Agenda Document Pack - Adult Care and Social Work Committee - 20/02/2024
North Lanarkshire Council · 20 February 2024
Back to Adult Care and Social Work Committee — 20 February 2024 and its agenda
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9 February 2024 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, 20 February 2024 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, T Carragher, K Docherty, W Goldie, L Jarvie, J Jones, 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 100
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Agenda 1 Declarations of Interest In Terms of the Ethical Standards In Public Life Etc. (Scotland) Act 2000 Operational 2 Assistive Technology Submit report by the Interim Chief Officer (Adult Social Work) providing an update on the new assistive technology team within North Lanarkshire Health and Social Care Partnership 5 - 10 3 Mental Health and Wellbeing Delivery Plan Submit report by the Chief Officer (Health and Social Care) providing an update on the delivery of Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire 11 - 24 4 Whole System Winter Planning 2023/24 Submit report by the Chief Officer (Health and Social Care Partnership) providing an update and confirming support for the winter planning arrangements within Health and Social Care Services 25 - 60 5 Winter Resilience Submit report by the Chief Officer (Health and Social Care Partnership) providing an update on the current winter resilience in place throughout the Health and Social Care Service 61 - 68 Performance 6 Annual Performance Report 2022/23 - Health and Social Care North Lanarkshire Submit report by the Chief Officer Health and Social Care providing an update on the performance of key areas of activity within Adult Health and Social Care for the period 1 July 2023 to 30 September 2023 69 - 78 Financial Page 3 of 100
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7 Revenue and Capital Budget Monitoring Report - Adult Social Care - Period 10 1 April 2023 to 5 January 2024 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) providing a summary of the revenue financial performance of the Health and Social Care Partnership (H&SCP) - North Lanarkshire and the financial performance of the Social Work capital programme for Period 10 79 - 90 Contracts 8 Contract Award Report Distress Brief Intervention Submit report by the Chief Officer (Health and Social Care Partnership) seeking approval to award a contract for a Pan Lanarkshire Distress Brief Intervention Service (DBI) 91 - 100 Page 4 of 100
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RT/GC/HH Date 20/02/24 Assistive Technology From Raymond Taylor, Chief Officer Adult Social Work (Interim) E-mail taylorr@northlan.gov.uk Telephone 01698 332001 1. Background 1.1. Following The guidance of the Scottish Government and COSLA (Convention of Scottish Local Authorities) North Lanarkshire Council have been working to meet the expectations of the new digital strategy for Scotland “A changing nation: how Scotland will thrive in a digital world.” This has resulted in the partnership’s dedication to getting the right support to the right people in the right way. There is a focus on wellbeing and an acceptance that exclusion from the digital world can increase isolation and limit our life chances. As a result of changing demographics, pressures on existing services and budget restraints it was recognised that a team was required to support the necessary steps to enhance and safeguard wellbeing through digital technology as well as making Executive Summary This report provides an update on the new assistive technology team within North Lanarkshire Health and Social Care Partnership and its impact since inception and aims going forward. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Endorse the progress of the new assistive technology team to date. (2) Endorse the progress on promotion of digital services by the team. (3) Endorse the uptake in technology and increase in engagement. 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 Programme of Work Resilient People Item 2 Page 5 of 100
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sure the most vulnerable people that we support have the skills, connectivity, and devices to participate in a digital nation. 1.2 North Lanarkshire Health and Social Care Partnership agreed an innovative approach and wanted to accelerate their approach of using assistive technology solutions to support people differently. The Assistive Technology Team (ATT) was created in January 2023. The new ATT consists of a Senior Officer, 4 Resource Workers and 8 Technology Support Assistants. The ethos of the team is to ‘Think Tech First’ and the ambition is to promote the use of assistive technology to improve quality, delivery, and safety in care planning across the partnership. Assistive Technology is at the forefront of the Strategic Commissioning Plan 2023-2026 and is integral to achieving better outcomes for people to maximise their independence and safety. The Team is based in the Dalziel Building, Motherwell with regular presence in localities. 2. Report Aims and Progress 2.1 In accordance with ‘Care in the Digital Age’ the team aims to deliver new digital solutions to support the national priorities around proactive and preventative care. The team are embedded within social work localities and work alongside the community alarm service, access social work, community care teams, reablement and intensive home support, Home Assessment Team (HAT), Integrated Day Services, Locality Support Services, Community Mental Health Team, Integrated Rehabilitation teams and third sector agencies. Since the inception of the new assistive technology team, work has been ongoing to increase awareness, knowledge, and uptake of digital solutions. 2.2 Digital solutions are becoming more accessible and increasing in variety and as a result can be utilised to enhance current service delivery models. The aim of the ATT is to ensure staff, people, carers, and families feel confident in the use of digital solutions to improve and enhance the delivery of care and support. Since February 2023 746 referrals have been received by the team. The following sections of the report provide some examples of the work the ATT team has been involved in. 2.3 A Komp test of change, funded by National Services Scotland began in March 2023. The Komp itself is a large self-standing screen with one button that turns it on and off. It is self-answering following a ten second count down. The Komp is accompanied with a separate application that allows service users families and friends to connect to the device. It is very user friendly. The simplicity of the device makes it a more inclusive option for those requiring support. We currently have 14 Komp devices available for trial in supporting people in our communities - currently four of these are to facilitate medication prompting and in one case this has removed the need for any home care visits. A further four have been deployed to minimise social isolation through daily contact with family and friends. Five service users have self-purchased devices after their initial trial period as they had been so successful in reducing isolation or removing the need for medical prompt visits from home support or family members. 2.4 The Team has tested and identified suitable GPS devices – pendants, wrist worn and an in-shoe device that are now being assessed and issued to service users. The team has issued nineteen devices to service users which have proven to be successful in providing assurance to family members / carers regarding their safety and wellbeing. The team regularly monitors their use to ensure they are being used. Page 6 of 100
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2.5 We have recently relocated the assistive technology flat to a new build property in Bellshill. The property is used to highlight technology solutions and facilitate training to staff groups across the partnership and council. Visits to the facility have continued to increase since the ATT have been in place, and the new location has received positive feedback from both service users and staff. The technology flat offers the opportunity to see technology in use and the ways in which it can promote independence and enhance quality of life. Engagement with the technology flat is now recognised as an integral part of induction processes for new members of staff across health and social work. To date over eighty-five training sessions have been undertaken in the flats for internal teams and twenty-five with external agencies. The technology flat is also a platform to compliment and promote North Lanarkshire Council’s self-management platform, Making Life Easier (MLE) which allows individuals to access information, professional advice and direct access to services and support. There has been a noted increase in individuals self-purchasing technology following visits to the Assistive Technology Flat, with the ATT team assisting individuals to set up newly purchased devices. Key Issues and future developments 2.6 The team continues to engage with community and voluntary sector groups to identify their needs in relation to assistive technologies. Engagement with North Lanarkshire Community Connectors has been undertaken to promote technology within their operational spaces. 2.7 Development work continues with Making Life Easier (www.makinglifeeasier.org.uk/) to allow members of the public to self-assess for possible technology solutions. 2.8 Further plans include working with colleagues from the Sensory Impairment Team to design a specific area in the assistive technology flat to highlight and demonstrate the solutions they can provide. 2.9 Embedding technology into routine assessment and planning activity across health and social car: • Using technology "experts" throughout all aspects of assessment and planning and review processes • Promotion of technology at the earliest possible opportunity in a person’s assessment and throughout their journey • Working with the home support service to promote assistive technology in supporting hospital discharge. • Continue to develop a training suite in the use of technology and how this can be used to support people living in North Lanarkshire. 2.10 The use of technology is now considered as part of all assessment and planning activity within health and social care. This includes technology solutions being part of conversations with service users whose circumstances and needs have changes and require their current support to be reviewed. There are challenges in ensuring staff have the confidence and skills to lead this approach and also to ensure individuals and their carers and families are supportive of such innovations However, through ongoing awareness-raising activities, training opportunities for staff and the use of the technology flat, the team is ensuring that all solutions are person-centred and appropriate for their needs. Page 7 of 100
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3. Measures of success 3.1 In 12 months, the Assistive Technology Team has made a considerable impact on assessment and planning and to the outcomes of people supported by the partnership. The team have been well received by all services and they are now embedded across teams. 3.3 The team continue to evolve and develop whilst responding to the challenges faced by the partnership as well as the fast-paced developments in the technology sector. The Team continues to engage with suppliers and professionals to ensure new technologies and developments are considered for use within the partnership where appropriate. 4. Supporting documentation 4.1 Appendix 1 Care in the Digital Age: Delivery Plan 2023-24 https://www.gov.scot/publications/care-digital-age-delivery-plan-2023-24/ 4.2 Appendix 2 Scotland Digital Health and Care Strategy https://www.gov.scot/publications/scotlands-digital-health-care-strategy/ Raymond Taylor Acting Chief Officer / Head of Service (Adult Social Work Services) Page 8 of 100
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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? An Equalities Impact Assessment was carried out when the team was established and is publicly available. 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 ☒ Finance have not reviewed this current paper; however, finance have been consulted throughout the life of the project and are currently members of the analogue to digital board. 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 Page 9 of 100
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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? The technology solutions provided by the approach in the paper are all in line with the Council’s wider Digital Programme of Work 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 10 of 100
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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 Date 20/02/24 Mental Health and Wellbeing Delivery Plan From Ross McGuffie, Chief Officer, University Health & Social Partnership NL E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 752 591 1 Background 1.1 Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire was launched in October 2019 to provide a shared vision and to drive significant shifts in culture (how we see and treat mental health and physical health), focussing on earlier intervention and prevention as well as the redesign and reconfiguration of services and development of new services. 1.2 The scope of the Strategy is not just about the mental health services delivered by the NHS, Integration Boards and Local Authorities deliver but understanding how we, along with our wider community planning partners and society, contribute to the mental health and wellbeing of the people of Lanarkshire. Executive Summary The purpose of this report is to provide an update to the Committee on the delivery of Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, 2019-2024 and to inform the Committee of plans to develop a Delivery Plan to implement the new national Mental Health and Wellbeing Strategy in Lanarkshire. Recommendations It is recommended that the Adult Care and Social Work Committee (1) Note the content of the report and endorse the approach. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (24) Review and design services around people, communities, and shared resources Programme of Work Resilient People Item 3 Page 11 of 100
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1.3 The joint strategic aims, aligned with partner organisations, of Getting It Right for Every Person (GIRFEP), a Mental Health and Wellbeing Strategy for Lanarkshire, are to: • Improve healthcare and wellbeing. • Strengthen effective leadership and governance for mental health services across all sectors. • Reduce health inequalities and improve health and healthy life expectancy. • Support people to live independently at home through integrated health and social care services. • Provide comprehensive, integrated and responsive mental health and social care services and supports in community-based settings; and • Support all children and young people to live as full and healthy a life as possible and to realise their full potential. 1.4 The aspiration set out in the Strategy is that people in Lanarkshire live in a community where everyone understands that there is no good health without mental wellbeing, where we know how to support and improve our own and others’ mental well-being and act on that knowledge, and where our mental well-being contributes to a healthier, wealthier, fairer, smarter, greener and safer Lanarkshire for all. 1.5 There are 4 main workstreams within the Programme: • Good Mental Health for All • Improving Access to Mental Health Support and Services • Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans • Specialist Mental Health Services 1.6 The Mental Health and Wellbeing Strategy Board and most project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 1.7 Over the course of 2022, we were able to look forward, endeavouring to take advantage of the opportunities and experiences of working in different ways. All workstreams reviewed their delivery plans to ensure that they took account of the impact of Covid-19; build on our recovery plans and the new ways of working that have developed over the course of the pandemic; whilst retaining a focus on the vision and objectives set out in the original Lanarkshire Mental Health and Wellbeing Strategy. 1.8 This report outlines the progress that has been made across all Strategy workstreams and sets out our plans to develop a Mental Health and Wellbeing Delivery Plan for Lanarkshire aligned to Scotland’s Mental Health and Wellbeing, the new national Mental Health and Wellbeing Strategy launched in 2023 by COSLA and the Scottish Government. 1.9 The achievements of the MHWS 2019-2024 have been comprehensive, however a sustained whole system approach to improving the mental health and wellbeing of the population is required. Our commitment to all stakeholders will continue to in 2024 co- create our Mental Health and Wellbeing (MHW) priorities alongside all Community Planning Partners to reflect a Plan to tackle the key challenges impacting upon population mental health and wellbeing. Page 12 of 100
