Agenda Document Pack - Adult Care and Social Work Committee - 18/02/2025
North Lanarkshire Council · 18 February 2025
Back to Adult Care and Social Work Committee — 18 February 2025 and its agenda
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7 February 2025 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, 18 February 2025 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: Karen Swan Clerk Telephone: 07919 730272 Clerk Email: committee@northlan.gov.uk M McCulloch, A McCrory, D Ashraf, C Barclay, B Baudo, M Boyd, G Brennan, B Burgess, J Cairns, W Goldie, H Gray, J Jones, P Kelly, K Larson, B McCulloch, R McKendrick, C McManus, C Quigley, N Shevlin, L Stubbs, R Sullivan, J Toner, C Williams, N Wilson, G Woods. Page 1 of 218
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Agenda 1 Declarations of Interest In Terms of the Ethical Standards In Public Life Etc. (Scotland) Act 2000 Operational 2 Mental Health and Wellbeing Strategy Review Report September 2024 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) providing an overview of Lanarkshire's Mental Heath and Wellbeing (MHW) Strategy 2019-2024 Getting it Right for Every Person (GIRFEP). 5 - 104 3 Whole System Winter Planning and Resilience 2024/2025 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) providing an update on the Health and Social Care Services planning arrangements for the coming winter months. 105 - 154 Performance 4 Strategic Commissioning Plan 2023-26 and Programme of Work Update Submit report by the Chief Officer (Planning, Performance and Quality Assurance) providing an update on the implementation of the Strategic Commissioning Plan 2023-26 and associated Programme of Work. 155 - 192 5 Adult Social Care Performance Report - Quarter 2 2024/25 Submit report by the Chief Officer (HSCP) providing an update on the performance of key areas of activity within Adult Health & Social Care for the period 1 July 2024 to 30 September 2024 (Quarter 2 2024/25). 193 - 206 Financial Page 3 of 218
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6 Revenue and Capital Budget Monitoring Report: Adult Social Care Period 10: 1 April 2024 to 6 December 2024 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) providing a summary of the revenue financial performance of the Health and Social Care Partnership - North Lanarkshire (Adult Social Care and Housing) and the financial performance of the Social Work capital programme, for the period 1 April 2024 to 6 December 2024. 207 - 218 Contracts 7 Contract Award for Self-Directed Support including Care at Home Entry Point 4 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) seeking to endorse the award(s) to the framework agreement for Self-Directed Support including Care at Home Entry Point 4 (copy to follow). Page 4 of 218
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref MD/CR Date 18/02/25 Mental Health and Wellbeing Strategy Review Report September 2024 From Morag Dendy, Chief Officer (Planning, Performance and Quality Assurance) E-mail dendym@northlan.gov.uk Telephone 1. Background 1.1 The scope and the scale of the Mental Health and Wellbeing Strategy was bold and ambitious to encompass the need for a whole system, life course and system wide approach to inform broader, long term sustainable changes that result in improvements. In recognition of the identified need for the broader approach; the range of supports, services related to population mental health, the scale and interdependencies between Executive Summary The report brought to the Adult Care and Social Work Committee provides a review and overview of the work over the period of Lanarkshire’s Mental Health and Wellbeing (MHW) Strategy 2019-2024 Getting it Right for Every Person (GIRFEP). The report content celebrates the success of the whole systems approach and delivery programme, the projects and workstreams included, and captures the benefits realised from the Strategy and also the beneficiaries of the work. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the progress made across the whole system in relation to promoting positive mental health and wellbeing. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities Programme of Work Resilient People Item 2 Page 5 of 218
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life circumstances, inequalities, social determinants and mental health the scope of work in Lanarkshire went broader than the national strategy. 1.2 The Partners supported a process to co-create a Mental Health and Wellbeing Strategy for all age groups informed by a range of research and evidence, including, national policies and strategies, local data, intelligence and need, mapping current supports and services, analysing current and future demand trends, and exploring any workforce implications to reflect the needs of people living in Lanarkshire. 2. Report 2.1 A key aspiration for the Mental Health and Wellbeing Strategy was to obtain mental health parity with physical health, tackle population fear of mental health; stigma and discrimination and make mental health an equal priority in the work undertaken by community planning partners and thus by all agencies. 2.2 The Mental Health and Wellbeing Strategy was the first in Scotland to cover the scope and scale of population mental health and wellbeing, to incorporate pre-birth to old age, encompass all supports and services, and engage the whole system across all agencies. 2.3 The report reflects the significant work that has been carried out throughout the period of the strategy and in some cases such as work carried out in children and young people’s mental health support and services exceeds expectations. This whole system approach delivers some innovative upstream supports and services for young people through community services where it is so needed and is accessible and timely. 2.4 The review report completes the implementation of the 2019-2024 strategy. It is critical that we remain proactive, continue to prioritise population mental health to overcome fear and stigma, and provide the right care, in the right place at the right time. Our aims continue to include that, our care, supports, services and establishments are future proofed, fit for purpose, modern, provide privacy, dignity, and advocacy for people with mild, moderate, severe and enduring mental health conditions. 2.5 Next steps will include a Lanarkshire MHW Delivery Plan, 2025, aligned with the Scottish Government/COSLA Mental Health and Wellbeing Strategy and Delivery Plan published in 2023. 3. Supporting documentation 3.1 Appendix 1 – Mental Health and Wellbeing Strategy Review Report September 2024 Morag Dendy Chief Officer (Planning, Performance and Quality Assurance) Page 6 of 218
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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 7 of 218
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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 8 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 1 Review Report Mental Health and Wellbeing Strategy 2019-2024 Appendix 1 Page 9 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 3 Sources Of Support Some of the content in this Strategy may have an emotional impact on you. Support is always available, and some of the national sources of help are listed here. Mind to Mind If you’re feeling anxious, stressed or low, or having problems sleeping or dealing with grief, find out how you can improve your mental wellbeing by hearing what others have found helpful by visiting www.nhsinform.scot/mind-to-mind Breathing Space Breathing Space is Scotland’s free, confidential listening service for individuals over 16 experiencing symptoms of low mood, depression or anxiety. You can contact them on 0800 83 85 87 Monday to Thursday from 6pm to 2am and 24 hours a day at weekends (from 6pm Friday to 6am Monday). Samaritans Samaritans provide confidential, non-judgemental emotional support 24/7 for people who are experiencing feelings of distre ss or despair. You can contact Samaritans free by phoning 116 123 or emailing jo@samaritans.org NHS 24 Mental Health Hub NHS 24 mental health services are available to everyone in Scotland. The services available include listening, offering advice and guiding you to further help if required. The Mental Health Hub is open 24/7 and you can contact them on 111. Childline Childline is a free service for children and young people for when they need support or advice. It is open 24/7, and there are many ways to get help. You can call 0800 1111 or visit their website www.childline.org.uk Page 11 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 5 Acknowledgement The success of the Lanarkshire’s Mental Health and Wellbeing (MHW) Strategy (the strategy) 2019-2024 is a result of a robust planning, a co-production process, ongoing engagement and equal roles in decision making. This has been strongly routed in trusted collaboration and joint implementation of the system wide approach to mental health and wellbeing in Lanarkshire. We wish to celebrate and recognise the efforts and commitment dedicated to this whole system strategy and the comprehensive programme of work. The strategy and the programme engaged a wide range of people who have worked so hard, consistently to deliver and in some places exceed the original aims of our strategy. People across a range of organisations have believed in its