifts and Hoists Submit report by the Chief Officer (Health and Social Care Partnership) seeking approval to award a contract for the supply, installation, removal, servicing and maintenance of stairlifts and hoists (copy herewith) 145 - 156 12 Contracts Awarded below Committee Approval Threshold Submit report by the Chief Officer (Assets and Procurement) advising of the contracts awarded between 1 April and 30 June 2023, with a value below the financial threshold requiring Committee approval (copy herewith) 157 - 164 Page 4 of 164
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1 North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref MF/AG Date 05/09/23 Implementation of the National Trauma Framework for North Lanarkshire From Alison Gordon, Chief Social Work Officer (Education, Families, Justice and Integrated Practice) E-mail Gordonal@northlan.gov.uk Telephone Executive Summary The Transforming Psychological Trauma: Knowledge and Skills Framework (The Framework) has been developed by NHS Education Scotland (NES) to support the delivery of Scottish Government and COSLA’s joint policy intention to create a trauma-informed workforce. Being trauma-informed will require long-term culture and system change across the Health and Social Care Partnership (HSCP) and the Council to create the conditions in which staff feel supported to care for and respond to citizens in ways that recognise the impacts of trauma and create relationships that heal and resist re-traumatisation. It will support the delivery of the ambitions of the Strategic Commissioning Plan and changes within the Council’s new Programme of Work. The purpose of this paper is to set out the actions being taken to embed the Framework in North Lanarkshire, highlight areas of practice where a trauma informed approach is already making a positive difference for children, families and individuals and outlining next steps, in ensuring North Lanarkshire becomes a leading trauma informed HSCP and council. It should be noted that a version of this report was considered and endorsed by the Wellbeing and Tackling Poverty Committee in May 2023. This report has been amended to provide more information on implementation and linked work within Adult Social Work and the HSCP. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Endorse the approach to the implementation of Trauma Informed Practice across the Health and Social Care Partnership as set out in this report. (2) Agree that the workforce should be trained at the ‘informed level’ as part of the suite of mandatory training. Adult Care and Social Work Committee Item 2 Page 5 of 164
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2 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 1. Background 1.1 Evidence of the full impact of trauma, particularly adverse childhood experiences (ACEs) has been emerging now for some time, establishing beyond doubt that its effects can be wide-ranging, substantial, long-lasting, and costly (NHS Education for Scotland, 2021). In response to this, Scottish Government established a National Trauma Training Programme, led by NHS Education for Scotland (NES) to support the ambition, agreed with COSLA, to create trauma-informed and trauma-responsive workforce and services across Scotland. 1.2 In 2019 the Scottish Government published the Scottish Psychological Trauma Training Plan (Trauma Training Plan) to support the local implementation of Transforming Psychological Trauma: Knowledge and Skills framework for the Scottish Workforce (The Trauma Framework). Working with COSLA, the commitment to the implementation of The Trauma Framework was reiterated in the Programme for Government 2021-22 along with the initiation of a Leadership Pledge of Support for Trauma Informed Practice to raise the standard of support across public and third sector organisations. COSLA and several local authorities and HSPCs have signed this pledge, including North Lanarkshire HSCP. See Leadership Pledge Signatories 1.3 The Trauma Framework outlines the importance of creating a trauma-informed system and organisation that supports the workforce engage with citizens in a trauma-informed way. This is reflected in 5-key drivers for trauma-informed practice which emphasise the importance of leadership and the wellbeing of the workforce: 1. Leadership and management 2. Workforce wellbeing 3. Workforce knowledge and skills 4. Experts by experience 5. Data and feedback loop 1.4 Being ‘Trauma Informed’, both at the practitioner and organisational level means being able to recognise when someone may be affected by trauma, taking this into account, and responding in a way that supports recovery, does no harm, and recognises and supports people's resilience. To achieve this, a trauma informed approach comprises 5 key principles: Safety, Trust, Choice, Empowerment, and Collaboration (see Appendix A). 1.5 The Trauma Training Plan, developed by NES, tailors training to the type of role and function performed by staff across 4 practice levels: trauma informed; trauma skilled; trauma enhanced, and trauma specialist (see Appendix B). 1.6 Being trauma-informed as an organisation has significant benefits for staff and the people they serve. Services are organised in ways that promote safety and trust to prevent re-traumatisation, and this is effective in preventing concerns and difficulties escalate, which in turn have a human and economic cost. The approach is addressing inequality by ensuring that those affected by trauma (staff or those they serve) do not experience barriers to life chances and choice as a result of trauma and that trauma is recognised and responded to in order to support recovery. Becoming a Page 6 of 164
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3 trauma-informed organisation is not simply about doing what we already do better, rather it is transformative in the way services are organised and delivery and therefore requires to be key part of the delivery of the ambitions of the Strategic Commissioning Plan. 2. Report 2.1 Scottish Government and COSLA asked all local authorities and health boards to appoint trauma champions to ‘oversee, encourage and raise awareness of trauma informed and trauma responsive practice across all services within their area’. The champions have a specific responsibility to influence local leaders to embed the five key drivers of trauma-informed practice (as detailed in 1.3) across their area. 2.2 The North HSCP nominated Margaret Flavell, Manager Adult Social Work as the champion. Andrew Gillies, Senior Education and Family Manager and Nancy Ferguson, Principal Psychologist were nominated as council champions and these officers link with leads in Scottish Government and the Improvement Service, as well as local leads in NHS Lanarkshire in relation to implementation. 2.3 Two steering groups have been established, one that is Pan Lanarkshire alongside a North Lanarkshire Steering Group involving staff from the HSCP and Education and Families, Enterprise and Communities, and People Resources with the purpose of providing strategic direction and coordination of support and training to promote the implementation of Trauma-Informed Practice. The Scottish Government has made £100K available to all local authorities over two years to support the implementation of Trauma-Informed Practice. A Senior Officer was therefore appointed in January 2023, to lead on the implementation of Trauma Informed Practice and build on, and add pace to, the work started to integrate the Trauma Training Programme with current training plans and other activities in place to deliver The Plan for North Lanarkshire. Additionally, there are 2 Health and Wellbeing officers being employed within the HSCP whose role in supporting staff wellbeing will be aligned with the outlined Trauma Informed Practice approach. 2.4 Councillor Woods, Convenor of the Wellbeing and Tackling Poverty Committee has been appointed as Elected Member Champion for the Council. Trauma Informed Practice across the HSCP 2.5 The importance of being trauma-informed in our approach to support citizens has been recognised by services across the partnership. The HSCP’s Strategic Commissioning Plan, is underpinned by the strategy to develop a trauma skilled work force, building on established work around nurture, resilience and other approaches centred on forming strong relationships with children, families and individuals. Awareness about the importance of trauma recovery has also been integrated into the delivery of work related to critical incidents and adult protection practice. 2.6 The importance of being trauma-informed also underpins the Partnership’s longstanding investment in prevention and early intervention work with our existing workforce and our third sector partners with its principles incorporated within the multiagency adult protection training, domestic abuse training and others although this requires further development. 2.7 The housing service is working to embed trauma-informed understanding of working with people across the service including through its implementation of the Solihull approach which supports emotional health and wellbeing in work with families. Other initiatives such as psychologically informed environments, ‘Family Plus’ and ‘Forever Page 7 of 164
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4 Homes’ have been piloted with housing and partners recognising the importance of trauma-informed approaches on improving outcomes. The Local Housing Strategy (2021-2026) and the Rapid Rehousing Transition Plan also set out how a trauma- informed workforce will improve outcomes for people in need of support with housing. Further work is underway to help identify the barriers and enablers for adopting a trauma-informed approach within housing. 2.8 An awareness of the impact of trauma is now also embedded into the approach to the design and development of North Lanarkshire’s community hub programme. Working with the Promise Development team and Council equalities officer we have begun to apply a ‘trauma lens’ using the Scottish Government toolkit and identified a number of improvement actions e.g., paint colours, signage, seating, layouts and signposting to supports and services. This work will continue as our new community hubs are introduced and through tests of change to address the barriers that those affected by trauma can experience while accessing supports and services. This work will also be further developed through existing workplaces across the partnership by teams applying a ‘trauma lens’ to their working environments. 2.9 The Council’s Equalities Delivery Board also has Trauma Informed Practice firmly sitting within its strategy, delivery framework and five objectives to ‘ensure that local public services are responsive to different needs and treat users with dignity and respect’. Training 2.10 The steering group is developing a strategy to use the National Trauma Training Plan to support implementation across the HSCP and North Lanarkshire. An e- learning module at the ‘informed level’ (see Appendix B) is in development for all staff in the Council and committee is asked to approve its inclusion within the mandatory suite of training for Council employees. The Health Board is asked to consider this also for NHSL staff. Beyond this, an assessment tool is being developed for services to identify at what level groups staff need training across the continuum of informed to specialist and training plans will be built around analysis of need, integrating trauma informed practice wherever possible. A specific training offer for education staff has been developed in collaboration with Education Scotland to enhance understanding of trauma responsive strategies, aligned with the outcomes within the Roadmap to Recovery. 2.11 Dr Claire Stark, Lanarkshire Trauma Coordinator, has delivered introductory sessions to 100 plus first line managers across the partnership. There are further planned sessions by Dr Claire Stewart, Lanarkshire Trauma Coordinator to the Strategic Leadership Team to increase leadership understanding, refresh engagement and to agree next steps. Additionally, Dr Claire Stewart has delivered an introduction to The Trauma Framework to the NL Council Corporate Management Team and elected members, which is now available to members digitally. 2.12 The principles of being trauma informed underpin and support all work with children, families, and adults. As such, the steering group has coordinated a review of training delivered to social work practitioners, housing staff, within education and across public protection to identify where the principles of trauma informed practice are embedded in training already and training packages have been updated to reflect these principles where required. Page 8 of 164
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5 Next Steps 2.13 There has been a lot of activity to raise awareness about trauma-informed practice to lay the foundations for a trauma informed workforce through training. However, the success of such initiatives will be limited without clear and unambiguous strategic and organisational support for the approach, which ensures it ties in with the vision and ambition of the Strategic Commissioning Plan (SCP) and the Plan for North Lanarkshire. Moving forward work undertaken by the Trauma Steering Group will become part of the ‘Resilient People’ element of the council’s new Programme of Work. We are at the beginning of this process that moves from an organisation that is trauma aware to one that is trauma informed as set out in Appendix C. Particular attention needs to be given to ensuring that we understand the impact and how outcomes for people are being improved through the development of a trauma informed workforce. 2.14 Embedding sustainable trauma-informed ways of working is about long-term culture change. The steering group has identified key priorities below linked to the 5 strategic drivers for a Trauma Informed organisation outlined in 1.3: 2.14.1 Workforce Wellbeing: The actions to deliver the NHSL and Council’s Mental Health Strategy for staff are underpinned by the 5 principles of a trauma-informed organisation. 2.14.2 Workforce knowledge and skills: Each service across the partnership should assess the level at which staff need training and a base line is established in order to update the training strategy for trauma informed practice. 2.14.3 Experts by experience: Individuals, families and communities drive our approach to becoming a trauma informed organisation using existing structures for participation and engagement. 2.14.4 Data and Feedback Loops: Base lines and outcome data for trauma informed practice are integrated and aligned with measures of success within the SCP and the Council’s new Programme of Work. Leadership Pledge 2.15 As set out in the Programme for Government 2021, a Leadership Pledge of Support has been introduced for organisations to demonstrate their commitment to supporting and embedding a trauma informed culture across their workforce and services. Signatories to this pledge agree to: • Work with others to put trauma-informed and responsive practice in place across our workforce and services. • Deliver services that wherever possible are actively informed by people with lived experience of trauma. • Recognise the central importance of relationships that offer collaboration, choice, empowerment, safety, and trust as part of a trauma-informed approach. Page 9 of 164
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6 • Respond in ways that prevent further harm, and that reduce barriers so that people affected by trauma have equal access to the services they need, when they need it, to support their own journey of recovery. 3. Measures of success 3.1 Staff are trained in Trauma Informed Practice at the level commensurate with their role. 3.2 Improvement action on trauma design of spaces is delivered in line with the implementation of town and community hubs with ongoing learning feeding into future design. 3.3 Staff engagement, retention and wellbeing is improved through the implementation of trauma informed work at a systems level. 3.4 HSCP, Council staff, partners, services, and environments recognise the prevalence and impact of trauma, how they may create barriers to support, the key role they play in people’s recovery, and how they can reduce the possibility of re-traumatisation. 3.5 Outcomes for children, young people and adults are improved through positive relationships with staff and evidenced in feedback from citizens on their experiences. 4. Supporting documentation 4.1 Appendix A Trauma-Informed System 4.2 Appendix B Trauma Training Plan 4.3 Appendix C Trauma Informed Roadmap 2023-25 4.4 Appendix D The Scottish Psychological Trauma Training Plan trauma-training-plan-final.pdf (transformingpsychologicaltrauma.scot) Alison Gordon Chief Social Work Officer (Education, Families, Justice and Integrated Practice) Page 10 of 164
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7 5. Impacts 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? There is a growing body of evidence that impact of adverse childhood experiences and trauma contribute to increased risk of a wide range of physical and mental health conditions and social problems, including involvement in the justice system (Scottish Government, 2018). A trauma-informed approach to the delivery of services mitigates these risks and is an important component in the strategic work to reduce inequalities and delivering priorities within the HSCPs Strategic Commissioning Plan and the Council’s new Programme of Work. 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 been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Cost of the Trauma Informed Practice implementation post (NLC 12) at mid-point including on costs is £58,381. Post is funded from approved carry forward and 2022-23 funding from Scottish Government. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts been discussed and agreed with People Resources? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Trauma Informed Practice features as a firm commitment within the strategy, delivery framework and objectives of the Equalities Delivery Board. In terms of trauma design of town and community hubs and their spaces, the Council’s Safety and Wellbeing team and Equalities officer are involved in plans and improvement actions. The TOD team are engaged in training roll out proposals contained in this report and as HR policies are reviewed the impacts of trauma will be considered in development of guidance and toolkits to promote the wellbeing of staff. It is important to note that many staff may have experienced trauma themselves, and some research suggests that those in human services have a higher prevalence of adverse experiences, which means that staff support and strategies to mitigate secondary traumatic stress are crucial (Scottish Government, 2021). Page 11 of 164
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8 There will be some impact around communication and engagement with communities and with staff if the report is approved. Particular emphasis will need to be given to engagement and communication around the training roll out. In terms of physical design of spaces, environment, and buildings there may be requirements to replace signage and other communications material. 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 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? 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 ☐ Page 12 of 164
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9 If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? There are risks to children, individuals and families of re-traumatisation and increased distress if staff are insufficiently trauma-informed in their approach and practice. The roll out of The Training Plan is a national policy priority and the extent to which services have integrated and applied the approach will be subject to external scrutiny, particularly in any joint strategic inspection of children’s or adult services. If our workforce do not recognise trauma as an important factor impacting health throughout a person’s life, there is a risk that we do not enhance the positive impact we are seeking to achieve against our citizens health and wellbeing outcomes. If our physical spaces are not designed and maintained to offer a sense of safety, calmness, dignity, and promoting choice and control it could significantly impact the positive impact and aspiration we have for our town and community hubs. This also extends to an impact on productivity of staff and our ability to provide supports and services that are inclusive and responsive in their delivery. The trauma roadmap applied to our operating model for town and community hubs will address this risk through the improvement action. Attention to the principles of Trauma Informed Practice has now been incorporated into the revised Strategic Policy Framework adopted by the Policy and Strategy Committee on 16 March 2023. Furthermore, Trauma Informed Practice now firmly sits within the objectives of the Council’s Equalities Delivery Board. The steering group is creating a project risk register in line with the development of the implementation plan as outlined in 2.11 which will identify the baseline risk level. 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. The nature of service within the Armed Forces means that a number of veterans may have been exposed to and remain impacted by traumatic experiences irrespective of any formal diagnosis. The work outlined in this report will strengthen the ability of services to respond in ways which are sensitive to this and avoid re-traumatisation thus supporting the council in is duties with respect to the Armed Forces Covenant. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). Page 13 of 164
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10 If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☒ A CRWIA will be completed with respect to the full Trauma Action Plan which remains in development however it is anticipate that improvements being carried forward will have a positive impact on both children and young people’s wellbeing and rights. Page 14 of 164
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11 Appendix A: Trauma-Informed System Page 15 of 164
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12 Appendix B: Trauma Training Plan Page 16 of 164
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13 Appendix C: Trauma Informed Roadmap 2023-25 Page 17 of 164
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13 Page 18 of 164
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Delayed Discharge and Hospital Occupancy Action Plan North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref RMcG Date 05/09/23 From Ross McGuffie, Chief Officer NL Health & Social Care Partnership E-mail mcguffier@northlan.gov.uk Telephone Executive Summary This paper is to inform committee of the Scottish Government’s Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan. Recommendations It is recommended that the Adult Care and Social Work committee: (1) Endorse the Scottish Government action plan on delayed discharge and hospital occupancy. (2) Acknowledge that the actions contained within are being built into the action plan for Operation Flow, to ensure a whole system approach is fully embedded in 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 1. Background 1.1 Winter 2022/23 was an incredibly challenging period for health and social care systems across Scotland, managing several complex factors including increased seasonal demand for unscheduled care and critical care due to the combined incidence of flu, Covid-19 and other respiratory infections. 1.2 Throughout this period, local systems have tried to manage through these competing demands with whole system actions such as Discharge Events and substantial developments such as Operation Flow within Lanarkshire. Adult Care and Social Work Committee Item 3 Page 19 of 164
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1.3 This has led to a greater understanding of the issues being faced and what works, with the greatest challenge facing all systems being how to turn this into plans that can create a sustainable difference. 1.4 The action plan brings together 12 whole system actions across the areas of Good Practice, Data Management and Workforce, that are essential in reducing pressure on staff and the system and in ensuring people receive the right care in the right place at the right time. The Action Plan is attached in Appendix 1. 2. Report Delayed Discharge and Hospital Occupancy Action Plan 2.1 The Action Plan places significant emphasis on ‘getting the basics right’ through consistent implementation of models such as the Discharge Without Delay programme, of which NHS Lanarkshire is a demonstrator site. This includes: • Use of admission avoidance approaches such as Hospital at Home, multi-agency input at the front door, Locality rapid wrap-around models and early whole-system input within the first 48hrs of admission for those who do require acute care. • The social care needs of patients are considered in every ward with social work input to wards with high frailty, providing expert advice and input to discharge planning. • Discharge Without Delay principles should be utilised to set jointly agreed Planned Dates of Discharge, reviewed daily and used to plan and prepare discharges. • Use of multi-agency teams to support senior decision making, with whole system visibility of plans and senior oversight and escalation to resolve any delay-causing issues. • Structured ward rounds or white board reviews 7 days per week to ensure there are priorities, plans and tasks set for the day and the parameters for criteria led discharge agreed to support early discharge. • Utilise Planned Dates of Discharge to commission/organise care. • Identify complex discharges early in their inpatient journey, including those with high frailty scores, to allow coordinated multi-agency management. • Ensure early engagement with families and carers to manage expectations. • Implement discharge to assess and intermediate care models to support discharge home and allow assessments for ongoing care to be undertaken in people’s own homes. Utilise community rehabilitation as the preferred place of recovery and intermediate care. 2.2 These ‘getting the basics right’ actions are included in NHS Lanarkshire’s Flow Foundation Bundle developed through Operation Flow. Page 20 of 164
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2.3 The twelve actions identified within the plan are noted below: 1 All systems to review and implement learning from their discharge event to embed improvements in an ongoing, ‘business as usual’ way 2 Put systems in place to provide the assurance necessary to confirm the measures set out in ‘Getting the Basics Right’ are consistently being applied 3 SG will continue work with NES to develop a toolkit of support and training materials to support discharge 4 Boards and IJBs to assess their systems and processes in terms of acute discharge planning and apply the DwD toolkit in every inpatient area, community hospitals and other off-site beds 5 SG to provide a tactical social care dashboarding solution to support HSCPs and HBs to have access to a core set of indicators, predicated on existing and robust management information to enable consistent and comparable data to be available at different levels of geography 6 SG to provide modelling of potential future demand to support more effective local planning 7 SG to support partners to develop forum to drive work towards more consistent and comprehensive data 8 SG/PHS/NSS to provide a strategic solution for the delivery of MI data for insights across health and social care using NSS’s Seer2 platform 9 SG to support local partners through NES to utilise international recruitment 10 Continue to pursue national recruitment campaign 11 Continue to pursue recruitment activity with DWP for Ukrainian displaced people and UK residents that are economically inactive 12 Increase in pay to £10.90 per hour in 23/24 for adult social care sector in commissioned services. Look at improvements to terms and conditions for adult social care in 2023/24 2.4 A number of face to face whole-system development sessions have been held to support learning from the Operation Flow firebreak, with a weekly whole-system Operation Flow Programme in Board to develop the next stages of the local action plan. 2.5 Five task and finish groups have been developed to implement the local action plan, which picks up actions 1, 2 and 4 in the table above. This will conclude the first phase of Operation Flow, with the aim of having sustainable implementation of these initial actions by summer. Phase two will then commence with a view to preparing for winter, with the third phase then being the wider transformation of services in the longer-term. 2.6 The North Lanarkshire HSCP has been involved in the previous exercises to build a social care dashboard outlined in action 5, with work ongoing to develop this through the new national Whole System Oversight and Planning Group, of which the North Lanarkshire Chief Officer is a member. 2.7 The Lanarkshire system continues to engage with the Scottish Government and NES around international recruitment, with some recent success through this approach. Page 21 of 164
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3. Measures of success 3.1 Through Operation Flow, the Lanarkshire system has undertaken a large-scale programme of change, which will pick up most of the actions outlined within the new national action plan. 3.2 Updates from the Operation Flow action plan and associated task and finish groups will be shared with committee. 4. Supporting documentation 4.1 Appendix 1 H&SC Delayed Discharge and Hospital Occupancy Action Plan Ross McGuffie Chief Officer North Lanarkshire Health & Social Care Partnership Page 22 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 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 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 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 23 of 164
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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? The Strategic Planning Group increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 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 risk on the risk register sets out the impact of unscheduled care challenges in the Lanarkshire system. 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 24 of 164
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Appendix 1 Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan March 2023 Page 25 of 164
