Agenda Document Pack - Adult Care and Social Work Committee - 03/09/2024
North Lanarkshire Council · 3 September 2024
Back to Adult Care and Social Work Committee — 3 September 2024 and its agenda
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23 August 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, 03 September 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, A McCrory, D Ashraf, C Barclay, B Baudo, M Boyd, G Brennan, B Burgess, A Bustard, J Cairns, W Goldie, J Jones, K Larson, M McBride, B McCulloch, R McKendrick, C McManus, A McVey, N Shevlin, L Stubbs, 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 Update on Self-Directed Support in North Lanarkshire Submit report by the Chief Officer (Adult Social Work Services) providing an update on the progressive implementation of Self Directed Support (SDS) nationally and locally. 5 - 14 3 Home Support Service Submit report by the Chief Officer (Adult Social Work Services) providing an update on progress on the implementation of the redesign of the Home Support Service. 15 - 28 4 Community Alarm Service Submit report by the Chief Officer (Adult Social Work Services) providing an update on the Community Alarm Service. 29 - 54 5 Home Assessment Team/Discharge without Delay Programme Update Submit report by the Chief Officer (Adult Social Work Services) providing an update on the Home Assessment Team/Discharge without Delay Programme in line with the national development of Home First. 55 - 68 Performance 6 Adult Social Care Performance Report - Quarter 4 - 1 January to 31 March 2024 Submit report by the Chief Officer (North Lanarkshire Health and Social Care Partnership) providing an update on the performance of key areas of activity within Adult Health and Social Care for the period 1 January to 31 March 2024 (Quarter 4) 69 - 82 Financial 7 Revenue and Capital Monitoring Report: Adult Social Care from 1 April to 21 June 2024 - Period 3 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&SCO) - North Lanarkshire (Adult Social Care and Housing) and the financial performance of the Social Work Capital Programme for the period 1 April to 21 June 2024 - Period 3 83 - 94 8 Sundry Debt Write Off 2024 Submit report by the Chief Officer (Adult Social Work Services) summarising outstanding debtor accounts, deemed uncollectable following all attempts at recovery or considered uneconomically viable to continue pursuing. 95 - 100 Page 3 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 DF/AB/LB/AMCG Date 03/09/24 An Update on Self-Directed Support in North Lanarkshire From Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) E-mail FraserDi@northlan.gov.uk Telephone 07583 114596 1. Background 1.1 Self-Directed Support in Scotland has its origins in North Lanarkshire. The opportunity to maximise choice and control for people and their families was recognised locally as far back as 2007 where concepts and approaches were tested on a small scale and evaluated through Lancaster University and form the basis of the work being done today. Executive Summary This report provides an update on the progressive implementation of Self-Directed Support (SDS) nationally and the position locally with reference to the Self-Directed Support Framework of Standards updated by Social Work Scotland in May 2024. The report will reinforce the whole system approach to continuing to promote maximum choice and control for people living in North Lanarkshire. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the progress made in North Lanarkshire to promote choice and control through Self-Directed Support (2) Note that a future report will be brought to detail the findings of a Self-Evaluation and associated Action Plan. 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 Page 5 of 100
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1.2 Early drivers of a more personalised approach, including individualising funding to promoting choice and control, recognised the increasing gap between assessed need for support services and available resources to deliver. At the time it was noted that there was a risk of being pushed down a route that limited access to resources to meet critical and substantial need only, missing the opportunity to intervene more proactively and prevent difficulty or crisis arising. 1.3 The fiscal challenges of today being experienced at a system wide level; within specific services and across the range of provision; and for individual people and their families; make the original drivers for change even more important. A whole system approach is being progressively implemented to mitigate as far as possible, the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. 1.4 A personalised approach, which includes the individual allocation of financial resource where that is needed, remains the preferred operating model for the whole system in North Lanarkshire and is being supported by some key actions described in the report. 2. Report Legislation and National context 2.1 The Self-Directed Support (Scotland) Act 2013 promotes equality, autonomy and improves lives for people who need support. It is a crucial piece of legislation for children, adults and carers in Scotland, emphasising choice, control, and dignity in care and support. 2.2 Since the act was implemented in April 2014 both the Care Inspectorate and Audit Scotland have produced reports on Self Directed Support stating that whilst there is evidence of positive progress, there is an inconsistency of practice and process across Scotland (Care Inspectorate Thematic Review of self-directed support in Scotland: Transforming Lives June 2019; Audit Scotland 2017 progress report Self-directed Support) 2.3 In March 2021 the national framework of eleven standards for the implementation of Self-directed Support was developed and published by Social Work Scotland. The standards and action statements were developed to ensure consistency of outcomes and approaches in SDS practice across Scotland experienced by supported people (children and adults) and carers, building up a framework of good practice in assessment for support, support planning and in provision of care and support resources. The framework of standards was then updated in 2022 to become 12 standards and has been updated again in May 2024. 2.4 The foundation of the framework of standards is that Self-directed Support is not new or something to learn, it is not about resource allocation frameworks, and it is not only about an offer of the four SDS options. Crucially, SDS is about the implementation of core social work/practitioner values of human rights and relationships in practice, and it empowers social workers/practitioner to be autonomous in exercising their professional judgement, and using their own knowledge, skills and abilities, in partnership with supported people. The alignment of the framework of standards with the approach in North Lanarkshire reflects the direct involvement of key officers in their design and development. Page 6 of 100
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2.5 Alongside the development of the standards, Social Work Scotland are finalising the format of self-evaluation to inform local improvement plans. As enthusiastic early adopters of this approach, it is the intention to work with all local stakeholders to undertake a self-evaluation in late summer / autumn. Honest reflection on strengths and challenges will define clear actions which are expected to maintain and strengthen the whole system approaches to promoting choice and control in North Lanarkshire. North Lanarkshire Profile 2.6 In 2024/25 3,029 people benefited from support arranged through the principles of self- directed support. The adults, children, young people and their families, were able to excerpt choice and control through understanding the resource available to them and making decisions about how best to use that resource to support the achievement of their outcomes. 2.7 Information provided to Public Health Scotland as part of the Annual Return Summary demonstrates the spread across ages in Figure 1 below. Figure 1 2.8 The individual budgets put in place are outlined below in the number of people opting to manage a direct payment, direct their own support or have the local authority put arrangements in place. Figure 2 offering the detail of the numbers of people across localities and Figure 3 providing the financial information. Figure 2 Page 7 of 100
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Figure 3 2.9 As previously reported to Committee Mosaic will replace SWIS as the line of business operating platform. The design work is taking into account the benefits of enhanced data analysis and significantly improved reporting capacity. 2.10 The number of people and financial values indicated above all represent unique stories and significant achievements in supporting people with complex needs in the community. Individual arrangements range from people who have support at all times of the day and night, to people who receive more modest supports over small parts of the day. Support arrangements include non-standard use of resources in the form of bespoke purchases to meet need reflecting genuinely individualised nature of planning and intervention. Future reporting will increasingly be able to show the breadth and depth of information to practitioners, localities, commissioning staff as well as to the governing committees. Partnerships 2.11 Self-directed support at times becomes synonymous with individual budgets but it is much more of an overarching approach to people living well connected lives within their communities, which may or may not include the need for an individual budget. 2.12 Third and voluntary sector partners play a crucial role in supporting the whole system response. Inspiring Scotland who were the fund manager of the Scottish Government Support in the Right Direction monies facilitated the opportunity for the North Lanarkshire Disability Forum, Equals Advocacy and Voluntary Action North Lanarkshire to empower people and carers to be equal partners in their care ensuring real choice and control over their lives including how they live and the services/supports they receive; participating in fulfilling activities and in their communities, and pursuing employment if that was what was important. 2.13 The fund of £460,000 between 2019-2024 supported 2,576 people to be. • better prepared and more confident in participation in assessment • informed and listened to • creative and flexible in the plans around their life • confident in the management of their own support and individual budgets • generally more knowledgeable and understanding of self-directed support principles and options for them. 2.14 The experience and learning from the SIRD achievements has directly influenced the creation of the Community Connector role which increases the capacity to support people in the community to be resourceful and use their own resources well, as well as support people to participate as equal partners in the more formal responses to their support where needed. Page 8 of 100
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2.16 The Community Connectors role, also hosted by the North Lanarkshire Disability Forum utilises £600k identified through the Winter Planning and Enhanced Support funding stream as well as the Improving Cancer Journey monies. The capacity to support the work in each locality is significantly enhanced through 10 Community Connectors. 2.17 The importance of whole life planning is being explored through the Getting it Right for Everyone Pathfinder work North Lanarkshire is engaged with. The role of the third and voluntary sector is crucial in supporting a broader approach to helping people plan for the long term without “medicalising” or “clientising” into more formal services and supports before that is needed, but equipping people well for when that is the right response. 2.18 Self-directed support also needs resilient communities that are welcoming and inclusive. Community Solutions works to the principles of self-directed support and promotes the ambition of people having well connected lives through all the work undertaken through their themed work as well as through their community consortia. 2.19 Work with Enterprise colleagues is exploring opportunity through community wealth building within health and social care. Using the NHSL and Council anchor status and considering community wealth building will not only promote choice and control for people who have support needs but will draw a focus on employee-owned business, small provider development, entrepreneurship and supporting existing providers. 2.20 The vast majority of the £93m supporting people to live full and active lives involves support through independent sector providers. The 10-year framework agreement supporting individualised funding arrangements is an important example of ethical commissioning with strong partnerships and active participation in the development of responses in North Lanarkshire. There are currently 56 providers on the framework supporting genuine choice. 2.21 The quality of provision remains high and is subject to separate, more detailed reporting. 2.22 The cost-of-living pressures, recruitment and retention of a skilled and flexible workforce remains a challenge for the independent sector in the same way that it impacts in other parts of the whole health and social care partnership. Work to support the sector has included the allocation of non-recurring resources through the Winter Planning, Enhanced Support monies to impact on infrastructure responses and capacity building which has been welcomed by the sector. 2.23 Partnership working with independent sector providers is also supporting the achievement of the Coming Home work, a welcome approach to supporting people locally rather than in hospital or out of authority resources disconnected from family and friends. 2.24 The successes of a truly self-directed support approach to care and support and the examples of how people’s lives have been transformed continues to inspire and build confidences. There are a relatively small number of people in North Lanarkshire who sit on the Coming Home register, and work continues to successfully supports people to move from institutional, buildings based services to arrangements which much better take account of individual lifestyles, communication styles and support of positive behaviours. Page 9 of 100
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2.25 Increasingly the complexity of people’s health care needs in the community involves interesting discussion about the design and delivery of safe care, including, but not limited to ventilation and respiratory care and supporting people with end-of-life care. The development of safe operating procedures and active care management remains a fluid and learning environment to getting it right for everyone. 2.26 The importance of the partnership approach to achieving the best possible outcomes for people is being further strengthened within the review of overarching meeting structures and governance. The active participation of representative from Scottish Care, People’s own voice, Communities, Carers and Trade Unions will be strengthened at all levels. Resilient workforce 2.27 Scottish Government Self-directed Support Implementation Study 2018. Report 3: Self- directed Support Case Studies included analysis of the North Lanarkshire approach as one of the case studies. The report noted that whilst the four self-directed support options are a gateway to choice and control, evidence was that equally important was: • the quality of assessment, including a genuinely ‘good conversation;’ • the degree to which there is a focus on outcomes; • the budgets available to meet these outcomes and the availability of local providers able to deliver the support required; and • the enabled creativity and authority of supported people, practitioners and the care market to find solutions to meet those outcomes. 2.28 Whilst there is good progress on many reflections from this report, a Self-Evaluation against current standards will help channel actions to greatest impact. In the meantime, there have been some key developments achieved. 2.29 A learning and development plan is in place to support new and existing practitioners, team leaders and seniors, managers and wider stakeholders. Practitioners, people who have support arrangement in place, family carers, independent sector providers and third and voluntary sector providers are also actively involved in the delivery of more formal training as well as in the ongoing refresh of the plan. 2.30 Work is ongoing with colleagues involved in the delivery of both local authority and independent sector Home Support service to Increase choice and control through individualising arrangements and planning with people to meet changing needs flexibly and responsively, understanding the focus on frailty. 2.31 In keeping with a place-based approach to empowering localities and facilitating decision making closest to the person, changes to the authorisation of individual budgets within an enabling approach to localities has been introduced. This approach has increased the speed of decision making, empowered practitioners and leaders, and increased the creativity and flexibility that underpins good SDS. CONCLUSIONS 2.32 Self-directed support is the approach threading through all of the work of the Health and Social Care partnership. The ability to respond to people uniquely and continue to individualise responses including where an individual budget supports choice and control will remain the route to mitigate the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. Page 10 of 100