purpose; pioneered new ways of working and initiatives, shown enormous resilience and got behind the multi-agency process. The strategy delivery has been successful despite a pause during the global pandemic, as well as the presence of system wide complexities and many competing demands. People have led, managed and co-ordinated a large scale change programme with multiple projects and workstreams over the past 5 years. This unique programme of work has gone some way to make a difference to people living with mental health conditions, change hearts and minds, kept the profile and priority of mental health and wellbeing high, made definite in-roads to tackle and reduce stigma related to mental health. A particular thank you and acknowledgement has to go to all of those people with lived experience, Carers, families who consistently and selflessly invested time to attend many meetings, events, hold the organisations to account and continue to influence and inform the strategy development and delivery with personal stories, experiences and generating ideas to influence the Strategy. People’s narratives are available on the webpage https://www.nhslanarkshire.scot.nhs.uk/strategies/ mental-health-wellbeing-2019-24/ Page 13 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 7 Terminology Overcoming stigma and discrimination is the key to making mental health easier to talk about. How we describe it can help our mind-set, feelings, emotions, and open up a dialogue about what matters to us, helps us feel seen and reduces fear and stigma. Having a common understanding and use of terminology helps to break down barriers. If you have good mental health, you might feel happy, confident, hopeful and generally satisfied with life. You are likely to feel connected to other people and to be making a contribution to society. You might also have a sense of meaning or purpose and a feeling of being at peace. These factors are important to living life well. When we experience poor mental health, life feels more of a struggle. We might often feel sad or tearful, and hopeless and exhausted. We might feel under unbearable stress, or often worried about money, the future, bad things happening to us or people we care about. All of these are very common experiences unless they are prolonged and there is a complicated combination of factors that can overwhelm us making it difficult to resolve them without help. Wellness means overall wellbeing. It incorporates the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person’s life. Each aspect of wellness can affect overall quality of life, so it’s important to consider all areas. It is the feeling that things are going well for us today, and can continue to go well for us tomorrow. Wellness is an individual pursuit—we have self- responsibility for our own choices, behaviours and lifestyles—but it is also significantly influenced by the physical, social and cultural environments in which we live. It is the belief that we have meaningful relationships and a sense of meaning and purpose. Although we may have setbacks, or experience stress, we are resilient and we have strength, material resources, and the support of others to survive and thrive. It has long been acknowledged that mental health is affected by a wide range of factors, including employment, housing, social connections, civic participation and poverty. All too often our communities’ experience of these factors is underpinned by an unequal distribution of income, power and wealth, which result in the stark inequalities in health that Scotland still faces today. Wellbeing Personal wellbeing is a particularly important aspect of our lives which we can describe as how satisfied we are with our lives, our sense that what we do in life is worthwhile, our day to day emotional experiences (happiness and anxiety) and our wider mental wellbeing. Wellbeing has been described as ‘A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment’ Mental health is used to describe a broad spectrum of terms including how we think, common mental health conditions and mental illnesses or psychiatric disorders. ‘Mental Health is defined as a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community’ Mental health conditions range from early stage mild emotional, psychological conditions to severe and enduring clinically diagnosed mental illness. Mental wellbeing is more than the absence of mental health problems: it may include life satisfaction, a sense of control, having a purpose in life, a sense of belonging and positive relationships with others. Page 15 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 9 Contents Creating the Conditions – Setting out the Case for Change – Building the Will 1. Executive Summary ................................................................................................................................................................11 2. Strategy Overview ..................................................................................................................................................................15 3. Strategy Planning Enablers ................................................................................................................................................21 - Strategic Needs Assessment - Governance - Workforce - Evaluation - Sustainability Strategy Programme Delivery 4. Good Mental Health for All ................................................................................................................................................41 5. Improving Access to Mental Health Supports and Services ..............................................................................47 6. Children and Young People’s Mental Health ..............................................................................................................53 7. Specialist Mental Health Services ..................................................................................................................................65 8. Psychological Services ........................................................................................................................................................69 Cross Cutting Themes 9. Communication and Engagement Strategy ..............................................................................................................73 10. Resources and Investment .................................................................................................................................................77 11. Evaluating Impact ...................................................................................................................................................................81 12. Sustaining Improvement ....................................................................................................................................................83 13. Next Steps .................................................................................................................................................................................87 Appendices Mental Health Useful Link ...........................................................................................................................................................88 Evaluation and Achievement Framework ............................................................................................................................89 Evaluation Evidence ......................................................................................................................................................................90 Strategy Design to Strategy Production Timeline ...........................................................................................................94 Page 17 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 11 1. Executive Summary 1.1 This report has been collated to provide a review and overview of the work over the period of Lanarkshire’s Mental Health and Wellbeing (MHW) Strategy 2019-2024 ‘Getting it Right for Every Person (GIRFEP) referred to in this report as ‘The Strategy’. 1.2 This report content celebrates the success of the whole systems approach and delivery programme, the projects and workstreams included, and captures the benefits realised from the Strategy and also the beneficiaries of the work. 1.3 The Scottish Government, Mental Health Strategy 2017-20271 was Scotland’s first 10- year strategy, demonstrating a commitment to achieve a sustained focus and continuous improvement in mental health support and services across Scotland. Through this strategy the Scottish Government set out 40 initial actions to better join up our services, to refocus these and to deliver them where and when they were needed. 1.4 In April 2018, NHS Lanarkshire and North Lanarkshire Integration Joint Board, the host organisation for Mental Health in Lanarkshire considered progressing with the 40 actions of the national Mental Health strategy. It was acknowledged that there should be a much stronger focus on wellbeing meaning a continued focus on supports and service provision and a greater emphasis onto the emotional health and wellbeing of Lanarkshire’s communities. The IJB outlined the strategic intention to develop a Lanarkshire Mental Health Strategy. The development was initiated in October, 2018 through widespread engagement and acknowledgement that we needed to go beyond the NHS mental health services to co- produce a whole system Mental Health and Wellbeing Strategy with the inclusion of the voices of all stakeholders, in particular people with lived experience. 1.5 The scope and the scale of the strategy was bold and ambitious to encompass the need for a whole system, life course and system wide approach to inform broader, long term sustainable changes that result in improvements. In recognition of the identified need for the broader approach; the range of supports, services related to population mental health, the scale and interdependencies between life circumstances, inequalities, social determinants and mental health the scope of work in Lanarkshire went broader than the national strategy. 1.6 Identified need in Lanarkshire included, promotion, prevention, all supports, all providers of services relevant to mental health and wellbeing. The population wide approach across the life course from pre- birth to old age was agreed to transform how we think about mental health, to make a difference, change cultures, beliefs, and behaviours at all levels and crucially in recognition of mental health and wellbeing affecting us all. 1Scottish Government mental-health-strategy-2017-2027 Page 19 of 218