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Next Steps: • Ensure alignment with the recently published Scottish Government/COSLA Mental Health and Wellbeing Strategy (June 2023) and associated evidence-based documents. • Undertake a self-assessment against the Scottish Government/COSLA Mental Health and Wellbeing Strategy Delivery Plan (Nov 2023) • Based on our self-assessment we will co-create our Lanarkshire MHW Delivery Plan 2024 – 2026 • To reinforce our whole system approach to workforce requirements and developments across MHW, we must develop our local thinking to align to the Scottish Government/COSLA Mental Health and Wellbeing Workforce Action Plan to ensure we have a diverse, skilled, supported and sustainable workforce across all sectors. 2 Report 2.1 The key achievements over the lifetime of the current Strategy are set out below. Good Mental Health for All 2.2 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. 2.3 The Covid 19 Pandemic was stressful for many and threw a spotlight on the relationship between mental and physical health. The impact was not experienced equitably. Those least able to draw on protective factors (good health; financial wellbeing; affordable housing; employment; being able to work from home; support home schooling) were less equipped to deal with the impact. It exacerbated long-standing inequalities in being able to thrive in the face of adversity. 2.4 The longer-term impact of the pandemic is likely to widen these inequalities further unless significant action is taken. This has taken on a new urgency with the emerging cost of living crisis, compounding the threat and further widening the gap. 2.5 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 2.6 The Good Mental Health for All Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Health Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and Common Mental Health Problems. 2.7 Key highlights include: 2.7.1 Promoting a confident, diverse and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention. 2.7.2 Promoting a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports. 2.7.3 Delivering a programme of work to tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require. Page 13 of 100
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2.7.4 Driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together. 2.7.5 Improving access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund 2.7.6 Delivering an annual Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them. 2.7.7 Exploring robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. Improving Access to Mental Health Supports and Services 2.8 This workstream has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and through the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy, 2017. 2.9 Action 15 of the Scottish Government’s Mental Health Strategy 2017-2027 aims to increase the workforce to give access to dedicated mental health professionals to all A&Es, all GP practices, every police station custody suite, and to our prisons. Action 15 received investment of over £35m from the Scottish Government with the aim of recruiting an additional 800 mental health workers across these key settings in Scotland. This action is part of the Scottish Government’s approach to mental health from 2017 to 2027, which is a 10-year vision. The government aims to provide access to the most effective and safe care and treatment for mental health problems across Scotland, meeting the same level of ambition as for physical health problems. 2.10 Primary Care Mental Health & Wellbeing Teams 2.10.1 The PCMHW model developed with Mental Health Liaison Nurses is now covering all 91 GP practices, supported by Lanarkshire Association of Mental Health (LAMH) Mental Health and Wellbeing Workers providing a non-clinical role. 2.10.2 Assessment Plus CBT based guided self-help intervention is now providing guided self- help intervention in 3 localities. 2.10.3 A Task and Finish Group has now been established to: - review the current Primary Care Mental Health (PCMH) service model to learn from our experience to date and ensure we make the most effective and efficient use of resources to provide a central point of referral for self & practitioner referrals of people experiencing mild to moderate mental health problems and divert patients from GP practice. - enhance and develop standard internal referral processes between the PCMH service, Primary Care Occupational Therapy and Community Link Worker programmes, Community Mental Health Teams, Mental Health Flow Navigation Centre & Community Addiction Services. 2.11 Transforming Mental Health in Emergency Departments (ED) 2.11.1 Flow Navigation Centre is now fully established in-hours providing an alternative to Emergency Department triage for a mental health assessment, supporting more people to be assessed at home or in the community. Page 14 of 100
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2.11.2 Direct links with the Psychiatric Liaison Nurse Service for Community Police Triage and Scottish Ambulance Service triage fully established in hours via the Flow Navigation Centre and Out-of-Hours at Douglas Street. Expanded in November 2021 to include British Transport Police. 2.11.3 Out-of-Hours service expanded and fully embedded. Patients triaged and assessed via telephone, virtual platform, or face-to-face. 2.11.4 Mental Health Advanced Nurse Practitioners now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. 2.11.5 Overall reduction of 68% in police attendance at Emergency Departments. 2.12 Custody Suites 2.12.1 We set out to develop a range of new ways of working within Custody Suites to deliver person centred, safe and clinically effective healthcare for people detained in Police custody across the 4 Lanarkshire Custody Suites. We also aimed to develop a new Mental Health and Wellbeing Team staffing model, aligned to the Unscheduled Care Team, the Primary Care Team, and the Community Mental Health Teams who will continue to provide care for the most unwell people who need specialist input. 2.12.2 Two Advanced Nurse Practitioners have been recruited through Action 15 funding in place and are providing a valuable mental health assessment resource to support people who present with mental health needs when detained for any period. Feedback has been positive. 2.13 Prisoner Mental Health 2.13.1 A Mental health Multi-Disciplinary Team staffing model for Shotts Prison has been developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. 2.13.2 Prisoner population of HMP Shotts now has improved access to a wider range of mental health services – in particular, psychological therapies and health improvement – through a match-stepped model of care. 2.14 Digital Solutions 2.14.1 Digital solutions explored to help provide services in new ways that make them more accessible and enhance patients’ experience. 2.14.2 Near Me is well-used, with CAMHS, Psychology, and Psychiatry the top 3 users of the system. 2.14.3 MORSE transition completed for all previous Midis users. Work remains underway for migration of remaining services. 2.14.4 Successful collaboration with Connecting Scotland to provide devices and support to service users. 2.14.5 Digital champions identified. Children and Young Peoples Mental Health and Wellbeing 2.15 Child and Adolescent Mental Health Services and Neurodevelopmental Services Page 15 of 100
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2.15.1 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services (CAMHS) and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). 2.15.2 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by the more complex mental health problems, moving early intervention support to the Schools Counselling Model, Schools Nursing and the Community Wellbeing Framework. 2.15.3 In January 2021, the Specialist Children’s Health Services Unit (SCHSU) was formed bringing a centralised approach to the operational delivery of children’s specialist health services across Lanarkshire. In April 2021, Health and Social Care North Lanarkshire received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 2.15.4 Major achievements include: • Choices and Partnership Approach (CAPA) embedded into CAMHS. • Waiting list initiative has supported a significant improvement in performance, with waits reduced from ~2,000 to under 400 and performance improved from under 30% against the Referral to Treatment Time target to over 70% at December 2023. • Recruiting and retaining staff who can provide the level of expertise required to enable us to deliver the national CAMHS specification fully by March 2026. • Putting in place an electronic documentation system that will ensure children and young people who use CAMHS are visible across the system. • New South Lanarkshire CAMHS facility within Udston Hospital, supporting CAMHS, the eating disorders team and the Neurodevelopmental Service opened to patients on 5th September 2022 and now fully operational. • Refurbishment of Airbles Road and Coathill CAMHS outpatient and staff base underway to bring North Lanarkshire estate to same standard. • Neurodevelopmental Service (NDS) Steering Group established to oversee development of the service and implement the NDS service specification for children and young people by March 2026. • Neurodevelopment Service funded establishment has more than doubled, with now enough capacity in place to meet monthly demand, though work is still required to continue to reduce the waiting list. 2.16 Children and Young People’s Community Mental Health and Wellbeing Support and Services 2.16.1 Delivering improvements for children and young people’s mental health and wellbeing is embedded in the North and South Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Robust progress has been made in offering a range of programmes of work with a focus on prevention/early intervention and promoting positive mental health and resilience. All practice is underpinned by The Promise, GIRFEC and UNCRC approaches. Page 16 of 100
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2.16.2 Funding from the National Children and Young People’s Mental Health and Wellbeing Programme is being provided for the delivery of community mental health and wellbeing supports and services for children and young people. This is to support the development and provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government is clear that funding is to be used for new or enhanced services. Project officers have been recruited by both local authorities and gap analysis, benchmarking and co-production of services has been undertaken. 2.16.3 A range of services have been developed at universal and additional levels which complement and value to other service preventative services which address the children’s and young people’s wellbeing, examples include: 2.16.4 Key achievements in North Lanarkshire • Living Life to the Full – provided by NLC Community Learning & Development • Family support for children impacted by neurodevelopmental difficulties – provided by Carers Together • LIAM (Let’s Introduce Anxiety Management) – Educational Psychology • Mentoring through sport – Active and Creative Communities • Support and services commissioned by through Empowering Clusters, through the community solutions approach, based on local need. • Pilot of family wellbeing practitioners based on cluster to divert referrals from CAMHS – Education and Families • Intensive Support for care experienced young people who have left care – Education and Families • Implementation of a digital mental health and wellbeing platform, Kooth, which has now launched and is available for children and young people aged 10-18 years (up to 26 for care experienced young people). Specialist Mental Health Services 2.17 Key achievements include: 2.17.1 Dedicated specialised Community Perinatal Mental Health Team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. 2.17.2 Multi-agency, multi-disciplinary Infant Mental Health team established. 2.17.3 Maternity and Neonatal Psychological Interventions Service established. 2.17.4 Review of Adult Rehabilitation Services completed. New referral form in place with a single point of referral; pathway to community rehab now live; planned date of discharge in place; new Community Rehabilitation Team nursing model embedded in practice; new Rehabilitation & Recovery Service Operational Policy in place. 2.17.5 South Lanarkshire Community Mental Health Team (CMHT) funding and staff transferred from the previous hosted arrangements with North Lanarkshire to enable integration of Community Mental Health services within South Lanarkshire HSCP. 2.17.6 Scottish Government funding for Dementia Post Diagnostic Support (PDS) Services utilised to create a single dedicated PDS service that focuses on those individuals not requiring secondary care input of an Older Adult CMHT. Page 17 of 100
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2.17.7 Adult Autism Assessment Service established as Phase 1 of a wider Adult Neurodevelopmental Pathway. Scotland’s Mental Health and Wellbeing 2.18 The new national Mental Health and Wellbeing Strategy recognises mental health as a cross-government priority, building on the partnership between the Scottish and Local Governments. 2.19 It recognises that underlying factors, inequalities and types of disadvantages affect certain groups of people who may suffer disproportionate impacts on their mental health. 2.20 We know that mental health does not just mean mental illness; it is a continuum that may include a range of needs, from having the right words to describe how we feel, through to everyday worries and feelings of distress or hopelessness. We must ensure that the right help is always available to those who experience severe and enduring mental health conditions and provide the wider support people may need to maintain good mental health. 2.21 In publishing the Strategy, the Scottish Government and COSLA acknowledge that all areas of Government will need to work together to achieve our shared vision and to make progress towards our outcomes, which are outlined below. The Strategy sets out a vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. 2.22 The Strategy describes a whole system model which very much aligns with the Lanarkshire Mental Health and Wellbeing Strategy 2.23 The Strategy sets out the following outcomes: • Improved overall mental wellbeing and reduced inequalities. • Improved quality of life for people with mental health conditions, free from stigma and discrimination • Improved knowledge and understanding of mental health and wellbeing and how to access appropriate support. • Better equipped communities to support people’s mental health and wellbeing and provide opportunities to connect with others. Page 18 of 100
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• More effective cross-policy action to address the wide-ranging factors that impact people’s mental health and wellbeing. • Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. • Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. • Better access to and use of evidence and data in policy and practice. • A diverse, skilled, supported and sustainable workforce across all sectors 2.24 It also identifies ten priorities which provide the structure for the first national Delivery Plan for 2023-25: 2.24.1 Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. 2.24.2 Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. 2.24.3 Better access to and use of evidence and data in policy and practice. 2.24.4 A diverse, skilled, supported and sustainable workforce across all sectors. 2.24.5 Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk. 2.24.6 Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies. 2.24.7 Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery. 2.24.8 Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk. 2.24.9 Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies. 2.23.10 Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery. 2.25 Given the close alignment between the Lanarkshire and national strategies, the Integration Joint Board has agreed that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire Delivery Plan, aligned to the actions set out in the national Delivery Plan, by Summer 2024. The timeline for this is set out in Appendix 1. Page 19 of 100
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3 Measures of success 3.1 An outcomes-focused Achievement Framework was developed (Appendix 2) for the Mental Health and Wellbeing Strategy that links the contributions made by projects and workstreams to outputs and the achievement of short- and long-term outcomes. 3.2 We noted in our strategy that as GIRFEP was implemented, people in Lanarkshire would see campaigns to promote ways of improving our mental wellbeing, changes and improvements to the way they access mental health support and services, new ways of working, observe new staff roles, a programme of work to tackle mental health stigma and discrimination, increased interventions to support prevention and early intervention as well as every effort to improve services for people with severe and enduring mental health conditions. 3.3 Ultimately, the strategy set out with an ambition to change the culture in Lanarkshire and improve people’s physical wellbeing and mental health. A final report is currently being developed to report on outcomes achieved over the period of the strategy. 3.4 A monitoring and evaluation framework is being developed to accompany the new national Strategy. This will set out how progress towards the outcomes will be measured. It will also take account of existing indicators and standards currently under development. 4. Supporting documentation 4.1 Appendix 1 Mental Health & Wellbeing Strategy Review and Refresh – Timeline 4.2 Appendix 2 Lanarkshire Mental Health and Wellbeing Strategy Achievement Framework. 4.3 Appendix 3 Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, 2019-23 4.4 Appendix 4 Scotland’s Mental Health and Wellbeing 4.5 Appendix 5 Mental Health and Wellbeing Delivery Plan, 2023-25 Ross McGuffie Chief Officer, University Health & Social Partnership NL Page 20 of 100
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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 21 of 100
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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 22 of 100
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Appendix 1 Mental Health & Wellbeing Strategy Review and Refresh – Timeline Page 23 of 100
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Appendix 2 Lanarkshire Mental Health and Wellbeing Strategy Achievement Framework Page 24 of 100