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2.33 The priority of work over the next 12 months, informed by the completion of a Self- Evaluation will be building resilience and sustainability: • In communities – helping people to help themselves first, ensuring the best information, advice and access to self-assessment / self-help. • In the Sector – recognising the importance of partnerships with all stakeholders, articulating that through good market facilitation and a focus on community wealth building. • In the workforce – training and development, fully using the care academy and developing the role of Scottish Care 3. Measures of success 3.1 The principles of SDS being delivered across Health and Social Care. 3.2 People can access information and support that helps them help themselves first. 3.3 Maintaining a place-based approach that empowers localities to facilitate decision making closest to the person. 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) Page 11 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? Balancing the available resources with demand is a key feature of supporting local decisions about best use of resources and supporting the flexible and imaginative use of the resource available. Measures described throughout the report are being introduced to support the demand and ensure equitable distribution of allocated funding. Future reporting will demonstrate the impact of changed ways of working. 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? This approach meets the requirements set out in the Self- Directed Support legislation. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☒ No ☐ Page 12 of 100
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If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☒ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk . All completed as part of the SDS Framework procurement exercise and currently under review as part of our Back to Basics / Locality Enabling Approach. 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? Our approach is to support people to remain at home and have access to locally based resource, thus reducing the impact on travel. 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? Aligns with the Resilient People POW and promoting our approach to delivering health and social care services. 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? We do not operate services within the principles of SDS and that demand and resources are not aligned. 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 ☒ Page 13 of 100
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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 14 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 DF/KW/AMCG Date 03/09/24 Home Support Service From Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) E-mail FraserDi@northlan.gov.uk Telephone Executive Summary In North Lanarkshire there has been a sustained approach to supporting people to live safely and independently at home, connected to their family, friends and local community for as long as possible. Whilst we have a range of social care supports available to support people North Lanarkshire Home Support Service is key to ensuring that people can remain at home and contributes to the sustained efforts to maintain a positive balance of care in the North Lanarkshire. This report will inform the progress on the implementation of the redesign of the Home Support Service which was approved in 2018. It will outline the work that has been undertaken following the recovery from the pandemic focusing on areas such as demand, complexity of support, workforce challenges, new models of delivery from acute setting and changing demographics. This will demonstrate that the model approved in 2018 remains fit for purpose and aligns with the current aims and objectives of the Strategic Commissioning Plan. Recommendations It is recommended that the Adult Care and Social Work Committee. (1) Acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model. 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 Statutory / corporate / service requirement Page 15 of 100
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Home Support Workforce 1. Background 1.1 The Health and Social Care Partnership are committed to ensuring individuals who are referred for a needs-based assessment to enhance their daily living get the right support, at the right time and in the right place. To maximise an individual’s independence and resilience, reablement and rehabilitation services are key to this process. 1.2 The plan for the new operating model to deliver Home Support was agreed by the IJB in March 2018. The model was based on the outputs of the Cross−Party Working Group, the advice from support officers and wider officer research, the proposed new model focuses on five major elements: • Integrated Model (Discharge to Assess in Localities) • Same Day Response/Reablement/First Support (Intensive and time limited) • Specialist Teams (e.g. supporting people with frequently changing needs and end of life / Palliative Care) • Ongoing Paid Support (allocation of an individual budget to deliver individual outcomes as part of SDS) • Quality Assurance (improving standards of care) 1.3 The plan outlined that the Home Support Service was to be a functional model based on two elements; assessment and planning (overall assessment and planning activity or the service) and long-term service delivery which will be referred to as the Living Well Service (providing support to those with complex health and social care needs). 1.4 The implementation of the new operating model commenced prior to the pandemic which included the centralisation of the management and administration of the service. Although elements were progressed, the pandemic had a significant impact on the Services’ ability to fully implement the model. 1.5 In response to the pandemic a number of changes had taken place to enable the service to operate during very challenging circumstances. Social care provision faced considerable workforce challenges as well as significant changes to the way care and Assessment and Planning Living Well Service Enabling Approach Page 16 of 100
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support was delivered. To support recovery there was significant investment which was reported through Winter Planning and Enhanced Support Business Case. The investment in a range of activities including Home Assessment, Reablement and rehabilitation was key to delivering key elements of prevention and early intervention which accelerated elements of the Home Support model. The success of the new model is also predicated on the investment and delivery of new systems Mosaic and dynamic scheduling system to modernise the service. Following this period of recovery a review was agreed in 2022 to ensure that the model agreed in 2018 remained fit for purpose. 1.6 This report will outline the work undertaken to engage staff and those who receive services as well as the partnership work that has been undertaken with the Care Inspectorate to improve the quality of service being delivered in North Lanarkshire to improve outcomes for people who need support. 2. Report 2.1 The service currently supports 2,235 individuals. Data gathered and used to inform changes highlights the significant growth in multi worker visits whereby 33.5% of all visits require two or more workers to support service users at each visit. This upward trajectory (graph 1) displays evidence of some of the challenges that are currently facing the service. Work is in the early stages of exploring single handed care, which will be of significant benefit to the service once this is fully embedded and supported in the future. 2.2 Over the last financial year, the service received 3,800 requests for assistance from people not known to the service. The number of care hours delivered has risen steadily since the pandemic (graph 2) and remains significantly higher than the hours delivered pre covid. Page 17 of 100
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2.3 Despite the increase in the hours provided, the number of service users have fallen in the corresponding time frame. The service users that are now supported present with more complex health and social care needs. As the number of individuals in the community with complex care needs continues to rise, the requirement for specialist provision becomes more apparent. 2.4 North Lanarkshire has, for many years, had a positive balance of care, a term which is used to refer to the balance of support and care available within the community- based settings compared with support within residential settings. This is supported by the continued investment in community – based supports and a long standing commitment to self-directed support. This is underpinned by community support which is co- designed with individuals and their carers/ families. This approach has resulted in a high proportion of individuals remaining at home. 2.5 Local Government Benchmarking Figures 2022/23 report that 65% of individuals over the age of 65 with long term needs receiving 10 or more hours of home care per week which is above the Scottish average of 61%. Along with other providers, NLC Home Support Service is a key resource within North Lanarkshire to enabling individuals to remain at home and retain a positive balance of care. 2.6 In line with the five key elements outlined by the cross-party working group integrated care remains a priority. The operating model for localities in UHNL HSCP is underpinned by an enabling approach which is being embedded through robust screening, assessment and resource allocation. This approach will ensure that individuals, carers and families have a support plan that is co-designed, with good information, utilising local resources and alternative support which is proportionate. Page 18 of 100
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Assessment and Planning 2.7 The development of an integrated approach through the establishment of Home Assessment Team working closely with Reablement and Integrated Rehabilitation Team builds on the work to deliver discharge to assess and same day response. This aligns the home support workforce with locality health and social work teams and will provide a range of resources to facilitate assessment and planning. By adopting this approach, it will ensure that when someone needs longer term support it is based on thorough assessment and support planning. This will be for people whose needs are more complex, including end of life care, within their own home. 2.8 The performance of both the Home Assessment and Reablement Team demonstrate that consistently more than 50% of people leave without ongoing support. In the last quarter 58% of people left reablement with no services or a reduction. The growing evidence highlights that short term assessment and reablement increases independence and reduces dependency on further care and support. 2.9 This work has also contributed to the improved discharge planning at both University Hospital Monklands and University Hospital Wishaw. Ongoing actions to maintain flow are essential to reduce readmissions and demand for long-term care and support, including the sustainability of the Home Support Service. A shift of focus to same day discharge and assessment and rehabilitation at home will improve outcomes and support quicker recovery. Living Well Service 2.10 When people need ongoing paid support, it is essential that waiting times are minimal and people have options as to how this will be delivered. Following assessment and support planning, individuals will have the option of NLC home support delivered by the Living Well Service. Supported people can consider how their support is delivered through the 4 options as outlined in the self- directed support legislation. At the point of review, options will be discussed including individual budgets or direct payments which can be used flexibly to meet identified outcomes. 2.11 The home support workforce in North Lanarkshire, provides essential support and care to individuals, carers and families. The Living Well Service will continue to provide care and support to individuals who require longer term, planned support. Due to the changing demographics and complexity of individuals requiring support, the workforce will be able to provide a responsive, flexible approach to those with fluctuating needs. 2.12 The workforce establishment and structure need to be finalised to allow for the model to be fully operational. This work will be ongoing with business partners and trade unions. Workforce 2.13 There are approximately 1,387 staff employed by NLC Home Support Service, with a worker profile of 6% male, 16.99% age 60 and over and 6.48% age 30 and under. This includes Home Support Workers in Reablement, Home Assessment Team, Intensive, Community Alarm and Living Well Service. The management and support roles were Page 19 of 100
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reviewed, and a new structure implemented in 2019. These roles support with scheduling visits, carrying out reviews, supervision and training. 2.14 Recruitment of Home Support Workers remains a challenge due to the high turnover of staff. However, the recruitment of staff to assessment and planning has been prioritised to support the operational model. 2.15 The need for a competent, confident workforce which is supported by a sustainable learning and development programme is key to ensuring safe, high-quality practice by motivated staff. The service has invested in dedicated staff to support learning and development through training, including refresher cycles, and investment in workforce development to provide high quality care. 2.16 An overall training plan has been created and has been made available to managers within the service. The plan ensures key activity is progressed including monitoring mandatory training for Home Support Workers as well as. highlighting registration requirements for all staff to deliver quality driven service offering flexibility and focused on service user outcomes. The below graph provides information relating to the increase of staff members undertaking core training. 2.17 The service has been reporting higher levels of absence over the past 12 months which has an impact on service delivery. There is ongoing work with Employee and Policy Officers to review the current situation. 2.18 It is important to note that the agreed model intended to deliver a more financially viable service. The budget allocation for 2024-2025 is £48.083m. The shift of resources to focus on prevention and early intervention is essential to assist in managing demand to ensure people get the right support at the right time. There are a number of key actions for the service to create efficiencies and they include the introduction of a dynamic scheduling tool which is a key development. Page 20 of 100