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12 1.7 This included raising awareness of mental health in its widest sense and tackling stigma and discrimination where it exists, the approach included thinking about the everyday supports and services people who experience mental health conditions will access in their daily living. 1.8 The Partners supported a process to co- create a Mental Health and Wellbeing Strategy for all age groups informed by a range of research and evidence, including, national policies and strategies, local data, intelligence and need, mapping current supports and services, analysing current and future demand trends, and exploring any workforce implications to reflect the needs of people living in Lanarkshire. 1.9 This approach directly responds to our previous and emergent priorities around Getting It Right for every Child (GIRFEC – original guide published in 2008) and Getting It Right for Everyone (GIRFE- Pilot work being carried out in 2024). 1.10 A key driver for this strategy was and remains the prevalence of mental health issues, problems within communities and the relationship to disparities and inconsistencies in access to health and social care, healthy living environments, employment and tackling poverty where it exists. 1.11 A key aspiration for the strategy was to obtain mental health parity with physical health, tackle population fear of mental health; stigma and discrimination and make mental health an equal priority in the work undertaken by community planning partners and thus by all agencies. 1.12 It is important to note and reflect on the early strategic investment made. Understanding the conditions for improvement, the context that influences improvement success, what helps and what hinders, will it work here, change to be lived from the Board level to working level are all key to successful transformation. These conditions were critical and essential factors enabling consistency throughout the period of the strategy. Some of the early conditions put in place included: • A shared vision • Specialist and dedicated senior leadership, capacity and capability • senior buy in and ownership of all partner organisations • taking an evidenced based, data and intelligence approach to improvement • a robust infrastructure with strong reporting arrangements • inclusion of all stakeholders2 as equal partners and a strong culture of collaboration • Enabling a constancy of purpose to constantly attempt to optimise all available resources • Frequent communication with everyone working across the programme and partner organisations • an emphasis on change that results in long term sustainable improvement This investment and insight has enabled a consistency of process, systems and structures, proactive planning, informed engagement & co-design, a disciplined use of improvement methodologies and an iterative approach to co-create and assemble the strategy and associated detailed plans. 1.13 The commitment to joint planning and investment, collective action and building new ways of working from a range of organisations included NHS Lanarkshire, Local Authorities, Community and Voluntary organisations, Police Scotland, NHS24 and Scottish Ambulance Service. 1.14 These organisations and networks joined the strategy development to inform and influence improvements in population mental health and wellbeing. A compelling document emerged, with a comprehensive programme of work. The assembled strategy gained full commitment and a pledge written into it by all Partners (multi-agency) to emphasis the collective ownership, heighten the priority and profile of mental health and wellbeing in all areas. The complexity and interdependencies of this work were understood, robustly planned for, and captured in the infrastructure and governance arrangements (see graphic on page 9) for the implementation programme. 2All stakeholders – People with lived experience, community and voluntary organisations alongside a range of health and social care staff - a person, group or organisation with a vested interest, or stake, in the decision- making and activities within a programme of work. Page 20 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 13 1.15 The Strategy was the first in Scotland to cover the scope and scale of population mental health and wellbeing, to incorporate pre-birth to old age, encompass all supports and services, and engage the whole system across all agencies. 1.16 The strategy work has placed a focus on supports and services being available to people where they live and in community settings in Lanarkshire. More is needed still to improve life circumstances and increase lifestyle choices to enhance mental health. Continuing this work is important to improve population mental health and contribute to a reduction in inappropriate use of specialist mental health services. 1.17 The public sector continues to change, as do the roles and relationships between people in communities, the NHS, social care and voluntary and third sector organisations. There have been many drivers (cost of living crisis, poor access to income/employment, post pandemic recovery from isolation and more) influencing population mental health and wellbeing over the period of the strategy. 1.18 The landscape is being continually reshaped by a combination of demographic changes more older people over 85, less people of working age, and the challenges of managing available funds and resources to address the needs of the populations we serve. All this continues to drive the need for effective and efficient changes and improvements. 1.19 We know that our mental health can affect every aspect of our lives and that this extends to the impacts on care partners/unpaid carers and families. Our overall health can be undermined by factors such as substandard housing, limited income, insecure employment, vulnerability to violence, social exclusion, and criminal justice. 1.20 On current trends, inequalities in health will persist over the next two decades: people in the 10% most deprived areas can expect to be diagnosed with major illness a decade earlier than people in the 10% least deprived areas. Also the lower the income, the greater the deprivation and the worse their health and wellbeing. 1.21 There continues to be an increased need for integration, consolidation, whole system approaches that get it right for everyone (GIRFE). For people to be seen in right place, by the right person, first time and to be seen as a whole person and not a health condition. Getting it right for everyone requires further integration in infrastructure, consolidation of all available resources and a proactive, informed delivery of care at all levels, in communities, closer to home. We must develop new ways of working and new roles within the workforce, as well as enhancements in where and how our support and services (care environments) are accessed and delivered. 1.22 In the strategy all Partners agreed that there was a growing need and priority for a refreshed and reinvigorated approach to mental health improvement to improve overall health outcomes and reduce inequalities. This remains the case in 2024, 1.23 Readers of this report will see the significant work that has been carried out throughout the period of the strategy and in some cases such as work carried out in children and young people’s mental health support and services exceeds expectations. This whole system approach delivers some innovative upstream supports and services for young people through community services where it is so needed- and is accessible and timely. 1.24 This review report will complete the implementation of the 2019-2024 strategy. 1.25 It is critical that we remain proactive, continue to prioritise population mental health to overcome fear and stigma, and provide the right care, in the right place at the right time. Our aims continue to include that, our care, supports, services and establishments are future proofed, fit for purpose, modern, provide privacy, dignity, and advocacy for people with mild, moderate, severe and enduring mental health conditions. 