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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 Date 20/02/24 Whole System Winter Planning 2023/2024 From Ross McGuffie , Chief Officer North HSCP E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 752591 1. Background 1.1 Annual ‘whole system’ planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Executive Summary This paper is coming to the Committee to provide an update on and confirm support for the planning arrangements being put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months – with particular recognition of the uncertainties and potential impacts that still remain relating to inclement weather, Covid 19, influenza, financial pressures, cost of living issues and other concurrent risks against the backdrop of major pre-existing system-wide pressures. This paper has been prepared by the multi-agency, multi-disciplinary winter planning group alongside the key action areas of Operation Flow 2. It has been presented to the NHS Lanarkshire Board and reviewed by PPRC and NL H&SCP SLT. Recommendations It is recommended that the Committee. (1) Acknowledge the extensive planning undertaken to date; the range of ‘early warning systems’ in place to seek to identify any issues and mitigate accordingly; and the variability of a series of scenarios which mean that the winter plan will require to be constantly reviewed and flexed to meet any emergent issues. 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 Programme of Work Resilient People Item 4 Page 25 of 100
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Lanarkshire Health and Social Care system – in common with that across Scotland - continues to face significant challenges. Last winter, health and social care services and staff had to contend with some of the most extreme winter pressures ever known, many of which continue to be issues for the system. 1.2 Planning for Winter 2023/24 commenced in August 2023 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). 1.3 Given the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as – and should be understood to be - a dynamic plan and one that is highly likely to be subject to change over the coming months. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific exercise was undertaken on 9 November 2023 to test system-wide planning. 1.4 Additionally, work undertaken last year by NHS Lanarkshire to take account of the increasingly likely eventuality of a number of concurrent risks which may well align to create increased system pressure has also been utilised as part of the wider winter planning process. These risks include, inter alia, further waves of Covid 19; increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages in all sectors and grades across the Health and Social Care sector; public health impact of cost of living crisis/fuel costs and subsequent demand on health and care services; inclement weather and available finances. 2. Report National Guidance / Scottish Government Correspondence 2.1 On 22 August 2023, Scottish Government hosted a national Winter Resilience event which highlighted a range of examples of good practice that could be considered as part of winter planning. The vast majority of these examples related to supporting good system flow all year round and many are already in place in a Lanarkshire context. There was however learning from the event which has been built into the Lanarkshire plan for 2023/24, including areas of work associated with system flow and support for additional care in a community context, thereby reducing reliance on hospital care. 2.2 A self-assessment relating to preparing for winter was also undertaken by the multi- agency group and duly submitted to Scottish Government on 22 September 2023. 2.3 National guidance was subsequently published on 24 October 2023 which set out the national expectations for those areas that local winter plans would be expected to address. 2.4 At the winter planning meeting of 17 November 2023, colleagues from Public Health Scotland shared a set of data on anticipated additional bed pressures on the basis of current/anticipated demand associated with prevalence of influenza, Covid and other respiratory illness as currently predicted. In turn, this will be monitored to capture any revisions and also sets a useful indication of the additional beds that may be required to support the system at peak periods. Page 26 of 100
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2.5 Some funding has been made available centrally in 2023/24 to support winter planning as well as some monies managed internally as part of the respective financial plans to anticipate winter pressures. Following discussion between the NHS Lanarkshire Director of Finance, the two Chief Financial Officers of the IJBs and Council Finance colleagues, funding to manage the impact of winter and ongoing pressures has been identified and further detail is set out at item 5 below. Approach to Winter Planning 2023/24 2.6 Whilst the winter plan will be a Lanarkshire wide plan, it is being structured in two main parts for 2023/24. This is to recognise the significant work underway currently as part of Operation Flow 2 – which is aimed at maximising flow through acute hospitals and associated care pathways. Continuation and emphasis of particular aspects of this work will form the basis of the winter planning for acute hospital services. 2.7 All other aspects of the Lanarkshire wide winter plan will be undertaken in the normal way via the multi-sectorial/multi-agency winter planning group. Representation from acute services/Operation Flow forms part of the wider group to ensure all necessary synergies are recognised and planning is appropriately integrated. 2.8 As well as the national guidance referred to at 3.4, there was also a debrief of the winter plan for 2022/23 and this also features as part of the planning for winter 2023/24. Acute Services/Unscheduled Care Winter Planning through Operation Flow 2 – including ‘power up’. 2.9 A system wide Operation Flow Pause Event was held on 29 September 2023 with managerial, operational and clinical leaders from across the system. The objective of the session was to provide space and time to consider if the plan aligned with needs, informed by learning from the peer review visit from colleagues from NHS Tayside. This included reassessing and confirming that the plan has the capability to deliver a better Winter for both patients and staff. 2.10 To enhance patient safety and staff well-being, the three priority areas agreed as continuing to underpin Operation Flow were noted to be: • Managing Demand across our system • Maintaining a positive admission and discharge balance • Maximising Outflow 2.11 Creating the right conditions for the success of the winter plan is essential. Consequently, preparation has included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation. System readiness is also underpinned by the delivery and implementation of the detail of the site and HSCP level improvement plans. This focused preparation period – ‘Power up’ – has ran through the month of October. 2.12 The actions that have been progressed to support Power up have included: 2.12.1 Testing the REACT processes as part of the new Front Door Target Operating Model to increase streaming of patients to the right part of the system in UHH and UHW. The Page 27 of 100
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testing has helped to ensure that processes are tested and staff confidence is increased prior to Go Live. 2.12.2 Maximise the availability of Senior Clinical Decision Maker in the Flow Navigation Centre as part of the new care model to support direction of patients to the right place and at the right time. The new care model was launched on 1 November 2023. 2.12.3 Increase ‘Near me’ consultation and ‘Call before you Convey’ between Hospital @ Home and SAS to increase efficiency and capacity within the service. 2.12.4 Completing the bed base modelling for UHW and UHH sites to inform future planning and consideration of reconfiguration of the bed base to manage demand. 2.12.5 Undertaking focused improvement work within Medicine for Older Adults – UHW to maximise flow across the acute site and offsite beds. 2.12.6 Fast tracking access to interim care beds at Cumbernauld Care Home to create acute capacity. 2.12.7 Undertaking a review of all inpatients categorised as Hospital Based Complex Clinical Care (HBCCC) to determine if appropriately coded and placed or if another care location is more appropriate to meet their needs. 2.13 The actions outlined above are aligned to the Acute sites and HSCP based improvement delivery plans and the remaining actions being progressed through the task and finish group structures. 2.14 As part of the ‘Power up’ plan, all patients who have been inpatient beyond, seven, 14 and 21 days will be reviewed to assess if alternative care options could be provided and, in turn, to assist in decompressing the respective hospital sites by accelerating discharge when safe to do so. 2.15 There will be continual oversight of flow through the Executive Flow Oversight Board on a weekly basis, utilising all appropriate data as well as multiple daily reviews of system operating issues and the necessary actions being agreed. Discharge Without Delay 2.16 Work continues in the enactment of the Discharge Without Delay programme and its related aspects, e.g. embedding of Planned Date of Discharge; consistent roll out of Home Assessment Team (North) and Home First (South); increased numbers of people being supported to die at home via ‘pathway 4’ and further work with third sector providers. 2.17 In particular, work being undertaken by the Home Assessment Team in North Lanarkshire has also made significant improvements in the number of people able to be supported out of hospital with no/little delay. 2.18 Similarly, through the development and embedding of the ‘Home First’ model in South Lanarkshire HSCP, additional capacity is being created to support the review of the Care at Home service. Page 28 of 100
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2.19 Both of these services are now seeing an increase in the number of people who are being supported to be rehabilitated to a level of being able to manage their own care independently or, in some instances, with a reduced level of care than may have been originally assessed when in the hospital or first referred. Social Care Provider Sustainability 2.20 Independent providers of social care in Scotland – notably care homes and care at home providers – have highlighted the extremely difficult operating environment. As well as the cost-of-living-crisis and the lasting impact of measures introduced during the management of the pandemic, vacancy pressures also continue to be a concern for a number of providers. 2.21 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider environment and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care workforce challenges) and statutory/legal parameters. On a Lanarkshire-wide basis, support and quality assurance for Care Homes continues on a whole system basis to be overseen by the Pan-Lanarkshire Care Home Assurance Tactical (CHAT) Group; and for Care at Home Services through the equivalent Care at Home Oversight Group. The Care Inspectorate participate in both of these meetings. General Practice and pharmacy opening 2.22 As in previous years, a local enhanced service to support general practices opening on the fourth day of the weekend/public holidays – that is, on 26 December and 2 January, as well as the Saturdays through January 2024 - has been offered and around 60% of practices are participating in this at one time or another throughout the period. There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, the Primary Care Out of Hours (PCOOH) Service, Emergency Departments and the FNC where possible. General Practice sustainability 2.23 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. 2.24 This was the subject of previous presentations to the Board which included describing the work ongoing to address capacity and demand – most notably, through the Primary Care Improvement Plan (PCIP) that is reported through to the NHS Lanarkshire Board and IJB(s) as per the expectations within the General Medical Services (GMS) Contract. 2.25 As part of the regular reporting to Government on system pressures through the winter period, there will be weekly updates on the numbers of practices where they believe they are unable to provide the full range of services that they would under ‘normal’ working conditions. This reporting process commenced on 13 November 2023. Primary Care Out of Hours 2.26 For a considerable period, and similar to most Scottish ‘out of hours’ services, the NHS Lanarkshire PCOOH Service has had to manage workforce availability challenges (notably in relation to GPs); and has regularly had to contend with escalating levels of demand. Page 29 of 100
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2.27 The new clinical model has assisted the PCOOH Service to move to a more multi- disciplinary workforce and competency-based model of care, thereby reducing the number of occasions when alternative arrangements have been introduced. This will also be enhanced over the winter period to ensure additional staff are available to manage the additional demand that can be anticipated across the peak activity periods in winter. Contingency Arrangements for Additional Deaths 2.28 As set out within national guidance and is the case every year, work is underway – including with local undertakers - to ensure that there is sufficient ‘pace’ of funeral services (both burials and cremations) to support the eventuality of a significant excess of deaths over the winter period. Additional mortuary capacity identified for Covid 19 is still in place and will continue to be available over this winter period if required. Covid 19 and Flu Vaccine Programme 2.29 Following final advice on the winter Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), the following groups are being offered an additional Covid 19 booster: • Residents in a care home for older adults and staff working in care homes for older adults. • Frontline Health and Social Care workers. • All adults aged 65 years and over. • Those aged 5 to 49 years in a clinical risk group, including those who are pregnant. • Those aged 5 to 49 years who are household contacts of people with immunosuppression. • Flu vaccines will be available to a wider range of individuals, including all >50-year- olds. 2.30 The programme is well advanced and take up of vaccines is on target to be consistent with national performance. In addition to this, there is a range of services designed to offer vaccines to any who are in geographical areas or part of a thematic/ethnic group where take up of vaccine is less than hoped for. Carers Support 2.31 Funding from the Carers (Scotland) Act 2016 allocation 2023/2024 has been used to enhance operational services for carers across both Partnerships. This included monies from this funding being directed to support ongoing work with carers, with a particular emphasis on the Self-Directed Support (SDS) agenda; and a strengthened internal capacity within the HSCPs to enable frontline staff in managing increasing demand with regards to supporting carers. Staff Wellbeing 2.32 NHS Lanarkshire’s Health and Wellbeing Strategy will form an integral part of the system wide winter plan, with the emphasis on providing a working environment in all areas across Health and Social Care where staff are able to enhance and maintain their personal and professional wellbeing and to reach their full potential in a culture that provides space, time and support for self- care. Page 30 of 100
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2.33 The Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded fully and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to manage the dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 2.34 Council employees can also access a range of materials to support health and wellbeing through the respective employee programmes. Adverse Weather 2.35 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both North and South Lanarkshire Councils have policies in place in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 2.36 A series of actions is open to the organisations – individually and in collaboration - in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations. Conclusions 2.37 A range of implementations and reviews have taken place to ensure the right conditions for the success of the winter plan. Preparation have included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation to support continuous patient flow and care. Concurrent Resilience Planning and Risks 2.38 As highlighted above, there is a potential of concurrent risks aligning to have a significant impact on the wider health and social care services. 2.39 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. A very well attended ‘Winter Breach’ event was held on 9 November 2023, organised by the Lanarkshire LRP and focussing on the potential disruption caused by severe flooding. 2.40 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. Page 31 of 100
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3. Measures of success 3.1 The success of the planning arrangements put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months impacts on all 9 of the National Health and Wellbeing Outcomes. 4. Supporting documentation 4.1 Appendix 1 Health and Social Care Winter Preparedness Plan 2023-24. Ross McGuffie Chief Officer North Lanarkshire HSCP Page 32 of 100
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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? A number of funding sources are being utilised to cover the cost of the additional services being introduced to support enhanced staffing and services across the peak winter period. For the majority of services, they will operate from mid-December through to mid-March. Funding sources include nationally provided Unscheduled Care monies; monies announced on 24 October to support additional winter planning; financial plans of both the NHS Board and the two H&SCPs as well as the potential use of some of the funding associated with Operation Flow and the attendant aspects which will be enhanced over the winter months. In total, it is anticipated that circa £4.0m will be utilised in funding all the additional services which will be provided and this can be funded from the available budgets. 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 Page 33 of 100