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Dynamic scheduling system 2.19 Individuals regularly request support and care at key points in the day and this can place pressure on the service. The current shift patterns of staff do not always match with the demand. The dynamic scheduling tool will assist with this but due to the number of different shift patterns that exist it will be necessary to consider how we address this to ensure a more efficient service. 2.20 A key aspect of service efficiency and improvement is the implementation of a dynamic scheduling tool to benefit Home Support Workers in the community and for those who schedule and plan work. It is an essential development to aid back-office staff to efficiently and effectively scheduler support and adapt quickly with changing needs. The tool is vital due to the current contract with Advanced/Kirona expiring on 31st October 2024, with no further option to extend as the current product is end of life. Following a procurement exercise Access CM were awarded the contract. 2.21 The contract to provide a dynamic scheduling tool will offer a wider range of benefits to staff and service users alike with the ability to produce accurate reports which will help to inform future demand upon the service. The tool will improve consistency, reduce missed visits, and incorporate travel time accurately. For the first time, the service will be able to monitor care delivery in real-time and monitor quality indicators such as punctuality, continuity and service duration. The tool will demonstrate how person- centred support improves quality of life and measures the effectiveness of care delivered. 2.22 Work patterns for frontline staff require to be reviewed. This will be essential to ensure any efficiencies arising from the implementation of a dynamic scheduling tool can be implemented. The workforce workstream have identified gaps in service provision that require to be addressed through the review. 2.23 Ongoing work continues for data cleansing and transfer as well as identifying training programmes in preparation for the new tool including the implementation of Mosaic (new case management system). Engagement 2.24 An important aspect in the review of the service model was to involve both staff and individuals who use the service by offering opportunities for them to shape the service by active participation. 2.25 Consultation with the workforce and stakeholders was undertaken through a series of events including face to face meetings across all locality areas and surveys to capture views and experiences of the current and future model. During each consultation event operational issues were captured and addressed which included ‘You Said, We Listened’. 2.26 Staff highlighted areas for improvement and issues that impacted on their work. They also had the opportunity to explore various options. Common themes reported by staff, • Not having enough travel time, • Having difficulty contacting their managers, Page 21 of 100
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• Waiting time for the Out of Hours Service and not always having enough time to undertake required tasks. • Impact of current work pattern on continuity and consistency of care including, lack of staff working backshifts, downtime at various points in the day and not having enough staff at peak times resulting in over time being utilised to ensure service delivery. 2.27 The engagement with supported people and their cares/ families highlighted recurring themes and included the need for continuity of care with consistency of carers and timing of visits however many reported that carers were respectful and courteous. 2.28 Following consultation with the workforce and stakeholders, benchmarking was undertaken with eight local authorities including Renfrewshire, East Dunbartonshire, South Lanarkshire, Inverclyde, Falkirk, Fife and Glasgow to gain a more in-depth knowledge and understanding of other Health and Social Care Partnerships, how they operate and manage Care at Home and Home Support provisions. This included gathering data across key areas of service delivery including preventing hospital admissions, facilitating hospital discharge, managing demand, cost and system. 2.29 The information collated has allowed the service to identify best practice and useful learning from others to develop a structure for the Home Support Workforce. A workforce plan is being finalised. Improving Quality 2.30 The proposed changes will ultimately ensure people have a high quality, safe and compassionate care and support, which is sustainable and maintained across all localities. 2.31 The service continues to work closely with the Care Inspectorate to meet requirements and make the improvements that have been identified through the inspection process. Challenges from staff absence and recruitment of appropriately skilled individuals have previously impacted on direct delivery and management teams, however, the service is starting to see an improving picture. Page 22 of 100
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2.32 The key issues and risks now arising from inspections are lack of consistency of support, system issues relating to the recording of missed visits and incorporating travel time, lack of training in developmental areas and outdated reviews and personal support plans. Good progress has been made in four of the teams, with two teams being high-risk areas for staffing and performance, particularly in relation to outstanding reviews and personal support plans. Improvement plans have been devised to progress the significant work, which is overseen by the Senior Social Work Manager. The full implementation of a dynamic scheduling tool will reduce missed visits, incorporate accurate travel time (both walking and driving) and improve consistency of scheduled care. 2.33 A demonstration has been provided to all Inspection Officers to give an overview of the main project benefits/goals, modules involved and examples of reduction in missed visits, improving efficiency and stronger continuity of care which have been consistently highlighted by the Care Inspectorate as areas for improvement. 2.34 The new inspection year commenced in April 2024 and the service has been advised each team will receive a full inspection during follow up visits, and will now involve three inspection officers, with a lead officer identified for each team. In addition, there are plans to conduct a separate review of recruitment processes during 2024, distinct from the ongoing inspections in localities. Conclusions 2.35 This report outlines the progress that has been made to implement the operating model for the Home Support workforce establishing a functional model. This will focus the workforce on distinct areas and ensure a delineation between assessment and planning and provision. 2.36 The impact of change detailed in the report will improve the quality and consistency of care and support, improve recruitment and retention, address impaired staff morale, improve Care Inspectorate grades and maximise efficiencies and capacity within the service. This will be supported by good governance, clear infrastructure, a skilled workforce and improved culture and environment. 2.37 There has been an incredible amount of work undertaken to ensure that the operating model is fit for purpose and can adapt into the future as we respond to whole system changes. A further update will be provided with the finalised operating model and associated workforce establishment. 3. Measures of success 3.1 The following measures of success have been identified: 3.1.1 Improving the wellbeing of supported peoples outcomes. 3.1.2 Evidence of reablement reducing service users’ dependence on long term home support, working collaboratively with the Assessment and Planning teams to ensure that we continue to support individuals’ independence and rehabilitation. 3.1.3 Improved discharge response from Lanarkshire and Glasgow Hospitals. Page 23 of 100
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3.1.4 Prioritised resources for ongoing longer-term support which will include the upskilling of the home support workforce to support service users with complex health and social care needs within their own homes. 3.1.5 A flexible and responsive service with evidence of improved quality of care, support and service delivery resulting in increased Care Inspectorate grades, staff, and service user satisfaction. 3.1.6 A competent and confident workforce, fully staffed teams with minimal turnover. 3.1.7 Ensure a sustainable financial model. 3.1.8 Have a service which can respond to future demand, with a workforce that can provide a flexible, responsive, outcome-based approach to supporting people at home. 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) Page 24 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? Currently working with Finance Business Partners to determine any financial implications to implement the operating model and associated structure. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts been discussed and agreed with People Resources? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts been discussed and agreed with Legal and Democratic? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☒ No ☐ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☒ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☒ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☒ No ☐ Page 25 of 100
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If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) by the Enterprise Architecture Governance Group (EAGG)? Yes ☒ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? A communication plan has been devised. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Key risks are relating to training, lack of funding for medication training and most of the training being delivered online, staff availability to undertake the work regarding the transferring of information to the DRS. Risks are recorded on the Corporate risk register and project risk register 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services. 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 26 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 DF/MF/JM/HH/AMCG Date 08/09/24 Community Alarm Service From Diane Fraser, Chief Officer / Head of Service (Adult Social Work Service) E-mail FraserDi@northlan.gov.uk Telephone Executive Summary This report gives an update on the Community Alarm Service since the last report in May 2023. It highlights the work undertaken and still required for the analogue to digital transition. It highlights the Community Alarm Service positive Care Inspection grades. It recommends the need for a staffing review to meet the needs of the developing service. Finally, it notes the service charging policy and sustainability. Recommendations It is recommended that the Adult Care and Social Work Committee (1) Acknowledge the contents of this Community Alarm Service update report. (2) Acknowledge the ongoing work being undertaken to support the transition from analogue to digital and the work completed to date. (3) Acknowledge the progress and challenges of progressing the move to the new digital ARC platform and the extensive work completed to date in preparation for this. (4) Acknowledge the positive Care Inspectorate grading that the service received from the Care Inspectorate. (5) Acknowledge the importance of sustainability including service charge. The Plan for North Lanarkshire Priority Improve economic opportunities and outcomes 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 Page 29 of 100
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1. Background 1.1 The Community Alarm Service operates 24 hours per day, 7 days a week, 365 days per year. When the individual activates the alarm, a signal is sent via the telephone line to the alarm receiving centre in North Lanarkshire which is staffed 24 hours a day, 365 days a year. A Response Advisor (call handler) speaks directly to the person to find out what kind of assistance is required. 1.2 The service currently provides support to 7,724 people in North Lanarkshire with the confidence that they can call for help at any time of the day or night, every day of the year and is an essential service when people experience difficulties such as a fall or sudden illness. 1.3 The number of people supported by the community alarm service has increased slightly since the previous report submitted in May 2023, most service users living within their own home, including all tenants living within NLC Sheltered Housing Complexes during out of hours and variously to registered social landlords across North Lanarkshire. 1.4 The Community Alarm Service currently provides a telecare service to 6,158 people using dispersed analogue and or digital community alarms and to 1,566 people within sheltered accommodation. 1.5 The service on average receives around 130 new requests per month for Community Alarm installations, the number of new referrals received per month has remained consistent with the figures from 2023/24. 1.6 In addition to the basic button and box which people associate with Community Alarms, there are over 1,000 pieces of assistive technology programmed through to the alarm receiving centre. This ranges from door contacts to hard wired smoke detectors for individuals with cognitive impairment, This has remained static since the previous report. 1.7 The service review work undertaken since the previous report to committee has focused on engagement with stakeholders and a focus on the staffing requirements of the service. Care Inspection grades have increased and it is evident that the service is effective, staff are committed, and service users satisfied with the support provided. A more detailed breakdown of service user engagement and participation is discussed later within the report. 1.8 The staffing resource aligned to the service has not been reviewed for a significant number of years and given the ongoing work of transitioning the service from analogue to digital, as well as increased call activity within the alarm receiving centre the decision was taken to review the staffing resource aligned to this aspect of the service. 1.9 University North Lanarkshire Health and Social Care Partnership (UNL HSCP) and North Lanarkshire Council (NLC) have invested significantly in early intervention and supported self-management for over a decade, with support for change and investment across all sectors which focus on wellbeing. The Community Alarm Service is a key part of supporting self-management with technological advancements creating the opportunity to move from being a crisis response service to being more proactive and preventative. 1.10 The above circumstances summarise the importance of the Community Alarms Service, the changes to the digital infrastructure and need to review the staffing Page 30 of 100
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compliment to ensure we realise the priorities and ambitions of the North Lanarkshire Health and Social Care Strategic Commissioning Plan. 2. Report Analogue to Digital Transition 2.1 Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout was scheduled to be completed by the end of 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. 2.2 Telecommunication suppliers are well on their journey to making this switch to ‘IP networks.’ Any systems relying on analogue lines, such as telecare, will be affected by this change. Individuals who have been provided with Analogue telecare equipment from North Lanarkshire Council must have their equipment updated to Digital ready devices to continue to receive a safe and reliable service. 2.3 Recent updates from Telephony providers such as British Telecom, have outlined they now expect all customers to be migrated over to a digital line by January 2027, other companies are also in the process of reviewing their timescales. 2.4 Despite the potential change in dates that will impact on the analogue to digital switchover, the community alarm service will continue to progress the digital upgrade as planned and hope to ensure that all service users in receipt of the community alarm service are fully digitised by the end of 2025. 2.5 North Lanarkshire as outlined in its previous report has been working closely with the Digital Office for Scottish Local Government. Across Scotland, most current solutions use analogue dial-up protocols to carry status and alarm signalling between the alarms devices in users’ homes and the Alarm Receiving Centres (ARC) - North Lanarkshire’s ARC is based in the Dalziel Building in Motherwell. Digital IP telephone lines are not designed to support these analogue protocols meaning that there is a risk that telecare alarm signalling will not operate reliably. This may result in a higher number of failed calls and redials being seen by the Community Alarm responders on the ARC system. 2.6 The plan for North Lanarkshire Council’s community alarm service is to transition to the new national digital ARC, this will ensure that the Alarm Receiving Centre (ARC) is fully digitised and will meet the digital requirements of our service while minimising the risks to analogue failures as the decommissioning of these old analogue lines progress. 2.7 This will allow the Partnership to adopt a new Digital Solution that will meet future requirements and can be customised to our specific operational requirements. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. At the time of writing several local authorities have successfully transitioned over to the new digital ARC that will be supported by Chubb and Sky Response. 2.8 The transition to digital has required the service to review all alarm devices that are in place within homes in the community and sheltered house residences and replace these current analogue devices with digital ready alarm devices. There will also be a Page 31 of 100