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Contents Foreword 1. Context ....................................................................................................................... 11 2. Delayed Discharge ..................................................................................................... 12 2.1 Defining a delayed discharge ................................................................................. 12 2.2 January 2023 Discharge Events ............................................................................ 12 3. Delivery Action ........................................................................................................... 13 3.1 Good practice ...................................................................................................... 13 3.1.1 Reduce length of stay and ensure people are discharged when they are clinically fit .................................................................................................................... 13 3.1.2 Getting the basics right ................................................................................... 13 3.1.3 Support already provided ................................................................................ 15 3.1.4 Actions for Best Practice ................................................................................. 16 3.2 Data and Managing Variation .............................................................................. 16 3.2.1 Analysis for future planning ............................................................................. 16 3.2.2 Using data-driven insights to manage variation ............................................... 16 3.2.3 Actions for Data and Managing Variation ........................................................ 17 3.3 Workforce................................................................ Error! Bookmark not defined. 3.3.1 Labour Shortages ........................................................................................... 17 3.3.2 Actions for Workforce ..................................................................................... 18 4. Sustaining Change .................................................................................................... 18 4.1 Transparency......................................................................................................... 19 4.2 Measuring Progress............................................................................................... 19 5. Conclusion and Next Steps ....................................................................................... 19 ANNEX A – Context ................................................................................................... 20 Short-term pressures on the NHS ................................................................................ 20 Persistent Demand ...................................................................................................... 20 Admissions into Acute .................................................................................................. 21 Ageing Population ........................................................................................................ 22 Frailty and Deconditioning ............................................................................................ 22 Social care vacancy levels ............................................................................................... 23 ANNEX B – Delayed Discharge ................................................................................. 25 Reasons for delayed discharge ........................................................................................ 26 Trends in delayed discharge ............................................................................................ 27 Flow through delayed discharge....................................................................................... 27 ANNEX C – Definition of Discharge Event ................................................................... 28 ANNEX D - Improving Urgent and Unscheduled Care ................................................. 30 Increasing capacity outwith hospitals ............................................................................... 30 Page 26 of 164
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Foreword Winter is challenging for the NHS every year, but winter 2022/23 was considerably more so for a variety of factors, not least the substantial increase in short-term seasonal demand for unscheduled and critical care due to the combined high incidence of flu, Covid-19 and other respiratory infections. This has placed exceptional pressure on an already strained system that was working hard to rebuild following the pandemic and striving to address the ‘backlog’ and meet high levels of demand for elective procedures. Additionally we have been responding to the deconditioning of those who either were waiting for care or had their care delayed due to fear of Covid-19 and/or a wish not to add to the strain on the health and social care system. In response to what we knew was going to be a challenging period, the Winter Resilience Plan set out a number of priorities in preparation for winter. Now that seasonal demand is subsiding, this Action Plan reflects on the strong evidence of what we know works and builds on the firm foundations of best practice to reduce delayed discharges and overall hospital occupancy, and reasserts the Scottish Government’s commitment to responding to the many challenges that still exist over the coming weeks and months. The Action Plan sets out the key actions which should be taken now to address the urgent issues around delayed discharge and high hospital occupancy we continue to experience and whose impacts are felt across the whole system. Immediate actions to ensure we are getting the fundamentals right consistently and in a way we can sustain can be found on pp10-11 of this plan. This Action Plan recognises the complexities of the challenges we are facing, whilst also acknowledging that the demands upon health and social care have changed significantly post- pandemic. Delayed discharge impacts on length of stay, and exit blocks cause access blocks, hence this plan emphasises the importance of a whole system response involving hospitals (acute led care), residential care (care homes) and primary/community care (including care at home). As set out in the recent NHS Delivery Plan Guidance for Board Annual Delivery Plans, the health and social care system must respond at all points along the patient journey, recognising the significant impacts interruptions to patient flow have on other parts of the system, such as the ambulance service and A&E. This plan proposes a set of immediate actions to be taken which represent good practice - and consideration should be given in delivery plans around how to embed and sustain these activities. Flow, the alignment of the discharge pattern with the admission curve, ensures patients get to the right bed at the right time and prevents unnecessary consumed capacity or increased length of stay. Working together across traditional boundaries will help us to improve flow through our acute settings, and delayed discharge as we work towards winter 2023/24. Multi-disciplinary and multi-agency teams are vital in enabling that all-important flow, and in moving the public away from the notion of doctor-led care as the default, particularly, in the context of this Action Plan, when it comes to discharge from hospital. Whilst it is impressive that around 97% of all discharges are without delay, we need to implement actions that we know are effective now to increase that figure and reduce the pressures we are experiencing across the NHS and in social care. The 3% of patients who do go on to be delayed in their care have a disproportionately poorer experience and poorer outcomes, and their delay consumes a high proportion of capacity (bed days lost). In all of our actions, we must bear the principles of realistic medicine in mind: ensuring patients, people, are involved in decisions about their own care and that we listen to their needs and wants at as early a stage as we can – particularly with regards to their wishes when it comes to leaving Page 27 of 164
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hospital and on into the care system. We must also recognise the ethical issues surrounding unnecessary, long-term hospital stays, and we must continue our concerted effort to reduced delayed discharge. Reducing delayed discharge is not a silver bullet to reducing hospital occupancy, but it is an important element to consider as part of the package of measures needed to improve flow. We must sustain the changes that have happened over winter 2022/23 to improve the flow of patients through urgent and unscheduled care, including, but not limited to discharge without delay. This Plan also recognises that there are challenges that will be difficult to address in the short term, such as recruitment and retention (in part itself caused by a declining supply of a working age population) and variability of capacity and demand throughout Scotland. But we know from the experience we have gained over the past months what works. This Action Plan draws together 12 actions we can take immediately under the following areas, with an over-arching aim alongside other measures of returning occupancy to pre-pandemic levels: Good practice – the evidence regarding what works is clear, and we need to adopt this consistently across both health and social care and ensure there is a continuous focus on evidence- based improvement. Data management – the data tells us the challenge and pressure the system is under, but we need to ensure that we continue to improve data and information so we move towards a whole system approach to developing intelligence that can be used to improve health and social care. Workforce – vacancy levels (particularly in social care) remain a key challenge and we must do all we can to support recruitment and retention. Whilst the immediate actions set out in this plan are essential in reducing pressure on staff and the system, assuring patient safety and addressing the ethical issues of unnecessary hospital stays, we must use these actions and learnings to support our ongoing commitment that people receive the right care in the right place at the right time. This Action Plan should be seen as a relatively short- term but important constituent part of our overall improvement agenda that gives assurance that we are as prepared as we can be for winter 2023/24 and beyond. With this longer-term objective in mind, we have commenced our annual planning cycle to help us assess current capacity against anticipated demand which will include surge activity at times when we know that the health and social care system is likely to come under increased pressure. This is set out in the NHS Delivery Plan which covers plans for both 2023/24, and for the medium term. John Burns Angie Wood NHS Scotland Chief Operating Officer Scottish Government Interim Director Social Care Page 28 of 164
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1. Context Winter 22/23 has seen extreme pressure across our health and social care system. But the pressures are not exclusive to the winter months alone. The average length of stay in hospital now stands at 8.4 days, which is a day longer when compared to the three years before the pandemic. This Action Plan sets out the issues facing the system and the actions we can take now to address them, with a particular focus on the bridge between hospital and care settings. There is a clear need to consider the potential social care needs of patients at an early stage in their hospital journey, and to discuss those with the patient and their family and current carers. Involving the patient in decisions about their health care and their subsequent care outwith the hospital setting is vital in both working towards our ambition of putting the patient’s needs and wishes at the heart of their care path, and in helping smooth the flow of patients as they transition into ongoing care, where necessary. 1.1 Older Population Scotland’s demographics are being shaped by an increasing older population and while we celebrate that people are living longer, this does mean that we are seeing a shift in front door presentation: we are admitting people who are older, with multi-morbidity and higher acuity than ever before. An increasing older population and the health inequalities which persist in our society mean that many people are entering their later years in poorer health, frail and with multiple morbidities. All of which is translating into longer hospital stays and a knock-on impact on the flow of patients through our hospitals and on into care after hospital. 1.2 Risks of Longer Hospital Stays People being in hospital for longer than necessary is one of the current key issues facing the system, which presents a number of ethical issues as this can be to the detriment of the patient. Spending too long in hospital can lead to: • risk of deconditioning and frailty • risk of healthcare associated infection, falls and delirium • a sense of disconnection from family, friends and usual social networks leading to boredom, loneliness and loss of confidence • distress for family and carers who have to spend time and money on regular visits to a hospital that may be some distance from home 1.3 Hospital Occupancy Hospital occupancy is an important measure as it reflects the pressure in a system and the ability of a hospital to move patients efficiently through a hospital and to a specialty bed. We know that hospital occupancy is high and this in itself is leading to an increased level of clinical risk as patient care is being delayed, which is most visible in the media coverage of long waits in Accident and Emergency (A&E) and ambulances queuing as they seek to admit patients. This is of course in spite of considerable effort being taken to divert the general public to the right place for their healthcare needs when A&E or a GP practice is not appropriate, and pausing of elective activity in some Board areas in order to generate capacity in acute settings. Pre-covid quarterly official statistics showed that acute bed occupancy was subject to seasonality, running between 85-89%. Official statistics also show that the medical group of acute beds generally run at a higher occupancy than the surgical grouping. But we know that in order to reduce occupancy Page 29 of 164
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levels to around these pre-covid levels, it requires a whole system response with both health and social care working together. Acknowledging that there are actions that can be taken at every point in the patient journey and implementing those actions we know work now will help relieve those pressures and set us on a path to better manage the inevitable increased demand we will see in Winter 23/24. Further context is given at Annex A. 2. Delayed Discharge 2.1 Defining a delayed discharge Put simply, a delayed discharge is when a patient remains in a clinical setting when they are deemed to be clinically fit to be discharged. Importantly around 97% of all discharges from hospital are not delayed. However, as of 24 February 2023 there are circa 1,800 patients whose discharge has been delayed, recorded via our management information systems. Whilst addressing delayed discharge is not the only solution to reduce hospital occupancy, it remains an important element, not least as these statistics represent people who are in a setting that is not appropriate for their care. It is also important to note that these figures are management information, are submitted daily, are not revised and have not been verified. Although the detail behind the overall number of patients whose discharge is delayed is often not reported, it is important to note that there are different categories of delayed discharge. These are broken down firstly by setting: acute, mental health and community hospitals. Public Health Scotland share a list of acute hospitals on their Official statistics Delayed Discharge publication and local authorities follow the same definitions as Public Health Scotland. They are further broken down by the type of delayed discharge: a standard delay or code 9 delay. Code 9 delays are when partnerships are unable, for reasons beyond their control, to secure a patient’s safe, timely and appropriate discharge from hospital. Code 9 delays can be split further into Adults With Incapacity (AWI) delays and Complex (also known as Code 9: Other delays). These are used where: • the patient lacks capacity, is going through a Guardianship process, and for whom the use of S13ZA of the Social Work (Scotland) Act 1968 is being considered (AWI delay). • the patient is delayed awaiting availability of a place in a specialist facility, where no facilities exist and an interim move would not be appropriate (i.e. no other suitable facility available) (Complex/Code 9: Other) • patients for whom an interim move is not possible or reasonable (Complex/Code 9: Other). More detail on Delayed Discharge can be found at ANNEX B. 2.2 January 2023 Discharge Events On 17 January 2023, the Chief Executives of NHS Scotland and COSLA wrote to all Territorial Boards, IJBs and LAs to request a focused discharge event beginning in the week commencing 23 January 2023 as a means of addressing unacceptably high occupancy rates. This letter includes a clear definition of the expectations around those events, which can be found at ANNEX C. Page 30 of 164
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These events proved invaluable, but learnings from these must be implemented, and should now lead to sustained action, as set out in this plan. 3. Delivery Action It is important that we focus efforts on improving the way we plan, prepare for and execute the discharge process from all inpatient settings, but particularly from acute hospitals. To do that it will be important that we focus initially on delivering improvements in both discharge from delay and discharge without delay. But we also need to improve the flow through our hospital settings, not least as it is important we create the capacity to increase the volume of elective activity some of which has been paused or delayed as a result of the pressure across the system. It is also and most fundamentally about improving the safety of our acute systems and avoiding harm. The following therefore sets out the actions that are required in the short term to help address the immediate pressure being experienced, much of which has been communicated previously. 3.1 Good practice 3.1.1 Reduce length of stay and ensure people are discharged when they are clinically fit. Patient length of stay can be affected by many factors including patient complexity as already described. We also know that two patients with identical complexity and acuity can have very different lengths of stay in different settings. This can be affected by system configurations (such as same day emergency care replacing admission in some settings), system efficiencies (such as delays to access downstream beds leading to acute de-functioning or delays to treatment), clinical risk thresholds (junior staff having a more cautious approach to discharging compared to senior staff) and provision of support services such as variation in follow up, investigation delays or community supports in place. We know that for older people with frailty, access to specialist Geriatric Medicine beds reduces the risks of death or nursing home at discharge1. We also know that delays to access specialty older people’s beds directly correlates with longer lengths of stay such that every day’s delay in accessing a specialty bed adds three days onto the overall length of stay2. 3.1.2 Getting the basics right The objective of this plan is not just about reducing occupancy as a measure, but this is important in mitigating risk factors such as hospital associated infections and thus a measure of patient safety. We have work already underway through the Discharge without Delay (DwD) programme. Evidence suggests that leadership must be committed to continuous focus on good discharge processes and be relentless in the pursuit of good practice every time. 1 Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD006211. DOI: 10.1002/14651858.CD006211.pub3 2 SCoOP Acute Hospitals Outcome Report 2018-2019 reduced.pdf (abdn.ac.uk) Page 31 of 164
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GETTING THE BASICS RIGHT TO PREVENT DELAYED DISCHARGE AND IMPROVE FLOW • Implement admission avoidance, locality rapid response wrap-around models, care management, multiagency input at the front door approaches. Whole-system input at an early point in the first 48 hours of admission to engage patient/family/carers in discharge discussions and prevent deconditioning of patients. • Ensure the social care needs of patients are considered on every ward and that there is social work input into wards with high frailty and ongoing care needs. Service managers/care at home managers should attend ward rounds (this may be virtually) to understand/challenge referrals, manage and mitigate risk or perceived risk, provide expert advice and engage in planning and preparation for discharge as part of wider MDT discussions. • All systems should implement Discharge without Delay principles to plan together as the patient recovers, and jointly set a Planned Date of Discharge – using the PDD bundle to aid implementation and reliable and consistent practice. Every patient must have a planned date of discharge, reviewed daily and this be used to plan and prepare in real time. • Senior decision-making should happen with multi-agency teams, with regular communication and visibility of the plan. Daily senior oversight and escalation in both Health Boards and HSCPs/LAs should be in place to prevent/resolve delay-causing issues. Utilise performance data to apply continuous improvement to any emerging systemic issues. The majority of NHS Board/partnerships have engaged with DwD and will shortly be provided with a DwD care bundle which supports acute wards to plan effectively with patients and carers from admission, and sets out the approach to wider-MDT planning for more complex patients. Leadership across the health and social care system should ensure that this best practice is applied reliably and consistently and monitored for effectiveness. Reducing occupancy levels is a whole-system aim, with action incumbent on each component part of the system to deliver it. In acute sites, that means optimising in day flow through early and effective discharge planning and preparation (using a planned date of discharge (PDD) approach) leading to pre-noon and weekend discharges. In community teams, a PDD approach means contributing to discharge plans, from admission, and responding to the ‘queue’ in advance of completion of treatment. There is strong evidence of system and individual benefit from focus on whole system wraparound in the first 48 hours of admission, supporting discharge and avoiding further deconditioning of patients. The work we have undertaken over the course of the winter has led to a richer and deeper understanding of what works and much of this has been communicated out to both the NHS and Social Care systems. The discharge intervention undertaken in January 2023 in all systems with a targeted and focused approach to ensuring all patients discharge is being effectively managed has also given some critical learning. The combination of all of this has led to the creation of a package of measures that we know has an impact on reducing delayed discharge and improving flow. There is very little in this package that is necessarily new or novel, but there is extensive evidence to support that when in place and used collectively and consistently, these actions can deliver big improvements in the discharge process and flow. We would therefore ask that the following measures be continued and/or implemented, and sustained, as a matter of priority: Page 32 of 164
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Although all of these are important, perhaps one of the most critical is the need to ensure it is truly a whole system, person-centred approach based on the fundamentals of realistic medicine. It is therefore essential that social care, social workers, clinicians, families and critically the patients themselves work together in lockstep. Notwithstanding that this may require life-changing decisions to be taken – particularly following what could be a prolonged stay in hospital. 3.1.3 Support already provided A range of additional support and supporting materials have been prepared and issued to delivery partners to support the health and social care system. Additional funding of £528m was allocated directly to Health and Social Care Partnerships for 2022/23. This funding was aimed at the following social care measures: • £124m to enhance care at home • £144m to support the December 2021 uplift to £10.02, as well as a further £200 million to increase the minimum hourly rate of pay in adult social care to £10.50 in 2022/23. This will rise to £10.90 in 2023/24 • £20m to support interim care arrangements • £40m to enhance multi-disciplinary teams so that more social work assessments can be carried out, and to support joint working between health and social care This funding was designed to maximise capacity, ensuring flow through the system. Over and above this an additional £8m was made available in January 2023 to support up to 300 extra interim care home beds as there was evidence that there was capacity in the system that was unable to be used without additional funding. • Structured ward rounds or white board assessment 7 days per week to ensure there is a plan for every day, which sets out tasks for the day and agrees the ward round priority order (sick, discharges, others) alongside parameters for criteria-led discharge to support early discharge. • Commission/organise care in response to the pipeline of upcoming work (patients approaching their PDD), not just when patients are delayed. • Early identification of complex discharges and appropriate referral as soon as possible. Every older person with frailty should have a clinical frailty score identified on admission to the ED or the admissions ward and appropriate referrals for specialist care made in accordance with local guidelines as well as early identification of needs (Medical, Mobility and self-care, Medicines, Mental Health, Me and Mine – family and carer support, and What Matters to Me) on admission with onward referral to appropriate professions and coordinated multi-agency team management. • Earliest possible engagement with families/carers to manage expectations, recognising it is not a valid option to remain in an acute setting once clinically fit to be discharged. • Implement discharge to assess models and intermediate care (bed or team) to support discharge home, wherever possible patients should not be assessed for ongoing care whilst at their most vulnerable or in an unfamiliar environment. Use community rehabilitation as the preferred place of recovery and intermediate care (and interim care home beds in the short-term) with a clear recovery plan in place. • Implement discharge to assess models and intermediate care (bed or team) to support discharge. Use community rehabilitation as the preferred place of recovery and intermediate care (and interim care home beds in the short-term) with a clear recovery plan in place. Page 33 of 164
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All of this builds on the existing investment to support activity to alleviate pressure such as the £62m to expand Care at Home and support an increase in the use of community equipment and Technology-Enabled Care (TEC) where appropriate supporting prevention and early intervention. Work has also been undertaken to support Health Boards and HSCPs to support patients and their families who have been classified as AWI as we know in those areas where best practice is implemented, it can dramatically reduce the delays for these patients A programme of meetings with all HSCPs is underway, beginning with those with the highest number of AWI delays per population. Each pinch point in the guardianship system and S.13ZA is examined with the HSCPs to see where improvements can be made and support provided. Good practice has been shared with HSCPs. Work is underway to identify emerging issues and develop a good practice paper in advance of next winter. We are considering whether it would be helpful to supplement this with a webinar where good practice can be discussed and an update given on plans to reform AWI legislation in the short to medium term. The work with HSCPs has been supplemented by joint statements on AWI practice by the Scottish Government with the Mental Welfare Commission and COSLA. 3.1.4 Actions for Best Practice 1 All systems to review and implement learning from their discharge event to embed improvements in an ongoing, ‘business as usual’ way Boards and IJBs to confirm this has been actioned by end March 2023 2 Put systems in place to provide the assurance necessary to confirm the measures set out in ‘Getting the Basics Right’ are consistently being applied Boards and IJBs to confirm this has been actioned by end April 2023 3 SG will continue work with NES to develop a toolkit of support and training materials to support discharge Toolkit and materials to be available by end April 2023 4 Boards and IJBs to assess their systems and processes in terms of acute discharge planning and apply the DwD toolkit in every inpatient area, community hospitals and other off-site beds Boards and IJBs to confirm this has been actioned by end April 2023 3.2 Data and Managing Variation 3.2.1 Analysis for future planning The work to gather and analyse data undertaken thus far has enabled a better understanding of the pressures being experienced across the health and social care system, but also provides us with a platform to consider how we can support future operational planning. Notwithstanding the IJB’s statutory strategic planning function, work is underway to provide modelled forecasting based on demography and historical demand trends to support future planning. This should also help local partners develop a good understanding of future demand based on their current capacity within both care at home and the care homes within their geographical area. 3.2.2 Using data-driven insights to manage variation Although the vast majority of local systems have detailed and granular data, we know that the quality of information is often not as robust or consistent as we would wish, given the different local Page 34 of 164