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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? Work is underway at both local and national levels on the public messaging in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. South and North Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Page 34 of 100
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As highlighted above, there is a potential of concurrent risks aligning to have a significant impact on the wider health and social care services. Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. A very well attended ‘Winter Breach’ event was held on 9 November 2023, organised by the Lanarkshire LRP and focussing on the potential disruption caused by severe flooding. Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. 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 35 of 100
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Appendix 1 Page 36 of 100
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15 Appendix 1 Health & Social Care Winter Preparedness Plan 2023/24 Page 37 of 100
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16 Contents Joint Foreword by Cabinet Secretary and Councillor Kelly .......................................... 3 Introduction ................................................................................................................ 5 Our Principles and Priorities for Winter 2023/24 .......................................................... 6 Learning from Last Winter ............................................................................................ 7 A Different Approach ..................................................................................................... 8 Working in Partnership ............................................................................................. 8 Improved data collection and reporting..................................................................... 8 Winter Summit ........................................................................................................ 9 Winter Preparedness Checklist ............................................................................... 9 Priority One. Ensure people receive care at home, or as close to home as possible, where clinically appropriate ........................................................................................ 10 Priority Two. Consistent messaging to the public and our staff that supports access to the right care, in the right place, at the right time ................................................... 12 Priority Three. Focus on recruitment, retention and wellbeing of our health and social care workforce .......................................................................................................... 13 Priority Four. Maximise capacity to meet demand and maintain integrated health and social care services throughout autumn and winter .................................................... 15 Priority Five. Support the delivery of health and social care services that are as safe as possible throughout the autumn and winter period, including delivery of a winter vaccination programme for Covid-19 and flu .............................................................. 17 Priority Six. Work in partnership across health and social care, and with other partners, to deliver this Plan ....................................................................................... 19 Priority Seven. Protect planned care with a focus on continuing to reduce long waits. ..................................................................................................................................... 20 Priority Eight. Prioritise care for the people in our communities who need it most. .. 21 Summary and Escalations .......................................................................................... 23 Page 38 of 100
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17 Joint Foreword by Cabinet Secretary and Councillor Kelly There is no doubt that this winter will present considerable challenges to people who need to access our health and social care system, which is why the planning cycle for this winter has started earlier than ever before. The Scottish Government and COSLA have been supporting the system to be as ready as possible for the pressures it will face since the end of last winter, so that people can continue to access health and social care services and support when they need it most. We expect an extremely pressurised winter, and local systems are preparing to work flexibly and responsively to prevent issues and address them as they arise, working across boundaries with the voluntary and independent sectors, and, vitally, with individuals, their families, carers and communities, to meet need and maximise impact. We continue to see a change in the demand for health and care services: our population’s needs are increasingly complex, and more complex personalised care is required at the point of discharge from hospital and onwards to a care home or their own home with support. This sits alongside the increase in patients we see every winter with respiratory illnesses such as flu and RSV, and weather-related injuries from falls and accidents. We are experiencing significant recruitment and retention challenges across the health and social care workforce. And of course, the potential for a rise in Covid-19 cases informs our thinking and scenario planning. This plan recognises the interdependence and integration of health and care services and seeks to ensure that people in Scotland receive safe and timely access to health and social care services and supports over winter. We have significantly strengthened our efforts to support the system in its planning and preparations for the inevitable challenges this coming winter will bring. Local systems are assessing their own readiness and will take decisions both to prevent and to address pressures as they arise. This plan aims to support local systems to, when needed, make changes, at pace, to relieve pressure and drive improvement, to provide the best levels of care possible for the people we serve. However, there is also a recognition that at times, we will need to prioritise care and support for those most in need, particularly when levels of demand and need rise. This Winter Plan sets out the actions we know from previous winters work to help relieve pressure points across the system. We believe the principles and measures set out in this Winter Plan are the right ones. Critically, we are encouraging the system to adopt a ‘home first’ approach when it is clinically appropriate to do so. Providing care in a home setting is better for people, and better for their families and carers and also frees up capacity in our hospitals. We are providing the conditions for the system to do this. For example, the Scottish Government is significantly increasing investment in hospital at home, an initiative providing acute care at home which has consistently delivered improved levels of patient satisfaction compared to in-hospital care. We are united in our resolve to deliver for our citizens, and the Scottish Government and COSLA have been working tirelessly to create the conditions needed for the whole system to deliver. This Winter Plan forms the basis of a joined-up and collegiate approach to increase resilience, reduce pressure and improve outcomes for our citizens across the complex landscape of health and social care. Page 39 of 100
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18 Michael Mathieson Councillor Paul Kelly Cabinet Secretary for NHS Recovery, COSLA, Health and Social Care Health and Social Care Spokesperson Page 40 of 100
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19 Introduction This Winter Plan represents a whole system approach to responding to a surge in demand for health and social care services. While the focus of this plan is on the winter months, the measures outlined are applicable to other times of the year when our health and social care system faces increased pressures. We are encouraging systems to adopt a preventative approach as far as possible to mitigate and reduce harm by ensuring people who need health and social care services are receiving the right care, at the right time and in the right place. Whilst this plan provides a national overview, in developing this plan we recognise the important contribution of the voluntary and independent sector locally in delivering care and acknowledge that these services are commissioned through local arrangements. This Plan seeks to address the specific operational pressures experienced across the health and social care system over winter. We have engaged with the independent and voluntary sector as partners and leaders in the delivery of social care across Scotland. Alongside partners, the Scottish Government and COSLA continue to discuss the creation of a National Care Service which will deliver improvements for people accessing community health and social care support. Although the health and social care system is well-used to planning, preparing and delivering care ahead of and throughout winter, we have strengthened our approach this year to reflect our experiences over the last few years. In doing so, we are embedding the following key components to support a more resilient health and care system better aligned to meeting people’s needs by: Whole system focus and oversight, recognising the critical interdependencies across the system. Earlier engagement and planning for winter than ever before. Having an approach that acknowledges and responds to pressures across the whole system. Implementing lessons learned from 2022/23 and previously. Supporting local systems to develop their demand and capacity plans to identify current and future requirements to support surge response. Developing a national target operating model with key resilience measures and a clear understanding of the impact that improvement work will have to achieve our targets. Taking action on returns from a preparedness checklist for local systems, ensuring we have a clear understanding of risks to the system both locally and nationally Improving data quality and reporting to support local and national assurance and understand when escalation is appropriate. Targeting interventions where there is greatest need. Utilising proven digital tools to maximise capacity. Providing the conditions needed for a ‘home first’ approach. Page 41 of 100
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20 Our Principles and Priorities for Winter 2023/24 We have developed a set of planning principles and priorities to guide our health and social care services as we put people at the heart of what we do, whilst we build our resilience to meet changing demand, recognising that surges can occur at any time of the year and not just winter. In developing our priorities, we have reflected on our approach in previous years and sought to build on what we know works, and stopped what has failed to have the desired impact, whilst strengthening our approach to both planning and delivery of the plan at a national level. In particular it is important for us to maintain a whole system focus given that people do not differentiate between the organisational boundaries in which each individual system operates, and given the knock-on impacts pressure in one part of the system has on others. By ‘whole system’, we mean every interface between an individual and the health and social care system: from pharmacy, primary care, NHS Inform, NHS 24, the Scottish Ambulance Service, to A&E and acute and community hospital settings, and on into care provided at home or in a care home setting. Carers and the voluntary sectors have a key role to play within the system. A whole system approach recognises that pressures within any area of the health and care system will impact other areas, and that any actions taken must consider this interdependency. The seven winter planning priorities, which we are empowering local systems to adopt, coalesce under three critical principles: Right care, right time, right place A partnership approach across the whole system Local and national actions we know work Page 42 of 100
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21 Learning from Last Winter Our approach this year has built on our response to previous winters, including the most recent, where we adopted a whole system approach to managing the extreme and unprecedented pressures we experienced. Last winter, we saw unacceptable waits for ambulances, queues of ambulances outside A&E, long delays in A&E departments, high levels of hospital occupancy, high levels of delayed discharge, high levels of unmet need within our communities, increased demand for GP appointments and increased demand for social care packages and assessment. Local systems, and the individuals and organisations that work within it to deliver health and care to our most vulnerable individuals – worked hard to meet high levels of demand and ensure people received care when they needed it most. However, we know that complex challenges remain and there is still work to be done to ensure people can access the care they need. To inform our approach moving forwards, we undertook a comprehensive exercise to understand the lessons learned from last winter which focused on the development, delivery, and governance of the published actions. The report makes several recommendations which have been considered and incorporated into the current winter planning work. The report highlighted that some actions and interventions had greater impact than others. However, even those with lower impact were still instrumental in building the resilience of the system to respond to surges in demand so should not be discounted. For example, Scottish Government made additional funding available for international recruitment in October 2022. We have learned that earlier communication of this intervention may have allowed local Boards and Partnerships to begin recruitment so that this could provide additional capacity in time for winter. For this year, we have worked with partners to bring forward recruitment campaigns. Critically, the report highlighted that to be effective, planning should begin much earlier and that is why this year, work began across the health and social care system in early Spring 2023. This included the launch of our Delayed Discharge and Hospital Occupancy Action Plan in March 2023, which set out a series of actions to be implemented and delivered throughout the year to build resilience and capacity in our systems. Page 43 of 100
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22 A Different Approach There are a number of critical areas where we have built upon the lessons learned from previous winters and taken a different approach to planning. Most notable of these are: Working in Partnership We have brought integrated planning into the core of preparations and have developed an extensive joint governance and assurance mechanism between the Scottish Government and COSLA. As part of this, a Whole System Planning and Oversight Group, which is chaired by Chief Executives from health boards, local authorities and a Chief Officer on behalf of Health and Social Care Scotland, has been overseeing and seeking assurance on the implementation of the Delayed Discharge and Hospital Occupancy Action Plan which sets out the interventions we know improve flow through the hospital and, vitally, improve the experience for people. We continue to support local systems to make the necessary changes to drive these improvements and to monitor the resulting impact as the actions set out in that plan are vital in reducing occupancy and delayed discharge, ultimately freeing up capacity as we head towards a period of higher demand, ensuring people and families are seen to when they need it most. The Whole System Oversight Group ensures alignment with other groups with the overall aim of improving the experience and resilience of the health and social care system. Where further assurance and escalation for joint decisions between Scottish Ministers, COSLA and the Co-Chairs of the Whole System Oversight and Planning Group on the deployment of options that support the resilience of Health and Social Care are required, a Collaborative Response and Assurance Group (CRAG), co- chaired by the Cabinet Secretary and COSLA Health and Social Care Spokesperson, will be stood up. Improved data collection and reporting We have supported local systems in the development and utilisation of data to help us better understand and respond to the challenges being experienced. As part of this, demand and capacity modelling, supported by Public Health Scotland (PHS), provides a set of resilience indicators at Board and HSCP level to enable local services to target interventions during surge responses. PHS are producing a number of scenarios for winter 2023/24 based on Covid-19, flu and additional hospital occupancy to help understand the potential scale and shape of the demand that Covid and flu may present this winter, particularly in acute hospital settings. These scenarios will be adjusted to incorporate emerging data and evidence throughout the winter. We have developed and launched two new dashboards ahead of this winter which collate data from across the whole system to give Scottish Government, COSLA and the system itself the intelligence required to inform decision-making and action. The Social Care Response and Delayed Discharge dashboard and the Whole System and Winter dashboard provide national and local level data across 25 and 35 Page 44 of 100