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requirement for digitally enabled peripherals such as falls detectors, door contacts etc, to be thoroughly tested to ensure that they are compatible with the new digital alarm receiving centre and alarm device. The ability to connect existing interconnected fire/smoke detectors via the digital alarm is currently not available. The Scottish Government are working with manufacturers on solutions to connect these devices to remove the need for multiple detectors to be in the same room. 2.9 The service has already changed around 3000 analogue alarms to a Hybrid digital ready unit which do not use the analogue telephone line, with a further 1000 planned to be exchanged by November 2024. 2.10 North Lanarkshire currently runs PNC 8.1 an analogue ARC provided by Tunstall Healthcare (UK) Ltd on servers within the NLC infrastructure. The current contract was due to end on the 31st of March 2024, however due to delays in the contract being awarded for the new digital ARC, an interim solution was required due to the current contract ending, as well as the current Tunstall Infrastructure and servers coming to the end of their life. 2.11 Work was undertaken by colleagues from the council’s IT infrastructure team who concluded that to reduce the potential risks to North Lanarkshire Council it was agreed that the services digital voice recorders would be switched off reducing risks of unsupported equipment failure occurring until a more robust plan could be put in place in the interim. 2.12 The Interim Software as A Solution (SAAS) has been procured from Tunstall because of the current servers that support the current Alarm Receiving Centre end of life. Colleagues from Infrastructure had determined that to do nothing would pose a real threat to the Community Alarm Service and the wider Council IT infrastructure, therefore an interim solution has been agreed. 2.13 The service has entered a 1-year contract for the SAAS solution with an option for a further year if required. The total contract amount is £107,000, however the service has a 90-day notice period to cancel the contract early, should the service be able to move to the new digital ARC, therefore reducing the costs of the overall contract. 2.14 Housing have undertaken an upgrade of all Sheltered Housing developments to a new Warden Call system that will be fully digital ready when the Digital ARC is implemented and are installing equipment in the remaining developments (which were upgraded a few years ago) to have a Digital connection available in readiness for the move to Digital. 2.15 The Community Alarm Service and the Technology team have supported housing colleagues throughout this process, ensuring hybrid digital alarms were placed in residents’ homes to ensure no loss of support throughout these works being completed. 2.16 There has been an increase in failing calls from Analogue devices identified across the UK because of the ongoing upgrades to Digital Telephony infrastructure we have seen this within our own Community Alarm Service where the primary number used to connect fails, but the backup number then successfully connects. This is being investigated with IT colleagues to identify what further resilience can be put in place to reduce these failures. Page 32 of 100
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Data Migration 2.17 The current data held on the Tunstall PNC system has over 25,000 client records, of which only 7700 are current users. With the current PNC system there is no facility to “batch” delete the 18,000 archived records. When the service migrates to the Digital ARC, we will be charged per client record, therefor it is imperative that only the current records are migrated to the new system. 2.18 Significant work has been undertaken to try and retrieve this data from the current PNC system, however as the service has no direct access to the databases on the PNC system, we are reliant on Tunstall providing this to us in a usable status. 2.19 The digital ARC provider has also recently developed a piece of software that they advise will do this conversion for us from the raw data but will have an associated cost yet unknown and will also require the same interrogation and verification required as the direct data from Tunstall noted above. Capital Spend 2.20 Capital monies have been set aside to support the transition from analogue to digital within the Community alarm Service. 2.21 During the course of the financial year 23/24 £325,000 had been spent purchasing 1500 hybrid alarms. 2.22 Due to ongoing testing of digital devices, it was decided after extensive testing by the technology team that 1000 LeGrande alarm devices be purchased, however due to delays with internal procurement processes, these will be purchased from the 2024/25 budget. 2.23 It is anticipated that £1,275,000 will be available to continue with the purchase of hybrid digital alarms in this financial year. 2.24 There is a projected increase in cost therefore a funding gap for future years that requires to be sourced. Community Alarm Service Review 2.25 Following the previous report submitted to committee in 2023 there had been discussions in relation to a whole service review in relation to the Community Alarm Service. 2.26 As part of the commitment to effective engagement and participation a number of different approaches have been adopted, some more successful than others. Specific events were organised but despite wide advertising, did not attract attendance. 2.27 As specific events did not attract participation in discussion, the service engaging in a more targeted way, through forums within Sheltered Housing Complexes and Integrated Day Services for example, so that the service was able to gauge service users views of the community alarm service. 2.28 During the last 12 months the service has attended various events and has spoken directly to over 200 Service users at a variety of events across North Lanarkshire. Page 33 of 100
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2.29 Feedback from service users was very positive, with many advising that having the Community Alarm provided them with reassurance should they experience a fall, required reassurance or required support with personal care. 2.30 The service also issued a questionnaire seeking service users feedback on the Community Alarm service, 124 questionnaires were returned. The findings of the questionnaire were that service users were satisfied with the service provided and that staff were helpful, polite and treated people with dignity and respect. 2.31 The service recently held an awareness day for Health and Social Care staff, stakeholders and third sector organisations over a 2-day period to provide more information and insight into the Community Alarm Service and how the service operates and functions. 2.32 Over the course of the 2 days, more than 200 people attended, with most leaving with a better understanding that the community alarm service is more than a button and box, type service. People were genuinely interested as to how the service operated and how we support service users who activate the community alarm. 2.33 Several focus groups were held with community alarm staff over a number of weeks in late 2023, each focus group was provided with an open platform to share their feedback, views, knowledge, and insight into the community alarm service. 2.34 The feedback was grouped into themes and further analysed to identify several important issues. Overall staff were incredibly positive about their roles/responsibilities and proud of the impact that their service had on individuals needing support from the community alarm service. 2.35 The key role benefits that staff described were the variety, flexibility, a strong team ethos, job satisfaction and most staff found the role to be rewarding. 2.36 There were some operational issues identified and most of them were resolved following the sessions. The main operational concern staff raised was the Community Alarm transport as this was becoming aged and unreliable due to age and mileage of these vehicles. Staff also raised some concerns regarding the shift patterns. 2.37 Both of these issues have subsequently been addressed with the Community Alarm Services ageing fleet of vehicles having been replaced in March 2024. The shift pattern concerns outlined by response advisors has also been addressed with a change to start and finish times for each of the three responder shift patterns resulting in a better work life balance and consistent work schedule. 2.38 It is evident that all staff employed within the community alarm service are committed and this has been evident with how staff across the service have responded with the introduction of new digital technology into the service. 2.39 The Assisted Technology Team have worked closely with the service and worked to support the response advisors as the new digital alarm platforms have come onstream. 2.40 The Care Inspectorate, the services regulator conducted an unannounced inspection of the community alarm service in April 2023, following the inspection the service was graded as follows: Page 34 of 100
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• How well do we support people wellbeing - Grade 5 Very Good • How good is out Leadership - Grade 4 Good • How Good is our staff team - Grade 5 Very Good 2.41 Following the Inspection Care Inspectors were complimentary on the service provided across North Lanarkshire by the community alarm service and feedback obtained during the inspection process from both service users and staff was positive and this was reflected in the grades awarded. All previous requirements had been met and the service has currently no requirements. 2.42 The importance of reviewing staffing requirements through the move from an analogue to digital solution was recognised through the engagement. 2.43 The alarm receiving centre is staffed 24hrs per day, Response Advisors respond to all incoming and outgoing activity in relation to community alarm and take calls for the Social Work Emergency Service (SWES) from 1.30am till locality offices open or when the team come on site at weekends. 2.44 The alarm receiving centre typically has more than over 40,000 call episodes per month, however most of these calls are to provide reassurance to service users within their own homes. 2.45 A Benchmarking exercise has been completed with other Alarm Receiving Centres in terms of response advisors manning the service 24 hours per day, North Lanarkshire has 3 response advisors on shift at any given time, however when compared to other Local Authorities our staffing numbers are on the lower end for staff resources. 2.46 Response advisors are a crucial part of the community alarm service; however, the establishment of this staff group has never been reviewed and during 2023 the service required to cover 900 additional shifts due to staff planned and unplanned leave. 2.47 Response advisor staffing is currently being reviewed as part of the wider engagement of the Home Support structure as it is recognised that additional staffing is required within this aspect of the service. 2.48 From the 1st of April 2024, the new Health and Care (Staffing) (Scotland) Act 2019 came into force. When enacted it revoked section 15 of the Public Service Reform (Scotland) Act 2010 and brings legislation requirements and guiding principles for those who commission and deliver health and social care services. 2.49 The Act also places a statutory duty on care service providers to ensure that, always, suitable qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of people using the service, and the provision of safe and high-quality care and in so far as it affects those matters the well- being of staff. Community Alarm Charging 2.50 In accordance with the Integration Scheme, the North Lanarkshire IJB is required to approve a balanced budget on the basis of funding delegated by North Lanarkshire Council and NHS Lanarkshire before the start of each financial year. Page 35 of 100
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2.51 Following approval of the budget, the IJB sends directions to both partner bodies setting out the agreed budget and the Strategic Commissioning Plan details the changes that the IJB is seeking to make in the design and delivery of health and care services. 2.52 However, decisions around charges for services remain with the partner bodies. In February 2020, North Lanarkshire Council approved the decision to commence Community Alarm charging from September 2020 as part of its budget setting process. Since that date, a charge of £3.40 per week (49p per day) has supported the sustainability of the service. Any calls made to the response centre are billed as normal telephone calls by the person’s telephone company. 2.53 The Council’s Discretionary Fees & Charges Policy was approved at Policy & Strategy Committee in September 2023. This policy was designed to allow for an annual uplift to discretionary fees and charges to support the implementation of one of the key principles of the approved Revenue Resources Budget Strategy which is that “Future charging models for services provided will be informed by benchmarking and the principles of full cost recovery”. The guidance states that all discretionary charges should aim to cover the full cost of providing the goods or services therefore in line with the policy, all discretionary fees and charges were to be increased annually from 1 April 2024 by a flat percentage of 5% (or any subsequent amendment to this policy). Services are required to ensure compliance with the policy and ensure discretionary fees and charges are increased accordingly. Any variation to this must be discussed and agreed with the Section 95 Officer. 2.54 Therefore, the charge for the community alarm service increased to £3.57 per week (51p per day) from the 1st of April 2024. Even with the slight increase applied from April, the charge for the community alarm service within North Lanarkshire remains one of the lowest when compared to all other local authorities across Scotland (see appendix 2). 2.55 The service continues to receive on average 130 new referrals for installation of community alarms on a monthly basis. Those being referred to the service are aware of the charge and should be offered a referral to the tacking poverty team to ensure their income is maximised by the referring agency or service. 2.56 The number of service users in receipt of the Community Alarm service has remained stable, at 7,700. A significant amount of data cleansing was undertaken when the charge was reintroduced. 2.57 The data cleansing exercise completed at the onset of the charge found that a significant number of service users had passed away, had moved into sheltered housing or had moved into a care home. The council’s data custodian supported the service with identifying these service users so that the data could be cleansed and updated to reflect actual service users in receipt of the community alarm. 2.58 Every person receiving or considering a Community Alarm Service has been and is offered support to maximise their income. 2.59 It was recognised that the agreed charge would support the Council and the Integration Joint Board to continue to deliver this service to a high standard through having the appropriate staffing and financial resources to meet the needs of those who use the Page 36 of 100