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systems in place and the number of different providers across the country. Within Social Care we also have not developed routine mechanisms to share information with local decision makers, but work is in hand to address this. Supported by analytical and digital colleagues within the SG, a tactical social care dashboarding solution is currently in development to support HSCPs and HBs to have access to a core set of indicators to enable consistent and comparable data to be available at different levels of geography. A cross-organisational forum will also be established to improve data collection including a review of methodology, processes and indicators. In parallel, joint SG/PHS/NSS work has now commenced looking at how to provide existing and robust MI data for insights across health and social care using NSS’s Seer2 platform alongside this faster-paced work. This work sits within the wider context of the Data Strategy for Health and Social Care Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age (www.gov.scot) and will report into the Data Board for Health and Social Care. 3.2.3 Actions for Data and Managing Variation 5 SG to provide a tactical social care dashboarding solution to support HSCPs and HBs to have access to a core set of indicators, predicated on existing and robust management information to enable consistent and comparable data to be available at different levels of geography Dashboard to be available by end April 2023 6 SG to provide modelling of potential future demand to support more effective local planning Modelling to be available by end April 2023 7 SG to support partners to develop forum to drive work towards more consistent and comprehensive data Forum to be established by end March 2023 8 SG/PHS/NSS to provide a strategic solution for the delivery of MI data for insights across health and social care using NSS’s Seer2 platform Solution to be agreed by end May 2023 3.3 Workforce 3.3.1 Labour Shortages We know there are significant recruitment challenges within Health and Social Care and particularly when compared to other sectors such as hospitality and retail. Social care in particular has been identified as an area with high levels of vacancies. A critical question is how to grow the care home workforce to accommodate higher occupancy levels. The actions set out below aim to address labour shortages across the sector. Staff demand for Healthcare and Social Care workers for the week to 13 January was 22.1% below the pre-pandemic baseline (February 2020). However, this data may obscure differences in demand between the health and social care sectors. So whilst it is important to take the action necessary to recruit additional staff, it is equally important to ensure that staff within the sector feel sufficiently valued and appreciated in order to retain this critical workforce. Staffing challenges in Social Work are also having an impact on the ability to discharge patients from hospital, given this sector’s statutory role in assessment and support planning (including the public protection role of Social Work). A workforce improvement plan is being developed jointly by COSLA and SG to address the immediate recruitment and retention issues for the Social Work Page 35 of 164
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workforce. This includes reserves lists, international recruitment and widening access into the profession through a fast-track route and graduate apprenticeships. There is reason to think that current pressures in social care may be a more significant contributor to delayed discharges than they were in the past, and that resolving the social care capacity crisis is vital if we are to improve discharge rates. The number of social care workers in Scotland decreased from 2020 to 2021 and there is no reason to think that it has increased significantly since then. Therefore work will continue to support Social Care Workforce capacity to undertake assessment of need and care planning required for hospital discharge. 3.3.2 Actions for Workforce 9 SG to support local partners through NES to utilise international recruitment Ongoing 10 Continue to pursue national recruitment campaign Ongoing 11 Continue to pursue recruitment activity with DWP for Ukrainian displaced people and UK residents that are economically inactive Ongoing 12 Increase in pay to £10.90 per hour in 23/24 for adult social care sector in commissioned services. Looking at improvements to terms and conditions for adult social care in 2023/24 April 2023 and ongoing 4. Sustaining Change Winter often results in both the NHS and Social Care experiencing the greatest pressure and involves many of the partners developing and implementing winter plans. But given what we know, it is essential that we mitigate against the need for crisis responses and develop Annual Delivery Plans that recognise there are peaks of demand and challenges at various points. We believe it is important to continue to focus on reducing discharges from delay as a priority, given the resultant impact on overall hospital occupancy and system flow, and indeed given the disbenefits to patients themselves of keeping them in a hospital setting unnecessarily. ADPs should, however, also focus on increasing discharges without delay once the delays pool has reduced in size. We will then, consequently, expect to see higher levels of patients being discharged without delay. This focus will support the wider whole-system approach to limiting hospital occupancy to safe and effective levels, which in turn will enable us to more quickly address the backlog of elective care exacerbated by the pandemic. Whilst not proposing to set a new target as such, we recognise stakeholder views that 85-90% generally represents a safe level of occupancy, and slightly higher (up to 92%) can perhaps be justified in certain local and short-term circumstances. As outlined earlier, reducing delayed discharge will not necessarily of itself reduce hospital occupancy to safe and effective levels, but it is an important element of the package of measures needed to improve flow. Page 36 of 164
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4.1 Transparency We intend to use this data on a weekly basis and fully expect local systems such as all Integrated Joint Boards to be actively monitoring, managing and sharing delayed discharge statistics as part of their core responsibilities. We also fully expect local systems to be making the necessary resource decisions to support these responsibilities to those they are accountable to through the Integrated Joint Board. 4.2 Measuring Progress The number of people whose discharge has been delayed remains stubbornly at around 1,800 across Scotland. We would expect that as we move past peak demand and towards the quieter summer months, this will move towards pre-pandemic levels (c1,400-1,550). Hospital occupancy levels of c85-89% - also pre-pandemic levels – remain a target which Boards are working towards using the range of measures available to them, including the actions in this plan. Currently, 97% of discharges are without delay, which is very encouraging, but again, it is important to focus on increasing this number to continue to free up flow. 5. Conclusion and Next Steps As outlined earlier, this action plan is intended to both highlight the broad-ranging work that is happening to improve hospital occupancy in both the short and medium term, and to set out the clear steps we know work that we can take now and in the coming weeks to address the urgent situation regarding discharge and occupancy we have been facing over winter. We must collectively direct resource and effort to focus on these actions in the short-term, and bake them into longer- term planning via ADPs. We know Winter 2023/24 will again be demanding for the health and social care system, but with the knowledge and tools we have, we have strong evidence pointing to where we should be focusing attention to ensure we are as prepared as possible to mitigate the spikes in demand on the system. It is only in collaboration between the NHS and social care – including with patients themselves – that we will be able to meet the stretching targets we have set in this paper. But we know that for the sake of our staff and patient safety, and to begin now to mitigate future challenges, we must be ambitious and purposeful in attempting to meet and exceed these targets. Page 37 of 164
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ANNEX A – Context Short-term pressures on the NHS As outlined above, we also know there is short-term demand due to high incidence of flu in particular, along with Covid-19, RSV, Group A strep and other respiratory infections that have placed exceptional pressure on an already strained system. This is compounded by the indirect consequences of Covid-19 which has led to diagnosis and/or treatment being delayed. All of this has translated into increased deconditioning of patients upon admission to hospital which in turns leads to increased length of stay and the need for a more complex care package (if applicable) in place on discharge. Furthermore, early and high impact flu seasons also have a direct impact on our acute settings. The numbers of hospitalised patients who tested positive for influenza reported in weeks 51 and 52 of 2022 (1319 and 1283, respectively) were higher than those reported for any week since the start of the 2016/2017 season. Persistent Demand But beyond the short-term pressure, wider demand on the NHS is continually having an impact due to an ageing population, disease morbidity, health inequalities (potentially compounded by the pandemic). These increase the demand for health and care services. Page 38 of 164
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NRS report that life expectancy has fallen in 2018-20 and 2019-21 and that healthy life expectancy has also been decreasing in Scotland, resulting in a lower proportion of life being spent in good health, which may have implications for both demand and supply of social care. In 2019-21, life expectancy at birth in Scotland was 76.6 years for males and 80.8 years for females. The gap in life expectancy between the most and least deprived Scottish Index of Multiple Deprivation (SIMD) deciles was 13.7 years for males and 10.5 years for females. Meanwhile population ageing continues and the number of over 85s, who are more likely to have complex and multiple health and care needs, is projected to double in 20 years. A recent cross-sectional study which linked national health and social care data to explore multimorbidity and social care use in those aged over 65, found that 93.3% of those receiving social care had multimorbidity, and that 16.2% of those with multimorbidity had received social care, compared with 3.7% of those without. In addition to the acute pressures, the wider context is that the number of people requiring social care is steadily increasing as a result of the population pyramid and increases in the burden of disease. Population projections indicate that the proportion of older people in the population, who typically have greater care needs, is increasing. This is alongside the impact of more people living with a disability or disease. Admissions into Acute However, we are not seeing an increase in acute admissions. The following presents a summary of emergency admission data alongside A&E performance: The shift in admission levels is due to multiple factors, including significant change in clinical pathways and investment to enhance out-of-hospital based care to ensure that patients receive the most appropriate care in the right setting for their needs. Page 39 of 164
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We are also making significant efforts to double our hospital treatment in the home through priority pathways including Hospital at Home, Outpatient Parenteral Antimicrobial Therapy and Community Respiratory Teams. Our virtual capacity now provides acute care the equivalent to the size of a large teaching hospital, again reducing admissions. Additionally, many patients spend longer in A&E receiving care and are discharged directly from the Emergency Department, due to capacity pressures elsewhere in the hospital. There has also been an increase in pathways which provide rapid assessment and streaming out of the Emergency Department and prevent admission, such as Same Day Emergency Care. Ageing Population Social care demand is affected by the ageing population and increased prevalence of long term conditions3. Scottish Health Survey data provides evidence that the proportion of people living with limiting long-term conditions increases with age4. Population projections indicate that the proportion of older people in the population, who typically have greater care needs, is increasing. This is alongside the impact of more people living with a disability or disease.5 NRS analysis has further found that life expectancy has been stalling and healthy life expectancy has been decreasing in Scotland, resulting in a lower proportion of life being spent in good health6, which will have implications for both demand and supply of health and social care. Frailty and Deconditioning In older people deconditioning can happen really quickly – 24 hours in bed can reduce muscle power by 2-5%, and in 7 days up to 20%, mostly in lower limbs which may be the difference between being able to walk or not. We know prevention is much more effective than treatment, and while deconditioning is, in theory, reversible, most older people do not regain their prior functionality and independence (https://thecareruk.com/deconditioning-the-warning-signs-and-how-to-prevent-it/). A survey conducted in Autumn 2022 examined reasons for increased length of stay compared to 2019/20 and highlights the impact of deconditioning. Health Boards were invited to complete the survey and 9/14 responded. Most Health Boards confirmed that they had an increase in bed days for patients with femur fractures, and frailty related conditions. High occupancy levels have been affected by COVID-19, with lockdowns impacting physical deconditioning due to reduced mobility. 3 Demand and expenditure for adult social care in Scotland | FAI (fraserofallander.org) 4 Summary - The Scottish Health Survey 2021: summary report - gov.scot (www.gov.scot) 5 Population Projections Scotland | National Records of Scotland (nrscotland.gov.uk) Scottish Burden of Disease Forecasting Briefing (scotpho.org.uk) 6 Healthy Life Expectancy decreases | National Records of Scotland (nrscotland.gov.uk) Page 40 of 164
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Social care vacancy levels Compounding this are the challenges in the social care sector, specifically in relation to staff vacancies and retention which in turn are making it more difficult for care to be provided in the community (care at home) but also to provide timely discharge from hospital. The following is an outline of reported staff vacancies within both care homes and the care at home sector, although it should be noted that this data is unpublished management information and therefore the quality and return rate is not as robust as other data sources. It is reasonable to conclude that the consistent high levels of vacancies in social care services could have a bearing on the waits for care packages as outlined above in the reasons for standard delayed discharge. Published figures from the Scottish Social Services Council (SSSC) show that, in 2021, the percentage of whole time equivalent (WTE) vacancies in care homes for adults was 7.9% compared to 5.4% in 2019. According to the RBS report on Jobs7 in December 2022 the strongest upturns in demand for permanent staff were seen across the Nursing/ Medical/Care and IT & Computing sectors. Nursing/Medical/Care also ranked second in strongest increase in demand for temporary staff among the eight monitored sectors. Hospitality and Retail have been identified as potential sectors that may be in competition for labour with social care. These sectors are characterised by notable proportions of jobs with low entry qualifications. In 2020, 49% of jobs in Accommodation & Food Services and 12% of jobs in Wholesale & Retail were classed as Occupation Skill Level 1, compared to a Scottish average of 9.9%.8 But even within these areas are experiencing challenges as the Business Insights Conditions Survey (BICS) indicate that 49.1% of Scottish Accommodation & Food Services businesses experienced difficulties filling vacancies in November 2022, compared with 38% of Scottish businesses overall, and 34.4% of businesses in Wholesale & Retail9. Social care providers are also very clear that they continue to lose staff to the NHS which has much better pay and conditions in comparison to social care staff, they anticipate that this will only get worse with the anticipated 23/24 NHS pay uplift. Entry level pay for adult social care in 7 RBS report on Jobs, December 2022. Results based on responses to questionnaires sent to a panel of around 100 Scottish recruitment and employment consultancies. 8 Scotland’s Labour Market: People, Places and Regions – background tables and charts - gov.scot (www.gov.scot). Level 1 occupations are those which equate to a competence associated with a general education and may require short periods of work-related training (e.g. bar staff, cleaning). 9 Business Concerns - BICS weighted Scotland estimates: data to wave 73 - gov.scot (www.gov.scot) Page 41 of 164
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commissioned services will be a minimum of £10.90ph from 2023/24. The current Agenda for Change Band 3 minimum is £12.23ph and the expected increase for 23/24 is currently £13.03ph. This is £2.13ph above the social care minimum rate. Finally, pay is often cited as a predominant factor relating to staff vacancies in this sector as despite this workforce being certified and regulated by the minimum £10.50 hourly social care wage. For comparison supermarket and retailers hourly pay ranges from £9.75 to £11 and NHS Staff at level 1 earning around £12.23 per hour. Page 42 of 164
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ANNEX B – Delayed Discharge Standard delays refer to all delays other than Code 9 delays. The following is a table breaking down delayed discharge by setting and type of delay between 23 November 2022 and 25 January 2023. Date Acute Mental Health Community Hospital All Delays Standard AWI Complex Total Acute Standard AWI Complex Total Mental Health Standard AWI Complex Total Community Hospital 23/11/2022 692 191 20 903 180 32 52 264 483 182 12 677 1,844 30/11/2022 668 189 33 890 175 36 56 267 468 171 11 650 1,807 07/12/2022 681 181 41 903 168 37 56 261 471 175 18 664 1,828 14/12/2022 646 183 41 870 160 44 51 255 454 170 32 656 1,781 21/12/2022 673 186 44 872 158 41 58 288 446 169 29 644 1,804 28/12/2022 605 185 42 832 150 37 61 248 433 171 29 633 1,713 04/01/2023 624 174 46 844 143 38 62 243 463 163 26 652 1,739 11/01/2023 628 176 46 844 147 40 56 248 473 151 24 649 1,741 18/01/2023 665 176 35 877 154 42 64 260 455 158 14 627 1,764 Change -27 -15 15 -26 -26 10 12 -4 -28 -24 2 -50 -80 % Change -4% -9% 43% -3% -17% 24% 19% -2% -6% -15% 14% -8% -5% The above table demonstrates the split across setting and type of delay: of the 1,764 delayed discharge (of 18/01/23) 50% were in acute, 15% were in mental health and 35% in community hospitals. These data are management information, are submitted daily, are not revised and have not been verified. However, this level of detail helps us to understand what lies behind the headline figure to manage flow. Although, standard delays have increased from about 900 in June 2021 to almost 1,300 in December 2022 (higher than a pre Covid-19 pandemic average of 1,100 delays). The following illustrates the trend of delayed discharge by category over time: Page 43 of 164
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Reasons for delayed discharge The majority of standard delays (about 70%) are usually waiting for suitable care arrangements in order to live at home (due to unavailability of services) or a place in a nursing home, and a post- hospital social care assessment as their principle reason for their delay at the monthly census point. Other reasons may include: • awaiting commencement of post-hospital social care assessment • non-availability of statutory funding to purchase Care Home Place • non-availability of statutory funding to purchase any Other Care Package • awaiting place availability in Local Authority Residential Home • awaiting place availability in Independent Residential Home • awaiting place availability in Specialist Residential Facility for younger age groups (<65) • awaiting place availability in Specialist Residential Facility for older age groups (65+) • awaiting place availability in care home (Dementia bed required) • awaiting place availability in an Intermediate Care facility • awaiting completion of care arrangements for care home placement • awaiting completion of care arrangements in order to live in their own home – awaiting procurement/delivery of equipment/adaptations fitted • awaiting completion of care arrangements - re-housing provision (including sheltered housing and homeless patients) • awaiting availability of transport The following illustrates the principle reasons over time: From the above chart, we can see that waiting for care arrangements in order to live at home is the most common reason for delays at the monthly census point. Between June 2020 and December 2021 this percentage has increased to a peak of 48%. Overall, this percentage has been decreasing since December 2021, with a slight increase in November 2022 to 41%. Community demand is complex and depends too on competing demands for mental health and drug & alcohol services as well as for social care packages and social work support. Page 44 of 164
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Trends in delayed discharge Published data indicates the number of delayed discharges in November 2021 was 1,539, which when compared to the 1,977 seen in November 2022, equates to an average growth of eight additional delays per week in the year up to November 2022. Although this sounds like a small amount of growth, this mounts up over time. Which leads to the conclusion that the system needs to be calibrated to deal with this higher throughput. On analysing the trends in delays that were discharged from 2016 to 2022, both the average length of stay prior to delay and the average length of delay have risen higher than pre Covid-19 levels. The chart on the left hand side shows that the average length of stay prior to delay has increased since the Covid-19 pandemic (about 20 days before the pandemic) and is now higher than the pre pandemic levels (27 days in December 2022): a 35% increase. The chart on the right hand side shows that the average length of stay at the point of discharge has increased from about 7 days before the pandemic to a peak of 13 days, in August 2022, and has decreased to an average of 10 days in December 2022: a 43% increase from the pre-pandemic levels. Flow through delayed discharge It is however important to note that the total number of recorded delayed discharges is only a snapshot in time. Patients in delayed discharge can become delayed as well as resolved and discharged, resulting in a constant flow of patients. If the flow of new patients into the delayed discharges pool is greater than the flow of patients being discharged or removed through other pathways, the delayed discharges will increase. For example, 1,557 people were discharged following delay in November 2022 but the total delayed discharges still grew by 67 from October, (1,910 to 1,977). As outlined, the length of delay can also vary. For some patients their discharge can be delayed by only a few days and for others by much longer. There is therefore clear evidence that more needs to be done to both increase the number of discharges from delay and reduce the number of patients becoming delayed in the first place. Page 45 of 164
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ANNEX C – Definition of Discharge Event Below is an excerpt from the letter to Boards, IJBs and LAs from Chief Executives of COSLA and NHS Scotland of 17 January: Discharge intervention required It is now necessary to undertake an urgent and focused piece of work in every health board and health and social care partnership area to meticulously review all patients currently in in-patient care across acute and community hospitals. It should be noted that none of the activity proposed is new but this is a renewed and joint focus on taking forward actions appropriate for your area, reflective of your specific challenges. This review should focus on all opportunities to set Planned Dates of Discharge (PDD), discharge patients home or to a homely setting and ultimately improve patient flow across the system. The review process should engage joint clinical and community health and social care operational teams from across the whole system and ensure that feedback and intelligence is triangulated with immediate action. It is expected that this approach will be supported by identification of additional interim and permanent placements. Alongside ongoing work to support PDDs, any reason for patient delays and the patient’s discharge plan must be considered for immediate resolution. Poorer outcomes for patients who have a longer stay in hospital than necessary are well evidenced, and current pressures are increasing this risk. In all discussions with patients, their unpaid carers and families we must ensure a clear understanding of this potential for harm. Remaining in hospital is not a safe choice when clinically and therapeutically fit for discharge. It will be essential that this exercise accounts for the changed risk profile for our acute systems at this time, recognising the risk to patients whose care and treatment is delayed with best efforts being achieved to support early discharge and prevention of further delay. Initiatives and services which support Discharge to Assess, plus choice and safety must inform decisions. The skills and knowledge of the community teams should contribute to assessment of risk. The Discharge without Delay and PDD approach should continue as an organisational priority. Information and guidance can be found on the Turas website: learn.nes.nhs.scot/63373 With urgency, whole-system teams must mobilise to operationalise and deliver this review. We are asking you to use this week commencing 16 January to prepare for this and agree an implementation plan with the review to begin week commencing 23 January across all acute and community sites. This will require visible leadership from both Accountable Officers and from all Professional Leaders. It is essential that this activity translates into a sustained overall increase in all possible discharges from these settings, including those deemed in delay, to release the much needed capacity within hospital settings. In practice we are asking you to work across the system to take forward a combination of actions. The following tools are considered best practice and useful in the identification of the tasks or services which contribute to delay, and support robust evidence-based action and improvement planning: • Day of Care Audit: Used by most health boards regularly to understand delay in their systems, should form the basis of whole-system improvement planning discussions (guidance and toolkit attached to this letter); Page 46 of 164
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• MADE: (Multi-Agency Discharge Event) an English approach adopted by many health boards to discuss and problem-solve existing delays. The guidance can be found here: england.nhs.uk/south/wp-content/uploads/sites/6/2016/12/rig-multi-agencydischarge.pdf • Criteria To Reside: used as a snapshot or a daily process to capture delay information and find solutions. Information can be found here on the definitions: england.nhs.uk/publication/process- and-definitions-for-the-daily-situation-report/. (A ‘what why how’ poster is attached to this letter which explains the context and how this information is used locally). Each area should prepare and hold a live list of all patients with PDDs as well as those patients who are delayed. PDDs should be reviewed daily to ensure timely discharge. Patients who are delayed should have a plan which is reviewed daily as a whole system and any mitigating actions taken to resolve this as soon as possible. You should ensure the appropriate local governance is in place to actively pursue and monitor the outcomes from the review on a daily and weekly basis. Further information on the expectation of national reporting to evidence the impact of this approach will be provided in the coming days. Page 47 of 164
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ANNEX D - Improving Urgent and Unscheduled Care Increasing capacity outwith hospitals We know that services managing demand must include both preventing the estimated 20% of admissions that are thought to be preventable. It must also include increasing alternatives to hospital admissions where services to provide acute specialist input at home (virtual capacity) exist for acute conditions that would normally need hospital admission. We know that these services are cheaper, safe and preferred by patients. It is important to focus on the wider system that impacts on flow, capacity, demand and ultimately results in delays across the system. Key priorities are to reduce inappropriate attendances to ensure the Right Care is delivered in the Right Place at the Right Time; avoiding unnecessary admissions that keeps care as close to home as possible; reducing length of stay to ensure patients are discharged when clinically and therapeutically fit; and avoiding delay wherever possible. This is underpinned by a collaborative improvement programme that supports improvement in systems and process that reduces unwanted variation and failure demand. The redesigned Urgent Care Programme focusses on reduced unnecessary attendances by signposting and triaging to more appropriate care. Where possible attendances at A&E services can be scheduled to a more appropriate service at the right time. This process has reduced self- presentations by circa 13% with an ambition to continue to improve through initiatives such as Call before you convey, which has proven particularly successful for care homes, and for pathways such as low risk chest pain. The Virtual Capacity programme focusses on keeping care as close to home as possible. Increasing out-of-hospital care to reduce attendances and admissions through priority pathways helps to develop a virtual hospital that improves outcomes, increases capacity and reduces risk of nosocomial infections. Current aims are to: • Increase Hospital at Home services by 50% • Spread successful OPAT services to all Health Boards • Establish Respiratory pathways • Develop case for other pathways of care such as Heart Failure • Using data to monitor and drive increases in performance • Supporting MDT collaboration and shared understanding of risk • Embed governance & oversight strategic functions in an integrated manner • Review next steps to develop urgent care – OOHs/SAS/NHS24 Improving Flow through the whole system will reduce length of stay and will be supported by consistent systems and processes that improve communication across multidisciplinary teams and multi- agency organisations to reduce variation. Page 48 of 164