1.26 Next steps will include a Lanarkshire MHW Delivery Plan, 2024, aligned with the Scottish Government/COSLA Mental Health and Wellbeing Strategy and Delivery Plan published in 2023. Page 21 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 15 2. Strategy Overview 2.1 The Strategy set out a compelling case for mental health as a Public Health priority and an area that required close working with all agencies to tackle mental health inequalities with an emphasis on the impact on people’s mental health with an urgent need to do more to promote and protect wellbeing, prevent common mental health problems and strengthen the provision of mental health care. 2.2 What is a population approach? There are several definitions of population health in use. The King’s Fund defines it as: An approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. ‘there is often a mis-perception that health and wellbeing of a population is only the responsibility of public health professionals; those specialists who are explicitly trained to plan and deliver public health services. The reality is that population health requires input from numerous partner organisations, such as the NHS, community groups, local authorities and political leaders, as well as public health teams whose action and influence should be seen as key in a population health approach’ It requires working with communities and partner agencies3. 2.3 Taking a population approach to mental health the Strategy commenced with an rigorous period of planning followed by extensive engagement, co-design, development and production stages with inclusive processes in place to oversee and develop the ambitious scope and scale of the strategy, a first for Scotland. 2.4 The engagement work was key to establishing a Lanarkshire wide approach to population mental health and wellbeing. This included bringing together stakeholders to represent an all ages, all services, all agencies in different meetings, focus groups, events, presentations and through a communication and engagement process to achieve buy-in and collective investment in the scope and scale of the work. In the early phase of the engagement work and through data, intelligence and collective decision making, support was established for the design and development of the Strategy, it would go beyond the NHS services to include all aspects of population mental health and wellbeing. To co-create, develop and respond to people’s mental health at all levels, it was agreed that all agencies, supports and services could play a vital role in improving the mental health and crucially the wellbeing of the population. Thus during the preparation phase Health, social care, local authorities, community and voluntary sectors and other community planning partners were engaged to agree the final scope and scale of the strategy and to provide a pledge and commitment to improving the future mental health and wellbeing of the people of Lanarkshire. 3Buck et al 2018, p18Page 23 of 218
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16 This reflected the policy approach within Health and Social Care – Planning with People: community engagement and participation guidance4 and the value placed on taking a whole system approach, engaging all key stakeholders in the design and development of services that affect them; to understand what works and turn the ambitions into sustainable improvements. 2.5 Following the wide ranging period of engagement, discussion, planning and creating the conditions for success, the programme was set up, given approval to proceed and work commenced work on designing, developing and producing the first whole system mental health and wellbeing strategy in Scotland. 2.6 The strategy took a multi-agency approach with the agreed scope including pre-birth to old age and all systems and processes. • In recognition of the prevailing conditions of gaps in community supports and services which has in the past lead to a greater demand on more specialist mental health services, the strategy development emphasised promotion and prevention and access routes such as NHS24/Scottish Ambulance Services • Added to this, the scope included giving consideration to all areas of work related to life circumstances, inequalities and social determinants related to mental health. • To do a whole system approach justice the Lanarkshire MHWS took on board all areas of society that affect the mental health of the population in order to highlight the interdependencies and consider whole system response. • The scope included all sector responses to mental health needs such as life circumstances, lifestyles (diet, exercise, socialisation), accessing early supports for all, and in particular those in need of immediate support or in distress, urgent care in-hours and out-of-hours provision, exploring new ways of working across the NHS to improve all access to supports, consistent care provided in a planned way, urgent care where and when required and also in improving what people in mental health crisis need in an emergency situation. 2.7 Critical to success was open, transparent, inclusive approach to our work and an equal partnership for people with lived experience, carers and families to co-create a mental health AND wellbeing strategy and delivery programme. 2.8 In its purpose the original Lanarkshire MHWS 2019-2024 advocated a holistic approach to achieving better mental health and wellbeing for all, and a Lanarkshire where every person can live a full life free from stigma and discrimination. The strategy included highlighting Mental Health as a Public Health priority; responded to contemporary research and evidence based practice, legislative context, gathered information and captured data from all available sources to inform the content. Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire - Lanarkshire mental-health- wellbeing-2019-24 was launched in October 2019. The final strategy included highlighting the fundamentals (things we all need for good mental health to prevail) and the interdependencies (the basic things we need to have a quality of life). The body of the work set out the importance of communities, the impact of deprivation on mental health, housing and mental health, employment, education, partnership working, stigma and discrimination, service user and carer perspectives, community planning for mental health, mental health inclusion, and cross cutting themes such as psychology and mental health and pharmacotherapy and mental health. People with mental health conditions can experience a combination of all of these factors resulting in poorer health and earlier death than those who do not experience these factors. 4Planning-people-community-engagement-participation- guidance-scotgov Page 24 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 17 The strategy highlighted core priority areas to be taken forward. Work on the programme commenced in 2019 with the main areas covered by the strategy including: • Good Mental Health for All • Improving Access to Mental Health Support and Services • Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans • Specialist Mental Health Services The programme included a number of interdependent cross cutting themes, all of which had sub groups reporting to the MHW Strategy Board • Strategic Needs Assessment, Communication and Engagement, Workforce, Evaluation and Finance 2.9 Our shared vision stated aspirations for a Lanarkshire where people could live in communities where everyone understands that there is no good health without mental wellbeing. To be part of communities and workplaces where we know how to support and improve our own and others’ mental wellbeing. A place where people can get the right help at the right time, expect recovery, and to fully enjoy their rights, free from stigma and discrimination. The joint strategic aims, aligned with partner organisations have been to: • Improve population mental health, social care and wellbeing; • Reduce health inequalities and improve health and healthy life expectancy; • Strengthen organisational connection, effective leadership and governance for mental health supports and services across all sectors; • Support all children and young people to live as full and healthy a life as possible and to realise their full potential. • Support people living with a mental health illness to live independently at home for as long as possible through community supports, integrated health and social care services; • Provide comprehensive, responsive mental health and social care services and supports in community based settings; and in hospital/in-patient settings when required 2.10 Based on the agreed scope of the strategy a programme with detailed plans across a number of projects/workstreams was developed factoring in support for health and mental health inequities and the socio- economic circumstances which impact mental health and wellbeing. The governance chart below sets out the change programme areas and reporting arrangements. Page 25 of 218