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service. It would be damaging to the service and the partnership to reverse the current charging arrangements. 2.60 It should also be noted that the transition from Analogue to Digital alarms will continue to attract further operating costs as each alarm will have as a minimum one roaming SIM card, however two may be required if there is no home broadband connection that can be used as a primary connection to the ARC. Current costs for these roaming SIM cards are £4.00 per month per unit, the cost of which could increase annually in line with inflation. The Digital Office have indicated that they will engage with Telecom suppliers to try and negotiate a Social Tariff, however this has not progressed yet. Based on a current installed estate of 7,700 alarm units this will bring an operating cost of between £360,000 and £450,000 per annum (based on £4.00 per month current charge or an anticipated £5.00 per month) to support the new digital alarms. 2.61 The income generated from the charge for community alarms is important to the continued development of the service and increased operating costs associated with digital advancement. It is however important to note that the Council had not pursued the recovery of debt and as noted in previous Committee Reports, given the vulnerability of people using the service, individual community alarms will not be cut off due to non-payment. 2.62 Invoices generated within the financial year 2023/24 amounted to £998k for the Community Alarm charge, however £202k remained outstanding at the end of year finance reporting period. This represents around 20% of invoices remaining outstanding. Outstanding invoices can be for several factors and the service is not always notified e.g. service user deceased, moved to sheltered housing, hospital or care home admission, unknown reason and nonpayment choice. The actual income received to date for financial year 23/24 amounts to £796k. 2.63 A sundry debt write off exercise is currently underway which will result in £137k of the outstanding debt being written off up to April 2022 as it has been deemed uneconomical to pursue. 2.64 At the point of the Charge being reintroduced in 2020 all recipients of the community alarm service were offered a review of their income by the financial inclusion team to ensure all benefits had been fully maximised. 2.65 Any recipient of the Community Alarm Service who make contact with the service to advise of financial difficulties in paying the charge is referred to the tackling poverty team (formerly financial inclusion team), however we would not remove someone’s alarm for nonpayment of the charge. 2.66 The service is continuing to review the number of non-payments that have accrued, and officers are working through information held within the mySWIS system. CONCLUSIONS 2.67 This report gives an update on the Community Alarm Service. It highlights the work undertaken for the transition of analogue to digital; both the challenges and progress are noted. Additionally, the positive Community Alarm Service gradings from the Care Inspectorate are recognised. From engagement and consultation, it is agreed that the service staffing resource requires review. Finally, it notes the service charging position. Page 37 of 100
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3. Measures of success 3.1 The Community Alarm Service maintains or improves the Care Inspection grades and subsequent service delivery. 3.2 Continued collaboration with the Assistive Technology team to support people in our communities with assistive technology and telecare equipment. 3.3 A service review is undertaken to identify the appropriate staff resource for the Community Alarm Service. 3.4 The Community Alarm Service further develops as a proactive and preventative service. 3.5 The analogue to digital transition is successful and achieved by the end of 2025. 4. Supporting documentation 4.1 Appendix 1 Analogue to Digital EQIA 4.2 Appendix 2 Weekly community alarm charge. Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) Page 38 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? Financial implications contained within the report. 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? HR will support the staff review mentioned within the report 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 39 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? Analogue to digital transition as outlined in the report 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? Analogue to Digital Transition, medium risk level. Risk owner, Graeme Cowan. 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 40 of 100
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Name of Policy / Budget Saving Analogue to Digital Transition Project Author Robert McClung Contact details McClungR@northlan.gov.uk Owner Diane Fraser FraserDi@northlan.gov.uk EqIA version number EqIA status Complete X Incomplete If Incomplete please say why - for instance pending further consultation / research Appendix 1 Page 41 of 100
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Section 1. About the Policy 1.1 Name of the policy / strategy / function / procedure: Is this a: - A new policy /strategy / function / procedure / service Budget saving Review of policy /strategy / function / procedure Review of Service Other (please specify) Community Asset Transfer Is this is a key strategic decision subject to the Fairer Scotland Duty Yes No 1.2 Person Responsible for the policy etc. Name: Robert McClung Job Title and Service / Team: Senior Officer Analogue to Digital project Lead (Adult Services) 1.3 What is the scope of the assessment? Detail where appropriate Whole of the organisation Service specific Discipline specific Other 1.4 What is the policy/ strategy/ function/ saving trying to achieve / do? Page 42 of 100
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Analogue to Digital Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started, and the rollout is scheduled to be completed by 2025. As of 2021 services can no longer sell analogue services such as BT and Virgin, and by and escalated process by 2023 no analogue tech nology can be sold also by any company. Analogue to Digital in Community Alarm Current telecare solutions in use in Scotland use analogue technology. This means that they send signals between the alarm device and Alarm Receiving Centre (ARC) by making a dialup phone call and sending a series of audible tones. Analogue signalling does not work reliably when sent over the digital phone lines that are being installed in user’s homes, grouped schemes, and ARCs Telecare is digital when signalling traffic is carried end-to-end (from a user’s alarm device to the ARC) in a digital format. This device is not connected to the user’s telephone line, instead it contains a SIM card that allows it to connect to the mobile telephone networks. This means that the Alarm Receving Centre, alarm devices and peripherals will now need to be digitally enabled to meet the future needs of the service users within our community. This project fits directly into the council’s ambition priority to - Improve the health and wellbeing of our communities. North Lanarkshire Health and Social Care partnership and North Lanarkshire Council is looking to develop a strategic business plan for the analogue to digital transition through the review and analysis of current service provision and their users. This project will look to have an in-depth look at understanding of current technology in place, current HSCNL digital workstreams and their impact on this project and collaboration, engagement of community alarm users, engagement of HSCNL staff in respect of technology and community alarm service and appraisal of alternative technology for future use within the partnership This project will look to provide our communities with the ability for self-management, proactive responses from services and for a holistic person-centered basis for a person’s wellbeing using technology. This project will have produced a strategic business plan for the analogue to digital transition along with all relevant risk assessments. Page 43 of 100
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Following the strategic business plan, this project will then focus on implementing the organizations transition from analogue to digital. This will come in the form of procuring a new alarm receiving center through a cloud hosted based system or hardware-based system, to replace our current analogue alarm receiving center. This will then allow for us to look at digitally enabled devices to replace our current analogue community alarms. 1.5 If this is a budget saving, how will the saving be achieved? This project will not focus on budget savings. Section 2. What do I know now? 2.1 Who are the stakeholders and beneficiaries? The stakeholders will be our residents within North Lanarkshire Council areas who are provided with a community alarm service or a telecare service. Other stakeholders will be employees who work for the community alarm service and Health and Social care who assess and prescribe telecare equipment. 2.2 What data, consultation, research and other evidence or information is available relevant to this assessment? (This is a desktop exercise) Digital Telecare National Briefing Document (2020) gives an overview of the work done by telephony providers around the transition of their analogue copper lines to new fibre digital lines. This was done without consultation of the public or any organisation. This document also outlines • An estimated timeline with an in-depth breakdown of the timescales to complete key operational components of the transition. • Estimated resources and costings for the transition. • Information on the impact that the transition will have on service users. • Potential benefits and opportunities of a digital telecare service. • Risks to be considered. • Recommendations that telecare service providers should follow to minimise disruption to their service users. • Information on resources available from the Digital Telecare Programme which will support the transition journey. North Lanarkshire have also enlisted a third part organisation to carry out reviews of the community alarm service which details peoples experience of using this alarm system. Page 44 of 100
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2.3 Considering the information in Section 1 and 2.1 and 2.2 2.3.1 If this policy is subject to the FSD what does it suggest about the impact or potential impact on socio-economic disadvantage? (please refer to FSD Interim Guidance) Low income People in receipt of a community alarm are now in the process of being charged for this. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Low wealth Material deprivation Area deprivation 2.3.2 Are any of the people communities listed below likely to be more affected by this policy than others? People who share one or more of the protected characteristics of the Equality Act 2010 Yes Details No Details Don’t Know Age (a particular age or range of ages) X 78.1% of community alarm users are aged 70 years and over. Disabled people and people with long term health conditions X Most users of the community alarm service fall within this characteristic. We are unable to pull statistics for this. Women and men, girls and boys X People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Pregnant women and new mothers (including breastfeeding women) X Lesbian, gay and bisexual people X Page 45 of 100
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People transitioning from one gender to another X People of different religions or beliefs or non-beliefs X Other groups Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Carers will be affected due their possible requirement to use the community alarm systems to summon support fore the person they are providing the care Asylum seekers X Employees – full and part time. Including SES, MAs etc. X Staff who work within the service will be affected by changes to their operating systems and procedures. Others 2.4 Do you have evidence or reason to believe that this policy will, or may potentially affect the Council’s duty to: (Please tick all that apply). Yes No Don’t Know Page 46 of 100
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1. Eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Equality Act 2010? X 2.Advance equality of opportunity between people who share a relevant protected characteristic and those who do not X 3. Foster good relations between people who share a protected characteristic and those who do not? X 4. Protect and promote human rights? X 5. Reduce socio-economic disadvantage X Please provide details. Section 3. What else do I need to know /find out? 3.1 Further consultation – Please use the table directly below to say who you will consult with (tick Yes or No). Consider those groups from section 2.3 where you ticked yes or don’t know. Once consultation has taken place provide the details below. People and communities Yes No Describe what you did, with whom and when. Please provide a brief summary of the responses gained and links to relevant documents, as well as any actions Age (a particular age or range of ages) X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Disabled people and people with long term health conditions X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Women and men, girls and boys X People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Page 47 of 100
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Pregnant women and new mothers and breastfeeding women. X Lesbian, gay and bisexual people X People transitioning from one gender to another X People of different religions or beliefs or non-beliefs X Other groups X Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Asylum Seekers X Trade Unions X Employee Equality Forum X Others X 3.2 What additional research or data is required? At this time all research and data has been provided by the Digital Office for Scotland as this is a nationwide activity being completed by external telephony providers which will affect all areas. Page 48 of 100
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3.3 What does the additional research and data tell you about potential or known effects? N/A Section 4. Assessing the impact and strengthening the policy Considering all the evidence you now have from section 1-3, how will the policy affect different people and communities in relation to equality, socio-economic disadvantage and human rights? 4.1 How does/will the policy and resulting activity affect those with the characteristics listed below (including employees)? Please use the table below to provide details. Detail any Positive impact Detail any adverse impact If adverse how can we mitigate this? Where no mitigating action is planned please say why not Age (a particular age or range of ages) The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Ensure that benefits have been maximised. Disabled people and people with long term health conditions The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Ensure that benefits have been maximised. Women and men, girls and boys People defined by their race, colour and nationality, Page 49 of 100
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ethnic or national origins. Married people and civil partners Pregnant women and new mothers (including breastfeeding women) Lesbian, gay and bisexual people People transitioning from one gender to another People of different religions or beliefs or non-beliefs Other groups Children and families Homeless people Looked after and accommodated people Care leavers Carers – paid / unpaid, family members The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Support is provide to ensure the person they care with has their benefits maximised to allow them to keep this service. Asylum Seekers Employees – full and part time. Including SES, MAs etc. The introduction to the digital telecare should provide a better working platform for staff with better call reliability and A new way of working may need to be introduced Support will be provided Page 50 of 100
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handling. This should reflect in their ability to take and field calls more efficiently which will require further training and support for staff to follow throughout the project. Others 4.2 What measures could be taken to strengthen the policy / strategy to help advance equality of opportunity, foster good relations, promote human rights and reduce socio-economic disadvantage. North Lanarkshire could look to build on its use of community alarm service reviews to carry out a more holistic in-depth review of a person’s needs. This would allow the service to maintain and enhance its relationship with the users of the alarm service. 4.3 Considering questions 4.1 and 4.2 what actions / measures will be put in place before introducing this policy please provide details. Action Timescales Responsible Officer Review details (include timescales) Section 5. Monitoring, evaluating and reviewing 5.1. How will you monitor the impact and effectiveness of the new policy? This will be reviewed at the beginning of the transition and throughout the implementation of the digital equipment. The full project will be subject to a review as in line with North Lanarkshire’s project management policy. Section 6. Making a decision and sign-off Recommendation Tick Comment (where applicable, please give more information e.g. where to pilot, what modifications, etc.) Timescales Introduce the policy New policy and procedures will be put in place once digital 12 Months Page 51 of 100