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Resilience Response North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/KO Date 05/09/23 From Ross McGuffie, Chief Officer, Health and Social Care Partnership E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 858143 Executive Summary This paper is to update committee on the actions being taken in response to current whole system health and social care service pressures. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Recognise the whole system Operation Flow 2 plans and implementation structures set out in the report. (2) Request future updates on progress. 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 1. Background 1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. 1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. Adult Care and Social Work Committee Item 4 Page 49 of 164
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2. Report Operation Flow 2.1 The Integrated Joint Board received an update on Operation Flow at its meeting on 22nd March 2023 and again at the Performance, Finance and Audit meeting on 19th April 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 2.2 Following two further face-to-face planning sessions that brought together leaders from across the whole system, a Task and Finish structure has now been developed to take forward the key actions agreed for Operation Flow 2 (see appendix 1). Developing and Implementing Operation Flow 2 2.3. Across the system, we have been not able to sustain the improvements in the weeks following the Firebreak period. However, work does continue to support the culture and behaviour change required across our Acute sites to improve efficiency and effectiveness by embedding the flow foundation bundles and pathways. 2.4 We know that establishing and maintaining good flow across our system is key to the success of Operation Flow 2. Consequently, we have established a task and finish group structure which is underpinned by our new 6 step Flow Model (outlined below and in Appendix 2) to support delivery of Operation Flow 2. A project plan which outlines the key objectives for Operation Flow 2 has been developed in collaboration with colleagues across the system and takes account of the learning from Firebreak. 2.5 Operation FLOW 1 involved considerable whole-system development work undertaken jointly by NHS Lanarkshire, Health and Social Care North Lanarkshire, South Lanarkshire Health and Social Care Partnership and Scottish Ambulance Service and this will continue through the duration of Operation Flow 2. 2.6 Five Task and Finish Groups have been established to lead in the development and implementation of the key elements aligned to the new flow model. The Task and Finish Groups are accountable to the Executive Flow Oversight Board (EFOB) which reports to Corporate Management Team (CMT). 2.7 A summary of each of their key high-level objectives is described below: Task and Finish Group 1: Core Group • Provides overview and co-ordination for success • Ensures Task and Finish Groups, 2, 3, 4 and 5 are on track for delivery • Undertakes weekly performance review in relation to progress of attaining trajectory milestones across our 23 Acute sites and system • Develop and describe the OOHs Flow Management / On call model • Develop and describes the resource plan for Operation Flow 2 • Ensures escalation to EFOB Page 50 of 164
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Task and Finish Group 2: Pre-Hospital / Avoiding Admission • Describe the operational model required to reduce demand via the FNC • Detail the workforce model required which supports admission avoidance and direction to other parts of our system • Roll out and expansion of consultant connect for SAS to reduce conveyancing to hospital when it is safe to do so • Implement the recommendations of the Strategic Review of Hospital @ Home which supports admission avoidance • Development of community access pathways to support people in the community Task and Finish Group 3: Pan Lanarkshire Front Door Redesign • Undertake a review of the current “as is” pathways across ED, Acute Receiving and Ambulatory Care to ensure that there is a shared understanding across the 3 sites • Undertake a resource review of ED’s shift by shift and complete comparison with 2019 data • Develop recommendations which details the Target Operating Model for Front Door Services across Lanarkshire Task and Finish Group 4: Ward and System Flows • Establish and embed a NHS Lanarkshire standardised huddle approach and template which embeds ward, site and system level escalation processes to support flow • Embed all elements of the Flow Foundation Bundle across all inpatient areas • Embed ward beat as part of huddle and flow foundation bundle • Develop a consistent and co-ordinated flow management model for NHS Lanarkshire Task and Finish Group 5: Frailty and Off-site Beds • Develop a Front Door Frailty Rapid Assessment Process • Develop and describe the Frailty Model for NHS Lanarkshire • Scope the “as is” offsite bed model • Develop recommendations that outlines the Target Operating Model for offsite beds to support system flow 2.8 We have also established a Data Governance Group which oversees all aspects of system development and ensuring that NHS Lanarkshire is compliant with Public Health Scotland definitions in relation to Urgent and Unscheduled Care. Embedding Best Practice, Accountability and Leadership 2.9 We know that to deliver the comprehensive plan we will need to work together to ensure that there is: • Cohesive Leadership across the Lanarkshire system • Ownership by all Operational Leaders in Acute, Community and Social Care, with improvement support, to deliver the pace of change required • Clarified roles and responsibilities to develop and deliver the plan • Clear measurable objectives across all elements of the plan to demonstrate the impact made and flexibility in our approach, if required, to deliver greater effect Page 51 of 164
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2.10 Progressing improvement work across our system is exceptionally challenging within our current resource profile, given that our system continues to be in escalation and full capacity protocols. However, we continue work together across our system to develop and implement change that will improve the efficiency and effectiveness of our system. These actions include: • Implementation and embedding of the Flow Foundation Bundle to support good flow across our sectors • Embedding structured Hospital Huddles to ensure situational awareness of flow, impact on patient safety and the actions required to respond to pressure • Implementation of consistent Escalation triggers and processes ensuring that the is clarity in roles and responsibilities across our wards, sites, sectors and system when responded to blockages and barriers to good flow and safety • Ensuring standardisation of patient flows and dispositions across our system • Developing and implementing assertive and continuous flow across all our Acute sites. Revising the Service Models to Build Capacity and Capability 2.11 Through learning from the Firebreak and from shared experiences from other Health Boards across Scotland, we know that there are several improvement actions that will require increased capacity and capability to improve flow and demonstrate a positive impact on our performance against the 4-hour target and these include: • Reducing demand with Senior Clinical Decision Makers in the FNC and with the Hospital @ Home Service • Increased functional site capacity with an expanded minor’s area in UHW and 7-day opening of Ambulatory Care units across all 3 sites • supporting discharge planning co-ordination with additional administrative support to wards • Increased service improvement support across the whole system • Increased flow management teams within the Acute sites • Tackling the blocks to flow by opening the discharge lounge over 7 days • Augmented data support for Operation Flow 2 and Trakcare and ensuring that we have access to accurate real time data 2.12 Consequently, we are looking at opportunities for investment through internal prioritisation processes and working closely with Scottish Government colleagues around the opportunities for reinvestment to support the project deliverables but also within the context of a financially sustainable plan for NHS Lanarkshire. Performance and Monitoring 2.13 We have established a robust monitoring process for Operation Flow 2. Each of the Task and Finish Group have developed project plans which outline the tasks that need to be accomplished to achieve the project goals and this detail is reported to Task and Finish Core Group each week. The overarching project plan for Operation Flow 2 provides an overview of progress against each of the high-level objectives for the Task and Finish Groups which is reported to EFOB on a weekly basis. 2.14 A performance management framework has been established for Operation Flow 2 which is underpinned by objectives and improvement milestones. Performance improvement trajectories have been developed for the Lanarkshire System and each Page 52 of 164
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of the Acute sites. We have established milestones for achievement by 30 June 2023, 31August 2023 and 31 March 2024. 2.15 Our key objective it to consistently improve NHS Lanarkshire’s performance against the 4-hour standard by achieving 70% against the 4-hour access performance by 31 August 2023 and 90% by 31 March 2024. Crucially, we know that this will significantly improve the clinical safety and experiences for our patients as well as health and well- being of our workforce. The impact of the project actions from each of the Task and Finish Groups will be measured against the: • Weekly 4-hour access performance • Weekly number 8 hour waits • Weekly number of 12 hour waits • Acute site occupancy levels, • Ward beat rate achieved / week • Discharge lunge use • Pre-noon discharge rate • Delayed discharges / week (Acute sites) • Delayed Discharge / Week (Community Hospitals) 2.16 A balanced scorecard has also been developed to monitor our progress against the objectives. In addition, Each of the Task and Finish Groups have developed a data measurement framework which details the process measures to deliver the outcome measures. 3. Measures of success 3.1 There has been a tremendous whole system effort to plan Operation Flow and to enact the firebreak at scale and pace. 3.2 The reduction in occupancy levels across all three sites has allowed NHS Lanarkshire to move from black to red status on 6th March 2022, following over 6 months in black status. 3.3 Attention has now moved to make the most of the system decompression to move forwards with the ambitious change programme identified to ensure the positive performance improvements can be sustained and indeed further improved over time. 4. Supporting documentation 4.1 Appendix 1: Operation Flow 2 structure 4.2 Appendix 2: Flow Model Ross McGuffie Chief Officer North Lanarkshire Health and Social Care Partnership Page 53 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 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 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 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? Page 54 of 164
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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? The associated IJB risk sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 55 of 164
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Appendix 1: Operation Flow 2 structure Page 56 of 164
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Appendix 2: 6 Step Flow Model Page 57 of 164
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Winter Plan Business Case Progress Report North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/MD Date 05/09/23 From Ross McGuffie, Chief Officer NL Health & Social Care Partnership E-mail mcguffier@northlan.gov.uk Telephone 01698 858143 Executive Summary This paper is to provide committee with a progress update on the Health and Social Care Winter Plan Business Case. Recommendations It is recommended that the Adult Care and Social Work committee: (1) Endorse the progress reports of each of the workstreams which comprise the Winter Planning & Enhance Supports Business Case. 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 1. Background 1.1 The Scottish Government allocated additional funding in 2021/2022 and 2022/2023 to increase capacity across the health and social care system. In February 2022, the Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target nonrecurring reserves to implement a series of proposals, including the development of a Home First model in North Lanarkshire, additional community nursing capacity, enhanced care at home capacity, and additional infrastructure supports. This report provides an update on the progress made with implementing these proposals. 2. Report 2.1 Within each phase of the implementation process, the business case proposals have been re-evaluated both within workstreams and through the Strategic Commissioning Plan Programme Board. Implementation plans are revised and reconfigured regularly Adult Care and Social Work Committee Item 5 Page 59 of 164
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to reflect the reality of recruitment challenges, the funding available and the outcomes achieved through the preceding phases. 2.2 The original aims of the business case were to increase assessment and planning capacity across the system and enhance direct provision of supports and services across a range of organisations. Workstreams have been established to implement plans and proposal against the following headings: • Home Assessment Team & Enhanced Integrated Rehabilitation Provision • Community Nursing • Increased Capacity Across Home Support Service, Equipment and Adaptations Service, Community Alarms Service & Assistive Technology • Hospital at Home • Building Capacity of Independent Sector Provider • Investment in Communities 2.3 Progress updates on each of the workstreams are attached to the report as Appendix 1, offering a summary of progress-to-date and planned future actions. 3. Measures of success 3.1 Progress continues to be made to implement the business case and undertake the recruitment as approved in order to progress the necessary change activity in line with the Scottish Government funding allocations. 4. Supporting documentation 4.1 Appendix 1 Winter Planning & Enhanced Supports Business Case – Workstream Updates 4.2 Appendix 2 Summary of Winter Planning Funding Ross McGuffie Chief Officer North Lanarkshire Health & Social Care Partnership Page 60 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Oversight and Governance on the Winter Business Case is through the Strategic Commissioning Programme Board. A representative from finance is on the Board. Appendix 2 – Summary of Winter Planning Funding 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts been discussed and agreed with People Resources? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Oversight and Governance on the Winter Business Case is through the Strategic Commissioning Programme Board. A representative from HR is on the Board. 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 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 61 of 164
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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? All appropriate associated risks are on the Service 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 62 of 164
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Appendix 1 Winter Planning & Enhanced Supports Business Case – Workstream Updates Workstream Home Assessment Team & Enhanced Integrated Rehabilitation Provision Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition Ring-fenced teams to enable: • A designated workforce with focus on facilitating discharge without delay and enabling admission avoidance • A robust discharge pathway for those who require home assessment and rehabilitation following discharge from both front door and downstream wards • A robust admission avoidance pathway for those not requiring hospital admission but requiring the benefit of a person centred approach to assessment in their own home setting • 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 within discharge services • An approach to avoiding admission to be developed with the IRT and locality teams- Systems in place to ensure that Home Support, Community IRT and Locality Social Work Teams will be aware of patients likely to transition to them from HAT at the end of the agreed assessment period. Agreement in place to ensure HAT transition outwards is not jeapardised. • Wide-ranging strong links with discharge facilitators within the hospital discharge hub- HAT is embedded in the Hospital Discharge Hubs and communication, liaison and multi-agency working in inherent. • Utilisation of the embedded Planned Date of Discharge (PDD) approach to identify suitable patients pathways • Close working relationship with associated teams: hospital Multi-Disciplinary Teams (MDTs), District Nursing, Integrated Rehabilitation Teams, Third sector colleagues with access to satellite equipment stores. Highlights Progress and Achievements: • Home Assessment Team soft launched in Wishaw in late April 2022 taking referrals from University Hospital Wishaw and University Hospital Monklands. • Cumbernauld soft launch in August 2022 • Cumbernauld and Wishaw Home Assessment Teams operating and almost fully staffed. • As of 3rd April 2023, 561 patients had been referred and discharge 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. The Hospitals involved in the referral were UHM 42%, UHW 55%, other 1% and 1% offsite bed. • During the month of March 2023 HAT had a total of 118 (up 26 referrals from February 2023) referrals across both sites. Patients were discharged into localities including Wishaw 31 (up 3 from February 2023), Motherwell 38 (up 22 from February 2023, Cumbernauld 26 (up 4 from February 2023), Airdrie 19 (down 3 from February 2023) • Workshops held in October to map pathways and review and agree pan-Lanarkshire referral criteria with all key stakeholders in the MDT including transfers of care into mainstream home support and rehabilitation services. Page 63 of 164
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• Interface with other teams/staff eg IRT, Locality Social Work, Home Support Teams, GPs • Of the 35.75 FTE Integrated Rehabilitation Team (IRT) posts supported within the Business Case, 29.5FTE have been recruited to. Ongoing Actions • HAT service model in development phase, this will be finalised by end of April 2023. • Additional accommodation restructuring ongoing at UHW to ensure teams are co-located appropriately for next steps. Review by planning team at UHW due to complete end of April 2023 - possibility of new options following same - previous review on hold. • Recruitment to HAT ongoing to build capacity and roll out across other NL localities (see appendix 1 for update). 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 • Virtual Board to be discussed to communicate and act as an early warning system/ barometer to downstream statutory support services re expected transition from HAT- discussion with IRT T/Ls, Advanced Practitioners reached agreement re early warning practices and agree no requirement for virtual board as highlighted in gap analysis • Discussions re CCA/ increase requests etc and implications for HAT • Further review of HAT/ Home First pan-Lan criteria to encompass admission avoidance and plan to develop pan-Lan poster for staff when complete Future Actions • 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 end February. Work ongoing to stabilise Airdrie and Cumbernauld localities for HAT with cross cover • Moving on to implement HAT in remaining localities, with Coatbridge and Bellshill • Communication and engagement activities are progressing including staff briefing sessions, reaching out to comms department re other comms including animation video • Review, analysis and recommendations to be undertaken to ensure HAT and home first approach is intrinsic within the wider HSCP teams and not a stand-alone service • Establish key links 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 64 of 164
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Workstream Community Nursing Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition As part of the SCP/ Winter planning work supported by Scottish Government, funding was agreed to support increased capacity in community nursing teams and to support delivery of the Community Nursing Review. Funding agreed and recruitment progress is highlighted below Posts Funded In post Band 3 HCSW 40 WTE 32.63 WTE Band 3 admin 8WTE 5WTE Band 5 RGN 15 WTE 11 WTE Band 7 ANP 2 WTE 1WTE Band 7 Practice assessor 2 WTE 2 WTE Band 8a Senior Nurse 1WTE 1WTE There has been turnover in the Band 3 HCSW staff group which has made growth challenging. Band 5 recruitment growth has also been challenging due to vacancies within current funded establishment which is prioritised. Progress and Achievements: • Community Nursing Review Programme Board established with two Short Life Working Groups set up and running o Care Management o Vision and modelling • Roadshows held • District Nursing Pathway Evaluation now ready for final comments • A rolling program for recruitment is being considered and evaluated • Delays to some actions due to work being carried out on Operation Flow • Work with Scottish Government in relation to retention, development of workplace and improving culture Future • Caseload complexity review • Define the criteria for core and additional caseloads in conjunction with the views of staff. Consideration will need to be given as to how this fits in with the MORSE system. Although changes are unlikely to be made before the end of the year/beginning of next year, simple changes of benefit to staff may be adopted. A couple of roadshows will be scheduled for further down the line. • The District Nursing service is aiming for a transformation surrounding how it delivers its services. There is a shift in the balance of care from acute to primary care and will need to consider what that will look like and how it can be made ‘fit for purpose’. There is further emphasis on health promotion and educating families. Page 65 of 164
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Workstream Increased Capacity Across Home Support Service, Equipment and Adaptations Service, Community Alarms Service & Assistive Technology Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition The expansion of current direct provision of support will include: • Home support expansion, making permanent some temporary measures which are required longer term to facilitate improved capacity and quality of service. Both frontline practitioners as well as logistics and operational management posts are included in the immediate requirements. • Increased capacity within the Equipment and Adaptation Service • Development of a dedicated Technology Team to support the use of technology within the HSCP to support individuals within their homes and communities. This team will focus on embedding technology into assessment and planning processes; providing training to all staff groups on technology and its use in care and support; supporting with risk assessments; ensuring technology support advice is embedded in SDS; and providing high level data on the technology being used within our communities. Highlights Home Support • 71.89 WTE permanent posts funded by the Business case allocated across localities; process commencing to match existing temporary staff into these posts within each team. • New Home Support Delivery Project Board established to progress high level Project Plan, with Risk Register, Benefits Realisation Plan and Workstreams agreed and being progressed. Technology Team and Equipment & Adaptation Service • Recruitment to posts complete for the Technology Team and in progress for the Integrated Equipment & Adaption Service • Technology team now embedded and links with locality teams being developed. Workstream Hospital at Home Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition Extension of Working Hours • Introduction of Advanced Nurse Practitioners (Band 7) to allow service hours and patient admission to service to continue until 10pm. • To allow 2 Band 7 ANPs to be rostered on 7 days a week (one from 8am-6pm, and one from 2pm-10pm) would require 4.58 WTE (including 22.5% planned leave allowance). • There is a current national shortfall in the availability of qualified Advanced Practitioners, therefore a training programme would need to be offered and supported, this requires up to 2 years to complete (although some potential internal Hospital @ Home candidates have already been supported through the advanced clinical care and Non-Medical Prescribing programmes, so may require less support before becoming fully qualified). Permanent Funding of Step-Down Pathway • During the Covid pandemic to assist with anticipated hospital flow and to increase our ability to serve GPs with hospital admission a “step down” hub was created to ring fence staff and create a designated flow for Acute inpatients to be discharged into the Hospital @ Home service. Page 66 of 164
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• This service improvement contributed to the increased referral activity and has admitted an average of 38 patients per month in 2021. Due to the clinical presentation of the patients at admission to Hospital @ Home the model could be slightly adapted to allow the patients to be managed by a Junior doctor (with Consultant in-reach when necessary) and band 5 nurses. Junior doctors have been difficult to recruit on a continuing basis, however an ANP band 7 nurse could provide clinical management to these patients. Highlights • Step down pathway has been operational since May 2020. The permanent funding of this allowed us to continue this service provision. Since the initial programme we have had some Band 5 RGNs leave the service for various reasons, some gaining promotion within the service. This has allowed them to be successful at gaining Band 6 Nurse Practitioner posts within the service. • The Band 5s and Band 4 have been in temporary posts, the permanent funding has allowed us to appoint on a permanent basis. We have 3 of the 4 Band 5 posts filled permanently with the third at the recruitment stage, after the previous successful candidate withdrew. The Band 4 is appointed permanently. • The Band 7 ANP who was appointed withdrew due to personal reasons, the new COR is with finance for approval to re-advertise. • The stepdown pathway has supported 390 patients from NHSL Acute wards from April 2022 to Feb 2023 Workstream Building Capacity of Independent Sector Providers Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition It was agreed that a local provider sustainability fund is established to facilitate an individualised approach to: • Supporting recruitment and retention • Supporting staff wellbeing • Supporting cross sector support to SVQ2 • Increase to Scottish Care support to the sector Highlights Two phases of funding bids have been completed Successful implementation of Interim care home beds programme Successful uptake of financial support in place to support Carers Page 67 of 164
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Workstream Investment in Communities Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition To make prevention and early intervention a reality, additional investment is required to add to the community capacity building work already well embedded in the Community Solutions Programme through VANL. Further investment through the new Improving Lives workstream will see development across a number of key priorities for the Partnership, in line with the Strategic Commissioning Plan, and to ensure there is sufficient capacity within the community and voluntary sector to respond to demand. The range of achievements via the Community Solutions Programme Approach has seen significant development through anchor organisations of; Support in the Right Direction, Community Connectors, Improving Cancer Journey and Social Prescribing. Early findings from the innovation test site introducing 3 conversations to improve First Point of Contact, has indicated that there is a need to invest more significantly in a robust response through the sector which would facilitate a further focus on prevention and wellbeing. This will be achieved through connectedness and valued activity with a combination of paid roles and community investment funding. Funding proposals are based on the appointment of Community Connector posts across key anchor organisations to support 3 Conversations with Older Adults, Younger Adults and Carers. An umbrella approach through Community Solutions will ensure a co-ordinated approach throughout North Lanarkshire and link clearly to the Community Consortia in promoting local opportunities for and with people, avoiding the need for more formal services for longer. The Community Connectors will also play an important role in the transitional arrangements for people at the point they may need more formal responses from the HSCP. A core, recurring investment of £1.1m pa supports the Community Solutions programme but an additional £1.2m over a two-year period would see the considerable expansion of the offer. Achievements: • Project to be embedded in the Community Solutions programme and named Improving Lives. • Project plan finalise and agreed by Chief Officer and Head of Planning, Performance and Quality Assurance. • Model for recruitment and deployment of Community Connectors agreed. • The current Support in the Right Direction link workers (2wte) have received a 12 month extension to their funding from SG (to 31 March 2024). This will be of benefit to the new Community Connectors as these existing staff have established good relationships across NL and can share learning thought their previous involvement in the 3 Conversation test of change. • Opportunity to extend the reach of the Community Connector posts by building in the Improving Cancer Journey funding. This investment means there will be a total of 10wte posts (NB this is an increase from the original proposal of 9.5wte). • Commissioning of locality hosts complete which allows us to recruit to the Community Connector posts once the ICJ application agreed by Macmillan. Activities: Complete • Project plan agreed. Page 68 of 164