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23 indicators respectively. Where these begin to move into below-optimal rates due to increased demand, early responses can be co-ordinated across systems and targeted interventions deployed as necessary. Winter Summit The first NHS and Social Care Winter Planning Summit, co-chaired by the Cabinet Secretary for NHS Recovery, Health and Social Care and COSLAs Health and Social Spokesperson, was held in August 2023. This Summit brought together more than 300 leaders from across the country to share best practice and local plans for this winter. Crucial to this summit was ensuring people who use our services were at the centre of our preparations. Social care providers, local government leaders and the independent sector were represented alongside NHS colleagues. The Summit generated key expert, stakeholder, and system-wide input into decisions on winter planning and preparedness in advance of responding to surges, including winter 23/24. Winter Preparedness Checklist Ahead of finalisation of this Winter Plan, we asked local systems to undertake a state of readiness check. The Winter Preparedness Checklist sets out four key areas against which we asked Health Boards and HSCPs to provide an assessment of preparedness for their local systems: Section 1: Overview of Preparedness and Business Continuity Section 2: Urgent and Unscheduled Health and Social Care, and Planned Care Section 3: Primary Care, Mental Health and Social Care Section 4: Health and Social Care Workforce and Staff Wellbeing We are now using the outputs of this checklist along with the Delayed Discharge and Hospital Occupancy Action Plan self-assessment returns and dashboard data to create a holistic system overview and provide targeted and tailored support to those areas identified as having scope to improve and increase resilience. This approach also encourages benchmarking across and within the system, and identification and sharing of best practice between areas. Page 45 of 100
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24 Priority One. Ensure people receive care at home, or as close to home as possible, where clinically appropriate Primary and community care is, for many people, the front door to the health service, where their needs are first raised. Each week in Scotland, there are around 680,000 GP consultations, with 28,000 people being seen in our hospital Emergency Departments. The Scottish Government is supporting primary care to provide essential care where it is needed most – in our local communities - with funding for multi-disciplinary teams which has been increased to £170 million this year. For many, A&E may not be the best place for their healthcare needs and our Urgent and Unscheduled Care Collaborative improvement programme offers patients alternative routes to urgent care. The ‘home first’ approach is not only better for people, but supports acute and primary care services too. This includes expanding Hospital at Home services. The Scottish Government is investing over £15 million in 2023/24 to deliver additional virtual beds this winter, significantly increasing capacity in our system and reducing the need for emergency admissions every week, and of course better for people who need acute care. Unpaid carers and social care services, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated health and social care approach will be critical year-round but particularly over winter. The use of telecare and digital technology to detect and alert health professionals when a person is needing support is a crucial tool, as is the ability to maximise existing community and third sector supports. Everyone in need of emergency mental health care must receive that support quickly, and wherever possible, close to home. People presenting with stress and/or distress are often conveyed to hospital when there can be community-based alternatives that support the patient as well as the system as a whole. This will also ensure that people seeking mental health support receive the right care, in the right place, at the right time, regardless of where, or what time of day they present – there should be no wrong door. The Scottish Government and local government are also continuing to maximise the use of digital tools such as increased use of Near Me in Flow Navigation Centres, Connect Me. Telecare and M365 collaboration to improve our systems and widen access, investing in Pharmacy First and community nursing teams to support people in their communities, and actively managing demand for urgent and unscheduled care to ensure that patients are triaged appropriately and directly. How we will jointly deliver this priority: Proactively support people at highest risk of hospital admission within our communities. Critical to this is the strong partnership working between Integration Authorities and local partner providers and third sector interface, as well as nationally through our engagement with sector leaders which helps us better understand and respond to the pressures and challenges facing the sector. Page 46 of 100
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25 Through the actions underway in the Urgent and Unscheduled Care Collaborative Programme, we will improve urgent care pathways in the community including enhanced links across the primary and secondary care interface. Work with NHS 24 and Boards to review alternative pathways for people with urgent care needs both in and out of hours. This could include opportunities for Primary Care Multi-Disciplinary Teams (MDTs) to provide resilience to Primary Care OOH teams to address capacity issues and divert care from A&Es, though it is important that community MDTs function both in and out of hours, to reduce unnecessary conveyance to hospital. Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and out of hours. Increase the use of Flow Navigation Centres to reduce avoidable visits to A&E, optimising use of Call Before You Convey and Near Me video consultations. Continue to optimise the roll-out of Near Me for social work and out of hours services. Through the SAS Integrated Clinical Hub multi-disciplinary team, undertake a remote clinical assessment of patients to care for people closer to home through self-care advice or referral to other pathways. Further expand the Hospital at Home service with an additional £3.6 million of funding to enable people to be treated at home, where appropriate, and to expand access to acute care at home with expansion of Hospital at Home to other specialty areas such as Respiratory, Heart Failure, Paediatrics and OPAT services. Involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, this means engaging with the patient, their families, and carers in hospital discharge discussions to ensure their needs and wants are central to decision-making. Develop a data-based understanding of people who return to hospital upon discharge with a care package. Drive improvement through the Mental Health Unscheduled Care Network to allow people to access care in the most accessible setting. Page 47 of 100
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26 Priority Two. Consistent messaging to the public and our staff that supports access to the right care, in the right place, at the right time. To ensure that people receive the most appropriate care and are empowered to support themselves and those they care for, the Scottish Government is continuing to invest in making high quality healthcare information accessible. A multi-agency communications group provides an expert forum to agree key messages and develop national and local communications plans to ensure the public is well- informed. How we will jointly deliver this priority: All Boards, Local Authorities, Primary Care Contractors, and Partnerships to redirect and signpost people to the appropriate service for their needs, through national and local communications. Ensure the public are aware of key sources of information that will support them with their care needs, whether that information is delivered in person (for example, through social workers, community pharmacy or their local General Practice), via the telephone (NHS 24 on 111 for physical or mental health concerns) or digitally (nhsinform.scot, the NHS 24 online app, Care Information Scotland or local council websites). Messaging will focus on what a service is for rather than seeking to direct people away from a particular service. Self-management and self-care using the guides on nhsinform provide the public with an accessible resource to treat many of the common winter illnesses without the need to interact with a health professional. Communications will aim to increase awareness of these resources. Communications activity will be based on insight that has been gathered from evaluation of campaigns from previous years. Continue to build preventative messaging into health and social care communications activity for Winter (eg the vaccination programme, Mind to Mind, Healthy Know How) and throughout the year. Collaboration across national and local messaging by all stakeholders to ensure consistent messaging. Resources will be developed by Scottish Government, Public Health Scotland and NHS 24 that will be available online for any stakeholders to use through their own communications channels such as social media accounts, e-newsletters or in-venue signage to support local activation. Undertake scenario planning to identify the communication actions which can be implemented based on the level of system pressure being faced in order that appropriate messaging can be activated nationally or locally. Raise awareness nationally of the technology hubs that are located throughout Scotland where people accessing and delivering services can go to see technology in a home setting. Raise awareness that assessments for longer-term care needs should be undertaken at home whenever possible to ensure individuals get the correct level of support to maintain independence and reduce unintended harm. Page 48 of 100
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27 Priority Three. Focus on recruitment, retention and wellbeing of our health and social care workforce. Our highly skilled and committed workforce is the cornerstone of our response every winter. In order to meet demand, we must continue to focus on recruitment and retention of our workforce, ensuring that we support the wellbeing of our staff through challenging periods of high demand. We are pursuing a range of different strategies to nurture and grow the workforce in both health and social care over the long term. Within our health workforce, for example, this includes continuing to grow controlled healthcare subjects intake in line with evolving demand projections and supporting the expansion of trainee doctor posts, to reflect the changing demands on our health and social care system. Between 700,000 and 800,000 people provide unpaid care for a relative or friend at home and within other community or residential supports, and so we must also consider and respond to the wellbeing and support needs of Scotland’s hugely valued unpaid carers, as well as supporting flexible access to Self-Directed Support for people who access support and their carers. How we will jointly deliver this priority: Invest in recruitment utilising the full range of potential activity and interventions across health and social care in order to protect and maintain high quality services, including international and domestic social care marketing and recruitment campaigns. In support of retention and recruitment of the social care workforce, we will work with partners to ensure system readiness for the implementation of the commitment to enable a minimum rate of £12 per hour for those providing direct care in commissioned services from April 2024. While this commitment may not address immediate workforce pressures, it seeks to recognise the valuable efforts of our social care workforce during extremely challenging circumstances. We have also established a joint social services and social care taskforce, co- chaired by the Scottish Government and COSLA, supporting delivery and acceleration of workforce improvement activity across the social care and social work workforces. Have confirmed contingency plans in place to cover NHS staff disruption to manage the impacts, ensuring staff are fully aware of plans. Invest in local, third and independent sector organisations to support care at home teams and the wellbeing for those who provide practical support to people who are ready for discharge, and across the wider community. Raise staff awareness of digital tools available to staff that can increase capacity such as use of Near Me, use of M365 platform to safely and easily communicate, collaborate and share information, the technology hubs that are located throughout Scotland, and maximising the use of telecare devices. Continue to explore how volunteers can provide support in discharge and consider appropriate use of established local and national volunteer partnerships. Ensure people who provide unpaid care are supported in their caring roles and supported to look after their own health and wellbeing. Last winter we published the National Carers Strategy which set out the actions underway to ensure carers are supported fully in a joined up and cohesive way. It brings together existing Page 49 of 100
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28 initiatives and new approaches, and proposes new and better ways to support carers. Continue to support Boards and HSCPs to work with students and with retirees who may wish to return to work on a part-time basis to build short-term capacity as required. Support all health and social care staff appropriately in accessing the range of available local and national staff wellbeing resources and raise awareness of the mental health and wellbeing resources available on the Mind to Mind website. Page 50 of 100
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29 Priority Four. Maximise capacity to meet demand and maintain integrated health and social care services throughout autumn and winter. Both COSLA and Scottish Government recognise that actions and improvements to maximise capacity are best and most sustainably delivered in an integrated and co- ordinated way across the whole system. Local Authorities, Boards and Integration Authorities together with the voluntary and independent sectors, and indeed with communities, lead the way on integration of health and social care to deliver better experiences and outcomes for the people who access services. How we will jointly deliver this priority: Ensure consistent and effective discharge planning takes place over seven days and the holidays. Reduce the time people need to spend in hospital by promoting early and effective discharge planning deploying the basics set out in the Delayed Discharge and Hospital Occupancy Plan sent in March 2023 and robust and responsive operational management, and by recognising and meeting the challenges of unmet need in communities. The basics identified within the March Plan include: Admission avoidance. Social work input on every ward. Implementation of Discharge without Delay and Planned Date of Discharge. Early identification of complex discharges. Early engagement with people, families and carers. Implementation of discharge to assess and intermediate models of care. Daily multi-disciplinary reviews of all patients to ensure understanding of criteria to reside, planned date of discharge and early referrals for supported discharge ahead of clinical readiness date. Use of home-based assessments for all Home Support packages to ensure accurate person-centred assessments, in familiar and homely environments. This also results in more efficient use of scarce resources. Work intensively with HSCPs and Boards across the country to reduce delayed discharges for patients with learning disabilities and complex care needs moving from inpatient treatment to the community, including through supporting the use of the Dynamic Support Register, a consistent process for regularly reviewing and taking action to support individuals with complex needs. Continue to work with and support systems to ensure that suitable accommodation and support packages are in place to address delayed discharge of forensic mental health patients. Support telecare providers to increase the use of proactive outbound calling to support people who have been identified as being at risk or more vulnerable and directing them to community-based support earlier to keep them at home longer and prevent unnecessary admissions to hospital. Reduce time spent in the Emergency Department by working with Boards to deliver rapid assessment and care, enhanced triage and signposting or redirection and reduce length of stay. Page 51 of 100
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30 Make improvements to reporting and performance dashboards that will support visibility of capacity in social care, including levels of unmet need within the community and people awaiting community care assessments – and how this data impacts on the wider system. Embed use of the new dashboards to support benchmarking between systems and sharing of best practice. Work with Boards to ensure sufficient Dentistry and Optometry capacity to support referrals from NHS 24 and OOH/unregistered patient care and holiday cover. Run a mental health bed occupancy survey throughout the winter to ensure we have an understanding of service pressures and can offer support as required. Continue to support Boards to increase the use of Hospital at Home to enable people to be safely cared for in their own homes. Continue to maximise the use of Planned Day of Discharge, Discharge to Assess, Hospital to Home teams, community rehabilitation and other discharge support services. Page 52 of 100