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18 Lanarkshire Mental Health and Wellbeing Strategic Executive Group R Primary Care Strategy Board C Lanarkshire Mental Health and Wellbeing Strategy Board A Improve Access to Mental Health Support & Services Children and Young People Mental Health & WellbeingGood Mental Health for all Specialist Mental Health Services Programme Approach Cross Cutting Approaches (eg estates finanace and workforce) Stakeholder and Partnership Engagement Key (Strategy Board Governance) R = Responsible A = Accountable C = Consulted I = Informed The Governance and reporting for strategy implementation will align with Partner organisations arrangements through the LMHW Strategy Board. This will include other committees and decision making groups in the councils and HSCPs Mentally Healthy Environments and Communities Mentally Healthy Infants, Children and Young People Mentally Healthy Employment and Working Life Mentally Healthy Later Life Reducing the Prevalence of Common Mental Health Problems, Distress, Self-Harm and Suicide Improving the Quality of Life of Those Experiencing Mental Health Problems Prisoner Healthcare Digital Solutions in Mental Health Transforming Mental Health in Emergency Departments Primary Care & Mental Health Wellbeing Custody Suites Prevention and Early Intervention Child & Adolescent Mental Health Services Children and Young People at Risk Neurodevelopmental Integrated Community Mental Health Services Review Rehab and Recovery In Patient Provision for Older Adults Perinatal Mental Health North Lanarkshire Strategic Planning Group C Community Planning Partnership Board South C North Lanarkshire Council I South Lanarkshire Integration Joint Board C North Lanarkshire Integration Joint Board A Community Planning Partnership Board North C South Lanarkshire Council I NHS Board I South Lanarkshire Strategic Planning Group C Page 26 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 19 2.11 The Covid-19 pandemic had a detrimental impact on the general populations mental health and wellbeing. The pandemic conditions created multiple stress factors for all. One explanation for the increase is the unprecedented stress in the general population was caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities. The exacerbation of mental health symptoms coincided with severe disruption to delivery of in-person mental health supports and services, leaving some disconnections for people and gaps in continuity of care for those who most needed it. 2.12 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. By the end of 2021 the situation had somewhat improved but still too many people remain unable to get the care and support they need for both pre-existing and newly developed mental health conditions. Whilst Strategy delivery was restarted in January 2021, there was a further pandemic related disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 2.13 Over the course of 2022, the Partners were able to look forward, consider backlogs, take on board people’s experiences and endeavour to take advantage of the learning, opportunities and experiences whilst adapting and working in different ways i.e. closer working between agencies and maintaining on-line approaches to connect more people. 2.14 All workstreams reviewed their delivery plans to ensure that they could take account of the impact of Covid-19; build on our recovery plans and the new ways of working that have developed over the course of the pandemic; whilst retaining a focus on the vision and objectives set out in the original Lanarkshire Mental Health and Wellbeing Strategy. Page 27 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 21 3. Strategy Planning Enablers This part of the review report will outline the cross cutting Projects and associated workstreams of the Strategy including; strategic needs assessment, governance and leadership, workforce, sustainability plan and evaluation. Additional strategic enablers such as: • Communication and Engagement has been covered in section 9 of this report as a critical factor to the successful implementation of the strategy. • Finance and investment is set out at section 10 of this report, which in essence describes that we attempted to track and optimise all established and new available funds and income streams within the programme. Strategic Needs Assessment - Data Compendium 3.1 Mental health is an integral part of public health and is as important as physical health to the overall wellbeing of individuals, communities and societies. Indeed, it has been said that ‘there is no health without mental health’ and everyone has mental health needs. In order to commission and deliver mental health supports and services that best meet the needs of the people of Lanarkshire we set out to obtain a clearer understanding of the mental health and care needs of the population. 3.2 We commissioned and compiled a data compendium to bring together the available data (qualitative and quantitative) on the mental health of the population of Lanarkshire to assist us in planning the strategy. 3.3 The data compendium was assembled in 2018/19 in collaboration with national and local health analysts. It utilised data provided by NHS Lanarkshire Public Health and Mental Health analysts, North and South Lanarkshire Social Work analysts and NHS ISD specialist mental health analysts. It built on data and analysis carried out by HSCP LIST analysts for the emerging Commissioning Strategies for North Lanarkshire and South Lanarkshire to provide a baseline against which we could measure to enhance the evidence base for Mental Health in Lanarkshire. The data compendium produced in July 2019 covered: • Population profile • Life Expectancy • Mental Health and Wellbeing (available data & information) • Deprivation and Isolation • Mental Health conditions • Suicide • Psychological Therapies • Children and Adolescent Mental Health • Multiple Long Term Conditions and Mental Health (Co-morbidities) • A range of information on current supports and services • Workforce Page 29 of 218
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22 Population Profile 3.4 In 2024, the estimated population of Lanarkshire taken from Census 2022 figures is 668,200. The latest projections of Lanarkshire’s future population, based on estimates for 2018, showed that the age structure of the population is expected to change between 2021 and 2042, with an increase in people aged 75 and over and fall in number of people aged under 30. 3.5 Key components in the changing Lanarkshire population are as follows: • There is a projected increase of 64.2% in the population aged 75 and over between 2021 and 2042. This would result in 34,494 more people in this age group. • The largest fall in population will be in the under 30 year olds, with a projected decrease of 10.7% between 2021 and 2042. There is estimated to be 24,026 less people aged under 30 in the next twenty years, likely to be contributed by fewer births. • Between 2021 and 2032, the number of people aged 50-54 is projected to fall by 14.4% and the number aged 55-59 by 20.5%. An overall projected decrease across both age ranges of 17,670. We envisage this having an impact on the age range of the workforce and by implication the availability of staff. 3.6 There has been a decrease in life expectancy in Lanarkshire over the last 10 years. Life expectancy is lower in Lanarkshire than in Scotland overall with life expectancy is lower in North Lanarkshire than South Lanarkshire. Figure 3.1 Projected percentage change in the age structure of Lanarkshire’s population, 2021-2042 Mental Health and Wellbeing 3.7 The Scottish Health Survey data describe that over 1 in 4 people experience a mental health episode in any year and nearly 1 in 6 people experience mental health conditions such as anxiety and different levels of depression. Public Health data, updated in March 20235 describes the following key points • The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) that measures mental wellbeing among adults and teenagers, the mean score for Scottish adults aged 16+ was 48.6. This is the lowest recorded in the time series. The WEMWBS scale runs from 14 (the lowest level of wellbeing) to 70 (the highest). • Twenty-two percent of those aged 16+ years in Scotland in 2021 reported having a General Health Questionnaire (GHQ) score of 4 or more, an indicator of potential mental health problems. This is an increase on the measure in 2019. • In 2021, 11% of adults had two or more symptoms of depression, and 6% reported having previously attempted suicide. These both represent slight declines from the measures in 2018/19. • In 2021, prevalence of depression (11%), anxiety (14%) and ever attempted suicide (6%) were at similar levels to 2018/19 combined. Prevalence of ever having self- harmed increased over this period from 7% in 2018/19 to 10% in 2021. • Adult mental health (mental wellbeing and mental health problems) outcomes are distributed unevenly across the Scottish adult population, with inequalities evident for age, gender, deprivation and socioeconomic status. 