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• Funding for physical activity programmes confirmed for 22/23. • New part time senior manager recruited to provide capacity to oversee implementation of Improving Lives programme. • Six Locality hosts agreed. Outstanding • Finance to be transferred to VANL • Governance arrangements for test of Individual Support Fund • Relationship to GP Community Link Workers to be strengthened with the aim of developing future joint proposals to make best use of available resources where possible. • Community Solutions thematic priorities review (first meeting took place 09 Feb) Future • Recruitment of 10 Community Connectors will be progressed once Macmillan agree the ICJ application (expect approval imminently). Page 69 of 164
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Appendix 2 Summary of Winter Planning Funding SUMMARY OF WINTER PLANNING FUNDING AND POSTS FUNDING DESCRIPTION Funding 2022/2023 Projected Costs 2022/2023 Variance 2022/2023 £m £m £m Recurring Budget 15.750 7.104 8.646 Non-Recurring Budget 1.162 0.448 0.714 Earmarked Reserves 7.712 2.447 5.265 TOTAL FUNDING 24.624 9.999 14.625 OPERATIONAL CATEGORY FTE APPROVED IN POST VARIANCE Integrated Rehabilitation Team 49.33 22.02 27.31 Home Assessment Team 138.68 58.08 80.6 Home Support 165.78 125.2 40.58 Infrastructure 18 9 9 Social Work Management 4 3 1 Community Alarms/Stores/Tech 20.2 13 7.2 Community Nursing 69.35 39.71 29.64 Hospital at Home 8.58 3 5.58 TOTAL FTE AS AT PERIOD 12 473.92 273.01 200.91 Page 70 of 164
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Quality Assurance Annual Report North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref MW/EM Date 05/09/23 From Maria Williamson (Acting) Chief Officer (Performance, Planning & Quality Assurance) E-mail WilliamsonM@northlan.gov.uk Telephone Executive Summary Quality Assurance have a wide and varied function including monitoring and evaluating key aspects of social work practice and performance. A central activity is the on-going contract monitoring of external social care providers. The environment in which we operate currently is complex and sharing of best practice and solution focused ideas are integral to ensure the people of North Lanarkshire receive good quality support to help meet their outcomes. Our commitment is to provide an annual report on activity carried out in the preceding year. The purpose of this report is to update Committee on our Quality Assurance activity over the annual period of 1 April 22 to 31 March 23. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Note and endorse the contents of the report. (2) Remit the report for information to IJB Performance, Finance & Audit Committee. (3) Remit the report for information to Education, Children and Families Committee The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (24) Review and design services around people, communities, and shared resources 1. Background 1.1 This report highlights Quality Assurance activity over the period 1 April 22 to 31 March 23 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Communications, Adult Adult Care and Social Work Committee Item 6 Page 71 of 164
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Support & Protection, In House Monitoring, Participation & Engagement, Carer Developments and Risk Management. 1.2 Full detail of these activities is included in Appendix A. 2. Report Contracts 2.1 The Quality Assurance Team work cohesively with the Corporate Procurement colleagues to implement robust contract arrangements, which balance quality against cost, to achieve overall Best Value for services provided to vulnerable people living in North Lanarkshire. A range of organisations are commissioned through a variety of arrangements and a methodical and systematic approach has been developed, resulting in 95% of services purchased by social work now having contractual agreements in place with clearly defined terms and conditions. These agreements range from national framework arrangements to individual service agreements. Contract Management Framework 2.2 All organisations from whom North Lanarkshire Council social work purchase services are required to adhere to contract monitoring arrangements. Quality Assurance have a key role in the application of these arrangements to ensure that the terms and conditions of the contract are met. Information gathered from contract monitoring also informs continuous strategic planning and commissioning, improvement identification and enables early intervention and support should difficulties in providing and sustaining services become apparent. 2.2.1 During this reporting period the Contract Management Framework has been refined following evaluation. As a result, some of the processes and procedures have been amended to enhance performance reporting, data collection and the overall experience. The agreed changes are effective from 1 April 2023. Regulatory Activity 2.3 Care Inspection activity during the reporting period of 2022/23 was spread across all key questions within North Lanarkshire older people’s care homes. North Lanarkshire care homes performance measures slightly lower than Scotland wide care homes in that 55.6% of grades of 4 and above were awarded. Scotland wide care homes achieved 63.9% of grades of 4 and above. 2.3.1 During the reporting period 52 SDS contractors were inspected. 45 contractors were awarded grades of good (4) and above. This is a percentage of 86.5%, which reflects delivery of high-quality care and support across SDS contractors supporting people in North Lanarkshire. In House Monitoring 2.4 The Quality Assurance team have been working on the development of an In-House Monitoring Framework during 2022/23. The suite of documents included within this Framework are awaiting approval from the Senior Leadership Team. Page 72 of 164
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Market Facilitation 2.5 Our approach to market facilitation means we are responsive to the changing needs and aspirations of people living in North Lanarkshire, whilst also reflecting the changing social care landscape. 2.5.1 One of the biggest challenges currently, is the lack of capacity available to choose from when a care and support package is required. There are many factors contributing to these challenges, including workforce retention and recruitment, cost of living increases, increased demand, complexity of support required and quality of care falling below expected standards. Quality Assurance continue to liaise with internal and external partners to identify solutions to the challenges. Procurement 2.6 In collaboration with Corporate Procurement colleagues and Locality Social Work Teams, Quality Assurance assist in the planning, coordination, and implementation of processes to ensure that when contracting new or existing work, the requirements of the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016 are adhered to. By doing so there can be confidence that the care & support services commissioned are legal, safe and outcomes focused whilst demonstrating Best Value. Fair Work 2.7 In 2021/22, we reported that most contractors had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This year 100% of providers on our Self-Directed Support including Care at Home framework, reported paying the Scottish living Wage. Complaints 2.8 Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The annual summary and analysis of complaints received over the period 2022/23 is available at Appendix 1. Duty of Candour 2.9 Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain open and honest when something goes wrong, that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is available is attached as Appendix 2. 3. Measures of success 3.1 Measures of success are contained within Appendix 1 of this report. 4. Supporting documentation 4.1 Appendix 1: Quality Assurance Annual Report 2022/23. Page 73 of 164
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4.1.2 Quality Assurance Annual Report 2022/23 - Appendix 1: Complaints 4.1.3 Quality Assurance Annual Report 2022/23 - Appendix 2: Duty of Candour Maria Williamson (Acting) Chief Officer (Performance, Planning & Quality Assurance) Page 74 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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? Public Sector Equality Duty and Fairer Scotland Duty assessment have bene completed as part of all procurement activity. 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 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 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 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 ☒ Page 75 of 164
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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? The annual Complaints and Duty of Candor reports will be published on the website. 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 related risks are noted in the service 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 76 of 164
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Appendix 1 Quality Assurance Annual Report 2022/23 Page 77 of 164
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1. Introduction Quality Assurance have a wide and varied function including monitoring and evaluating key aspects of social work practice and performance. A central activity is the on-going contract monitoring of external social care providers. The environment in which we operate currently is complex and sharing of best practice and solution focused ideas are integral to ensure the people of North Lanarkshire receive good quality support to help meet their outcomes. The Quality Assurance Team work collaboratively with our internal Health and Social Care Partnership colleagues and with external stakeholders to ensure the delivery of services that are underpinned by human rights, inclusion, achieving potential, choice and control. The activities reported in this 2022/23 annual report reflects the commitment to a creative and dynamic approach that helps reduce resource barriers and promotes good outcomes for people. Our priorities are directed towards the Scottish Government’s nine national health and wellbeing outcomes, the ambitions of the Plan for North Lanarkshire and the Strategic Commissioning Plan. This report outlines activity over the period 1 April 22 to 31 March 23 and includes updates on our work in the areas of Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Communications, Adult Support & Protection, In House Monitoring, Participation & Engagement, Carer Developments and Risk Management. 2. Contracts The Quality Assurance Team work cohesively with the Corporate Procurement colleagues to implement robust contract arrangements, which balance quality against cost, to achieve overall Best Value for services provided to vulnerable people living in North Lanarkshire. A range of organisations are commissioned through a variety of arrangements and a methodical and systematic approach has been developed, resulting in 95% of services purchased by social work now having contractual agreements in place with clearly defined terms and conditions. These agreements range from national framework arrangements to individual service agreements. Tables 2a and 2b below illustrate graphically the extent of the work that has been carried out in engaging with providers from the community & voluntary sector, the independent sector and private contractors in a proportionate and balanced way to ensure service provision is provided safely and is of a high quality throughout the team of the contract. As of 31 March 23, 95% of all social work spend had the provision of a formal contracting arrangement. This is an increase from 93%, reported in year 2021/22. Work is in progress for the remaining 5%, which are awaiting formalisation of Individual Service Agreements. Quality Assurance continue to progress with the necessary arrangements to ensure all spend has robust contractual and legal agreements in place; however, it should be noted that due to the fluidity of contracting and commissioning, achievement of 100% compliance may not always be possible. Page 78 of 164
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160 140 120 100 80 60 40 20 0 Spread of Contractors 2022/2023 148 61 28 7 4 9 3 11 2 3 5 1 6 13 4 Table 2a Table 2b We currently purchase services from 305 different provider organisations, which is a slight increase of 2 from 2021/22 when we reported purchasing services from 303 provider organisations. The biggest shift to note is in the number of providers operating as part of our Self-Directed Support, including Care at Home Framework, which has increased to 61 providers from 52 reported 2021/22. It is anticipated that this increase on the SDS Framework will create greater capacity with more choice available to people who access services. 3. Contract Management Framework (CMF) All organisations from whom North Lanarkshire Council social work purchase services are required to adhere to contract monitoring arrangements. Quality Assurance have a key role in the application of these arrangements to ensure that the terms and conditions of the contract are met. Information gathered from contract monitoring also informs continuous strategic planning and commissioning, improvement identification and enables early intervention and support should difficulties in providing and sustaining services become apparent. Page 79 of 164
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North Lanarkshire Council value the services delivered by contractors and Quality Assurance Senior Officers link closely with contractors to establish transparent and honest relationships, through the application of regular monitoring activity as agreed within the Contract Management Framework. During this reporting period the Contract Management Framework has been refined following evaluation. Following consultation through workshops and provider forums, feedback from Quality Assurance Senior Officers and commissioned social care contractors was collated on the various tools within the Framework. As a result, some of the processes and procedures have been amended to enhance performance reporting, data collection and the overall experience. Consideration was also given to the resource implications for social care contractors; therefore, the revised approach has been streamlined to avoid duplicate reporting where possible. The agreed changes effective from 1st April 2023 are listed below: - • The development of a Participation and Engagement Toolkit to support the inclusion of direct stakeholder feedback and engagement by Senior Officers, as part of Contract Monitoring arrangements. Contractors are central to the method of engagement implemented by Senior Officers to ensure feedback is collated in a person centred, responsive and flexible way. A 5% sample of people using the service being monitored has been defined. • Creation of Key Performance Indicators to inform sampling areas during monitoring visits by Senior Officers. A monitoring report will ensue with a copy being provided to the contractor. • Enhanced financial monitoring of block funded services. • Modifications to qualitative and quantitative data being requested from contractors on a quarterly basis including reporting on notifiable and non-notifiable accidents and incidents and the achievement of supported people meeting outcomes. • Addition of a ‘purple’ tier rating for if there is an on-going Large-Scale Investigation or there is significant risk of closure in the immediate 6-month period (See Table 3a) • Risk rating criteria changed on Monitoring Prioritisation Assessment to better reflect level of monitoring activity required in turn effectively targeting resources. The Monitoring Prioritisation Assessment (MPA) is the key component of the Contract Management Framework. The MPA is the up-to-date position statement on the performance of commissioned contractors. The processes of monitoring and the accompanying report build evidence of real time accessible information regarding the quality-of-service provision, performance and outcomes over the life of a contract/framework. Table 3a – MPA Tier Levels & Monitoring Frequency STATUS INDICATED MONITORING LEVEL Purple Large Scale Investigation (LSI) or Service Closure Processes that are imminent within 6 months Red Significant concerns in relation to service performance, contract compliance. TIER 4 Contract monitoring visit frequency – 1 to 4 weekly. Amber (high) Moderate concerns in relation to service performance, contract compliance TIER 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Amber (low) Minor concerns identified in relation to service performance and contract compliance TIER 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly. Page 80 of 164
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Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Contract monitoring visit frequency – annually in most cases. Each Tier suggests a minimum monitoring frequency (Table 3a). The basis of monitoring considers the commitments made by the contractor as part of their agreement with the Council including, but not limited to, Standard Terms and Conditions, Data Protection Terms and Conditions, Special Terms and Conditions, commitments made in relation to Fair Work Practices and Community Benefits and relevant national standards. Table 3b below highlights Tier Levels for the reporting period 2021/22 and for the reporting period 2022/23. It is positive to see that Tier 1 services had increased from 72% to 85%. Due to the increase all other tiers show a reduction. Despite this, contractors continue to face increasing demands due to workforce recruitment and retention issues, higher level of Care Inspectorate scrutiny and challenges with financial sustainability. Contractor’s have reported the benefit from the monitoring role of Senior Officers and the early interventions and solutions offered. Table 3b 4. Regulatory Activity Care Inspection activity during the reporting period of 2022/23 was spread across all key questions within adult and older people’s care homes. Key Question “How good is our care and support during the COVID 19 pandemic” was embedded into the Key Question “How well do we support people’s wellbeing” by the Care Inspectorate. However, care homes for children and young people and school care accommodation continued with the COVID specific key question included within their specific Care Inspectorate quality framework. This is reflected in Table 4a whereby 5 care homes were inspected in this area. 4 care homes were awarded grades of 4 (Good) and 1 care home was awarded a grade of 3 (Adequate). Table 4b shows 83 Care Inspections assessing Key Question “How good is our care and support during the COVID 19 pandemic” haven taken place across Scotland and from this most care homes were awarded grades of adequate (3) and good (4) highlighting an equivalent position to North Lanarkshire. Page 81 of 164
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Care Inspection Grades - North Lanarkshire Based Care Homes As At 31/03/2023 16 14 12 10 8 6 4 2 0 How good is Table 4a below details an analysis of the key question “How well do we support people’s wellbeing”. The data has been extracted from Tables 4b and 4c below. North Lanarkshire Care Homes performance measures slightly lower than Scotland wide care homes in that 55.6% of grades of 4 and above were awarded. Scotland wider care homes achieved 63.9% of grades of 4 and above. Table 4a How well do we support people’s wellbeing Number of Care Homes Assessed Grades Awarded Percentage North Lanarkshire Care Homes (Table 4b) 27 0 x Excellent 4 x Very Good 11 x Good 10 x Adequate 2 x Weak 0 x Unsatisfactory 0% 14.8% 40.8% 37% 7.4% 0% Scotland Wide Care Homes (Table 4c) 97 3 - Excellent 23 x Very Good 36 x Good 33 x Adequate 2 x Weak 0 x Unsatisfactory 3.1% 23.7% 37.1% 34% 2.1% 0% Care Homes in North Lanarkshire: 2 care homes were the subject of Large-Scale Investigations, under Adult Support and Protection legislation, with significant support provided by the Care Inspectorate and Senior Council Officers to address and improve quality improvement measures. Although there have been short term improvements there is little evidence of these improvements being sustained over a longer timeframe. Continuous monitoring and intensive engagement with each of these care homes continues. Table 4b How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? our care and support during the COVID-19 pandemic? Adequate 2022/2023 10 5 5 3 4 1 Good 2022/2023 11 15 10 6 8 4 Very Good 2022/2023 4 1 1 3 0 0 Weak 2022/2023 2 1 0 0 2 0 Page 82 of 164
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During the reporting period 2021/22, 14 out of 22 care homes were assessed as adequate for the key question “How well do we support people’s wellbeing”. This was 66.6% in comparison to the reporting period 2022/23 when adequate grades achieved under the same key question were 37%. This change highlights a significantly improved overview of the quality of care being provided with 55.5% of grades being higher than adequate. Care Homes in Scotland (excluding North Lanarkshire): North Lanarkshire Council currently has people placed within 148 care homes that are located elsewhere in Scotland. North Lanarkshire Council retains care management responsibilities for the people living in out of authority care homes. The host authority where the care home is geographically located is responsible for care home contract monitoring, however, not all local authorities operate in the same way. The Quality Assurance Team receives regular updates from host authority contacts in relation to out of authority care homes. Table 4c Self-Directed Support (SDS) including Care at Home: Prior to the pandemic, the Care Inspectorate changed their quality inspection themes for registered services. It was reported in 2021/22 that this was fully implemented for Care Homes and some self- directed support contractors, but 40 SDS contractors were still to be inspected using the new themes as of 31 March 22. Although there remain some self-directed support contractors who have not been inspected using the new quality framework, the majority have now been inspected. Table 4d below illustrates activity. Table 4d Page 83 of 164
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Care Inspection Grades- Self Directed Support including Care at Home as at 31/03/2023 20 18 16 14 12 10 8 6 4 2 0 How How How good is well do we support people's wellbein g? How good is our leaders hip? How good is our staff team? How good is our setting? well is care and support planned ? our care and support during the COVID- Care & Support Environ ment Staffing Manage ment & Leaders hip 19… Adequate 2022/2023 7 7 2 0 3 0 0 0 0 0 Excellent 2022/2023 1 0 0 0 0 0 3 0 0 1 Good 2022/2023 8 9 5 1 4 0 3 0 3 8 Very Good 2022/2023 11 6 3 1 3 0 19 1 9 10 Weak 2022/2023 0 0 1 0 0 0 0 0 0 0 From the 52 SDS contractors that have been inspected, 45 have been awarded grades of good (4) and above. This is a percentage of 86.5%, which reflects delivery of high-quality care and support across SDS contractors supporting people in North Lanarkshire. It should be noted that the percentage above is calculated from the grades awarded under “How well do we support people’s wellbeing” and Care and Support, reflecting the two different inspection methodologies. 5. In House Monitoring During this reporting period the Quality Assurance team have been working on the development of an In-House Monitoring Framework. The suite of documents included within this Framework are awaiting approval from the Senior Leadership Team and it is intended that a test of change across Home Care services will commence in August 2023. This test of change will inform any further refinements and modifications prior to roll out across all In House services including Locality Support services, Children’s Houses, and Integrated Day Services. The aim of the In-House Monitoring Framework is to support implementation of best practice and a culture of continuous improvement. Progress on the implementation will be reported in future reports. 6. Market Facilitation Sustainability arrangements remined in place to ensure social care services continued to operate in a financially secure and viable manner following the impact of the COVID pandemic. The criteria for which Social Care Providers were reimbursed was phased out gradually, with the arrangements ending on 31st March 2023. However, due to contractors reporting significant increases in their costs., there continues to be a requirement to provide support and guidance to ensure they remain financially sustainable, to enable the continuation of service delivery across the authority. Page 84 of 164
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We recognise that services provided by external organisations make an important contribution to our ability to offer choice in supporting the health and well-being of people who use social care services. Therefore, our approach to market facilitation means we are responsive to the changing needs and aspirations of people living in North Lanarkshire, whilst also reflecting the changing social care landscape. One of the biggest challenges currently, is the lack of capacity available to choose from when a care and support package is required. There are many factors contributing to these challenges, including workforce retention and recruitment, cost of living increases, increased demand, complexity of support required and quality of care falling below expected standards. Quality Assurance continue to liaise with internal and external partners to identify solutions to the challenges. Provider Recruitment Event – A co-designed large -scale recruitment event is planned to be held in April 2023 to promote the sector and attract and encourage new people to work within social care. The event will support our commissioned contractors to recruit suitable staff and in turn maximise their capacity to provide care to the people of North Lanarkshire. Building Capacity – A programme of activity to build capacity across the sector enabled us to work with providers over two phases. This approach was in recognition of the pressures contractors face due to ongoing recruitment and retention issues across the social care sector. Through non-recurring funding from the Scottish Government, proposals were invited from contractors on the Self-Directed Support including Care at Home Framework, to build capacity and upskill staff teams to support our communities across North Lanarkshire. 40 proposals were submitted to be considered, including requests to support recruitment drives, staff training and development, incentives including joining bonuses, driving lessons and IT investments. 7. Carer Developments To ensure robust and ongoing support for Carers, we have, in conjunction with South Lanarkshire Council and Lanarkshire Carers, developed a Joint Partnership Statement to build on existing trust and partnership working between the named organisations. It provides a common reference point; useful to guide collaboration on a daily basis, avoid confusion and provide clarity as and when required. The agreement supports mutual understanding and expectations between partners (Lanarkshire Carers; North Lanarkshire Social Work and South Lanarkshire Social Work) in relation to the delivery of Adult Carer Support Plans (ACSPs). The roles, responsibilities and boundaries of all partners are defined and agreed. The agreement also provides a staff information and awareness raising tool and ensures that carers have access to accurate information and are signposted and referred appropriately. 8. Participation and Engagement There is a strong history of engagement and participation within North Lanarkshire. To strengthen our approach and progress our next Participation and Engagement Strategy, over the reporting period we have proactively linked with a range of key stakeholders to explore options and agree a model that ensures supported people, including underrepresented groups or communities, can play as active a role as they choose, in helping shape services. This approach ensures that supports and services are informed and led by people with lived and/or relevant experience of support, and that policy and strategy reflects the views, wishes, needs and aspirations of supported people. Page 85 of 164
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9. Communications To actively promote services and support for people, we have been working with the Communications Manager to develop a robust communication plan that provides clear and timely information, provides easy access to publications, showcases good news stories and promotes the sector. Members of the quality assurance team have undergone training to enable them to populate the revised Health and Social Care North Lanarkshire website: https://hscnl.org.uk/ Development of this website will be continuous and additional resources will continue to be made available. 10. Information Governance Our Information Governance Framework enables the safe and secure use of sensitive and other information to support the health and wellbeing of the people across our communities. It ensures that we meet our legal and ethical duties in relation to handling and managing information to a high standard. The role of Quality Assurance in information governance includes, but is not limited to: 1. Advice, monitoring and supporting the processing of: • Subject access requests (SARs) including Information Commissioner’s Office (ICO) reviews and complaints. • FOISA (Freedom of information requests) including Scottish Information Commissioner reviews and complaints. • GDPR breach notifications • Data protection impact assessments (DPIAs) • DSAs/ISAs and data protection terms and conditions in contracts • Schedule 2 requests for information relating to criminal activity (usually from the police) • Work with other services to support the information governance function for social work (risk assessments, legal data protection team, legal FOI team). 2. Manage and support: • Corporate reporting of KPIs for Information Governance • HSCNL contributions to the Corporate Data Management Team (DMT) • HSCNL contributions to the Lanarkshire Data Sharing Partnership (LDSP) • Development and maintenance of recording and reporting systems for information governance. • Development and review of policies and procedures for information governance, both for social work and corporately via DMT. The Information Governance function in social work has undergone significant changes over the reporting year. Many of these changes have contributed to the improvement of how we process information requests and the reporting functions. Activities have included the following: - • Development of a core group within Quality Assurance to support and maintain the functions of information governance. • Enhanced promotion of skills and awareness of information governance within social work, including training of staff and awareness of the online mandatory training courses and development of service specific training in Subject Access Requests (SAR’s) • Development of additional training for social work staff. • Review and update of Subject Access Requests (SAR’s) recording systems. Page 86 of 164