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transformation of the service is complete Adjust the policy then introduce Introduce the policy with justification regarding potential adverse impact Stop and withdraw the policy Name of Policy Head of Service /Senior Manager sign-off: Name Job title and division/ team Date Signature For further information please contact: Name: Hugh Holt Job title: Senior Officer Service: Adult Services Contact details: Holth@northlan.gov.uk Page 52 of 100
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Appendix 2 Weekly Community Alarm Charge Local Authority Weekly Charge Additional Charges or Variances Perth & Kinross Means tested Borders Means tested Highlands Means tested West Dunbartonshire £6.50 Argyll & Bute £6.45 Angus £5.99 Further £1 Every week for Telecare Equipment North Ayrshire £5.32 £2.60 for Islands Edinburgh £6.39 East Dunbartonshire £4.85 Falkirk Council £4.75 East Ayrshire £4.74 Clackmanshire £4.60 Stirling £4.60 South Ayrshire £4.41 West Lothian £4.30 East Lothian £4.05 Midlothian £4.00 Orkney islands £4.00 Glasgow £3.96 East Renfrewshire £3.25 Renfrewshire £3.88 Aberdeenshire council £3.85 Aberdeen City Council £3.85 Dundee City £3.85 Dumfries & Galloway £3.60 North Lanarkshire £3.57 Moray £3.50 Shetland Islands £3.15 Fife £3.09 Inverclyde £2.90 South Lanarkshire £2.33 Comhairle nan Eilean Siar £1.50 Page 53 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 DF/MF/SS/IN Date 19/09/23 Home Assessment Team/Discharge without Delay Programme Update From Diane Fraser, Chief Officer (Adult Social Work Services) E-mail FraserDi@northlan.gov.uk Telephone 07583114596 Executive Summary This HAT report highlights the background to creating capacity across the health and social care partnership via the business case funding. It outlines the agreed priorities: prevention and early intervention, empowering people in our communities and a more efficient whole system approach. This includes an explanation of the Home Assessment Team (HAT), early stages of development and plans for further implementation in line with the national development of Home First. It evidences the multi-disciplinary approach in supporting hospital admission avoidance and discharge arrangements. Finally, it explains the risks and challenges and the next steps. Recommendations It is recommended that the IJB PFA Committee: (1) Acknowledge the report. (2) Endorse the strategic direction of HAT and the implementation of HAT across North Lanarkshire. (3) Acknowledge the significant development in HAT practice across North Lanarkshire The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities Programme of Work Resilient People Page 55 of 100
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1. Background 1.1 In September 2021 the IJB approved the establishment of a Change Fund to create additional capacity and support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire Health and Social Care Partnership, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan: • Do the right thing first time • Provide a range of community services and supports to people to live well in connected communities • Focus on what matters to people • Be at the forefront of technical and sustainable solutions • Promote prevention and early intervention • Ensure North Lanarkshire is the best place to work, volunteer and care 1.2 Priorities for the use of the Change Fund were identified as: 1.2.1 Prevention and early intervention, targeting spending on helping people to live healthier and safer lives and maintaining their independence at home or in the community. This means less spending is required on hospital or specialist care later. 1.2.2 Empower individuals and communities, involving them in service design and delivery. This should result in services that match what people need and want. 1.2.3 Improve efficiency by adopting a whole system approach to improve and deliver services. 1.3 A Winter Planning & Increased Capacity Business Case was developed, and this set out a total recurring investment of £6.759m in three main categories: • Assessment and planning capacity • Direct provision of services and supports • Infrastructure capacity 1.4 Home Assessment sits within the first of these categories and is the approach that North Lanarkshire is taking to implement what is known nationally as Home First. 1.5 It is recognised that being in hospital disconnects people from their family, friends and social network and can result in a sense of isolation, loss of confidence and depression. Older people in particular experience functional decline as early as 72 hours after admission and are more likely to have an episode of delirium or infection. Every unnecessary day in hospital increases the risk of an adverse outcome for the individual, drives up the demand for institutional care and reduces the level of investment that is available for community support. (PubMed - Swinnerton, Price, ‘Recognising, Reducing and Preventing Deconditioning in Older People’. 2023). 1.6 Discharge without Delay (DWD) is a vital component of the Scottish Government’s Unscheduled Care Programme with a Home First approach fundamental to its success. The aim is to prevent delay to discharge where an acute medical issue has been addressed. Reducing delay for people who can be assessed within their own homes rather than a hospital ward is an essential element of reducing the length of hospital Page 56 of 100
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stays and thus releasing unnecessarily consumed capacity. This approach requires a shift in mind-set to; “Why not home? Why not now?” and has been proven to result in more positive individual outcomes for people. (SCIE, ‘Hospital Discharge and Preventing Unnecessary Admission, 2022). 1.7 North Lanarkshire’s Home Assessment Team, (HAT), is a multi-disciplinary social work, health and social care resource which applies a whole system approach to planning and preparation for hospital discharge and admission avoidance by facilitating both assessment and intervention within each person’s own home. HAT will support by adjusting the balance of care both at the front door and back door of hospitals. 1.8 To enable timely discharge from hospital and prevent unnecessary admissions, HAT provides: 1.8.1 Rapid access to the support that people require to enable them to return home or avoid admission to hospital. 1.8.2 Time-limited support to enable an assessment of each person’s immediate and longer- term support needs in their own home, taking into account and optimising use of personal and community networks. 1.8.3 A designated workforce focused on enabling discharge and maximising function in the home environment by increasing the number of timely post-discharge assessments and providing a rapid community response to prevent hospital admission. 1.8.4 A robust discharge pathway for those who require home assessment and rehabilitation following discharge from both hospital front door and wards. 1.8.5 Flexibility to deploy the workforce across the sectors. 1.8.6 Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?). 1.8.7 Clear leadership and presence within discharge arrangements services. 1.8.8 Close links with individuals involved in the Planned Date of Discharge process to identify appropriate patients for the HAT pathway. 1.8.9 Close working relationships with Rehab Team, District Nurses, Acute, Allied Health Professionals, Hospital at Home and Hospital Discharge Support Programme (3rd sector) with access to the equipment store to support hospital admission avoidance and discharge arrangements. 2. Report 2.1 HAT Roll-out Phase 1: Wishaw and Cumbernauld fully implemented Phase 2: Motherwell and Airdrie fully implemented Phase 3: Coatbridge and Bellshill: • Coatbridge commenced December 2023 although not fully staffed yet with work ongoing to progress. Page 57 of 100
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• Bellshill not yet fully operational, but utilising Motherwell-based HAT Home Support staff to support discharges via HAT. 2.2 Service Model • Standard Operating Procedure agreed. • Workshops held to map pathways, review and agree pan-Lanarkshire referral criteria with all key stakeholders in the MDT including transfers of care into reablement, mainstream /longer term home support and rehab services. • HAT staff accommodation secured in university hospitals and community. • Induction programme established. 2.3 Data and measurement • Data spreadsheet developed to record activity and enable monitoring of performance and outcomes. This continues to be revised according to activity and developments. 2.4 Recruitment • Recruitment to HAT ongoing to build capacity and roll out across all NL localities. The pressures within the system regarding workforce are widely acknowledged and adjustments continue to be made to skill-mix. • Several recruitment campaigns have been progressed across health and social care to recruit across the team including Home Support, Physiotherapy and Occupational Therapy staff. • Several Home Support Workers have expressed an interest in transferring to HAT. This will be facilitated as soon as their posts have been backfilled. • It is the intention for existing staff to be able to work flexibly across sectors as required to meet demands. 2.5 Leadership and Operational Management • Interim operational management of HAT has been delegated to two Locality Social Work Managers, aligned to the 2 hospital sites of University Hospitals Monklands and Wishaw, and an NHS Service Manager, working closely with the discharge arrangements and the hospital social work teams. This will be rolled out across the six localities. • They are reviewing the operational structure of the HAT and holding regular meetings with Team Leads including Allied Health Professionals and IRT to take forward any outstanding work to establish HAT. • Strategic management is also undergoing a review to ensure integration into the new GIRFE/Enabling Approach arrangements. 2.6 Risks and challenges 2.6.1 The implementation and embedding Home Assessment practice presents with several risks. Page 58 of 100
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Risk Mitigation The release of a substantial number of Home Support Workers from the mainstream/longer term service will impact on the delivery of long-term home support including disruption of existing care packages and potential increase in unmet need Working closely with in-house home support and the independent home care providers across the sector to create the capacity required to release this resource. People are not supported as required due to ineffective, inefficient and inconsistent reablement activity Ring-fenced reablement teams established to meet need Regular weekly Reablement meetings between Home Support and Rehab Teams across 6 localities to target reablement activity and achieve practice consistency Lack of trust in HAT process Targeted engagement activities between HAT, ward and community staff to develop trust and confidence in assessment at home Patients’ outcomes may be poorer due to deconditioning in the hospital setting which ultimately leads to increased dependency on formal supports or transfer to long term care home placement Promote earlier discharge from hospital and assessment at home Planned Date of Discharge (PDD) is not fully embraced Refreshed PDD process Low referral rate to HAT HAT presence in hospital settings to develop further trust and confidence Recruitment challenges Planned, phased and strategic recruitment Low Pharmacy input Ongoing pharmacy input and medication training across relevant staff Limited access to pool cars Further purchase of pool cars Lack of capacity on Acute sites to support HAT Accommodation and space identified for HAT staff 2.6.2 Other challenges: • Timely movement of people into services, if required, including Reablement, IRT, long-term home support. • Funding for non paye costs to be agreed and sourced as not included in the initial business plan. Page 59 of 100
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Embedding the approach 2.7 As HAT has developed, further synergies have been identified with other key programmes of work to improve our prevention and early intervention response. This includes Getting It Right for Everyone (GIRFE), the Frailty Strategy, Home Support Refresh, the Back to Basics Enabling approach and the Operation FLOW Optimal Discharge Planning Target Operating Model. 2.8 The interface with other parts of a person’s journey is critical. Whilst some individuals will not require any statutory support, there will be those who would benefit from further intervention. Therefore, while we ensure FLOW through the acute hospital sites, this is also required within community settings and timely access to reablement, and rehabilitation will be critical to enable people to maximise their potential and ensure that they receive the support that is right for them. 2.9 Reablement provision was significantly impacted during the pandemic due to capacity and workforce issues. Subsequently, there have been changes within the Home Support Service and Integrated Rehab Teams (IRT) to ensure that Reablement can be fully remobilised. This entails a separation of assessment and planning functions, including Reablement, HAT and IRT, and a long-term “Living Well” Service. 2.10 Weekly meetings have been established between relevant staff in HAT, Home Support, Reablement and Rehab Teams to facilitate effective communication regarding individual service users and reablement activity and subsequent goal setting supported by a standard operating procedure. 2.11 Each locality is developing a multi-disciplinary enabling approach to ensure an effective and timely response that taps into community resources, where appropriate, through our recently appointed third sector community connectors. Next Steps 2.12 Embed HAT across North Lanarkshire whereby Home First becomes the norm in Acute and Community and align with the Target Operating Model to optimise discharge. 2.13 Conclude recruitment and complete roll-out across localities. 2.14 Communication and engagement activities continue including staff briefing sessions. 2.15 Ensure Lanarkshire-wide referral criteria are widely known. 2.16 HAT process and patient/service-user pathways used in everyday practice. 2.17 HAT patients/service users to be discussed on Planned Date of Discharge (PDD) call. 2.18 Full remobilisation of Reablement. 2.19 Improved interface with the Equipment Store and Assistive Tech Team and subsequent service delivery. 2.20 Ensure HAT is embedded in whole system approach aligned to GIRFE principles and Back to Basics Enabling Approach. Page 60 of 100
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2.21 Undertake a test-of-change in Airdrie/Wishaw which will aim to: Identify the range of preventative and early intervention services. Build on the prototypes developed through the Partnerships involvement in the national GIRFE Pathfinder Programme. Improve access through changes to first point of contact. Put in place robust screening and allocation through an MDT and enabling approach. Reduce waiting times through embedding the team around the person, working to a single, shared plan and eradicating unnecessary referrals. 2.22 Establish key linkages within the Health & Social Care Whole System Dashboard and track wider impacts of the service on Delayed Discharge performance, and capacity of the Home Support Service Data on activity impact 2.23 Since its inception in April 2022 to 2nd July 2024, 2,119 patients in total had been referred to and supported by the Home Assessment Team. 2.24 As illustrated by the chart below, there has been a natural, gradual build and expansion of the team as staff have been recruited and trained. This is reflected in the gradual build-up in the volume of referrals. Whilst all localities are not yet fully operational, an average of 120 new individuals are currently supported by the service every month. Those people who are referred to HAT are also being discharged quicker from hospital to be fully assessed in their home environment, with 82% of individuals referred to HAT and discharged from hospital on the same day. 2.25 As HAT has become established the team has been able to accept more complex cases and fully support the multi-disciplinary team working that is required to support a “Home First” approach for individuals. We can see below that over time, as more complex cases were being accepted in financial year 2023/24, that the proportion of people recorded as completing the service with no further service required decreased; however, we know from our monitoring of delayed discharges that the HAT approach is improving flow. Page 61 of 100