5https://www.scotpho.org.uk/health-conditions/ mental-health/key-points/ Page 30 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 23 Deprivation and Isolation 3.8 As the final Marmot6 review (Feb 2010) identified in classing sustainable places and communities as a policy priority, place plays an important role in tackling inequalities – it plays a role in mental and physical wellbeing, informs access to public services, shapes economic outcomes through travel, employment and regeneration, and contributes to environmental standards and climate change. However, again, it is also an issue which can have disproportionate impacts on deprived areas through lower income, worse air quality and in turn higher incidences of respiratory disease; poorer access to greenspace and closer proximity to vacant and derelict land; and worse transport links and in turn access to employment and services. The importance of social isolation and loneliness on our health is widely recognised with social relationships recognised as important social determinants of health • Social isolation is associated with health- risk behaviour in deprived neighbourhoods. • Loneliness is associated with health-risk behaviour in deprived neighbourhoods. • Residents in deprived neighbourhoods are more likely to be lonely than the general population. Mental Health Conditions 3.9 Our brains are hard wired to look for things, threats that may cause us harm. We know that a little anxiety, adrenalin can be natural and keep us safe. However, when anxiety gets out of control it can become overwhelming, debilitating causing fear, and some people can find it hard to control their worries. For these people feelings of anxiety are more constant and often affect their daily lives. 3.10 Everyone has spells of feeling down from time to time, but depression is more than feeling sad or unhappy. Depression can make you feel persistently sad and down for weeks or months at a time. While some people believe that depression is trivial or not a genuine health problem, it’s undeniably a real condition that affects around one in 10 people over the course of their lives. It impacts people of all genders and ages – including children. Studies show that around 4% of children in the UK between the ages of five and 16 are depressed or anxious7. 3.11 We have found out through ongoing research, engagement and evaluation that, when people are asked about their mental health, responses will be subjective and based on their own experience of their own mental health. For someone with no history of mental health concerns, a persistent but even slight low mood may still constitute their mental health being the worst it has ever been. But for someone with a history of depression, for example, the same low mood might have them rating their own mental health as good. • In 2024, people continue to experience mental health challenges with more women than men are currently struggling with poor mental health (18.5% of women vs 12.5% of men). • While men are likelier to rate their mental health more positively than women are, men continue to account for a higher number of suicides • Relationships and careers are among the most common contributing factors for stress, anxiety and feelings of low mood. They’re also some of the first aspects of our lives to be affected by problems with our mental health and wellbeing8. • Young people, aged 16-24, are by far the most likely to say they experience mental health struggles followed by 45-54-year- olds with the most positive when it comes to their mental health, being 25-34-year- olds, with more people in this age category describing their current mental state as being excellent and the best it’s ever been • Older adults 50-59 report significant challenges to their mental health and independence with 42% reporting feeling more anxious over the past 12 months (March 2024)9 • Older members of society 75+ are perhaps more likely to experience poor mental health as a result of loneliness or grief. 6https://www.instituteofhealthequity.org/resources-the-marmot-review 7https://www.nhsinform 8https://www.forthwithlife.co.uk/blog/mental-health-statistics-uk/ 9Age UK Research Page 31 of 218
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24 We understand that as the population changes and grows health needs will change and so require the health and social care services and support provided to adapt to provide for the population. We will continue to make improvements, integrate were required and work closely together to provide the right support and services in the right place at the right time for everyone. 280.0 270.0 260.0 250.0 240.0 230.0 220.0 210.0 200.0 North Lanarkshire South Lanarkshire 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 Figure 3.2 Anxiety/Depression Estimated Prevalence Rate per 1,000 of the population, by Lanarkshire HSCP of residence and financial year 25.0 24.0 23.0 22.0 22.0 21.0 20.0 19.0 18.0 North Lanarkshire South Lanarkshire 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 Figure 3.3 Psychosis Estimated Prevalence Rate per 1,000 of the population, by Lanarkshire HSCP of residence and financial year 3.12 The Mental Health Foundation (MHF)10 called on the Scottish and UK Governments to take actions to reduce anxiety. MHF research published from a survey undertaken during Mental Health Awareness week 2023 recorded that 30% of adults in Scotland with feelings of anxiety say they are not coping well, 44% of adults in Scotland with feelings of anxiety say they keep it a secret, with 70% of adults in Scotland felt anxious in the previous two weeks. 10https://www.mentalhealth.org.uk/about-us/news/our-new-research- reveals-anxiety-gripping-scotland-many-people-struggle-cope Despite anxiety being so common, stigma and shame play a part in how people deal with anxiety. The results of the polling make it clear that financial stress is giving rise to anxiety across Scotland, showing that existing support for people who are struggling does not go far enough. The most commonly reported cause of anxiety in the past two weeks was being able to afford to pay bills, reported by one-third (33%) of respondents, while 42% said that financial security would help prevent anxiety. This research is representative of the experience of people in Lanarkshire. Page 32 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 25 Figure 3.4 Anxiety/Depression Co-Morbidities for Lanarkshire residents, financial year 2021/22 Figure 3.5 Psychosis Co-Morbidities for Lanarkshire residents, financial year 2021/22 3.13 We have accepted that physical and mental health are closely linked. Long-term physical conditions (LTC’s) are those which can’t currently be cured but can be managed with medication and/or other treatment. Having a long-term physical condition can lead to social isolation, low self-esteem, stigma and discrimination. Having an LTC may cause fatigue, confusion, frustration, worried or stressed, especially when dealing with pain, tests, treatments or flare-ups. All of these things can make you more likely to develop a mental health problem such as depression or anxiety. Page 33 of 218
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26 • Digital Strategy, including digital mental health and wellbeing resources and digital therapies) • Tackling Poverty • Child Poverty Delivery Plans • Work across the Community Planning Partnership’s (CPP) to tackle health inequalities (bi-directional relationship between mental health and factors such as poverty, employment, discrimination and trauma, housing and education and build this into decision-making, governance and planning processes) • Third Sector Community Mental Health and Wellbeing Fund via VASLAN and VANL • Our Health Together • Dementia Strategy • The Promise • Community Mental Health and Wellbeing Supports and Services (Children and Young People) • Whole Family Wellbeing Funding, Fair work Priority Outcomes 1. People at risk of suicide feel able to ask for help, and have access to skilled staff and well-coordinated support. Suicide Prevention North Lanarkshire will continue to deliver the Living Works Training programme including ASIST, Safe TALK and Suicide TALK. 2. People affected by suicide are informed and know how to seek help Suicide Prevention. North Lanarkshire will continue to develop and create a coordinated approach to public awareness campaigns, which maximises impact. 3. Suicide is no longer stigmatized 4. We provide better support to those bereaved by suicide. Upskill 3rd. sector partners to support communities affected by suicide. 5. Through learning and improvement, we minimise the risk of suicide by delivering better services and building stronger, more connected communities. Suicide Prevention North Lanarkshire will identify and facilitate preventative actions targeted at risk groups. Suicide Prevention in Lanarkshire 3.14 Scotland’s Suicide Prevention Action Plan, published (2018), contained commitments aimed at continuing the downward trend in deaths by suicide based on known and emerging evidence about factors which can be associated with suicide. These include: • Responding to people in distress • Talking about suicide • A focus on awareness raising and suicide prevention training • Improving the NHS response to suicide • Developing the evidence base • Supporting change and improvement 3.15 Suicide Prevention in Lanarkshire is aligned to a wider strategic and policy landscape (snapshot – not exhaustive!) • Lanarkshire Mental Health and Wellbeing Strategy • Creating Hope Together • Distress Brief Intervention • Rollout of National Trauma Transformation Programme • Stigma Free Lanarkshire • Primary Care Transformation • Scotland’s Self-Harm Strategy Page 34 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 27 What We Aim to Achieve 1. The number of people taking their own life is reduced 2. A reduction in suicide across high risk groups 3. Increasing awareness of mental health and suicide prevention 4. Increasing the number of staff accessing mental