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• Review and update of GDPR breach notification process. 11. Procurement In collaboration with Corporate Procurement colleagues and Locality Social Work Teams, Quality Assurance assist in the planning, coordination, and implementation of processes to ensure that when contracting new or existing work, the requirements of the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016 are adhered to. By doing so there can be confidence that the care & support services commissioned are legal, safe and outcomes focused whilst demonstrating Best Value. Throughout 2022/23 this partnership approach has enabled our Commercial Pipeline to be further developed. Transparency is a fundamental principle of public procurement, helping to ensure best value and proper scrutiny of contract awards. The Commercial Pipeline brings valuable insight to support the planning and delivery of public procurements, whilst enabling the widest possible- population of potential suppliers to be sighted on upcoming public sector contracting opportunities. Further refinements have also been made to our Contract Mobilisation processes, to embed timescales and key stages from the award of contracts to contracts going live. Over the period, we have focused on stakeholder communication plans, regular implementation meetings and the roles and responsibilities of key social work staff throughout the term of contracts, which are integral to effective service delivery. This approach helps to minimise contract implementation delays & barriers and promotes effective partnership working and the achievement of successful outcomes for the people of North Lanarkshire. We have also introduced the inclusion of Contract Exit Strategies and defined this within the contracting terms and conditions. This approach will ensure clarity when terminating contracts during their term (if required), contracts coming to a natural end and contracts at risk of early termination. This improved guidance is helpful during the period when provider sustainability features on the Social Work Risk Register. Early in 2023 there was representation from Quality Assurance to support the Corporate Procurement team at Lanarkshire’s Meet the “Real” Buyer Exhibitor. This event enabled potential contractors to ask specific care related questions. There were 337 attendees on the day and the feedback from the supply base was very positive. Representation from the Quality Assurance team will attend future events. Quality Assurance leads on procurement activity for all social work services, including those focused on children, families, justice services and adults. There are close links between departments to ensure joined up planning, clear procurement processes and subsequent contract monitoring arrangements. Page 87 of 164
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Table 11 describes a sample of procurement activity undertaken in 2022/23. Table 11 Contract Comments and Benefits Flexible Framework for Self- Directed Support and Care at Home Services + £900M value, 10 years, will result in less frequent re-tenders. + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Annual entry and exit points for Contractors currently in Year 3 + Secured an increase in the number of contracted providers, improving the choice and control for supported people Flexible Framework for Non- Traditional Respite + £4M, 10-year agreement, will result in less frequent re- tenders. + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Covers an existing gap within National ‘Respite’ Frameworks + Annual entry and exit points for Contractors currently in Year 2 + Secured an increase in the number of contracted providers, improving the choice and control for supported people Digital Counselling Service and Online Platform of Support + £120,000 funding had been allocated from within Scottish Government’s Mental Health Services allocation to the Council to pay for the solution in year 1. + Follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Anticipate that further years funding can be secured should the solution prove to be successful. Counselling Service for Care Experienced Young + Funding available year 1 via Scottish Government (initial year £50k) subject to annual review. Options years included to give option to extend agreement. + Follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Based within Intensive Services Hub, Cecil Street, Coatbridge and work with 16–25-year-olds who have experienced trauma and adversity. Lifelong Links + £8000 plus VAT for the first year. Proposal for Funding + Children in local authority care including children in residential care and care leavers ADL SmartCare + £291,268.92 whole life budget over 4 years. (£71,041.20) + GCloud 13, cloud software solutions + GCloud 13 allows searching of software solutions. Hoists and Adaptations + £12,000,000 whole life budget over 5 years. + Split into Lot 1 and Lot 2 + Supply, Installation, Removal and Servicing of Straight and Curved Stairlifts + Supply, Installation, Removal, Servicing and Maintenance of Ceiling Track Hoists Page 88 of 164
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Contractors Paying Scottish Living Wage 6% 94% % N/a % Yes 12. Fair Work The Fair Work Convention has been in place since April 2015 and acts as an independent advisory body to Scottish Ministers. The Convention’s vision is that by 2025, people in Scotland will have a world leading working life where fair work drives success, wellbeing and prosperity for individuals, businesses, organisations and society. As part of the council’s commitment to Fair Work and our ambition to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. Tracking Contractor progress has been included in the Social Work Contract Management Framework. Contractors report on community benefits activity and Scottish Living Wage compliance. The information provided contributes to the overall assessment of contract compliance. Community Benefits - During 2022/23 Quality Assurance increased focus on the delivery of community benefits, following new contract awards and implementation. Our approach means link senior officers meet with contractors to review, promote and encourage new initiatives that offer employment to people in the local community, youth training and training for people from disadvantaged groups, traineeships, apprenticeships, and volunteering opportunities. Scottish Living Wage - In 2021/22, we reported that most contractors had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This year 100% of providers on our Self-Directed Support including Care at Home framework, reported paying the Scottish living Wage. Across all contractors of commissioned services, 94% are now paying employees the Scottish Living Wage. The remaining 6% of contractors provide non-care related services or are within the cross-border category whereby the Scottish Living Wage does not apply. Table 12 13. Children, Families and Justice Quality Assurance monitors most Children’s Services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. Page 89 of 164
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Improved links and processes in joint working between Quality Assurance and Children & Families mean that the noted development areas reported in 2021/22 have been progressed and all children and young people placements are conveyed to the appropriate teams. Quality Assurance have been supporting the development of Children, Families and Justice risk management arrangements, whereby attendance at the Social Work Risk Forums and membership of same is promoted across these teams. The Governance arrangements for Children and Families risk arrangements have been defined within the Adult Health and Social Care Risk Management Local Strategy. 14. Complaints Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The annual summary and analysis of complaints received over the period 2022/23 is attached as appendix 1. 15. Duty of Candour Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain open and honest when something goes wrong, that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is a requirement of the Council and the report for 2022/23 is attached as appendix 2. 16. Adult Support & Protection The lead for Adult Support and Protection sits within the Adult Headquarters Social Work team; however, Quality Assurance have a key function to monitor the performance of social care contractors including care homes, so we work closely with our Adult colleagues. Adult Support & Protection activity can highlight patterns/trends and/or contract compliance concerns. Maintaining an overview allows for early intervention and support for contractors if required. A Senior Officer from Quality Assurance is identified as the Adult Support & Protection Link Person, which supports robust monitoring. Quality Assurance have representation on the Pan Lan Adult Support & Protection Care Home Task Group. The aim of this group is to identify and respond to feedback and address any inconsistencies that may arise in key messages being communicated by various professionals in relation to when an ASP referral should be made to the Local Authority. Adult Support & Protection Coordinators from North and South Lanarkshire Council and representation from both the Care Inspectorate and Scottish Care also participate in this group. To ensure a co-produced and partnership approach, a nominated care home manager participates the views of the wider care home population. Work is ongoing to support care home managers to have confidence in their decisions about when to make an ASP referral. We continue to promote attendance and participation with contractors, in North Lanarkshire Council Adult Support and Protection training. 17. Adult Health & Social Care Risk Management There is a nominated Risk Champion and depute for Adult Health & Social Care, as we all as range of risk facilitators across the service. A key function over the past months has been the implementation Page 90 of 164
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of the new Corporate Risk Management Strategy and the associated Adult Health and Social Care Risk Management Strategy. Significant progress has been made to update the risk register for Adult Health & Social Care. Quality Assurance have taken a lead role in coordinating the reviews of risks in partnership with risk owners. Throughout the reporting year several Risk Forums and a Risk Identification meeting have taken place. The current membership of the Risk Forum is under review at this time. Work continues to review individual risks, wordings and assessment to ensure they are clearly articulated in a way that means identification of controls and actions is more focussed and meaningful. 18. Quality Assurance Planned Developments 2023/24 There are several developments in progress or planned for the period 2023/24, which will be conveyed in future reports. Details of some of the planned developments are noted below: • Roll out of In-House Monitoring • Social Work Self Evaluation • Chief Social Work Officer Report • Quality Assurance Newsletter • Review of Contract Management Framework & associated data analysis • Development of Engagement & Participation Strategy • Establish membership of Risk Forum & streamline current risks. • Ethical Commissioning Self-Assessment & Action Plan • Recommence Care Home Provider Forum • Support Succession Planning • Refine Induction Pack • Establish systems around Contractor Capacity Reporting • Embed the role of Locality Senior Officer Links • Agree and implement post covid care home arrangements/forums. • Further development of market facilitation plan • Continued Large Scale Investigation involvement. This report has covered Quality Assurance activity undertaken during the period 1 April 2022 to 31 March 2023 and highlights progress made in key activities noted in the last reporting period. The additional resource of two Senior Officers to the team in January 2023 has had a positive impact on outcomes achieved in developing creative and solution focused approaches to performance and compliance both internally and externally. Page 91 of 164
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Appendix 1 Social Work Complaints Annual Report 2022/23 Page 92 of 164
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16 14 12 10 8 6 4 2 0 Locality/Service 15 11 10 9 6 6 6 5 4 4 2 1 1 0 Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw HQ Stage 1 Stage 2 Introduction This report provides an overview of Social Work’s performance in terms of handling complaints received between 1 April 2022 and 31 March 2023 and covers Adults and Education, Families & Justice. This report describes how complaints have been managed by social work services, details the number and nature of complaints received during the year and demonstrates our commitment to learning and improvement. There remained a residual effect of the Covid 19 pandemic in terms of the numbers of complaints received in 2022-2023, underlining the impact this unprecedented global event had upon service provision and the lives of those who use our services. Complaint activity Overall, complaint activity rose by 81% from 2021-2022. A significant increase: however, complaints are still slightly less than they were pre-pandemic. In terms of complaints per population, they stand at 0.35 per 1000. Overall complaints received for the reporting period were 221, an increase of 99 [58%] from former reporting period. A breakdown is provided below. Education and Families 81 complaints were received in relation to Education & Families services this year, 49 received last year, an increase of 32 [65%]. The chart below is a summary of locality complaint activity for Education and Families services. Of the 81 complaints received, 80 were assigned. One complaint couldn’t be assigned to any locality or service due to lack of information. Adult Social Work Services 140 complaints for adult services this year, 73 received last year, an increase of 67 [92%]. The chart below is a summary of locality complaint activity for Adult Social Work Services. Page 93 of 164
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Complaint Process We always aim to provide the highest possible quality of service across our communities and are committed to ensuring accountability and transparency. We recognise there are times when we get things wrong and fail to meet the expectations of those who use our services. We welcome feedback as it provides information that helps us to learn from complaints and shape and improve the way services are delivered. Complaints are viewed as a positive communication tool and are actively encouraged. As per the Scottish Public Services Ombudsman [SPSO] definition, we regard a complaint as any expression of dissatisfaction, by one or more members of the public, about our action or lack of action, or about the standard of service provided by us or on our behalf. Anyone can make a complaint, either verbally or in writing, face to-face, by phone, letter or email. People are directed and encouraged to use the North Lanarkshire Council online portal to make a complaint but retain the right to use any of the aforesaid options. A two-stage statutory social work complaints process was introduced on 1 April 2017, which harmonised complaint handling processes across all council services. The process is as follows: • Stage one – ‘frontline resolution’: we will always try to resolve complaints quickly, within five working days, and in exceptional circumstances extend for a further five days. • Stage two – ‘investigation’: if people remain dissatisfied with our stage one response, they can escalate their complaint to stage two. Complaints that are complex or need detailed investigation from the outset can be looked at immediately at stage two. These complaints will be acknowledged within three working days and a written response provided within twenty working days; this can be extended in exceptional circumstances. Following completion of the complaints process, if the person remains dissatisfied, they can ask the SPSO to consider their complaint further. We always advise of this entitlement and provide contact details. Performance Indicators The Complaints Standard Authority developed a suite of four mandatory performance indicators in association with the Local Authority Complaint Handlers Network on which we are represented. These indicators [undernoted] are a valuable source of information as they help to identify recurring or Locality/Service 30 25 24 22 20 15 15 12 11 10 10 9 10 6 5 4 5 3 5 4 0 Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw HQ Stage 1 Stage 2 Page 94 of 164
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underlying issues, derive/drive learning from complaints and highlight potential areas for improvement. • Indicator One: the total number of complaints received. • Indicator Two: the number and percentage of complaints at each stage that were closed in full within the set timescales of five and 20 working days. • Indicator Three: the average time in working days for a full response to complaints at each stage. • Indicator Four: the outcome of complaints at each stage. Education and Families – Performance Information Compliance with statutory timeframes to complete complaint 23.7% not within timeframes 22.7% not within timeframes 59.4% within timeframes 54.6% within timeframes 16.9% met with extension 22.7% met with extension Average S.1 – 6.2 working days Average S.2 – 23.3 working days Page 95 of 164
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Cause of Complaints Complaint Outcome Page 96 of 164
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Adult Social Work Services– Performance Information Compliance with statutory timeframes to complete complaint 24% not met within timescales 16% not met within timescales 52% met within timescales 63% met within timescales 24% met with extension 21% met with extension Average S.1 – 5.4 working days Average S.2 – 23.2 working days Cause of Complaints Page 97 of 164
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Learning from Complaints Communication Safe Driving Conduct Support Planning Importance of PPE Importance of ID N/A Complaint Outcome Learning from Complaints The learning from all social work complaints this year have highlighted: • The importance of good communication. • The need to ensuring that those who use our services and their carers are informed from the outset that they may need to contribute towards the cost of their care. • The need to improving information and advice for those who need to contact and seek support from social work services. • That people have the right to use their Self-directed Support (SDS) individual budgets as creatively as necessary to reach their agreed outcomes, as long as the use of public funds are legal and do not bring the council into disrepute. Outcomes are often specific to the complaint, but when there are organisational learning points that influence policy or procedure, we need to ensure these are acted upon. Individual learning is dealt with directly with the complainant and through supervision, and more general issues are managed through supervision with team members and reminders at team meetings. Page 98 of 164
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47% of all social work complaints recorded did not highlight any learning, while 33% were attributed to communication failure as the singular cause of complaints. Other issues cited were safe driving/parking, wearing appropriate PPE and ID badges, quality of service and conduct of staff. We recognise the importance of learning from complaints and acknowledge that having a learning outcome recorded is an area that requires immediate attention. We understand that complaints help organisations learn more about the experiences of people who use their services, and that complaints can be helpful to enable us to work in a better way. At present, learning from complaints is a non-mandatory performance indicator. However, the Scottish Public Services Ombudsman are interested in the systemic changes that are made following complaints. Going forward, we will work directly with our central and locality teams to ensure better recording and learning from complaints is embedded in practice to ensure quality services are delivered. Comment and compliments Across social work, seven compliments were made 2022-2023 in relation to complaint handling – all referred to quick actions by responsive staff to provide resolution. 5 other comments were logged but were mapped as neutral and non-critical. Training Training on the Dynamics system, where complaints are recorded, is offered as required. The licence allocation system has recently been reviewed, and licence permissions granted only to management support team members and to system administrators. Rationalisation of licence holders will increase opportunities to have closer collaboration and training across the service. Colleagues in Chief Executive’s office lead on training on system issues, and Quality Assurance Senior Officer leads on complaint handling training. The Scottish Public Services Ombudsman offer training on topics such as investigating complaints. Currently, this is only offered virtually, but there are plans to introduce in person training and to increase the number of training opportunities offered. We actively encourage participation in training on complaint handling and management. Scottish Public Services Ombudsman The SPSO considered seven complaints of which two are subject to ongoing enquiry, one had recommendations made for resolution, with the remaining four no actions taken. Page 99 of 164
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Child Friendly Complaints Procedure The SPSO are introducing a new Child Friendly Complaints Procedure, which will go live on 1 April 2024. This procedure will ensure that children’s rights under the United Nations on the Rights of the Child [UNCRC] are met through a child-centred complaint process. Their aim is to co-design and implement a public sector complaints service that meets children’s rights and needs. They are working in co- operation with children, young people, public bodies and wider stakeholders. Initially, it was envisaged that the new procedure would be fully implemented by 1 April 2023. However, following feedback from engagement and testing work, a more targeted pilot has been agreed. The pilot will focus on key services provided to children and young people, such as schools, social work services and children’s health services. The aim of this work will be to test the new approach in practical settings, both to ensure it results in the right outcomes for children, and that it is efficient, practical, and workable for the public sector bodies managing the process. Full guidance on the new process should be made available by summer 2023, with a soft launch of the new process in April 2024. Quality Assurance Quality Assurance senior officers provide training and support to social work managers and teams in relation to the complaint handling process. A suite of letter templates are available, which provide guidance on model answers and best practice when engaging with complainants. Complaints are often routed directly through the Quality Assurance officer who acknowledges receipt and assigns complaints to the relevant team manager. Guidance on response times and content is provided. Complaints that relate to both health and social work/social care services are routed through the relevant lead organisations complaints process, but there is an integrated approach to resolution and any joint learning outcomes are shared. Care Opinion Care Opinion is a non-profit organisation, funded mainly through subscriptions from health and care organisations. At present, 500 health and social care organisations use Care Opinion across the UK. Care Opinion have been sharing people’s experiences of health and care services online in Scotland since 2013 and have built a national and international reputation for their innovative and value-led approach to online feedback. Feedback is considered integral to quality improvement and for staff it is an opportunity to see the system and the service provided through the person’s eyes. Subscription to Care Opinion gives a further platform for people who use social work services to comment on the quality of the service that we provide but may also encourage people to make formal complaints. Usage of Care Opinion has been slow – however, there has been marked increases in comments posted about social care services over the course of the preceding quarter. Anecdotal information from our partners in NHS Lanarkshire suggests that in the early stages, uptake can be poor, but that sustained promotion will drive traction and momentum. There is a Care Opinion implementation group who meet regularly to agree plans for increased promotion and shared learning . To support the use of Care Opinion as a vehicle to promote feedback on services, our revised Contract Management Framework requires all contracted providers, through their quarterly monitoring return, to report on their use and promotion of Care Opinion as a method of seeking feedback. Page 100 of 164
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Conclusion The principal cause of complaints continue to identify poor staff communication, staff attitudes and quality of service. This is further reflected within the learning outcomes, which indicate the need to improve communication, practice and approach to those using social work services. As a partnership we are committed to improving learning from complaints which is also one of the key performance indicators that are reportable to the SPSO. We will, over the course of 2023-2024 place further emphasis on identifying and applying learning from complaints, recording learning outcomes and evidencing subsequent improvements. We will also emphasise the need to ensure that all complaints are dealt with in the identified timeframes, with clear communication of outcomes. Although 100% of complaints that were sent directly to social work were acknowledged by the due dates, only 58% overall were completed within statutory timeframes. Complexity of issues, new processes, staffing, IT systems and very tight time frames for resolution were the contributory factors in failure to complete all complaints within time. Improvement in these areas are expected in 2023-2024. Further actions – 2023-2024 Several key actions have been identified to strengthen our approach when dealing with complaints including using the learning to improve the quality of experience for those who use our services. The actions are: 1. We ensure a robust log and learning from complaints is implemented to support the improvement of services that support people across our communities. 2. We develop a programme of reflective learning sessions across teams - Complaint activity and learning remains an agenda item in team meetings and links across services and localities are maintained with Quality Assurance Senior Officer who will review complaint activity as required. 3. We continue to promote Care Opinion as one of the key mechanisms for engaging with members of the public and to generate meaningful feedback. 4. We provide system training to all members of the management support teams who now have responsibility for logging and tracking complaints. 5. We provide complaint handling training sessions on at least a quarterly basis as a refresher session, or for training for new staff. 6. We support the implementation of Child Friendly Complaints Handling Procedures. Page 101 of 164
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Appendix 2 Duty of Candour Annual Report 2022/23 Page 102 of 164
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Introduction North Lanarkshire Health and Social Care Partnership recognises that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental. The duty of candour arrangements which we have implemented reflect the Scottish Government’s commitment to place people at the heart of health and social care services in Scotland. When harm occurs the focus must be on personal contact with those affected; support, and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 was implemented on 1st April 2018 placing an organisational duty (Duty of Candour) on health, care, and social work services to be open and honest with people in their care. The overall purpose of this duty is to ensure organisations are open, honest, and supportive when there is an unexpected or unintended incident resulting in death or harm as defined in the Act. All health and social care services in Scotland have a duty of candour, a legal requirement which means that when things go wrong and mistakes happen, the people affected understand what has happened, receive an apology, and that organisations learn how to improve for the future. A key part of this duty is that Health and Social Care publish an annual report about the duty of candour in our services. This short report describes how the services we commission, and our own services have operated the duty of candour during the time between 1 April 2022 and 31 March 2023. Information about policies and procedures All social care organisations have a Duty of Candour policy. All staff who are employed in the sector should be aware that all instances that necessitate implementation of Duty of Candour must immediately be reported. In such instances, a manager will then take the appropriate action, ensuring relevant bodies [depending on the sector] such as Social Work and Care Inspectorate are notified of the event. Where an incident occurs that triggers the duty of candour, managers have responsibility for ensuring that the duty of candour procedure is followed. Information on Duty of Candour and reportable incidents is described in detail within Appendix A. 82 commissioned organisations were asked to provide information in relation to Duty of Candour activity in the reporting period. Of the 34 [41%] that responded, there were six reported incidents. Details of those who responded are noted in Appendix B. All North Lanarkshire Council social work in- house services - home support, integrated day services, locality support services and children services were also asked to provide information. There were no Duty of Candour incidents reported from any of the council provided services. Reporting of Duty of Candour incidents are an integral part of our Contract Monitoring Framework and all should be reported on quarterly contract monitoring returns. How many incidents happened to which the duty of candour applies? In the reporting period, six incidents have been reported to which the duty of candour applied, one in relation to maladministration of paracetamol, and five where a person fell and sustained physical Page 103 of 164