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2.26 Of the those requiring a further service, the service with the highest number was the Community Alarms Service (16% of total completing). This was followed by Home Support Reablement (13%), then Integrated Rehab Team (IRT) - Physio and Mainstream Home Support (both 11%) and IRT – Occupational Therapy (10%). Service at Completion Home Support - Reablement 13% Locality SW Referral 1% Home Support - Mainstream 11% Integrated Day Service 0% Integrated Rehab Team - Physio 11% LSS 0% Integrated Rehab Team - OT 10% District Nurse 6% Rehabilitation - Other 1% NL Leisure 0% Community Alarms 16% Third Sector 3% 2.27 The contribution of the Home Assessment Team also appears to be having an indirect impact on the Partnership’s overall performance in relation to patients’ discharge being delayed in hospital. The charts below illustrate the significant reduction in the number of bed days delayed per week in both acute sites and off-site wards, particularly towards the end of 2023 and into early 2024. Page 62 of 100
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Conclusions 2.28 This report provides an update on the establishment of HAT in North Lanarkshire, which includes background, progress to date, plans, recruitment update, successes, risks and next steps. 2.29 The delivery of high-quality support is critical to support individuals who are at risk of admission to a hospital or who have complex discharge needs. The improvement work to establish the Home Assessment Team (HAT) is critical to the delivery of the Plan for North Lanarkshire and the University Health and Social Care North Lanarkshire Strategic Commissioning Plan. 2.30 HAT provides assessment at home with a focus of complementing established practice and supporting service redesign and streamlining of other key areas of work including the longer-term vision of the development and implementation of an enabling hub approach across the North Lanarkshire Health and Social Care Partnership. Page 63 of 100
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3. Measures of success 3.1 Data spreadsheet developed to record activity and enable monitoring of performance and outcomes. This continues to be revised according to activity and developments. 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) Page 64 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 funding for HAT provided via the Winter Planning & Increased Capacity Business Case has been incorporated into baseline budgets and as such is part of routine financial management arrangements. A funding gap has been identified for non-PAYE (Pay as You Earn) costs therefore this cost impact requires to be resolved through the current financial sustainability arrangements. 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? To address the risks outlined in this report successful recruitment is required 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 65 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? This is captured in the Home Support Programme Board/Discharge Without Delay Owner is Karen Workman 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 66 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 03/09/24 Adult Social Care Performance Report – Quarter 4 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 January 2024 to 31st March 2024 (Quarter 4). 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 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 January 2024 to 31st March 2024 (Quarter 4). 2.2 The performance data for Quarter 4 and associated trend information is included as Appendix 1. 2.3 Areas for improvement and planned actions are agreed and developed on an exception basis (i.e., for those indicators which are amber or red, based on tolerance thresholds). These are detailed as Appendix 2 of this report. 3. Measures of success 3.1 Measures of success are contained within Appendix 1 of this report. 4. Supporting documentation 4.1 Appendix 1: Adult Social Care Dashboard 4.2 Appendix 2: Areas for Improvement (Quarter 4, 01st January 2024 to 31st March 2024) 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 Q4 2023/24 Q1 2023/24 Q2 2023/24 Q3 2023/24 Q4 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 30 28 28 31 31 GREEN 2.16 Assistive Technology - Number Of People With Technology (18-64yrs) 633 632 631 618 624 2.17 Assistive Technology - Number Of People With Technology (65+) 853 818 825 856 858 2.18 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 1418 376 816 1355 2011 GREEN 2.19 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 61.2% 64.0% 70.3% 70.0% 60.8% RED 2.20 Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 56.1% 45.8% 48.0% 58.8% 58.5% RED 2.21 Balance Of Care - % Of People (Age 65+) 45% 42.6% 40.2% 36.7% 34.0% 36.4% RED 2.22 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 51.5% 47.5% 49.9% 53.5% 63.4% RED 4.2 Complaints Processed Within Timescale (NLC) 85% 68% (Stage 1) 89% (Stage 2) 84% (Stage 1) 100% (Stage 2) 76.5% (Stage 1) 57.1% (Stage 2) 81.3% (Stage 1) 100% (Stage 2) 92.9% (Stage 1) 100% (Stage 2) GREEN 4.3 Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 21.2 21.7 22.0 21.9 22.0 GREEN 4.4 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 44.2 44.9 45.8 45.6 45.9 GREEN 4.5 Care Home - Average Length of Stay 865 870 832 891 835 834 GREEN 4.6 Number Of People With Self Directed Support 1,000 1956 2070 2093 2092 2089 GREEN 4.7 Number Of People With A Direct Payment 240 359 329 342 357 379 GREEN Page 73 of 100
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6.1 Community Alarm Service Users 75 Years And Over Per 1000 Population Under Review 187.8 191.8 193.9 196.5 195.8 ... ... ... 7.20 % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 11.7% 12.4% 14.8% 12.7% 20.1% GREEN 7.21 % Of Adult Protection Investigations Going To Initial Case Conference 20% 21.2% 20.3% 10.4% 19.2% 11.9% RED 7.22 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 73.4% 76.6% 77.8% 76.3% 81.7% GREEN 7.23 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 71.2% 76.6% 74.2% 75.9% 71.5% GREEN 9.4 Breakeven Position - Projected Outturn (NLC) >=0 £9.327M underspend (Period 12 projection) 3.014m Underspend 4.304m Underspend 3.112m Underspend £3.331m underspend ... ... ... 9.6 Sickness Absence (NLC) - days lost per person 9.22 11.96 3.34 6.93 10.29 13.74 RED Page 74 of 100
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Appendix 2 – Areas for Improvement 1. Reablement and associated services Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 70.0% 60.8% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 58.8% 58.5% RED Balance Of Care - % Of People (Age 65+) 45% 34.0% 36.4% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 53.5% 63.4% RED Narrative & Corrective Action REABLEMENT / HOME ASSESSMENT TEAM The aim of rehabilitation and Reablement services is to ensure that our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities, including preventative approaches, self-management and choice over supports and services. In addition, the shift in the balance of care toward delivering services by Self-directed Support, allowing people to have greater choice and control in their own lives, requires that further consideration is required as to the performance indicators that might best represent how the delivery of services is changing. Working in these new ways, there is an associated increase in system capacity and improvement in patient flow by reducing the occupied bed days caused by Delayed Discharge. The development of the Reablement service is interdependent with work to develop Home Assessment Teams, the ongoing Review of Home Support services and the development of Locality Enabling Hubs. This is further dependent on the work to ensure that Reablement and Rehabilitation practice is cohesive across HAT, Home Support and Integrated Rehab Teams. Whilst recruitment remains a challenge for such services, with HAT teams not fully staffed and therefore little capacity to mitigate the impact of any sickness absence and annual leave, significant progress has been made. As well as raising awareness and understanding of HAT, the practice of assessment at home and a “Home First” approach embedded in everyday practice, tests of change are currently underway in UHM (Wards 14 & 20) and UHW (Ward 7) to introduce Non-Prescriptive Referrals for Home Support. This follows analysis of data and information showing discrepancy between prescribed discharge care plans and the actual care that patients required post-discharge, leading to a reduction in care provided. The purpose of the ToC is to increase the accuracy of Home Support Referrals and improve patient outcomes by adopting non-prescriptive referrals, whereby potential referrals are screened by Home Support Team Leads and support is delivered on basis of need-led input and available resources are optimised. The Team Leads will be deployed to proactively identify potential referrals for home care within the ward. Their role will involve providing guidance, coaching, and overall management of the Page 75 of 100
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situation, ensuring that the size of care packages is appropriate based on the individual patient's needs. It is hoped that evidencing a reduction in care required and provided will assist and influence clinicians and Allied Health Professionals to reassess their risk tolerance levels and adapt their approach accordingly. The data, particularly the outcomes for patients, will be analysed to identify further improvements and the potential to scale the approach. Further work to adopt a model of pre- PDD interface is planned in the coming months. For 2023/24, the longer-term trend was for more service users to complete the Reablement process, however in March there was a reduction in those completing from previous months. Looking at the change in service provision for Q4 following completion of the Reablement process, we can see that in Cumbernauld there has been a long-term trend for an increase in the number of people completing the Reablement process with no service. Page 76 of 100
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The most recent reporting details that the total number of referrals accepted by HAT is 1935. 133 referrals were accepted in April 2024, which is the highest monthly figure recorded, to date. The volume of referrals to HAT in a calendar month is now regularly >100; this is the eighth month in the last year that the total accepted referrals has been over 100. In the last year, Wishaw had 27% of all referrals, with Airdrie, Motherwell and Cumbernauld having between 19% and 22%. The volume of referrals for Bellshill and Coatbridge have increased over the last three months with Coatbridge now accepting similar volumes to the more established Motherwell team. 0102030405060708090 Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw Q4 - Service users completing reablement process by change in service 0 20 40 60 80 100 Cumbernauld - Service users completing reablement process by change in service Decreased Hours Increased Hours No Service Same Hours Page 77 of 100
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There is little movement in percentage terms for the origin of referrals since the last reporting; overall UHW Wishaw has generated more referrals than UHM. Monklands 876 45% Wishaw 1002 52% Other 58 3% The majority of referrals received related to females (59%), with the largest number in the age range 75-84 years old (39%). Under 65s only accounted for 9% and there is no one aged under 18 recorded. Page 78 of 100
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The majority of cases have up to two Social Care services in place at the time of HAT referral. The largest input service remains Home Support, followed by OT, which is consistent across the last 12 months. 95% of people were recorded as completing the HAT process. 37% of those completing HAT were recorded as requiring further service. Some data issues will be addressed in future HAT reporting, as the definition of ongoing service is being reconfigured to not include referrals being made to other certain services, such as NL Leisure. At the end of the HAT process 64% required no further service. Page 79 of 100
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Significant effort continues to be applied to reduce discharge delays and in Q4, there was a notable decrease in the number of delays with reduction in both onsite and offsite bed days lost due to delayed discharges. This is a positive trend and more coordinated approach to the work of the Flow Boards and concise monthly planning should see sustained impacts on overall system performance. IEAS Change and Improvement work within the Equipment & Adaptation Service is governed by the Equipment & Adaptation Service (EAS) Governance Board. This ensures coordinated planning and communication, particularly in relation to performance management. Following a recruitment process, a new Equipment & Adaptation Service Manager has been appointed and is now in post, completing an induction process, local training and familiarisation. The MICES Replacement Project is on track, with a “Go Live” date of 05/08/24 for ELMS2, to be known as “Lanarkshire Equipment Ordering Service” to replace the outgoing MICES system. A full programme of training is in delivery and the introduction of the new system will facilitate improved management and performance information and easier integration of data with wider partnership systems. 2. Adult Protection Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance Service at Completion HS - Reablement 12% HS - Mainstream 11% IRT - Physio 11% IRT - OT 11% Rehabilitation - Other 1% CAS 16% Locality SW Referral 1% IDS 0% LSS 1% District Nurse 6% NL Leisure 1% Third Sector 3% Page 80 of 100
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% Of Adult Protection Investigations Going To Initial Case Conference 20% 19.2% 11.9% RED Narrative & Corrective Action North Lanarkshire Social Work Services received 798 ASP referrals during Quarter 4 203/24. This represents a decrease of around 10% in comparison with Quarter 4 of the previous year (from 891 to 798). Despite the overall decrease, we have seen an increase in ASP referrals from Police Scotland and NHSL; Police referrals have increased by approximately 12% and Health referrals by around 13%. However, we have seen slight decreases in referrals from Scottish Fire and Rescue and NLC Housing when compared with the previous year. Over the last 12 months, the Care Home sector have generated the greatest number of AP1 referrals, however in Quarter 4 the number of referrals from Care Homes fell by around 40%, leaving Health as the highest referrer for the period. Despite this reduction, the Care Home sector remain a priority for our ongoing ASP work to support improvements in both the quality of referrals and defensible decision making. Analysis of the referrals has highlighted that Community based referrals are more likely to progress to ASP investigation when compared to referrals from Care Homes. Referrals generated by Social Work and community 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. It is important to highlight that the NLC Social Work Adult Support and Protection procedures have been updated. There are significant changes to the language used in the procedures and describe how we now view ASP “Inquiries and investigations”. The service now refers to initial inquires as ‘inquiries without investigatory activity’ and ASP investigations and ASP ‘Inquiry with investigatory activity’. Importantly, investigatory activity involves any direct contact with the adult or their legal proxy and as such, it is anticipated there will be a rise in investigatory activity, which will be reflected in future reports. There were 151 ASP inquires with investigatory activity carried out during this quarter, which is a significant increase of 68% when compared to the same quarter last year (increasing from 90 to 151). The data shows that the conversion rate from initial inquiry without investigatory activity to inquiry with investigatory activity is 19% for Quarter 4. The reasons recorded for inquiry with investigation activity were Psychological/Emotional harm (47), Physical (38), Self-neglect (31), Financial (20), Institutional harm (4) Self-harm (1), Sexual (2), and not recorded (8). From the total of 151 inquiries with investigatory activity, 18 progressed to case conference for further action during Quarter 4, which represents 12% of all investigatory activity cases. This is a 20% increase from the same quarter in the previous year (15 to 18). In Quarter 4, 2% of the total ASP referrals progressed to an AP Case Conference; this rate is consistent with Q4 in the previous year. Internal audits of ASP records have identified discrepancies between the Social Work Information System and the Locality trackers submitted by senior social workers on a weekly basis. For example, SWIS holds records for 18 Case Conferences held for Q4 but Locality trackers indicate that there were 35 Case Conferences held during the period. Ongoing work will be completed with colleagues in localities to ensure that required information is recorded on SWIS, accurate records of Case Conferences are stored in SWIS, and performance and management information is produced. 3. Sickness Absence Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance Page 81 of 100