health and suicide prevention training 5. Reducing access to means of suicide 6. Learning from investigations and reviews into unexpected deaths 7. Providing better information and support to those bereaved or affected by suicide 8. Supporting research, data collection and monitoring 9. Building community capacity to help reduce the stigma and taboo associated with suicide Suicides across Lanarkshire. Table 1: Number of Suicides by 5-Year Rolling Average Years North Lanarkshire South Lanarkshire 2014 – 2018 43 38 2015 – 2019 47 41 2016 – 2020 52 44 2017 – 2021 54 42 2018 - 2022 55 44 Suicide in Scotland in 2022 • In 2022 there were 762 probable suicides in Scotland, an increase of 9 (1%) on the previous year’s figure of 753 • Female suicide deaths increased by 18 to 206 deaths in 2022, while male suicides decreased by 9 to 556 deaths in the latest year • The rate of suicide mortality in males was 2.9 times as high as the rate for females. Rates have been consistently higher for males throughout time, ranging from 2.6 to 3.6 times since recording began • The rate of suicide mortality in the most deprived areas in Scotland was 2.6 times as high as in the least deprived areas in Scotland. This is higher than the deprivation gap of 1.8 times for all causes of death • Over half of all probable suicide deaths in 2022 were due to hangings, strangulations or suffocations. Around 1 in every 5 probable suicides were due to poisonings Page 35 of 218
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28 Suicides in Lanarkshire in 2022: Key Points • There were 96 suicides (deaths from intentional self-harm and events of undetermined intent) registered for Lanarkshire residents in 2022, up from 83 in 2021 (15.7% increase) • There were 50 suicides (deaths from intentional self-harm and events of undetermined intent) registered for North Lanarkshire residents, down from 52 in 2021 (decrease of 3.8%) • There were 46 suicides (deaths from intentional self-harm and events of undetermined intent) registered for South Lanarkshire residents, up from 31 in 2021 (increase of 48.4%) • 5 year running average data is used to provide a more accurate picture of trends rather than year on year: Lanarkshire: 2018-2022 average number per year of probable suicides is 100, an increase of 4 from the years 2002-200 6 (increase of 4%). North Lanarkshire: 2018-2022 average number per year of probable suicides 55 up from 53 in the years 2002-2006 (increase of 3.8%). South Lanarkshire: 2018- 2022 average number per year of probable suicides 44, the same as in the years 2002-2006 (no change). What is it? Lifelines Lanarkshire is an information and guidance document aimed at supporting Children and Young People up to the age of 18 (or 26 for care experienced adults) at risk of self-harm and/or suicide. Who? For anyone working with children/ young people. Assessment and intervention guidance will mostly be used by those working directly/in an enhanced way with children/young people. Where? Most commonly used in educational establishments but should be applied wherever needed. When? When a child/young person is thought to be at risk of self-harm and/or suicide or when they ask for help. Why? Its preventative and early intervention approach promotes mental health and wellbeing and considers harm minimisation and how to avoid loss of life 3.16 Creating Hope Together Scottish Government and COSLA’s suicide prevention strategy11 with an action plan12 detailing the actions for 3 years, which implements the first stage of the strategy, and the four long term outcomes it sets out. To achieve the vision, government and COSLA will deliver across these long term outcomes which together will affect change across our society, services, communities, and individual experiences. We should recognise that much has been achieved on suicide prevention, at a national and local level – too much to include in this overview of Lanarkshire’s MHW strategy work. The examples include the social movement ‘United to Prevent Suicide’ and its fantastic campaign work, Just Ask, suicide prevention training sessions: Suicide TALK; Safe TALK; ASIST, Ask Tell, Safetalk Scottish Mental Health First Aid, the pilot bereavement support services that are already helping families, the learning resources which are bringing greater awareness and skill in the workforce, and the resources and data we are providing to guide local action. Creating Hope Together – National Outcomes Framework 4 Long Term Outcomes 1. The environment we live in promotes conditions which protect against suicide risk 2. Our communities have a clear understanding of risk, risk factors and its prevention 3. Everyone effected by suicide is able to access high quality, compassionate, appropriate and timely support – which promotes wellbeing and recovery 4. Our approach to suicide prevention is well planned and delivered through close collaboration between national, local and sectoral partners. Our work is designed with lived experience insight, practice, data, research and intelligence 11Creating-hope-together-scotlands-suicide- prevention-strategy-2022-2032 12Creating-hope-together-scotlands-suicide- prevention-action-plan-2022-2025 Page 36 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 29 3.17 Psychological Therapies (PT) 2020 - 2024 data We all have a range of psychological needs. Psychological therapies and interventions are proven evidence-based clinical approaches that can make a real difference to the people of Lanarkshire’s mental and physical health13. This section of the report reviews the data relating to access to Psychological Services over the period of 2020-2024 The waiting list for psychological therapy treatment has generally increased since the beginning of 2022/23. The number of patients on the waiting list has increased from a low of 1,814 in May-22 to a peak of 2,719 in Mar-24. The proportion of patients on the waiting list that have been waiting greater than 18 weeks for treatment has also increased throughout the period. In Apr-22, 27.1% of patients on the waiting list had been waiting greater than 18 weeks for treatment. This increased to 40.8% of patients by Apr-24 The average quarterly RTT for psychological therapies treatment has broadly remained between 80% and 90% since Q1 of 2018/19. The RTT target of 90% was met in Q1 of 2020/21, before a sharp decline in the average was observed at the onset of the Covid-19 Pandemic. The RTT% recovered in each subsequent quarter of the financial year, reaching a post-pandemic high of 85.8% in Q2 of 2021/22. Again, the average RTT remained above 80% in each quarter until Q2 of 2023/24, where the value fell to 79.1%. There was a rebound in the average the following quarter (Q3, 82.5%), however, the RTT% fell again to a post-pandemic low of 78.1% in the most recent quarter (Q4 2023/24). Figure 3.6 Psychological Therapies Waiting List Under/Over 18 Weeks Figure 3.7 PT Referral To Treatment % by Financial Quarter 13https://www.gov.scot/publications/psychological- therapies-interventions-specification/documents/ Page 37 of 218
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30 The average quarterly RTT for psychological therapies treatment has broadly remained between 80% and 90% since Q1 of 2018/19. The RTT target of 90% was met in Q1 of 2020/21, before a sharp decline in the average was observed at the onset of the Covid-19 Pandemic. The RTT% recovered in each subsequent quarter of the financial year, reaching a post-pandemic high of 85.8% in Q2 of 2021/22. Again, the average RTT remained above 80% in each quarter until Q2 of 2023/24, where the value fell to 79.1%. There was a rebound in the average the following quarter (Q3, 82.5%), however, the RTT% fell again to a post-pandemic low of 78.1% in the most recent quarter (Q4 2023/24). The highest quarterly RTT% for the time period was 91.6%, recorded in Q1 of 2020/21. Pre-pandemic, Psychological Therapies were receiving around 2,500 referrals each quarter, with just over 20% of these being for digital therapy such as SilverCloud and Beating the Blues. A significant decline in referrals was observed in Q1 of 2020/21, however, by the end of the financial year referrals had returned to a similar level, though the proportion of total referrals that were for digital therapies had increased significantly. In Q4 of 2020/21, there were 2,676 referral received, of which 50.0% were for digital therapies. There was a significant increase in the total number of referrals received in Q1 of 2021/22 reaching more than 4,000. This is due largely to the increase in referrals for digital therapies received, rising by more than 60% between Q4 of 2020/21 (1,349) and Q1 of 2021/22 (2,180). Total referrals have remained broadly stable since Q1 of 2022/23. However, the proportion of total referrals that are for digital therapies has begun to decline. In Q4 of 2021/22, there was a period high of 4,099 patient referrals, of which, 57.5% (2,356) were for digital therapies. By comparison, in the most recent quarter, only 48.2% (1,815) of total referrals were for digital therapies. The increase in non-digital referrals observed has placed increasing pressure on consultant led therapy, with demand for non-digital therapy almost back at pre-pandemic levels. Figure 3.8 Referrals to PT Service by Financial Quarter Page 38 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 31 Pre-pandemic, there was an average of 1,600 completed waits reported each month. The highest quarterly total observed for the period presented was 2,936 in Q4 of 2021/22. The increase in completed waits post- pandemic can largely be attributed to the rise in digital therapy referrals. In 2023/24, the total number of patients starting treatment increased in each subsequent quarter. In Q1 of 2023/24, 2,464 patients started treatment. By Q4 of the year, 2,722 patients started treatment, an increase of 10.5% over the 12-month period. The longest patient waits for treatment reached a high of 89 weeks in Nov-20. Following a decline to 42 weeks in Aug-22, the longest patient waits have since risen proportionally to the waiting list, increasing to 60 weeks by Apr-24. Figure 3.9 Completed Waits Within/ Over 18 Weeks Figure 3.10 PT - Waiting Lists + Longest Wait Page 39 of 218