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harm. All incidents reported were from a commissioned care home service. No Duty of Candour incidents were reported by North Lanarkshire Council in-house social work services. The low number and type of reported incidents indicate that there may be some uncertainty over situations where Duty of Candour responsibilities should be invoked. Refresher sessions on Duty of Candour duties will be delivered to our in-house teams over the course of 2023-2024. Reminders and information slides will be sent to all our commissioned services to ensure that they are fully aware of the duties under the Act. Details of incidents where Duty of Candour applied. Nature of incident: Duty of Candour raised for accident where resident fell and fractured his femur. Incident fully investigated and reported. Relative invited to a Duty of Candour meeting but declined to attend. Nature of incident: Duty of candour raised for incident whereby a resident received an overdose of Paracetamol. No lasting harm occurred. Incident fully investigated and reported. Relative invited to Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for an incident where a resident had staples to a wound in her head following an unwitnessed fall. No lasting harm occurred. Incident fully investigated and reported. Relative declined invite to attend Duty of Candour meeting. Nature of incident: Duty of Candour raised for incident where a resident had sutures to head wound following a witnessed fall. No lasting harm occurred. Incident fully investigated and reported. Family were invited to attend a Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for incident concerning a resident who sustained a fracture due to witnessed fall. Incident fully investigated and reported. Family were invited to attend a Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for incident concerning a resident who sustained a fracture due to an unwitnessed fall. Incident fully investigated and reported. Relatives were invited to a Duty of Candour meetings but declined to attend. Unfortunately, there were incidents where Duty of Candour duties should have been invoked but were not. Reasons for failure were inexperienced management and lack of familiarity with Duty of Candour procedures. Another factor was due to Police involvement in two serious incidents, where it was understood that Police involvement superseded Duty of Candour. Conclusion Within the reporting period, there were no Duty of Candour incidents reported from in-house home care or social work services and only six from commissioned care home providers. From those reported, none had lasting consequences for the person to whom the duty applied - appropriate action taken, lessons learned, procedures and training revised, and where applicable, families informed, and invited to discuss in more detail. In future, if any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify lessons learned, with the result of the review Page 104 of 164
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shared with the relevant person/persons. This approach will minimise the impact on the organisation and the vulnerable people that we strive to support. Appendix A – Definition of Harm and appropriate level of response Grading of Harm Definition of Harm Level of Response No harm, incident prevented Any service user safety incident that had the potential to cause harm but was prevented. These incidents are outside of the scope of the duty of candour. Social work professionals may however feel it is appropriate to inform the person involved if it is in their best interest. No harm, incident not prevented Any service user safety incident that occurred but no harm was caused to the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Low Harm Any service user safety incident that led to the extra observation or minor treatment such as first aid or additional medication for the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Moderate Harm A level of harm that is not permanent but has led to a moderate increase in treatment or prolonged psychological harm of more than 28 days. For example, a return to theatre, an unplanned readmission to hospital, unexpected admission to critical care, a prolong hospital stay or additional out service user visits. Duty of candour is a statutory requirement. Notification should be given to the person affected or their representative in person including an explanation of the incident, the process for investigation and an apology. This will be followed up in writing and on conclusion of the investigation the findings and outcome will be available to the service user of their representative. Serious Harm Any service user safety incident that has resulted in permanent harm that is directly related to the incident and not the natural course of an illness or the underlying condition of the person affected. Examples of severe harm are permanent lessening of bodily functions, sensory, motor, physiological or intellectual function, removal of the wrong organ or limb or brain damage. Duty of candour is a statutory requirement – see above. Death Any service user safety incident that directly resulted in the death of a person and is not related to their illness or underlying condition. Duty of candour is a statutory requirement – see above. Page 105 of 164
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Appendix B Organisations who provided a response: all but one returned a nil response. All New Beginnings Angels Aspire Beechwood Care Home Capability Scotland Care One Professional Care Solutions C-Change Cera Care Cornerstone Deanston Care Home Enable Scotland Enhance Supported Living Services HRM Inclusion Scotland Invercare Keane Premier Support Services Key Housing Lanarkshire Association for Mental Health Lanarkshire Care Partners Local Lanarkshire Care Lochside Manor Love Partners in Play Penumbra PHEW Potential Living Quarriers Scottish Autism Support for Ordinary Living The Richmond Fellowship Scotland Thera Care Turning Point Scotland Wheatley Care Page 106 of 164
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Adult Social Care Performance Report – Quarter 4 2022/23 North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/SF Date 05/09/23 From Ross McGuffie, Chief Officer, North Lanarkshire Health and Social Care Partnership 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 1st January 2023 to 31st March 2023 (Quarter 4). 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) Acknowledge 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 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, which is comprised of a range of performance measures that are drawn from across both health and social work systems and includes relevant targets and trajectories for the measures chosen. 1.2 Based on a traffic-light system, areas for improvement are identified within the performance framework each quarter for those that have been flagged as Red or Amber status. The performance review meetings are used as a means for jointly agreeing corrective actions in these areas. Adult Care and Social Work Committee Item 7 Page 107 of 164
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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 1st January 2023 to 31st March 2023 (Quarter 4). 2.2 The performance data for Quarter 4 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 4, January to March 2023) Ross McGuffie Chief Officer North Lanarkshire Health & Social Care Partnership Page 108 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 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 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 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 109 of 164
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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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☒ Page 110 of 164
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Appendix 1 – Adult Social Care Dashboard PLEASE NOTE FOR ALL INDICATORS UPWARDS ARROWS DENOTE POSITIVE PERFORMANCE Outcome (National Health & Wellbeing) Ref. KPI Target / Indicator 2017/18 Target 2018/19 2021/22 Q4 2022/23 Q1 2022/23 Q2 2022/23 Q3 2022/23 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance 2. People, Assistive Technology - Number Of G including 2.11 People With Technology (0-17 36 34 34 33 30 those with yrs) disabilities or Assistive Technology - Number Of long term 2.12 People With Technology (18- 1,452 1,452 631 635 629 629 633 conditions, or 64yrs) who are frail, are able to live, as far as 2.13 Assistive Technology - Number Of People With Technology (65+) 866 852 853 839 853 reasonable practicable, 2.14 Reablement - Number Of People Completing Reablement Process 1600 2000 1170 334 666 1049 1418 R independently R and at home or in a homely 2.15 Reablement - % Of New or Increased Home Support 70% 70% 63.1% 67.1% 60.6% 55.0% 61.2% setting in Packages Which Are Reablement their Reablement - % Of People With R community 2.16 No Home Support Service 50% 50% 24.8% 26.6% 33.7% 34.2% 28.8% Required At End Of Process 2.18 Balance Of Care - % Of People 45% 45% 45.3% 45.5% 45.4% 43.7% 42.6% R (Age 65+) 2.19 IEAS - % Deliveries Achieved 80% 80% 61.7% 66.6% 75.1% 63.4% 51.5% R Within 7 Working Days Quarterly 4. Health and 4.3 Care Home Placements At End Of 24 24 21.3 22.0 22.2 21.5 21.2 G social care Quarter - Per 1000 Popn 65+ services are 4.4 Care Home Placements At End Of 50 50 44.0 45.5 46.3 44.8 44.2 G centred on Quarter - Per 1000 Popn 75+ helping to 4.5 Care Home - Average Length of 865 819 828 939 743 870 A maintain or Stay Page 111 of 164
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improve the quality of life of people who use those services 4.6 Number Of People With Self Directed Support 950 1,000 1256 1290 1322 2042 1956 G 4.7 Number Of People With A Direct Payment 210 240 321 299 328 336 359 G 7. People who use health and social care services are safe from harm 7.19 % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 20% 18.9% 15.0% 17.5% 16.2% 11.7% R 7.20 % Of Adult Protection Investigations Going To Initial Case Conference 20% 20% 23.9% 19.6% 16.3% 14.1% 21.2% G 7.21 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 60% 79.3% 72.8% 76.3% 78.4% 73.4% G 7.22 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 50% 66.3% 72.1% 67.4% 69.0% 71.2% G Page 112 of 164
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Appendix 2 – Areas for Improvement (Quarter 4, January – March 2023) 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 Reablement - Number Of People Completing Reablement Process Reablement - % Of New or Increased Home Support Packages Which Are Reablement Reablement - % Of People With No Home Support Service Required At End Of Process Balance Of Care - % Of People (Age 65+) IEAS - % Deliveries Achieved Within 7 Working Days Quarterly IEAS continues with a Programme of improvement works, with improvements to premises and focussed recruitment activity in progress at the time of reporting. Sustained workforce challenges, specifically recruitment and retention of suitably skilled and experienced IEAS staff have resulted in challenges with the delivery and uplift of equipment. Specific resources have been assigned to addressing outstanding uplifts within the areas of highest demand and this, alongside other focussed activity has released pressure and some capacity in the system to address performance with timely deliveries. It should be noted that whilst such services continue to support Delayed Discharge improvement works, such activity naturally requires a reduced focus and capacity to support Community Services. The service is undertaking an exercise to self-assess their performance, using Scottish Government baseline figures for Equipment/Adaptations. It is hoped that a more integrated Performance Framework can be developed for services in this area, showing how the services complement and interact with each other, such as combined and/or complementary metrics for Reablement and the Home Assessment Team (HAT). It is notable that whilst the percentage of Reablement Home Support packages is below target that the HAT received increasingly more referrals. Page 113 of 164
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A Home Assessment Team Development Plan is in place to streamline and reduce duplication of service from the teams working in this area. The dynamic between Integrated Rehabilitation, Hospital Social Work, Home Assessment Team and Reablement has been recognised as allowing an opportunity to provide one seamless combined service. The development plan is currently focussed on services to support discharge, however a second phase is planned, looking at the interaction with Hospital at Home and other services placed to support admission prevention and avoidance. Multi-disciplinary and multi-agency focus groups are planned to look at the available resources and patient/client pathways, which will inform the implementation of the development plan. A governance framework has been developed to support this work, which is overseen by the Home Support Programme Board. An Assistive TEC Team was implemented in February 2023 to support further innovation in this area and is actively working with services across the North HSCP, including a trial of the KOMP system for medication prompts as an alternative to in-person visits. At May 2023, the team have received 187 referrals and 57 of these have resulted in the supply/purchase of technology that has benefitted the person in regaining independence in an area of their life; the impact on wider services will be quantified as the new service is developed and then evaluated. Page 114 of 164
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50 0 45 40 35 30 25 20 15 10 5 43 31 24 21 18 18 9 3 4 1 7. People who use health and social care services are safe from harm % Of Adult Protection Referrals Passed To Care Team For Investigation The overall number of AP referrals has increased, which is viewed as a net positive and is actively encouraged by services. However, there is some experiential learning and development required for staff in partner agencies to prevent inappropriate referrals, as there is a high proportion of non-AP and referrals resulting in no further action being submitted. Dynamic and detailed feedback is being provided to partner agencies, including Police and SAS regarding referrals to promote use of the mechanism and encourage continual improvement. Page 115 of 164
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RM/MD/NL/LH Date 05/09/23 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 04: 01/04/2023 to 21/07/2023 From Maria Williamson, (Acting) 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 23 February 2023, and the Integration Joint Board (IJB) approved its Financial Plan on 22 March 2023. The approved Gross Expenditure Budget for the H&SCP – NL (Adult Social Care and Housing) is £253.885m. 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 2023 to 21 July 2023 (Period 04) and includes projected outturn forecasts for the financial year ended 31 March 2024, 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 £253.885m and is currently projecting an underspend of £3.014m. The Social Work capital programme has a total budget of £2.188m and is currently projecting a breakeven position. 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 Item 8 Page 117 of 164
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1.2 2023/24 is the third 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, as well as an adjustment following an update to the Strategic Capital Investment Programme (P&S December 2022 Committee) has resulted in a revised budget of £2.188m, as demonstrated by Appendix 4. 2. Report Revenue: Analysis of Significant Variances 2.1 Within Employee costs, the Service currently anticipates an underspend of £5.037m. This primarily relates to slippage in relation to the recruitment of posts across the Service. 2.2 Property Costs are anticipated to be overspent by £0.177m. This is predominantly due to higher than anticipated spend on Care of Gardens, via the HRA budget, all of which is offset by higher contributions from NLC Housing, shown as income. 2.3 Payments to Other Bodies and Transfer Payments are detailed in Appendix 2. This expenditure accounts for £153.055m of the annual budget and is forecast to have an in-year net overspend of £1.929m (1.3%). This is primarily in relation to the Care at Home sector who provide services to individuals via the SDS commissioning framework. This projected outturn includes a drawdown of £3m from the social care demand reserve as per the IJB strategy to address demand pressures within the 2023/24 Financial Plan. These projections are demand led and are based on full year costs for both current clients and those on the anticipated lists therefore they will alter as the year progresses, updates will be provided in future reports. 2.4 The Service anticipates a total under recovery of income of £0.047m. An over-recovery of £0.150m relates to Care of Gardens as highlighted in section 2.2, partially offset by an under-recovery of £0.197m which is mainly as a result of lower than anticipated income from charges for Community Alarms and Integrated Day Services. Revenue: Earmarked Reserves 2.5 The Integration Joint Board have set aside reserves of £35.766m for specific Adult Social Care commitments. It is anticipated that £25.928m of the earmarked reserves will be used during 2023/24, with £9.838m being carried forward to 2024/25, as highlighted in Appendix 3. All expenditure to be met from reserves are excluded from the outturn position. Capital: Analysis of Significant Variances 2.6 The Integrated Equipment and Adaptation (IEAS) capital programme budget funds equipment for individuals and adaptations to properties to allow those individuals to live independently at home. The projection for 2023/24 is currently a break even position due to demand levels not returning to pre-pandemic levels. 2.7 The programme this year will also include the purchase of equipment to be used by the Equipment and Adaptations Service to wash and disinfect equipment. The costs of this will be offset within the overall council capital programme. 2.8 Following on from the pandemic, there are heightened uncertainties in respect of demand and complexity of need and therefore this budget will continue to be monitored closely and any forecast movements will be highlighted in future reports. Page 118 of 164
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2.9 Appendix 5 outlines 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 4.1 Appendix 1 Revenue – Subjective Analysis 4.2 Appendix 2 Revenue – Payments to Other Bodies & Transfer Payments Analysis 4.3 Appendix 3 Revenue – Status of Earmarked Reserves 4.4 Appendix 4 Capital – Budget Movements 2023/24 4.5 Appendix 5 Capital – Summary Expenditure by Thematic Category Maria Williamson (Acting) Head of Planning, Performance and Quality Assurance Page 119 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 been discussed and agreed with Finance? 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 Finance 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 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 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 ☐ Page 120 of 164
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5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for 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? 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 121 of 164
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5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 122 of 164
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APPENDIX 1 [1] [2] [3] [5] [6] EMPLOYEE COSTS 89,157,711 84,120,706 5,037,005 FAV 5.7% Slippage in relation to recruitment of posts in general across the Service PROPERTY COSTS 2,817,536 2,994,084 (176,548) ADV (6.3%) Higher than anticipated spend on Care of Gardens (Housing) SUPPLIES & SERVICES 5,800,839 5,770,163 30,676 FAV 0.5% TRANSPORT & PLANT 1,790,897 1,770,594 20,303 FAV 1.1% ADMINISTRATION COSTS 1,234,036 1,163,054 70,982 FAV 5.8% Lower than anticipated spend in Carers budgets PAYMENTS TO OTHER BODIES 54,607,989 55,165,572 (557,583) ADV (1.0%) Please refer to Appendix 2 for analysis TRANSFER PAYMENTS 98,446,795 99,818,181 (1,371,386) ADV (1.4%) Please refer to Appendix 2 for analysis CAPITAL FINANCING COSTS 0 0 0 0.0% REVENUE FINANCING COSTS 0 0 0 0.0% OTHER EXPENDITURE 28,858 21,541 7,318 FAV 25.4% Minor underspend in "other" expenditure TOTAL EXPENDITURE 253,884,661 250,823,894 3,060,767 FAV 1.2% NLC CONTRIBUTION (190,726,778) (190,726,778) 0 0.0% NLC CONTRIBUTION - HOUSING (1,945,010) (2,095,010) 150,000 FAV (7.7%) In relation to higher than anticipated spend on Care of Gardens NLC CONTRIBUTION - TRANSPORT (550,737) (550,737) 0 0.0% INCOME FROM HEALTH (55,467,390) (55,452,026) (15,365) ADV 0.0% FEES AND CHARGES (1,428,167) (1,184,575) (243,592) ADV 17.1% Lower than anticipated income in relation to charges for Integrated Day Services and Community Alarms OTHER LOCAL AUTHORITIES (30,000) (30,000) 0 0.0% BUDGETED USE OF IJB RESERVES (3,176,336) (3,176,336) 0 0.0% OTHER INCOME (560,243) (622,089) 61,847 FAV (11.0%) Overrecovery in relation to returned private sectors housing grants INCOME (253,884,661) (253,837,551) (47,110) ADV 0.0% NET EXPENDITURE 0 (3,013,657) 3,013,657 FAV 0.0% [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Subjective Analysis Period 04 (01 April 2023 - 21 July 2023) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % ANALYSIS Page 123 of 164
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APPENDIX 2 [1] [2] [3] [5] [6] SDS Framework 1 & 2 97,732,362 99,087,997 (1,355,635) ADV (1.4%) Demand led activity. Independent Care Homes 44,038,741 45,052,823 (1,014,082) ADV (2.3%) Demand led activity. Payments to NHS Lanarkshire 2,180,713 2,180,712 1 FAV 0.0% Position reflects anticipated in year payments Non Traditional Respite 335,283 214,958 120,325 FAV 35.9% Position reflects anticipated Locality demand Other Local Authorities - General 127,909 79,972 47,937 FAV 37.5% Position reflects anticipated in-year demand Voluntary Organisations 5,548,932 5,450,147 98,785 FAV 1.8% Position reflects anticipated in-year demand Payments to Other Bodies - General 883,330 705,826 177,504 FAV 20.1% Position reflects anticipated in-year demand Housing Support (RSL's) 714,433 730,184 (15,751) ADV (2.2%) Position reflects projected contract levels Locality Flexibility 218,068 214,387 3,681 FAV 1.7% Position reflects anticipated Locality demand Private Sector Housing Grants 1,152,378 891,258 261,120 FAV 22.7% Position reflects anticipated in-year demand Medical Fees 122,635 112,635 10,000 FAV 8.2% Position reflects Service's approach to absence management Agency Fees 0 262,855 (262,855) ADV 0.0% Position reflects anticipated in year payments Other 0 0 0 0.0% TOTAL EXPENDITURE 153,054,784 154,983,753 (1,928,970) ADV (1.3%) [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Payments to Other Bodies & Transfer Payments Analysis Period 04 (01 April 2023 - 21 July 2023) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % ANALYSIS Page 124 of 164
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APPENDIX 3 Contract Monitoring Staff 160,386 79,876 80,510 0 160,386 22/23 Saving: Muirpark 600,000 600,000 0 0 600,000 Carers Act 2018 - Support 2,700,995 957,000 1,743,995 0 2,700,995 Covid Reserve 750,000 750,000 0 0 750,000 Social Care Demand risk 9,536,640 9,536,640 0 0 9,536,640 Tech digitial Improvements 566,400 566,400 0 0 566,400 Violence Against Women (Joint Intiative with SLC) 30,000 30,000 0 0 30,000 Increase Advocacy provider 118,208 88,667 29,541 0 118,208 LSWM post 76,635 76,635 0 0 76,635 Discharge to assess/ PDD 304,345 304,345 0 0 304,345 Adapations Funding 388,315 388,315 0 0 388,315 Tech Improvements - SWIS 700,000 350,000 350,000 0 700,000 Tech Improvements - Comm Alarms 587,932 221,150 366,782 0 587,932 Tech Improvements - Home Scheduling System 3,775,744 1,000,000 2,775,744 0 3,775,744 Adult Protection Contribution 50,000 50,000 0 0 50,000 MH 2 NL10s 188,924 100,000 88,924 0 188,924 Cost of Living Helpline 574,912 274,912 300,000 0 574,912 HS resilience 3,646,000 3,000,000 646,000 0 3,646,000 Local Gov pay award (cost of 2022/23 pay award in 2023/24) 2,830,443 2,830,443 0 0 2,830,443 Staff Training Academy "grow your own" 1,200,000 1,200,000 0 0 1,200,000 Social Worker Regrading 3,169,000 345,892 2,823,108 0 3,169,000 Building Capacity Funding Across The Ip Sector (part of Business Case) The Winter Planning & Enhanced supports Business Case TOTAL 35,766,563 25,928,919 9,837,644 0 35,766,563 NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Status of Earmarked Reserves Period 04 (01 April 2023 - 21 July 2023) Adult Social Care & Housing - INTEGRATED TOTAL CommentsDESCRIPTION OF EARMARKED RESOURCE Approved Reserve Total 2023/24 2024/25 No Longer Required 3,811,684 3,178,644 633,040 0 3,811,684 Page 125 of 164
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APPENDIX 4 Approved budget (5 year Capital Program, commencing 2021/22) 2,200,000 Reprofiling from 2021/22 200,000 Included in opening budget Social Work Key Ambition Integrated equipment & adaptations Acceleration in 2022/23 (11,847) Included in opening budget Social Work Key Ambition Integrated equipment & adaptations Updated Strategic Capital Investment Prg (P&S Dec 2022) (200,000) Included in opening budget Social Work Key Ambition Integrated equipment & adaptations REVISED CAPTIAL BUDGET 2023/24 2,188,153 0 0 0 Theme NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Budget Movements 2023/24 Period 04 (01 April 2023 - 21 July 2023) Social Work Capital Programme BUDGET MOVEMENTS 2023/24 £ Period Division Thematic Category Page 126 of 164
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APPENDIX 5 Social Work: Integrated Equipment and Adaptations 2,188,153 331,828 390,733 1,797,420 2,188,153 0 TOTAL 2,188,153 331,828 390,733 1,797,420 2,188,153 0 UNCOMMITTED FINAL OUTTURN OUTTURN VARIANCE NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Summary Expenditure by Thematic Category Period 04 (01 April 2023 - 21 July 2023) Social Work Capital Programme Theme BUDGET ACTUAL COMMITTED Page 127 of 164
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Sundry Debt Write Off 2023 North Lanarkshire Council Report Does this report require to be approved? ☒ Yes ☐ No Ref DF/PMcA/AB Date 05/09/23 From Diane Fraser, Chief Officer (Adult Social Work Services) E-mail fraserdi@northlan.gov.uk Telephone 01698 332001 Executive Summary The purpose of this report is to present to Committee a summary of outstanding debtor accounts which are deemed uncollectable following all attempts at recovery or are considered uneconomically viable to continue pursuing. In accordance with financial guidelines a bad debt provision has previously been established for the outstanding accounts highlighted below. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Endorse the decision of the Chief Accountable Officer and Head of Financial Solutions under delegated responsibilities to write off £9,013.89 for debts under £500. (2) Approve the write off of £167,917.13 which includes debts greater than £500. (3) Remit this report to Finance & Resources Committee. The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (21) Continue to identify and access opportunities to leverage additional resources to support our ambitions 1. Background 1.1 During 2022/23 the Council issued invoices with the approximate value of £105m. 1.2 Within Adult Health & Social Care there are a number of chargeable services mainly in the following areas: • Home Care Charges • Nursing Home and Residential Home Accommodation Charges • Community Alarms • As well as chargeable services, invoices are raised to other local authorities, health, and universities. Adult Care and Social Work Committee Item 9 Page 129 of 164
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1.3 The value of Adult Health & Social Care invoices raised during 2022/23 was £64m. This figure includes invoices raised to other local authorities, health, and universities (£63m). 1.4 In conjunction with the corporate debt recovery team, every effort is made to recover any unpaid debt including reminder letters, the use of collection agents and legal action. However, despite these steps there are a number of debts that are deemed uncollectible or are considered not economically viable to engage further collection activities and costs. This annual process of assessing the likelihood of debt non- recovery conforms to accepted best accounting practice and is a realistic assessment of expected income. 1.5 The Council will continue to seek collection of the outstanding balance if the circumstances of the debtor alter, and recovery is deemed practical. 2. Report 2.1 Analysis of the outstanding balances has been conducted and £176,931.13. has been identified as uncollectable. 2.2 There are a number of reasons why the outstanding balances are being written off and these are summarised below: • Deceased. The debtor is deceased and there have been insufficient funds within the estate to meet the sum due. • Small Balances/Uneconomic to Pursue. There are insufficient funds or no realisable assets that are available to meet the debt and it is uneconomic to continue to seek recovery of the sum due. • Gone Away. The debtor has moved address and cannot be located. • Recovery exhausted. Despite all efforts the service has now been informed that these accounts will not be recovered. 2.3 The following tables categorise the value of debt recommended for write off by cause and value: Deceased 38 48,882.43 Small Balances/Uneconomic to Pursue 21 5,889.22 Gone Away 0 0 Recovery Exhausted 30 122,159.48 Total 89 176,931.13 Value Analysis < £500 62 9,013.89 > £500 27 167,917.24 Total 89 176,931.13 2.4 The value of accounts identified for write off represents a very small proportion of the accounts raised annually by Adult Health & Social Care. This is reflective of a number Page 130 of 164