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31 Priority Five. Support the delivery of health and social care services that are as safe as possible throughout the autumn and winter period, including delivery of a winter vaccination programme for Covid-19 and flu. Protecting people who may be most impacted by severe illness, hospitalisation or death from Covid-19 and flu, through vaccination, is a key means of protecting individuals from illness and reducing demand on our health and social care systems. We want to see as many people protected from Covid-19 and flu as possible this winter to help protect people’s health and alleviate pressure on the health and social care system. The winter vaccinations programme started on 4 September and the majority of vaccinations will be complete by 11 December to ensure protection before the main winter pressures begin (the programme will run until 31 March 2024). Scotland is the only nation offering a free flu vaccine this winter to everyone aged 50- 64 and deployment of both Covid-19 and flu vaccinations continues to be guided by advice from the JCVI. This winter programme focuses on those at greater risk of severe illness from Covid and flu; namely those aged 65 and over and those aged 6 months to 64 years at clinical risk. Priority is also being given to those who are unpaid carers. Improved demand and capacity forecasting around Covid-19, flu and underlying winter pressure scenarios is informing thinking and scenario planning to help national and local partners better understand and respond to the challenges being experienced. These scenarios will be adjusted to incorporate emerging data and evidence throughout the winter. Alongside this it will be important for us to continue to closely monitoring rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. In addition to vaccination and infection prevention, social connections, exercise and meaningful activity are vital for the wellbeing and quality of life of everyone, but in particular those living in a care home. It therefore remains fundamentally important that people living in care homes remain connected to their loved ones even in infectious outbreak situations in line with Public Health Scotland Covid-19 Guidance. How we will jointly deliver this priority: Work with Boards to operationalise delivery of the winter vaccination programme, bringing this forward for those at highest risk where possible (care home residents, people aged 75 and over and people with weakened immune systems aged 12 and over) as a precautionary measure in light of the emergence of new variant BA.2.86. Work with partners to ensure all eligible health and social care workers, carers and household contacts of the immunosuppressed have access to their flu and Covid-19 vaccines to help build resilience within the health and social care system. Encouraging high vaccination uptake within care homes in particular is vital. Page 53 of 100
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32 Continue to work with Executive Board Nurse Directors, Chief Social Work Officers, and Care Homes to collaborate on the delivery of person-centred safe care and support to enable people to be looked after in their communities, where possible Offer children aged 2-5 years the flu vaccination from the outset of the programme to ensure they receive the earliest protection to help stop the virus spreading. To have maximum impact early completion of vaccination amongst this group is essential. Offer the flu vaccination to all school age children in Scotland. Offer seasonal flu vaccination to poultry and outbreak team workers. This is in response to the increased vigilance and monitoring of outbreaks associated with Avian Influenza. Work with Boards and wider partners to use data, along with local knowledge, to target outreach work and reduce barriers to vaccinations amongst under- served communities and where uptake continues to be lowest, including Polish, Gypsy/Traveller, African and Black/Caribbean ethnic groups and people in areas of highest SIMD. Work with Boards to vaccinate all cohorts as advised by JCVI, by 11 December. Continue to support and use demand and capacity forecasting around Covid- 19, flu and underlying winter pressure scenarios to inform thinking and scenario planning. With partners such as PHS, continue to closely monitor rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. Continue to work with local partners to ensure family/friend visits are supported in all care settings. Page 54 of 100
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33 Priority Six. Work in partnership across health and social care, and with other partners, to deliver this Plan. To deliver on our commitments, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures), maintain a flexible approach, and enable an effective response and support to whole-system winter pressures. How we will jointly deliver this priority: The Chief Operating Officer for NHS Scotland and Director for Social Care Resilience and Improvement, supported by Health and Social Care Directors and COSLA Officials, will report to Ministers and COSLA Leaders on progress of addressing whole-system pressures throughout the winter period. A Whole System Oversight and Planning Group (WSOPG) is in place and has strategic oversight of health and social care pressures through the winter period. Working on a subsidiarity basis, local monitoring will continue, and health and care organisations will utilise their established governance and response structures to manage pressures. In addition, established National Incident Management Plans will enable a multi-agency team including the Scottish Government and COSLA to assist Boards and HSCPs in responding to any emergencies or major incidents through established procedures. This will include a shared escalation plan between the Scottish Ambulance Service and NHS 24 for early identification and management of surge and risks. The third and voluntary sectors and organisations representing unpaid carers will be integral to these governance structures to assist with identification of issues and co-production of solutions. Page 55 of 100
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34 Priority Seven. Protect planned care with a focus on continuing to reduce long waits. Unfortunately, Boards have had to take the difficult decision over the last two winters to step down planned care in order to treat people requiring emergency treatment. Given the impact this has had on waiting lists, and on patients themselves, we are committed to protecting planned care throughout this winter. Following the recently set ambitious targets, Boards have made significant progress in reducing the number of people waiting more than two years for an outpatient appointment by end of August, and 10 out of 14 territorial Boards reported five patients or fewer waiting more than two years. We will continue to work closely with the Boards and HSCPs to maximise planned care capacity and where the majority of long waits in some specialities remain, ensure these are cleared as quickly as possible. How we will jointly deliver this priority: Strive to protect cancer care with a focus on continuing to prioritise new urgent suspicion of cancer patients and protect theatres for cancer operating. Work with Boards to maximise capacity through pooled lists: locally for high volume specialties (new and return patients) and regionally/nationally for longest waits/specific specialities. Maximise theatre capacity including National Treatment Centres through expanded sessions in evenings and weekends. Support Boards to maximise clinical validation of waiting lists to identify, where appropriate, alternative forms of treatment. Continue to support Boards in the adoption of Active Clinical Referral Triage (ACRT) and Patient Initiated Return (PIR) to improve patient care and reduce waiting times by eliminating unnecessary face to face attendances. Deliver the actions contained in the Endoscopy and Urology Diagnostic Plan. Encourage the optimisation of digital solutions, standardise pre-operative assessment to reduce the need for unnecessary appointments and cancellations releasing capacity. Protect planned care through maximising the use of day surgery units including increasing the proportion of procedures converted to day case surgery. Page 56 of 100
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35 Priority Eight. Prioritise care for the people in our communities who need it most. Some people are more vulnerable to the pressures and challenges brought about by winter, the colder weather, and Covid-19. We recognise the issue of poorly heated homes as a driver of poor health and almost £3bn has been allocated during the ongoing cost of living crisis to tackle poverty and protect people as far as possible. This includes £350 million this year for heat, energy efficiency and fuel poverty mitigations. Anticipatory, or Future, Care Planning aims to support people to think and plan for changes in their health and care that might happen when they are living with a serious illness, have a longer-term condition or disability that could get worse, or are getting older and frailer, focusing on what matters to them. There are a number of actions that can be taken within existing legislation and process to address pressures within health and social care services to ensure that adults with incapacity (AWI) can be discharged from hospital when medically fit and cared for in a setting more appropriate for their needs. Delays in the court system are often cited as a cause of unnecessary delay with the AWI guardianship process. The Scottish Courts and Tribunals Service (SCTS) has confirmed that there is currently no backlog in civil law cases, and that any cases relating to guardianships for AWI can be actively prioritised. This is particularly the case where input from the courts could help to facilitate moves that are of benefit to the patient. SCTS has highlighted that applying for interim guardianship orders where appropriate will enable cases to be expedited more quickly. How we will jointly deliver this priority: Relaunch the Warmer Homes Scotland scheme from October with more funding and more help for households at risk of fuel poverty to receive a climate-friendly heating system, insulation and increased energy efficiency. Direct people to the Scottish Government’s Cost Of Living website which has a range of resources including how to get in touch with your local council for help with energy and bills, and has specific advice for older people or those who are disabled. Continue to scope options for increasing creation and review of Anticipatory Care Plans (including renaming as Future Care Plans) focusing on specific population groups. Provide the Covid-19 booster for those at higher risk, as per the JCVI statement of August 2023, and explore access for older and frailer groups to receive their flu and Covid-19 vaccines in their home in partnership with local agencies and the independent sector. Continue to encourage close working with our valued partners in the independent sector, and with unpaid carers, to enable continued support for older and frailer people who may need practical help to keep them safe and well. Where necessary, local systems will prioritise social care and support services for those who need it most and are considered to be at a critical or substantial risk level. Page 57 of 100
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36 Continue to work together with Partnerships, Boards, and people with lived experience to reduce inappropriate out-of-area residential placements and inappropriate hospital stays for people with learning disabilities and complex care needs. Encourage the use of local authority applications for guardianship of Adults With Incapacity where appropriate (as opposed to private applications) and apply for interim guardianship orders where appropriate to expedite cases. We have updated the national best practice guidance for Adults With Incapacity, noting that it is and average of 91 bed days for a private guardianship application. The guidance draws on experiences of statutory partners and aims to set out for local systems models of good practice to support a reduction in delayed discharges where adults lack capacity Provide support to allow the timely discharge of Adults With Incapacity, including: o Targeted guidance for practitioners, using good practice examples, as referenced. o Proposals for reform of legal aid practice. o Ongoing training at basic, intermediate, and advanced levels for practitioners delivered on a joint basis with NES, MWC and the Law Society. o Targeted meetings with HSCPs with higher numbers of AWI delayed discharges to offer assistance and understand the local challenges to help inform any necessary national response. Increase public awareness and uptake of Power of Attorney, to ensure people continue to have their wishes and voice heard and to help enable people to be discharged from hospital as quickly as possible to the best setting for their ongoing care. Support the continued roll out of the Healthcare Framework for Care Homes that provide proactive and preventative multidisciplinary care to vulnerable individuals. Page 58 of 100
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37 Summary and Escalations This Winter Plan sets out the actions being implemented across the health and social care system in order to prepare for the increase in demand and pressure we expect to see over winter 2023/24. These actions are being adopted as part of a business as usual approach to local planning for surges in demand and complement local surge/escalation and capacity plans. To support this, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures) and maintain a flexible response covering whole-system winter pressures. Working on a subsidiarity basis, local monitoring will continue, and health and care organisations will utilise their established governance and response structures. Page 59 of 100
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38 © Crown copyright 2023 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-83521-434-3 (web only) Published by The Scottish Government, October 2023 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS1365422 (10/23) w w w . g o v . s c o t Page 60 of 100
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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 Date 20/02/24 Winter Resilience From Ross McGuffie, Chief Officer University Health & Social Partnership NL E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 752 591 Executive Summary While NHS Lanarkshire stood down its live Covid incident in January 2023, the impact of the pandemic is still widely felt across the health and social care system as a whole. In February and March 2023, NHS Lanarkshire undertook a ‘Firebreak’, with the aim of allowing the three acute sites to decompress, prioritising activity to support the reduction of site occupancy and improve surrounding performance. While the Firebreak was a strong success, reducing site occupancy and delayed discharges and improving front door performance, this was not able to be sustained in the longer term. Operation Flow 2 has since progressed, supported by nationally agreed funding, to support the implementation of key elements learned from the Firebreak, with the aim of making sustainable changes to the whole health and social care system for winter. In line with the national Delayed Discharge and Hospital Occupancy Plan and the NHS Scotland Winter Preparedness plan, a whole system winter plan has been developed for Lanarkshire, focusing heavily on Operation Flow 2 actions as previously presented to Committee. While the system as a whole has remained pressured throughout the festive period and into January, it has remained much more stable than the previous year. Recommendations It is recommended that the Adult Care and Social Work Committee. (1) Acknowledge the content of the report and endorse the approach. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Item 5 Page 61 of 100
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1 Background 1.1 Operation Flow commenced in early 2023, with a 9-day Firebreak taking place that reduced site occupancy by around 15% and supported NHS Lanarkshire to move from black to red status on 6th March 2023. 1.2 Since then, learning from this intervention has led to the Operation Flow 2 action plan and developments that commenced in summer 2023 with the aim of having the whole health and social care system better prepared for winter 23/24. 2 Report Operation Flow 2 – January Firebreak 2.1 One of the key areas of learning from Operation Flow has been the positive impact of targeted and intensive firebreaks. Early January is always a significant pressure point across the health and social care system following two four-day weekends, so a proactive Firebreak took place from Wednesday 3rd – Friday 12th January 2024. 2.2 The 3 acute sites and 2 HSCPs developed plans with a range of actions which included: • Increased Hospital @ Home capacity to reduce admission where appropriate. • Enhanced use of Hospital Assessment Team and Home First to support earlier discharges. • Length of stay reviews of patients to support discharge planning. • Increased use of discharge lounge. • Additional on-call support. • Enhanced medical cover and additional nursing staff. • Senior staff supported Board Rounds. • Maximised Senior Decision within the Flow Navigation Centre (FNC) to ensure patients access the most suitable treatment pathways and/or clinical advice. 2.3 All non-essential meetings were stood down to free up members of the senior team to support flow enhancing activities across the whole system. System Learning 2.4 Following the January firebreak, a learning review was undertaken, with a number of highlights noted: • Structured, organised and robust processes. • Team working and MDT collaboration. • Timely discharge planning. • Real time solutions found for challenges. • Focus on patient safety and getting the right care in the right place at the right time. • Occupancy reduced. • Ward beat achievement improved. • Increased discharges. • Improved weekly performance. • Frailty team at front door – 25% avoided downstream moves. Ambition statement (24) Review and design services around people, communities, and shared resources Programme of Work Resilient People Page 62 of 100