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Sickness Absence (NLC) - days lost per person 9.22 10.29 13.74 RED Narrative & Corrective Action Long and short-term sickness absence is managed in accordance with the relevant policies for NLC, with monitoring of policy application managed within each service. Page 82 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 03/09/24 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 03: 01/04/2024 to 21/06/2024 From Morag Dendy, Chief Officer (Planning, Performance and Quality Assurance) E-mail LynchN@northlan.gov.uk Telephone Nicola Lynch, Business Finance Manager, 07581007187 1. Background 1.1 The Council approved its General Revenue Fund Budget on 15 February 2024, and the Integration Joint Board (IJB) approved its Financial Plan on 27 March 2024. The 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 2024 to 21 June 2024 (Period 03) and includes projected outturn forecasts for the financial year ended 31 March 2025, 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 £267.478m and is currently projecting an underspend of £0.271m. The Social Work capital programme has a total budget of £2.171m 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 Page 83 of 100
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approved Gross Expenditure Budget for the H&SCP – NL (Adult Social Care and Housing) is £267.478m. 1.2 The Council approved its new 5-year Strategic Capital Investment Programme on 14 March 2024. Financial Year 2024/25 is the first year of the programme, with £2.200m approved for Social Work for the current year. Net reprofiling from 2023/24, results in a revised budget of £2.171m, as demonstrated by Appendix 4. 2. Report Revenue: Analysis of Significant Variances 2.1 Within Employee costs, the Service currently anticipates an underspend of £6.100m. This is in relation to the non-recurring reduction of employer’s superannuation costs, coupled with slippage in relation to the recruitment of posts across the Service. 2.2 Supplies and Services are anticipated to be overspent by £0.208m. This is mainly as a result of an anticipated overspend in equipment and adaptations. 2.3 Transport and Plant is anticipated to be overspend by £0.651m. 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. 2.4 Admin costs are anticipated to be overspent by £0.103m and this is as a result of higher than anticipated spend in Legal fees linked to legal work for ‘Adults with Incapacity’. 2.5 Payments to Other Bodies and Transfer Payments are detailed in Appendix 2. This expenditure accounts for £165.081m of the annual budget and is forecast to have an in-year net overspend of £4.845m (2.9%). This is primarily in relation to the Care at Home sector who provide services to individuals via the SDS commissioning framework. 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. 2.6 The Service anticipates a total over recovery of income of £0.031m. An over-recovery of £0.136m relates to returned private sector housing grants and recharge income from other Council Services, these are both partially offset by an under-recovery of £0.195m which is mainly as a result of lower than anticipated income from charges for Community Alarms and Integrated Day Services. Revenue: Earmarked Reserves 2.7 The Integration Joint Board have reserves of £24.804m for specific Adult Social Care commitments. It is anticipated that £4.737m of the earmarked reserves will be used during 2024/25, with £20.067m being carried forward to 2025/26, as highlighted in Appendix 3. All expenditure to be met from reserves are excluded from the outturn position. Capital: Analysis of Significant Variances 2.8 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 Service currently anticipates a breakeven position. Page 84 of 100
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2.9 Following on from the pandemic, there remain 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. 2.10 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 Appendix 1 Revenue – Subjective Analysis Appendix 2 Revenue – Payments to Other Bodies & Transfer Payments Analysis Appendix 3 Revenue – Status of Earmarked Reserves Appendix 4 Capital – Budget Movements 2024/25 Appendix 5 Capital – Summary Expenditure by Thematic Category Morag Dendy Chief Officer (Planning, Performance and Quality Assurance) Page 85 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 86 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 87 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 88 of 100
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APPENDIX 1 [1] [2] [3] [5] [6] EMPLOYEE COSTS 90,625,610 84,525,385 6,100,225 FAV 6.7% Anticipated underspend mainly as a result of the non-recurring reduction of employer's Superannuation costs, coupled with slippage in relation to recruitment across the Service PROPERTY COSTS 3,149,721 3,202,249 (52,528) ADV (1.7%) SUPPLIES & SERVICES 6,031,049 6,239,621 (208,572) ADV (3.5%) Projected overspend in equipment and adaptations and small tools, offset by underspends in other Supplies areas TRANSPORT & PLANT 1,788,318 2,439,580 (651,262) ADV (36.4%) Projected overspend in relation to Internal Transport charges and staff mileage costs ADMINISTRATION COSTS 773,465 877,406 (103,941) ADV (13.4%) Projected overspend in relation to Legal fees and general admin PAYMENTS TO OTHER BODIES 59,152,485 60,447,181 (1,294,696) ADV (2.2%) Please refer to Appendix 2 for analysis TRANSFER PAYMENTS 105,929,328 109,479,684 (3,550,356) ADV (3.4%) Please refer to Appendix 2 for analysis CAPITAL FINANCING COSTS 0 0 0 0.0% REVENUE FINANCING COSTS 0 0 0 0.0% OTHER EXPENDITURE 28,858 27,639 1,219 FAV 4.2% TOTAL EXPENDITURE 267,478,834 267,238,746 240,088 FAV 0.1% NLC CONTRIBUTION (206,810,962) (206,810,962) 0 0.0% NLC CONTRIBUTION - HOUSING (2,229,010) (2,229,010) 0 0.0% INCOME FROM HEALTH (56,465,630) (56,551,847) 86,217 FAV (0.2%) FEES AND CHARGES (1,428,167) (1,233,122) (195,045) ADV 13.7% Lower than anticipated income in relation to charges for Integrated Day Services and Community Alarms OTHER LOCAL AUTHORITIES 0 (3,528) 3,528 FAV 0.0% BUDGETED USE OF IJB RESERVES 0 0 0 0.0% OTHER INCOME (545,065) (681,410) 136,346 FAV (25.0%) Overrecovery in relation to returned private sectors housing grants and recharge income from other Council Services INCOME (267,478,834) (267,509,880) 31,046 FAV (0.0%) NET EXPENDITURE 0 (271,134) 271,134 FAV 0.0% [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Subjective Analysis Period 03 (01 April 2024 - 21 June 2024) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % VARIANCE ANALYSIS Page 89 of 100
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APPENDIX 2 [1] [2] [3] [5] [6] SDS Framework 1 & 2 105,152,245 108,989,216 (3,836,971) ADV (3.7%) Demand led activity. Independent Care Homes 46,974,146 48,651,340 (1,677,194) ADV (3.6%) Demand led activity. Payments to NHS Lanarkshire 2,285,090 2,283,745 1,345 FAV 0.1% Position reflects anticipated in year payments Non Traditional Respite 335,283 109,999 225,284 FAV 67.2% Position reflects anticipated Locality demand Other Local Authorities - General 127,909 117,129 10,780 FAV 8.4% Position reflects anticipated in-year demand Voluntary Organisations & Payments to Other Bodies - Gen 7,936,976 7,843,313 93,663 FAV 1.2% Position reflects anticipated in-year demand Housing Support (RSL's) 777,083 490,468 286,615 FAV 36.9% Position reflects projected contract levels Locality Flexibility 218,068 213,992 4,077 FAV 1.9% Position reflects anticipated Locality demand Private Sector Housing Grants 1,152,378 1,105,028 47,350 FAV 4.1% Position reflects anticipated in-year demand Medical Fees 122,635 122,635 0 0.0% Position reflects Service's approach to absence management Other 0 0 0 0.0% TOTAL EXPENDITURE 165,081,813 169,926,864 (4,845,051) ADV (2.9%) [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Payments to Other Bodies & Transfer Payments Analysis Period 03 (01 April 2024 - 21 June 2024) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % VARIANCE ANALYSIS Page 90 of 100
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APPENDIX 3 Contract Monitoring Staff 87,351 74,279 13,072 0 87,351 22/23 Saving: Muirpark 27,485 27,485 0 0 27,485 Carers Act 2018 - Support 2,595,745 508,000 2,087,745 0 2,595,745 Social Care Demand risk 12,682,932 531,933 12,150,999 0 12,682,932 Tech digitial Improvements 389,719 180,000 209,719 0 389,719 Increase Advocacy provider 65,667 65,667 0 0 65,667 Discharge to assess/ PDD 109,196 109,196 (0) 0 109,196 Adapations Funding 308,571 308,571 0 0 308,571 Tech Improvements - SWIS 700,000 92,235 607,765 0 700,000 Tech Improvements - Comm Alarms 464,604 16,800 447,804 0 464,604 Tech Improvements - Home Scheduling System 3,698,423 441,455 3,256,968 0 3,698,423 Adult Protection Contribution 50,000 38,299 11,701 0 50,000 MH 2 NL10s 161,633 93,930 67,703 0 161,633 Cost of Living Helpline 359,993 246,985 113,008 0 359,993 HS resilience 656,188 330,361 325,827 0 656,188 Staff Training Academy "grow your own" 1,128,466 372,348 756,118 0 1,128,466 Building Capacity Funding Across The Ip Sector (part of Business Case) 0 The Winter Planning & Enhanced supports Business Case TOTAL 24,804,931 4,737,622 20,067,309 0 24,804,931 1,318,958 1,300,078 18,880 1,318,958 NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Status of Earmarked Reserves Period 03 (01 April 2024 - 21 June 2024) Adult Social Care & Housing - INTEGRATED TOTALDESCRIPTION OF EARMARKED RESOURCE Approved Reserve Total 2024/25 2025/26 No Longer Required Page 91 of 100
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APPENDIX 4 Approved: Year 1 budget (5 year Capital Program 2024/25 to 2028/29) 2,200,000 Reprofiling from 2023/24 (28,677) Included in opening budget Social Work Key Ambition Integrated equipment & adaptations REVISED CAPTIAL BUDGET 2024/25 2,171,323 0 0 0 Theme NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Budget Movements 2023/24 Period 03 (01 April 2024 - 21 June 2024) Social Work Capital Programme BUDGET MOVEMENTS 2024/25 £ Period Division Thematic Category Page 92 of 100
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APPENDIX 5 Social Work: Integrated Equipment and Adaptations 2,171,323 253,852 340,592 1,830,731 2,171,323 0 TOTAL 2,171,323 253,852 340,592 1,830,731 2,171,323 0 UNCOMMITTED FINAL OUTTURN OUTTURN VARIANCE NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Summary Expenditure by Thematic Category Period 03 (01 April 2024 - 21 June 2024) Social Work Capital Programme Theme BUDGET ACTUAL COMMITTED Page 93 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 DF/PMcA/MS/AM Date 03/09/24 Sundry Debt Write Off 2024 From Diane Fraser, Chief Officer /Head of Service (Adult Social Work Services) E-mail fraserdi@northlan.gov.uk Telephone 01698 332001 1. Background 1.1 During 2023/24 the Council issued invoices with the approximate value of £117m. 1.2 Within Adult Health & Social Care there are a number of chargeable services mainly in the following areas: • Home Care Charges Executive Summary The purpose of this report is to present to Committee a summary of outstanding debtor accounts which are deemed uncollectable following all attempts at recovery or are considered uneconomically viable to continue pursuing. In accordance with financial guidelines a bad debt provision has previously been established for the outstanding accounts highlighted below. Recommendations It is recommended that Committee: (1) Acknowledge the decision of the Chief Accountable Officer and the Head of Financial Solutions under delegated responsibilities to write off £140,917.93 for debts under £500. (2) Approve the write off of £19,581.98 which includes debts greater than £500. (3) Remit this report to Finance & Resources Committee. The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (21) Continue to identify and access opportunities to leverage additional resources to support our ambitions Programme of Work Statutory / corporate / service requirement Page 95 of 100
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• Nursing Home and Residential Home Accommodation Charges • Community Alarms • As well as chargeable services, invoices are raised to other local authorities, health, and universities. 1.3 The value of Adult Health & Social Care invoices raised during 2023/24 was £59m. This figure includes invoices raised to other local authorities, health, and universities (£58m). 1.4 In conjunction with the corporate debt recovery team, every effort is made to recover any unpaid debt including reminder letters, the use of collection agents and legal action. However, despite these steps there are a number of debts that are deemed uncollectible or are considered not economically viable to engage further collection activities and costs. This annual process of assessing the likelihood of debt non- recovery conforms to accepted best accounting practice and is a realistic assessment of expected income. 1.5 The Council will continue to seek collection of the outstanding balance if the circumstances of the debtor alter, and recovery is deemed practical. 2. Report 2.1 Analysis of the outstanding balances has been conducted and £160,499.91 has been identified as uncollectable. 2.2 There are a number of reasons why the outstanding balances are being written off and these are summarised below: a) Deceased. The debtor is deceased and there have been insufficient funds within the estate to meet the sum due. b) Small Balances/Uneconomic to Pursue. There are insufficient funds or no realisable assets that are available to meet the debt and it is uneconomic to continue to seek recovery of the sum due. c) Gone Away. The debtor has moved address and cannot be located. d) Recovery exhausted. Despite all efforts the service has now been informed that these accounts will not be recovered. e) Other. 2.3 The following tables categorise the value of debt recommended for write off by cause and value: Deceased 13 6,206.03 Small Balances/Uneconomic to Pursue 6 6,370.19 Gone Away 0 0 Recovery Exhausted 23 7,875.84 Other 10,008 140,047.85 Total 10,050 160,499.91 Value Analysis < £500 10,041 140,917.93 > £500 9 19,581.98 Total 10,050 160,499.91 Page 96 of 100
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2.4 The value of accounts identified for write off represents a very small proportion of the accounts raised annually by Adult Health & Social Care. This is reflective of a number of activities aimed at improving collection rates, reducing debt arising and streamlining the recovery process. 3. Measures of success 3.1 The Service continues to engage in a number of activities aimed at improving collection rates, reducing debt arising and streaming the recovery process. 3.2 These include: • Implementation of Debt Recovery Procedures • Performance Management Reports • Payment Arrangements • Payment by Direct Debit 3.3 The Council will continue to seek collection of the outstanding balance if the circumstances of the debtor alter, and recovery is deemed practical. 4. Supporting documentation 4.1 n/a Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) Page 97 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 98 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 99 of 100
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