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of activities aimed at improving collection rates, reducing debt arising and streamlining the recovery process. 3. Measures of success 3.1 The Service continues to engage in a number of activities aimed at improving collection rates, reducing debt arising and streaming the recovery process. 3.2 These include: • Implementation of Debt Recovery Procedures • Performance Management Reports • Payment Arrangements • Payment by Direct Debit 3.3 The Council will continue to seek collection of the outstanding balance if the circumstances of the debtor alter, and recovery is deemed practical. 4. Supporting documentation n/a Diane Fraser Chief Officer (Adult Social Work Services) Page 131 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 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 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 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 132 of 164
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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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 133 of 164
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Contract Award for Administration Support of Engagement and Participation (Supported People) North Lanarkshire Council Report Does this report require to be approved? ☒ Yes ☐ No Ref: NLC-CPT-23-024 Date: 05/09/23 From Maria Williamson, (Acting) Chief Officer (Planning, Performance and Quality Assurance) E-mail WilliamsonM@Northlan.gov.uk Telephone: 01698 332093 Executive Summary Committee is asked to approve the award of a Contract for Administration Support of Engagement and Participation (Supported People) (the ‘Agreement’) to North Lanarkshire Disability Forum (NLDF). The Agreement is for an initial period of 24 months anticipated to commence on 2 October 2023. The council reserves the right to extend the Agreement for additional periods up to a maximum of a further 12 months. The value of the Agreement is nine hundred thousand Pounds Sterling (£900,000) exclusive of VAT. Recommendations It is recommended that Committee: (1) Approves the award of the Agreement to North Lanarkshire Disability Forum at the value of nine hundred thousand Pounds Sterling (£900,000) exclusive of VAT. The Plan for North Lanarkshire Priority Enhance participation, capacity, and empowerment across our communities Ambition Statement (19) Improve engagement with communities and develop their capacity to help themselves 1. Background 1.1 The requirements of the Agreement have never been contracted before by the council therefore historical information or data is not available. Adult Care and Social Work Committee Item 10 Page 135 of 164
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1.2 Previous reporting outlined our planned approach to strengthen Engagement and Participation (E and P) with supported people. Our intention was to create an active participation and coordination remit, hosted by one lead organisation, which would: • Become the central point for the partnership to route engagement and participation activity. • Strengthen the feedback loop back to the partnership. • Provide representation across key forums. • Co-chair relevant forums/working groups. • Administer small pockets of funding on our behalf, to enhance E&P activity across under- represented groups. This approach was previously approved by Committee on 16th May 2023. 1.3 A consortium led by North Lanarkshire Disability Forum, partnered by Voice of Experience and Lanarkshire Links was the successful bidder. 1.4 The initial intention was to have new arrangements in place from July 2023. Due to procurement timescales and requirements, it is now proposed that a contract with the consortium headed by North Lanarkshire Disability Forum commences on 2nd October 2023. 2. Report 2.1 A group of technical and procurement representatives was formed to develop and agree the procurement strategy for the Agreement to enable the council to achieve maximum benefit for the requirements. 2.2 The initial estimated value of the Agreement dictated that the procurement procedure be undertaken in accordance with the Public Contracts (Scotland) Regulations 2015. An advert for the procurement opportunity was published on the Public Contracts Scotland and the UK Find a Tender (FTS) website. 2.3 The procurement procedure was undertaken as an “Open Procedure”. Invitation to Tender documentation published by the council received a total interest from 6 companies with the council receiving one tender submission. This submission was put forward by a consortium of three organisations, as they felt that offered them the most appropriate approach. Those organisations who initially expressed an interest but did not submit a tender were subsequently contacted so that we could ascertain the reasons why they did not submit. Of the organisations contacted, only one responded, citing that their main lead for developing tenders had been on extended leave and on that basis, they chose not to submit. 2.4 Based on the evaluation criteria and scoring methodology set out in the invitation to tender package within the procurement procedure, an evaluation of tender responses received was completed by members identified by the UIG. Selection stage responses were assessed first and compliant tenderers that satisfied / declared that they met the published minimum selection stage criteria progressed to the award stage evaluation. Following identification of the recommended tenderer(s), their selection stage responses were assessed in more detail to ensure they satisfied the minimum selection stage criteria applied. Page 136 of 164
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2.5 This recommendation to award the Agreement follows the completion of a procurement procedure where the consortium led by North Lanarkshire Disability Forum has been evaluated as demonstrating Best Value for the council. 2.6 Appendix 1 confirms the scoring achieved by the tenderer, further details of the procurement procedure is provided in Appendix 2 and the SME status and location of all tenderers is located within Appendix 3. Financial / Budget Consideration 2.7 The pre-tender wholelife estimate budget for the Agreement was £900,000. Following completion of the procurement procedure, the value of the Agreement to be awarded is nine hundred thousand Pounds Sterling (£900,000) exclusive of VAT. 2.7.1 The costs associated with delivery of the Agreement will be contained within the Revenue budget for Adult Social Work. Price Stability 2.8 Contract is fixed price over a three-year period. This approach enables the Contactor sufficient time to plan and execute activity across the three-year term. Supports recruitment and retention of staff as a three-year contract provides continuity of employment. Community Benefits 2.9 The council is committed to maximising the delivery of community benefits. The procurement included a community benefit requirement, this approach is designed to deliver local community benefits where possible. 2.9.1 Within their tender, North Lanarkshire Disability Forum committed to deliver the following community benefits within the Agreement: Community Benefit Type Quantity Committed Financial Support for a Community Project / Organisation 1 Non-financial Support for a Community Project / Organisation 1 2.9.2 The community benefits delivered as part of the Agreement does not include the creation of jobs or apprenticeships. Fair Work First 2.10 Within their tender submission, North Lanarkshire Disability Forum advised a commitment to the following areas of the Scottish Governments “Fair Work First” initiative: a. Actively encouraging applications from under-represented groups and are a Disability Confident employer, ensuring any person declaring a disability, who meets the minimum requirements for the role will be offered an interview; Page 137 of 164
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b. Are an accredited Living Wage employer in receipt of the Living Wage Employer mark since 2022; c. They have open communication channels such as an Open-Door policy, regular support and supervision, annual appraisals plus regular team meetings; d. Have a structured training and development programme which is reviewed annually and is informed by current service requirements, personal development and any emerging trends in their service provision; e. Promote diversity and equality in the workplace through their Flexible Working policies which include Family Friendly working hours, Flexible working (including hybrid/remote where possible); f. Zero hours contracts are not used within the organisation. Where flexible hours are required, staff are employed on a minimum number of hours, for the length of the contract funding, or permanent contracts. We are committed to supporting our employees to have security of employment and do not utilise fire and rehire policies. Contract Management 2.11 Officers from Quality Assurance, Health and Social Care North Lanarkshire (HSC NL) will be responsible for managing the Agreement, which will be undertaken in accordance with the contract and supplier management conditions applied within the Agreement. 3. Measures of success 3.1 The Agreement will deliver the following outcomes: 3.1.1 Best Value has been demonstrated by North Lanarkshire Disability Forum. 3.1.2 Supported people across the authority area will be able to play as active a part as they choose in helping inform strategy and planning around the type of support and services delivered locally. This includes currently under-represented groups and people that we find it hard to engage. 4. Supporting documents 4.1 Appendix 1 Summary of Tender Evaluation Process 4.2 Appendix 2 Summary of Procurement Process 4.3 Appendix 3 SME Status and Location of All Tenderers Maria Williamson (Acting) Chief Officer, (Planning, Performance and Quality Assurance) Page 138 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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? Accredited Scottish Living Wage Employer and commitments noted at 2.10. EQIA completed. 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 been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Allocation for this award is already accounted for in the budget. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts 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 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 139 of 164
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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? This award will ensure a broad reach to raise awareness and support proactive engagement with people across our communities. It will also enable active participation in shaping service provision. 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 140 of 164
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Appendix 1 – Summary of Tender Evaluation Process Final Rank Tenderer Name Total Tender Score (%) Recommended for Award (Y / N) 1 North Lanarkshire Disability Forum 85.40% Y Page 141 of 164
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Appendix 2 – Summary of Procurement Process Response CPT Contract Reference Allocated: NLC-CPT-23-024 Procurement Procedure Utilised: Open Procedure Governing Legislation / Regulations: Public Contracts (Scotland) Regulations 2015 Date Contract Strategy Approved: 30 June 2023 Tender Platform Utilised: PCS-Tender (PCST) Date Contract Notice Published: 03 July 2023 Total Expressions of Interest Received: 6 SME % of Expressions of Interest: 6 NLC Based % of Expressions of Interest: 3 Tender Return Deadline: 20 July 2023 Number of Tenders Received: 1 Tenders Received from SME’s: 1 Tenders Received from NLC Based Tenderers: 1 Number of Non−compliant Tenders: 0 Number of Compliant Tenders: 1 Number of Recommended Tenderers: 1 Basis of Award: Quality: 70 % Price: 30% Evaluation Team: Officers from Social Work and Corporate Procurement Anticipated Start Date of the Agreement: 02 October 2023 Total Agreement Period (Months): 36 (24 +12) Awarded Value of the Agreement: £900,000 Page 142 of 164
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Appendix 3 – SME Status and location of all Tenderers Name of Tenderer Size of Tendering Organisation (Micro, Small, Medium or Large) Location (Local Authority / Council Area) North Lanarkshire Disability Forum Micro North Lanarkshire Page 143 of 164
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Contract Award for the Supply, Installation, Removal, Servicing and Maintenance of Stairlifts and Hoists North Lanarkshire Council Report Does this report require to be approved? ☒ Yes ☐ No Ref: NLC-CPT-23-007 Date: 05/09/23 From Ross McGuffie, Chief Officer, North Lanarkshire HSCP E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone: Executive Summary Committee is asked to approve the award of a contract for the Supply, Installation, Removal, Servicing and Maintenance of Stairlifts and Hoists (the ‘Agreement’) to; Lot 1 – Handicare Accessibility Limited Lot 2 – Stairlifts (Scotland) Limited The Agreement is for an initial period of 36 months anticipated to commence on 01 October 2023. The council reserves the right to extend the Agreement for additional periods up to a maximum of a further 24 months. The value of the Agreement shall not exceed Twelve Million Pounds Sterling (£12,000,000) exclusive of VAT. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) approves the award of the Agreement to Handicare Accessibility Limited to Lot 1 and Stairlifts (Scotland) Limited to Lot 2 at the maximum value of Twelve Million Pounds Sterling (£12,000,000) exclusive of VAT across both Lots. 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 Adult Care & Social Work Committee Item 11 Page 145 of 164
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1. Background 1.1 Health and Social Care North Lanarkshire provides services to people in their own homes through the Equipment and Adaptations Service which include installation, removal, maintenance and servicing of a range of stairlifts and hoists. The provision and maintenance of this equipment supports Health and Social Care North Lanarkshire’s strategic commissioning intentions to enable its residents to remain within their own homes and live safe, healthy and independent lives in their communities. 1.2 These requirements have been fulfilled through contracts with two independent sector suppliers (Handicare Accessibility Limited and Stairlifts (Scotland) Limited) which expire on 30 September 2023. These contracts have delivered an effective “one stop shop” for service users and efficient recycling and stock management in partnership with North Lanarkshire’s Equipment and Adaptations Service. 1.3 In order to provide continuity of services, Health & Social Care North Lanarkshire instructed North Lanarkshire Council to establish new contractual arrangements to continue the provision of these services. There are two services to be delivered under these contracts: • Lot 1: Supply, Installation, Removal and Servicing and Maintenance of Straight and Curved Stairlifts, Through-the-Floor Lifts and Step-Lifts. • Lot 2: Supply, Installation, Removal, Servicing and Maintenance of Ceiling Track Hoists and Servicing and Maintenance of Portable Hoists and StandAids 1.4 The main objectives of these contracts are to ensure that the provision and servicing of this equipment meets the expectations and demands of service users and meets best value both in quality and price. The contract aims to • Deliver high quality products suitable for the needs of service users which are compliant; • Provide timely and effective servicing and maintenance of products; • Deliver cost-effective asset management and maintenance planning; and • Provide a consistent and reliable service for service users 1.5 The Council has determined from previous contract experience, that a ‘one stop-shop’, one for stairlifts and one for hoists, which includes supply, service and maintenance, was preferable. This arrangement minimises disruption for service users, provides a more responsive service, and avoids any disputes between different suppliers over warranty and service issues, particularly in breakdown situations. Servicing is managed externally by the supplier, saving both time and resource in planning these visits 1.6 Suppliers will also be required to provide efficient recycling and stock management of stairlifts and ceiling track hoists in partnership with the Equipment and Adaptations Service. Removed equipment is stored by the supplier and recycled exclusively for future Health and Social Care orders. This reduces both costs and installation times and enables the service to meet growing demands in a cost-effective way. 1.7 The requirements within the Agreement are currently under contract with Handicare (lot1) and SSL Scotland (Lot 2) This arrangement is due to expire on 30/09/2023 with the Agreement detailed within this report due to supersede it. Page 146 of 164
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2. Report 2.1 A group of technical and procurement representatives was formed to develop and agree the procurement strategy for the Agreement to enable the council to achieve maximum benefit for the requirements. 2.2 The initial estimated value of the Agreement dictated that the procurement procedure be undertaken in accordance with the Public Contracts (Scotland) Regulations 2015 An advert for the procurement opportunity was published on the Public Contracts Scotland and the UK Find a Tender (FTS) website. 2.3 The procurement procedure was undertaken as an “Open Procedure”. Invitation to Tender documentation published by the council received a total interest from 16 companies with the council receiving two tender submissions for Lot 1 and two tender submissions for Lot 2. 2.4 Based on the evaluation criteria and scoring methodology set out in the invitation to tender package within the procurement procedure, an evaluation of tender responses received was completed by members identified by the UIG. Selection stage responses were assessed first and compliant tenderers that satisfied / declared that they met the published minimum selection stage criteria progressed to the award stage evaluation. Following identification of the recommended tenderer(s), their selection stage responses were assessed in more detail to ensure they satisfied the minimum selection stage criteria applied 2.5 This recommendation to award the Agreement follows the completion of a procurement procedure where Handicare Accessibility Limited and Stairlifts (Scotland) Limited have been evaluated as demonstrating Best Value for the council. 2.6 Appendix 1 confirms the scoring achieved by each tenderer, further details of the procurement procedure is provided in Appendix 2 and the SME status and location of all tenderers are located within Appendix 3. Financial / Budget Consideration 2.7 The pre-tender whole life estimate budget for the Agreement was £12,000,000. Following completion of the procurement procedure, the maximum value of the Agreement to be awarded is Twelve Million Pounds Sterling (£12,000,000) exclusive of VAT. 2.9 The costs associated with delivery of the Agreement will be contained within the Revenue and Capital budgets for Health and Social Care. Price Stability 2.10 The prices within the tender will remain fixed until 31 March 2025. Thereafter, the Contractor may adjust the Services Charges from 1 April of each year to reflect increases or decreases in the percentage increase or decrease in the Consumer Prices Index during the previous 12 month period provided that any increase shall be capped at the percentage increase in the Consumer Prices Index in the preceding 12-month period or 4%, whichever is lower. Page 147 of 164
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Community Benefits 2.11 The council is committed to maximising the delivery of community benefits. The procurement included a community benefit requirement, this approach is designed to deliver local community benefits where possible. 2.12 Please refer to Appendix 4 for the Community Benefits secured. 2.13 The community benefits delivered as part of the Agreement does not include the creation of jobs or apprenticeships. Fair Work First 2.14 Within their tender submission, Handicare Accessibility Limited and Stairlifts (Scotland) Limited advised that they will commit to the following areas of the Scottish Governments “Fair Work First” initiative: • Payment of the real Living Wage • Offer flexible and family friendly working practices for all workers. • Action to tackle the gender pay gap and create a more diverse and inclusive workplace. • No inappropriate use of zero-hours contracts • Investment in workforce development • Appropriate channels for effective voice, such as trade union recognition Contract Management 2.15 Officers from the Equipment and Adaptation Service will be responsible for managing the Agreement which will be undertaken in accordance with the contract and supplier management conditions applied within the Agreement. 3. Measures of success The Agreement will deliver the following outcomes. 3.1 Best Value has been considered to be demonstrated by Handicare Accessibility Limited and Stairlifts (Scotland) Limited. 3.2 the appointment of two Contractors who have the experience and capability to deliver. an innovative, high quality and responsive service. 3.3 the contract award procedure is compliant with the procurement legislation and internal. procedures. 3.4 secures a range of community benefits. 3.5 supports payment of the living wage to staff employed in the delivery of the requirements; and 3.6 performance is proactively managed against a number of Key Performance Indicators. Page 148 of 164
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4. Supporting documents 4.1 Appendix 1 Summary of Tender Evaluation Process 4.2 Appendix 2 Summary of Procurement Process 4.3 Appendix 3 SME Status and Location of All Tenderers 4.4 Appendix 4 Community Benefits Ross McGuffie Chief Officer ( Health & Social Care Partnership) Page 149 of 164
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☒ If Yes, have all relevant financial impacts been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Budget implications discussed with finance in the planning of the procurement exercise. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts 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 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 Impac to dataprotection@northlan.gov.uk t Assessment (DPIA) been carried out and e-mailed 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 150 of 164
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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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 151 of 164
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Appendix 1 – Summary of Tender Evaluation Process Lot 1 Final Rank Tenderer Name Total Tender Score (%) Recommended for Award (Y / N) 1 Handicare Accessibility Limited 98.20% Y 2 Stairlifts (Scotland) Limited Non-compliant Lot 2 Final Rank Tenderer Name Total Tender Score (%) Recommended for Award (Y / N) 1 Stairlifts (Scotland) Limited 89.60% Y 2 Prism Medical UK Limited Failed to satisfy selection stage criteria Page 152 of 164
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Appendix 2 – Summary of Procurement Process Response CPT Contract Reference Allocated: NLC-CPT-23-007 Procurement Procedure Utilised: Open Procedure Governing Legislation / Regulations: Public Contracts (Scotland) Regulations 2015 Date Contract Strategy Approved: 28 June 2023 Tender Platform Utilised: PCS-Tender (PCST) Date Contract Notice Published: 28 June 2023 Total Expressions of Interest Received: 15 SME % of Expressions of Interest: 40% NLC Based % of Expressions of Interest: 6.6% Tender Return Deadline: 31 July 2023 Number of Tenders Received: Lot 1 – 2 Lot 2 – 2 Tenders Received from SME’s: 1 Tenders Received from NLC Based Tenderers: 0 Number of Non−compliant Tenders: Lot 1 – 1 Lot 2 – 0 Tenders Excluded at Selection Stage: Lot 1 – 0 Lot 2 – 1 Number of Compliant Tenders: Lot 1 – 1 Lot 2 – 2 Number of Recommended Tenderers: Lot 1 – 1 Lot 2 – 1 Basis of Award: Quality: 60% Price: 40% Evaluation Team: Staff from Adult Care & Social Work Anticipated Start Date of the Agreement: 01 October 2023 Total Agreement Period (Months): 60 Awarded Value of the Agreement: £12,000,000 Page 153 of 164
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Appendix 3 – SME Status and location of all Tenderers Name of Tenderer Size of Tendering Organisation (Micro, Small, Medium or Large) Location (Local Authority / Council Area) Handicare Accessibility Limited Large West Midlands Prism Medical UK Limited Large Wakefield Stairlifts (Scotland) Limited SME Glasgow Page 154 of 164
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Appendix 4 -Community Benefits The two contractors have identified within their offerings a variety of community benefits. Stairlifts (Scotland) Limited have commited to:- Educations, Skills Development & Training • 2x educational visits • 4x workplace visits • 2x work experience placements for individuals aged 14-16 • 2x work experience placements for individuals 16+ years of age Supply Chain Development • 1x business mentoring and advice session for SME or voluntary organisation • 1x business event or briefing. Community Engagement • 2x non-financial support for a community project Handicare have committed to:- Handicare will wherever possible invest in the local community through local recruitment, the use of local sub-contractors and purchases through local supply chain vendors. • Vehicle Fuel – All engineers vans and surveyors’ vehicles local to the area (24 company vehicles based in the region) • Vehicle Maintenance / repairs – local garages will continue to provide servicing & repair of our local fleet vehicles. • provide work experience placements for school leavers • Recruit for engineers / surveyors / management positions via local Job Centres • Advertise positions in local press • Provide apprenticeship positions to local youths or long term unemployed Page 155 of 164
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Contracts awarded below Committee approval threshold North Lanarkshire Council Report No From Chief Officer (Assets and Procurement) Email mckinstryj@northlan.gov.uk Telephone James McKinstry 07939 281102 Executive Summary This report notifies the Committee of the contracts awarded between 1 April 2023 to 30 June 2023. It sets out those contracts awarded with a value below the financial threshold requiring Committee approval. Recommendations It is recommended that the Adult Care and Social Work Committee are: (1) advised of the Contracts awarded below Committee approval threshold between 1 April 2023 to 30 June 2023 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 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 Chief Officer of Assets and Procurement award these contracts on behalf of the appropriate Chief Officer. 1.3 The Chief Officer of Assets and Procurement is required to notify Committee on a regular basis of any such contracts awarded on behalf of Procuring Service Areas. Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ Ref BF/JMcK Date 05/09/23 Item 12 Page 157 of 164
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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 Chief Officer of Assets and Procurement on behalf of the appropriate Chief Officer. 2.3 The contracts awarded by the Chief Officer of Assets and Procurement 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 April 2023 to 30 June 2023 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 (Assets and Procurement) Page 158 of 164
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact 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 been discussed and agreed with Finance? 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 been discussed and agreed with People Resources? 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 been discussed and agreed with Legal and Democratic? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Where Legal impacts have been identified, they have been established and addressed in each specific Contract Strategy and incorporated into the project. Page 159 of 164
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Contracts awarded by the Council are compliant with GCSOs and procurement legislation. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☒ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? All contracts listed have been assessed by the Enterprise Architecture Governance Group (EAGG). 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? 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 ☐ Page 160 of 164
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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. Contract award procedures may be susceptible to legal challenge if they are not discharged in accordance with GCSO and procurement legislation. 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. 5.11 Children’s rights and wellbeing impact Does the report contain any information regarding any council activity, service delivery, policy, or plan that has an impact on children and young people up to the age of 18, or on a specific group of these? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact and the provision that has been made to ensure there has been appropriate consideration of the relevant Articles from the United Nations Convention on the Rights of the Child (UNCRC). If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 161 of 164
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APPENDIX 1 – SUMMARY OF BELOW THRESHOLD CONTRACT AWARDS Contract Description/Ref Contract Award Date Contract Start Date Contract End Date Contract Extension Contract Value (inc extension) (£s) Successful Tenderer Supplies Services Works No of Tenders Received Route* Dementia - Post-diagnostic support for carers 20/04/2023 01/06/2023 31/03/2025 N/A £498,000.00 Alzheimer’s Scotland Services 1 *N Direct Award of Vehicles for Health and Social Care 15/05/2023 15/05/2023 30/06/2023 N/A £499,990.55 Suzuki GB PLC Supplies 1 **DAF3 *Contract awarded via the use of the Negotiated Tendering Procedure in terms of quality and cost of service provision. **Direct Award from the Crown Commercial Services RM6244 Standard & Specialist Vehicles Multi-Supplier Framework, Lot 1 - Purchase of Passenger Cars to best value provider. Key – Procurement Route CO - Contract Open Procedure CR - Contract Restricted Procedure FO - Framework Open Procedure FR - Framework Restricted Procedure FMCC - Mini Comp Council Framework FMC3 - Mini Comp 3rd Party Framework DAFC - Direct Award Council Framework Page 162 of 164
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DAF3 - Direct Award 3rd Party Framework DAH&SC - Direct Award Health & Social Care Related Services N - Negotiated Contract EXT - Extension to Contract/Framework Page 163 of 164
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