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2.5 A number of challenges were also noted that require further exploration and development: • Weekend Care Home discharges. • Reduced referrals and discharges during week between Christmas and New Year. • Off-site bed purpose – need clear expectations with staff, patients and families. • Side room demand due to flu/covid impacting both 8hr and 12hr performance. • Referral rates, unplanned referrals and cancelled discharges remain high. • Admin capacity to keep Trak updated. Impact on site performance 2.6 While the January firebreak provided a comparative boost in performance from the previous year (4hr performance 62% for week ending 14th January), performance overall was still lower than before the Christmas period, with both 12hr waits and occupancy increased. 2.7 At week ending 14th January, site occupancy was 102%, up from 98% pre-Christmas. 2.8 While performance is not yet at the levels being aimed for, winter performance has been much more stable in 2023/24. When comparing daily performance from mid- December to mid-January 22/23 and the corresponding days in 23/24, performance was better in 23/24 in all but 6 instances (2 equal, 4 worse, 22 improved). 2.9 Comparative performance with neighbouring Boards highlights NHS Lanarkshire’s comparative improvements in ED performance from 2022/23 to 2023/24. Delayed Discharge 2.10 Delayed Discharge performance has remained much more stable than in previous winter periods, with strong and consistent discharge rates of over 100 per week being maintained since October and throughout December and January. 2.11 While dips in both referrals for supported discharge and discharges from delay were noted in both the Christmas and New Year weeks, discharge performance recovered to normal levels on week beginning 8th January. Page 63 of 100
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2.12 At 15th January, the national Delayed Discharge census shows the positive performance improvements: 2.13 Weekly management data highlights the much greater stability in delay numbers and the consistently high volume of discharges being supported. For context, during peak winter pressures in 2019/20, North Lanarkshire supported on average 77 supported discharges per week, but now consistently supports well beyond 100. Next Steps 2.14 A number of new posts commence in January 2024, completing the recruitment as planned for Operation Flow 2, supporting the full roll out of the new planned model. Page 64 of 100
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2.15 The new hospital site Flow Oversight Boards will support a whole system and integrated approach to full implementation of the plan and ongoing service improvement, particularly around the area of integrated discharge planning. 3 Measures of success 3.1 Revised governance arrangements have been established to support the operational delivery, underpinned by a robust performance management framework. 3.2 Flow Oversight Boards have been set up for each acute site, supported by representatives from the HSCPs and Scottish Ambulance Service. A joint HSCP Flow Oversight Board has also been established between the North and South HSCPs. 3.3 The key objective of each Flow Oversight Board will be to improve performance at a site/sector level, as set out in the Whole System Key Performance Indicators: • Reducing Demand by redirection and streaming of patients via REACT. • Reduce Admission Conversion to <25%. • Reduce Occupancy <95%. • Reduce LOS in Wards. • Improve Daily Ward Beat > 90%. • Increase am Discharges > 40%. • Improve 4 Hour to >70%. • Reduce 12 Hour Waits > 10/day. • Reduce Delayed Discharges. 4. Supporting documentation 4.1 N/A Ross McGuffie Chief Officer, University Health & Social Partnership NL Page 65 of 100
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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 66 of 100
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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? Information is being shared across several forums including the HSCP Strategic Planning Groups and the HSCP Website. Understanding the impact from a patient experience and staff welling-being perspective is key, therefore, formal evaluation of Operation Flow 2 will commence from the 1 November 2023 in collaboration with colleagues from Strathclyde University. 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? Ensuring demand can be met. Risks already included on the 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). Page 67 of 100
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If Yes, has a Children’s Rights and Wellbeing Impact Assessment (CRWIA) been carried out? Yes ☐ No ☐ Page 68 of 100
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref RMcG/SF Date 15/01/24 Adult Social Care Performance Report – Quarter 2 From Ross McGuffie – Chief Officer – North Lanarkshire HSCP E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone 01698 858143 1. Background 1.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. 1.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions. 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 01st July 2023 to 30th September 2023 (Quarter 2). Recommendations It is recommended that the 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 (25) Ensure intelligent use of data and information to support fully evidence based decision making and future planning Programme of Work Resilient People Item 6 Page 69 of 100
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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 01st July 2023 to 30th September 2023 (Quarter 2). 2.2 The performance data for Quarter 2 and associated trend information is included as Appendix 1. 2.3 Areas for improvement and planned actions are agreed and developed on an exception basis (i.e., for those indicators which are amber or red, based on tolerance thresholds). These are detailed as Appendix 2 of this report. 3. Measures of success 3.1 Measures of success are contained within Appendix 1 of this report. 4. Supporting documentation 4.1 Appendix 1: Adult Social Care Dashboard 4.2 Appendix 2: Areas for Improvement (Quarter 2, July – September 2023) Ross McGuffie Chief Officer North HSCP Page 70 of 100
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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 71 of 100
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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 72 of 100
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Appendix 1 – Adult Social Care Dashboard PLEASE NOTE FOR ALL INDICATORS UPWARDS ARROWS DENOTE POSITIVE PERFORMANCE Ref. KPI Target 2023- 24 2022/23 Q2 2022/23 Q3 2022/23 Q4 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance 2.15 Assistive Technology - Number Of People With Technology (0-17 yrs) 1,452 34 33 30 28 28 G 2.16 Assistive Technology - Number Of People With Technology (18-64yrs) 629 629 633 632 631 2.17 Assistive Technology - Number Of People With Technology (65+) 853 839 853 818 825 2.18 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 666 1049 1418 376 816 G 2.19 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 60.6% 55.0% 61.2% 64.0% 70.3% G 2.20 Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 50.2% 58.4% 56.1% 45.8% 48.0% R 2.21 Balance Of Care - % Of People (Age 65+) 45% 45.4% 43.7% 42.6% 40.2% 36.7% R 2.22 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 75.1% 63.4% 51.5% 47.5% 49.9% R 4.3 Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 22.2 21.5 21.2 21.7 22 G 4.4 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 46.3 44.8 44.2 44.9 45.8 G 4.5 Care Home - Average Length of Stay 865 939 743 870 832 891 A Page 73 of 100
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4.6 Number Of People With Self Directed Support 1000 1322 2042 1956 2070 2093 G 4.7 Number Of People With A Direct Payment 240 328 336 359 329 342 G 7.20 % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 17.5% 16.2% 11.7% 12.4% 14.8% R 7.21 % Of Adult Protection Investigations Going To Initial Case Conference 20% 16.3% 14.1% 21.2% 20.3% 10.4% R 7.22 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 76.3% 78.4% 73.4% 76.6% 77.8% G 7.23 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 67.4% 69.0% 71.2% 76.6% 74.2% G Page 74 of 100
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Appendix 2 – Areas for Improvement 1. Reablement and associated services Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 45.8% 48.0% R Balance Of Care - % Of People (Age 65+) 45% 40.2% 36.7% R IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 47.5% 49.9% R Narrative & Corrective Action The number of people completing Reablement in Q2 was 398. Of 398, a total of 179 had either the same or increased levels of support, while 28 people died before completing process. A total of 191 had no or reduced support at the end of the process (90 no service; 101 reduced service). Overall, 48.0% of people completing Reablement had no or reduced support at the end of the process. A working group has been formed to update the Standard Operating Procedures for Reablement. The group has MDT representation from the six localities, including locality Integrated Rehabilitation Teams and Home Support. Rehabilitation and Reablement have increased their levels of collaboration with the Technology Team to introduce more technology options, supporting improved outcomes for service users. A number of staff awareness sessions have taken place and where possible, co-location of Technology Team staff within the locality has enhanced the knowledge and understanding of tech options, built relationships and improved joint working. Wishaw locality has been involved in a test of change to take all functional and environmental assessments away from Access Social work and this has proved to be very successful in reducing waiting times for service users and provided quicker access to rehabilitation. This approach will be further tested in another locality to assess the effectiveness of this way of working. The number of IEAS deliveries in Q2 was 8448. Of these, 4556 were special deliveries and non-core equipment, which are excluded from the calculation per the guidance. Of 3892, which are the deliveries in scope, 1942 were achieved within the 7 working day target. There are continued challenges faced by IEAS, however performance against the seven-day standard appears to have stabilised. There has been focused work on reducing the number of outstanding uplifts and higher priority deliveries. The ordering and delivery of equipment should be prioritised according Page 75 of 100
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the risk matrix, however most items ordered remain a Priority 1 and almost all equipment requested from hospitals is deemed essential for discharge, which increases strain on the service. IEAS staffing levels have significantly improved; the current position overall is a deficit of 5.89 WTE, however a refreshed induction and training programme for new staff members requires that the full capacity of these new staff is not wholly available to the service as yet. The procurement of the ELMS2 digital management system will improve processes, management information and communication. The system is currently in build and the training is being planned; the rollout is planned over six months with full integration expected in Autumn 2024. The Balance of Care figure is calculated as the proportion of people aged 65+ receiving 10+ hours of Home Support in the period against the total of; - people aged 65+ in long term care home placement (Q2 figure = 1334) - People aged 65+ in NHS long stay facilities placement (Q2 figure = 107) - People aged 65+ receiving 10+ hours Home Support in week (Q2 figure = 837) The “Home First” approach is well established in North Lanarkshire and is demonstrated by the work of the Home Assessment Team. Since its inception the Home Assessment has seen 1,433 individuals, with the service seeing in excess of 100 new people every month. Consistent levels of capacity have been created in the Wishaw, Motherwell, Cumbernauld and Airdrie localities, with Bellshill and Coatbridge developing plans to develop their local teams in the near future. Of those 1433 total people engaged with the HAT process, for those 1338 who are recorded as completing the process, 872 or 66% of those people required no further services on completion of the HAT process. For those who completed the process and were in receipt of a service, 466 or 26% were noted as having at least 1 service and 113 of those or 24% were in receipt of 2 or more services. Page 76 of 100
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The largest input service within the Home Assessment team is Home Support, where 72% of referrals receive home support, followed by 52% of referrals receiving Occupational Therapy input. For those who have been supported through the Home Assessment Team, 65% have required no further support at the end of the process. This has remained fairly consistent since the inception of the service. Those who require further support can be signposted to various community resources, or referred for more formal types of support. 17% of people who reuqire further support have been referred to the Community Alarm Service, 12% to mainstream Home Support, 11% to the Reablement service and 11% to the Integrated Rehabilitation Team. The HAT service remains a short-term level of support and assessment with the average time from referral to completion being 15 days and this has remained stable over time. The next steps for the project are to complete recruitment and the locality roll-out, ultimately leading to adopting the HAT approach for all people being discharged from hospital, allowing for a seamless flow to Reablement and greater capacity within Home Support. Further service improvements are expected through the review of Home Support, which has necessary interdependencies with HAT, Reablement and IRT teams. The Home Support Programme Board governs and provides strategic direction for this work. 2. Adult Protection Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 12.4% 14.8% R % Of Adult Protection Investigations Going To Initial Case Conference 20% 20.3% 10.4% R Narrative & Corrective Action The number of AP referrals received in Q2 was 846. At time of reporting, 730 of the 846 referrals had a referral decision recorded. Of those 730, 108 were passed to the Care Team for Investigations. Of the 108 that progressed to investigation, 96 of those had an investigation decision recorded at time of reporting. Of those 96, 10 progressed to an initial Case Conference. The number of ASP referrals received by localities continues to rise. Care Homes continue to be the primary source of referrals for ASP, which has been a consistent trend over the last 12 months. It is important to recognise that number of referrals does not automatically equate to the number of adults at risk of harm. Work continues to be undertaken with Care Homes and relevant stakeholders to promote high-quality ASP referrals and defensible Page 77 of 100
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decision-making based on a good understanding of risk, harm and the impact (or lack-of) this has on the adult being referred, and ultimately whether ASP is the correct referral route to take. In addition, community based referrals are more likely to progress to ASP investigation when compared to referrals from Care Homes. Referrals generated by Social Work and partners often relate to multiple types of harm but our analysis has identified that self-neglect and hoarding continue to rise; these cases are often complex and require a long-term, inter-agency response. Police “Adult Concern” reports continue to rise; combined with ASP referrals, these generate a significant body of protection work that is undertaken by localities to keep adults in the community safe. Page 78 of 100
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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 20/02/24 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 10: 01/04/2023 to 05/01/2024 From Morag Dendy, Chief Officer (Planning, Performance and Quality Assurance) E-mail LynchN@northlan.gov.uk Telephone Nicola Lynch, Business Finance Manager, 07581007187 Executive Summary This report provides a summary of the revenue financial performance of the Health & Social Care Partnership (H&SCP) – North Lanarkshire (Adult Social Care & Housing) and the financial performance of the Social Work capital programme. The report incorporates the period 1 April 2023 to 5 January 2024 (Period 10) 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 £254.399m and is currently projecting an underspend of £3.112m. This is an adverse movement of £0.877m since the previous committee report and is predominantly the result of additional spend expected in employee costs, equipment and adaptations and transport costs as well as projected increases in relation to independent care homes. 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 Programme of Work Statutory / corporate / service requirement Item 7 Page 79 of 100
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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 £254.399m. 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 £4.073m. 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 £0.162m. 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 Supplies and Services are anticipated to be overspent by £0.188m. This is mainly as a result of an anticipated overspend in equipment and adaptations. 2.4 Transport and Plant is anticipated to be overspend by £0.248m. This is mainly due to higher than anticipated costs in relation to staff mileage, coupled with estimated running costs associated with vehicles for use across the Service. 2.5 Admin costs are anticipated to be underspent by £0.657m and this is as a result of lower than anticipated spend in Carers budgets. 2.6 Payments to Other Bodies and Transfer Payments are detailed in Appendix 2. This expenditure accounts for £153.213m of the annual budget and is forecast to have an in-year net overspend of £1.229m (0.8%). 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 £2.3m 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 anticipated, therefore projections will alter as the year progresses, updates will be provided in future reports. 2.7 The Service anticipates a total over recovery of income of £0.192m. An over-recovery of £0.150m relates to Care of Gardens as highlighted in section 2.2 and £0.153m relates to returned private sector housing grants, these are both partially offset by an under-recovery of £0.192m which is mainly as a result of lower than anticipated income from charges for Community Alarms and Integrated Day Services. Page 80 of 100
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Revenue: Earmarked Reserves 2.8 The Integration Joint Board have set aside reserves of £35.766m for specific Adult Social Care commitments. It is anticipated that £17.472m of the earmarked reserves will be used during 2023/24, with £18.294m 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 2.9 The Integrated Equipment and Adaptation (IEAS) capital programme 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. 2.10 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. 2.11 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. 2.12 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 Morag Dendy Chief Officer (Planning, Performance and Quality Assurance) Page 81 of 100
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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 82 of 100
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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 83 of 100
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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 84 of 100
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APPENDIX 1 [1] [2] [3] [5] [6] [7] EMPLOYEE COSTS 89,175,484 85,102,275 4,073,209 FAV 4.6% (374,384) Slippage in relation to recruitment of posts in general across the Service PROPERTY COSTS 2,817,536 2,979,644 (162,108) ADV (5.8%) 11,809 Higher than anticipated spend on Care of Gardens (Housing) SUPPLIES & SERVICES 5,807,039 5,995,869 (188,830) ADV (3.3%) (301,003) Projected overspend in equipment and adaptations and small tools, offset by underspends in ICT, and other Supplies areas TRANSPORT & PLANT 1,788,318 2,036,339 (248,021) ADV (13.9%) (183,958) Higher than anticipated costs in staff mileage, coupled with estimated running costs associated with vehicles for across the Service ADMINISTRATION COSTS 1,568,685 910,914 657,771 FAV 41.9% 8,568 Lower than anticipated spend in Carers budgets PAYMENTS TO OTHER BODIES 54,766,392 54,662,966 103,426 FAV 0.2% (238,495) Please refer to Appendix 2 for analysis TRANSFER PAYMENTS 98,446,795 99,779,652 (1,332,857) ADV (1.4%) 38,529 Please refer to Appendix 2 for analysis CAPITAL FINANCING COSTS 0 (0) 0 0.0% 0 REVENUE FINANCING COSTS 0 0 0 0.0% 0 OTHER EXPENDITURE 28,858 11,464 17,394 FAV 60.3% 5,876 Minor underspend in "other" expenditure TOTAL EXPENDITURE 254,399,107 251,479,122 2,919,984 FAV 1.2% (1,033,058) NLC CONTRIBUTION (190,726,778) (190,726,778) 0 0.0% 0 NLC CONTRIBUTION - HOUSING (1,945,010) (2,095,010) 150,000 FAV (7.7%) 0 In relation to higher than anticipated spend on Care of Gardens NLC CONTRIBUTION - TRANSPORT (550,737) (550,737) 0 0.0% 0 INCOME FROM HEALTH (55,985,194) (56,065,801) 80,607 FAV (0.1%) 120,437 FEES AND CHARGES (1,428,167) (1,236,375) (191,792) ADV 13.4% 951 Lower than anticipated income in relation to charges for Integrated Day Services and Community Alarms OTHER LOCAL AUTHORITIES 0 0 0 0.0% 0 BUDGETED USE OF IJB RESERVES (3,176,336) (3,176,336) 0 0.0% 0 OTHER INCOME (586,885) (740,343) 153,459 FAV (26.2%) 34,654 Overrecovery in relation to returned private sectors housing grants and recharge income from other Council Services INCOME (254,399,107) (254,591,379) 192,274 FAV (0.1%) 156,043 NET EXPENDITURE 0 (3,112,257) 3,112,258 FAV 0.0% (877,015) [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Subjective Analysis Period 10 (01 April 2023 - 05 January 2024) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % MOVEMENT VARIANCE ANALYSIS Page 85 of 100
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APPENDIX 2 [1] [2] [3] [5] [6] [7] SDS Framework 1 & 2 97,732,362 99,087,998 (1,355,636) ADV (1.4%) (1) Demand led activity. Independent Care Homes 44,038,741 44,746,653 (707,912) ADV (1.6%) (225,388) Demand led activity. Payments to NHS Lanarkshire 2,311,732 2,041,615 270,117 FAV 11.7% 24,309 Position reflects anticipated in year payments Non Traditional Respite 335,283 57,135 278,148 FAV 83.0% 46,980 Position reflects anticipated Locality demand Other Local Authorities - General 127,909 72,784 55,125 FAV 43.1% 8,227 Position reflects anticipated in-year demand Voluntary Organisations 5,599,877 5,378,697 221,180 FAV 4.0% 87,639 Position reflects anticipated in-year demand Payments to Other Bodies - General 859,769 674,002 185,767 FAV 21.6% (38,852) Position reflects anticipated in-year demand Housing Support (RSL's) 714,433 691,654 22,779 FAV 3.2% 38,530 Position reflects projected contract levels Locality Flexibility 218,068 156,442 61,626 FAV 28.3% 24,186 Position reflects anticipated Locality demand Private Sector Housing Grants 1,152,378 1,067,740 84,638 FAV 7.3% (144,498) Position reflects anticipated in-year demand Medical Fees 122,635 105,724 16,911 FAV 13.8% 3,223 Position reflects Service's approach to absence management Agency Fees 0 362,174 (362,174) ADV 0.0% (24,321) Position reflects anticipated in year payments Other 0 0 0 0.0% 0 TOTAL EXPENDITURE 153,213,187 154,442,617 (1,229,431) ADV (0.8%) (199,966) [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Payments to Other Bodies & Transfer Payments Analysis Period 10 (01 April 2023 - 05 January 2024) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % MOVEMENT VARIANCE ANALYSIS Page 86 of 100
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APPENDIX 3 Contract Monitoring Staff 160,386 78,782 81,604 0 160,386 22/23 Saving: Muirpark 680,000 677,958 2,042 0 680,000 Carers Act 2018 - Support 2,700,995 104,000 2,596,995 0 2,700,995 Covid Reserve 750,000 0 750,000 0 750,000 Social Care Demand risk 9,456,640 4,898,100 4,558,540 0 9,456,640 Tech digitial Improvements 566,400 306,681 259,719 0 566,400 Violence Against Women (Joint Intiative with SLC) 30,000 30,000 0 0 30,000 Increase Advocacy provider 118,208 85,667 32,541 0 118,208 LSWM post 76,635 76,635 0 0 76,635 Discharge to assess/ PDD 304,345 267,255 37,090 0 304,345 Adapations Funding 388,315 388,315 0 0 388,315 Tech Improvements - SWIS 700,000 100,000 600,000 0 700,000 Tech Improvements - Comm Alarms 587,932 213,331 374,601 0 587,932 Tech Improvements - Home Scheduling System 3,775,744 671,707 3,104,037 0 3,775,744 Adult Protection Contribution 50,000 50,000 (0) 0 50,000 MH 2 NL10s 188,924 70,593 118,331 0 188,924 Cost of Living Helpline 574,912 219,823 355,089 0 574,912 HS resilience 3,646,000 2,891,623 754,377 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" 1,200,000 329,295 870,705 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 17,472,768 18,293,795 0 35,766,563 NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Status of Earmarked Reserves Period 10 (01 April 2023 - 05 January 2024) Adult Social Care & Housing - INTEGRATED TOTALDESCRIPTION OF EARMARKED RESOURCE Approved Reserve Total 2023/24 2024/25 No Longer Required 3,811,684 2,836,668 975,016 0 3,811,684 Page 87 of 100
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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 10 (01 April 2023 - 05 January 2024) Social Work Capital Programme BUDGET MOVEMENTS 2023/24 £ Period Division Thematic Category Page 88 of 100
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APPENDIX 5 Social Work: Integrated Equipment and Adaptations 2,188,153 1,317,408 1,566,635 621,518 2,188,153 0 TOTAL 2,188,153 1,317,408 1,566,635 621,518 2,188,153 0 UNCOMMITTED FINAL OUTTURN OUTTURN VARIANCE NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Summary Expenditure by Thematic Category Period 10 (01 April 2023 - 05 January 2024) Social Work Capital Programme Theme BUDGET ACTUAL COMMITTED Page 89 of 100
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☒ Yes ☐ No Ref: Date: 20 February 2024 Contract Award for Distress Brief Intervention Service [DBI] NLC NLC-CPT-23- 088-CPT-23-088 From Ross McGuffie, Chief Officer, University Health & Social Care Partnership NL E-mail Ross.McGuffie@lanarkshire.scot.nhs.uk Telephone Executive Summary Committee is asked to approve the award of a contract for a Pan Lanarkshire Distress Brief Intervention Service (DBI) (the ‘Agreement’) to: Lifelink. The Scottish Government allocated ringfenced funding for the Distress Brief Intervention Service (DBI) national pathway pilot is coming to an end with services contracted up to Mar 24. The Scottish Governments ‘Protecting Scotland, Renewing Scotland, the Governments Programme for Scotland, 2020-21’[3] (published September 2020) set out that it expects local health boards and health and social care partnerships to have DBI embedded locally by March 2024. Agreement has been reached with NHS Lanarkshire and South Lanarkshire Council for one commissioned service, delivered Pan Lan with North Lanarkshire as the lead procuring partner. As lead procuring authority, North Lanarkshire will assume all contractual management responsibility. A recurring funding commitment to continue beyond the pilot across Lanarkshire has been agreed with NHS Lanarkshire, with funding allocated from Primary Care & Action 15. The Agreement is for an initial period of 24 months anticipated to commence on 1 April 2024. The council reserves the right to extend the Agreement for up to a maximum of a further 12 months. The value of the Agreement is one million, nine hundred and seventeen thousand, and thirteen (£1,917,013) exclusive of VAT. Recommendations It is recommended that the Committee: (1) approves the award of the Agreement to Lifelink at the value of one million, nine hundred and seventeen thousand, and thirteen Pounds Sterling (£ 1,918,262) exclusive of VAT. Item 8 Page 91 of 100
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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 Programme of Work Resilient People 1. Background 1.1 The Scottish Government’s Mental Health Strategy 2017 – 2027 and Suicide Prevention Strategy 2022 – 2032 both refer to the work of Distress Brief Intervention (DBI) in their aim to provide better support to people presenting in distress. DBI trained staff provide a compassionate response to people in distress, an approach described as ‘ask once get help fast’ adopting the principles from the Time, Space, Compassion (2021) report. 1.2 The present Distress Brief Intervention (DBI) Service is part of a wider Scottish Government led pilot across several sites. The pilot evaluation determined that DBI was working well, was of benefit to those that used it, and that local authorities and health boards were directed to subsume a DBI service into their suite of provision for those affected by serious mental ill health. 1.3 The purpose of this agreement is to procure a single contractor across all of Lanarkshire to support adults over 16 years of age and continue with the national pilot for those under 16 years of age, with severe mental health problems. 1.4 Presently, there are three organisations delivering this service – one in North Lanarkshire and two in South Lanarkshire. It is anticipated that one of the key benefits of a unified approach is that there will be consistency of quality of provision, and that by upscaling the budget across all of Lanarkshire, this will enable wider reach and ensure that more of the overall budget that is available is expended on direct service delivery costs. 1.5 The requirements within the Agreement are currently under contract, with arrangements due to expire on the 31 March 2024. The Agreement detailed within this report is due to supersede it. 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” following the Regulations for contracting social and other specific services. Invitation to Tender documentation published by the council received a total interest from three companies with the council receiving two tender submissions. Page 92 of 100
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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, 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 Lifelink has 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 is located within Appendix 3. Financial / Budget Consideration 2.7 The pre-tender whole life estimate budget for the Agreement was £1,918,262 Following completion of the procurement procedure, the value of the Agreement to be awarded is: one million, nine hundred and seventeen thousand, and thirteen Pounds Sterling (£1,917,013) exclusive of VAT. 2.8 The costs associated with delivery of the Agreement will be contained within the revenue budget for NHS Lanarkshire - Primary Care and Action 15. Price Stability 2.9 Pricing is fixed for the duration of the Agreement. Community Benefits 2.10.1 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. 2.10.2 Within their tender, Lifelink committed to deliver the following community benefits within the Agreement: Community Benefit Type Quantity Committed New Job for an Individual from a Priority Group (Full Time) 1 New Job for an Individual from a Priority Group (Part Time) 1 New Job for an Apprentice from a Priority Group (Full Time) 1 New Job for a Graduate from a Priority Group (Full Time) 1 MCR Pathways 1-2-1 Mentoring Programme (or equivalent Programme) 2 Educational Support and Skills Transfer 3 Page 93 of 100
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2.10.3 The community benefits delivered as part of the Agreement includes the creation of jobs or apprenticeships. Fair Work First 2.11 Within their tender submission, Lifelink demonstrated commitment to the Scottish Governments “Fair Work First” initiative, such as rates of pay above national minimum wage, employee benefits, an environment where staff voice is sought, represented and responded to. Lifelink are committed to comprehensive staff training, continuous professional development and an environment of empowerment, health and wellbeing. Lifelink commit to flexible working, effective work-life balance, are committed to fair work practices and actively promote equality and diversity. Contract Management 2.12 Officers from NHS Lanarkshire, North and South Lanarkshire Council’s 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: • DBI Level 2 service provider will have DBI practitioners who are skilled and resourced to meet the needs of the supported person. • Equitable access to DBI Level 1 across all of Lanarkshire. • Record and compile required DBI service delivery data. • Deliver DBI Level 2 in accordance with DBI Standard Operating Procedures [SOP]. • Work collaboratively with local community services, voluntary and 3rd Sector providers. 3.2 Best Value has been considered and demonstrated by fulfilment of a competitive tender process, considering both price and technical aspects. 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 Ross McGuffie Chief Officer, University Health & Social Care Partnership NL Chief Officer Page 94 of 100
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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? Within their tender submission, the provider advised that they commit to following the Scottish Governments “Fair Work First” initiative. 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? Funding for the service is via NHS Primary Care & Mental Health and directed to NLC to lead on the procurement for the service on behalf of NHS Lanarkshire, SLC & NLC. Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Arrangements in place to draw down funding from NHS Lanarkshire. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts 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 95 of 100
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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? 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 96 of 100
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Appendix 1 – Summary of Tender Evaluation Process Final Rank Tenderer Name Total Tender Score (%) Recommended for Award (Yes / No) 1 Lifelink 93.16 Yes 2 Lanarkshire Association for Mental Health 81.20 No Page 97 of 100
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Appendix 2 – Summary of Procurement Process Response CPT Contract Reference Allocated: NLC-CPT-23-088 Procurement Procedure Utilised: Open Procedure Governing Legislation / Regulations: Public Contracts (Scotland) Regulations 2015 Date Contract Strategy Approved: Insert Date Tender Platform Utilised: PCS-Tender (PCST) Date Contract Notice Published: 28 November 2023 Total Expressions of Interest Received: 10 Tender Return Deadline: 9th January 2024 Number of Tenders Received: 2 Tenders from SME’s: 2 Tenders from Lanarkshire Based Tenderers: 2 Tenders from Supported Businesses: 0 Number of Non−compliant Tenders: 0 Number of Compliant Tenders: 2 Number of Recommended Tenderers: 2 Basis of Award: Quality: 93.16% Price: 81.20% Evaluation Team: Patricia Kearns -NLC, Ann Marie Darcy – NLC, Gary Patterson – SLC, Susan Cochrane – NHS Lanarkshire, William Gilmour – NLC, Paula Macleod – NHS Lanarkshire Anticipated Start Date of the Agreement: 01 April 2024 Total Agreement Period (Months): 36 months Awarded Value of the Agreement: £1,917,013 Page 98 of 100
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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) Lifelink Medium North Lanarkshire Lanarkshire Association for Mental Health Medium South Lanarkshire Page 99 of 100
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