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32 Child and Adolescent Mental Health (CAMHS) Data 2020-2024 3.18 NHS Scotland Child and Adolescent Mental Health Services (CAMHS) are multi- disciplinary teams that provide (i) assessment and treatment/interventions in the context of emotional, developmental, environmental and social factors for children and young people experiencing mental health problems, and (ii) training, consultation, advice and support to professionals working with children, young people and their families14. The tables below set out the activity and performance of CAMHS over 2020-2024. 3.19 The figure below shows the waiting list for CAMHS treatment generally showed an increasing trend between Jul-20 and Jul-22. The number of patients on the waiting list increased from a low of 831 in Jul-20 to a peak of 1,629 in Jul-22, a near doubling in the two-year period. The proportion of patients on the waiting list that have been waiting greater than 18 weeks for treatment also increased significantly during this period. In Jul-20, 44.4% of patients on the waiting list had been waiting greater than 18 weeks for treatment. This increased to 78.2% of patients by Aug-22. There has since been a significant decline in the total waiting list, reaching a low of 535 for the most recent month. The proportion of patients waiting greater than 18 weeks for treatment has also declined significantly. In Apr-24, only 20.6% of patients had been waiting greater than 18 weeks for treatment 3.20 Figure 3.12 below shows referral to CAMHS by financial quarter. CAMHS referrals have shown significant variation between financial quarters, though it seems that there has generally been a declining trend in referral numbers since 2018/19. In 2018/19, there were a total of 4,348 patient referrals to CAMHS services. Figure 3.11 CAMHS WL Under/Over 18 Weeks Figure 3.12 CAMHS by Financial Quarter With the exception of 2020/21, total referrals declined in each subsequent financial year, reaching 3,595 in 2022/23. In 2023/24, total referrals increased to 3,669, a rise of just 2.1% on the previous year. 14https://www.gov.scot/publications/child-adolescent- mental-health-services-camhs-nhs-scotland-national- service-specification/ Page 40 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 33 3.21 Figure 3.13 below shows CAMHS Referral to Treatment by Quarter Year periods. The average RTT% for CAMHS has shown significant variation between quarters. The sharp decline in the RTT% from Q4 of 2021/22 mirrors waiting list changes. A significant increase in the number of patients starting treatment was observed in Q2 and Q3 of 2022/23 in attempts to reduce the size of the waiting list. As a high proportion of the patients on the waiting list had been waiting greater than 18 weeks for treatment, this increase in activity had a detrimental effect on the RTT% for a period of time. The upturn in the RTT% in 2023/24 corresponds to the reduction of the waiting list and the number of patients waiting greater than 18 weeks for treatment. The highest quarterly RTT% for the time period was 80.7%, recorded in Q4 of 2020/21. A low of 19.1% was recorded in Q3 of 2022/23. Figure 3.14 Completed Waits Within/Over 18 Weeks 3.22 Figure 3.14 shows completed waits within or over 18 weeks Pre--pandemic, there was an average of 490 completed waits reported by CAMHS each month. After a period of low activity between Q4 of 2019/20 and Q1 of 2022/23, a period high of 592 completed waits were recorded in Q3 of 2022/23. The increase in activity in between the end of 2022/23 and the beginning of 2023/24 corresponds to a reduction in the waiting list and the RTT%. In Q4 of 2023/24, the number of completed waits reduced to 223.Page 41 of 218
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34 3.23 Figure 3.15 shows CAMHS waiting list and longest wait over time period 2020-2024. Longest patient waits increased proportionally with waiting list size, increasing from 62 weeks in Apr-20, to a peak of 176 in Dec-22. There was since been a stilted reduction in the longest wait, which in Apr-24 was still 109 weeks. Governance - whole population approach and whole system working 3.24 In Lanarkshire, NHS Lanarkshire are accountable for the health of the population. Cognisant with this report, North Lanarkshire Integration Joint Board (IJB) is responsible for planning, commissioning, and monitoring mental health services provided in the community and in hospitals across Lanarkshire. Some IJBs are also responsible for levels of secure mental health services, with NHS boards having that responsibility in other areas. Working across organisation boundaries, navigating different funding regimes is currently necessary as, Mental Health advice, support and services are provided across a range of organisations such as by HSCPs, NHS boards, councils and the charity and voluntary sectors. A consistent message in the strategy delivery has been that Mental Health is a feature of our overall health, is everyone’s business and as such requires a whole system approach. The governance, leadership and decision making regarding population mental health supports and services is however fragmented, and accountability is complex, with multiple bodies involved in funding and providing mental health supports and services. Over the period of the strategy collaboration has relied on robust programme governance arrangements, dedicated resources (in- kind and funded), excellent joint working arrangements and a shared vision of getting it right for every person at all levels. Taking a whole systems approach to mental health and wellbeing has been possible through the multi-agency membership of the Lanarkshire Mental Health Wellbeing Strategy Board and infrastructure. With successful joint working and planning the programme of work has been successful across the spectrum of projects/workstreams supports and services. Page 42 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 35 We acknowledge that Mental health problems don’t exist in isolation. Mental health conditions can lead to other problems in people’s daily lives, such as with housing, money, work and benefits. People living with mental health problems are twice as likely to require support and advice with money matters, such as council tax arrears. as people who are not diagnosed with a mental health condition. These problems mean that people who experience mental health challenges, crisis and diagnosed illness’ often need more support from a range of council services than others. Local Authorities provide services essential to the delivery of good outcomes, particularly but not exclusively, to people with mental health conditions and the most vulnerable in our communities. Alongside treatment from mental health services, many people also benefit from getting help from community organisations, funded and supported by the Third Sector organisations such Lanarkshire Association for Mental Health, other general local services for aspects of their daily lives. Public health and Local Authorities have such an important role to play through the delivery of services like social housing, social care, housing and leisure services. Social work makes an important contribution to the public domain; Social Workers and Mental Health Officers in particular are working with people with mental health conditions and helping to support them, achieve change in their lives and helping them to contribute through a range of connections and relationships. Social workers are uniquely placed to offer insight and contribution to mental health provision as social workers hold legal duties under the Social Work (Scotland) Act 1968 placing responsibility on them for assessing the needs of those in the local authority area. As such, social work supports the effective interaction and joint working in the process of delivering services and interventions to adults and children under the auspices of the above- noted legislation. Working within this multi- agency context, social workers, mental health officers hold a duty to offer perspective to ensure that a Human Rights enabling and strengths-based approach that is cognisant of the intersectionality of poverty, social justice and inequality is central to the delivery of services. This also requires a collaboration, partnership working, empowerment of clients and a particular balance of need, risk and rights. 3.25 Our next steps must consider any improvements that can be made in Governance to support a whole systems approach, systems and strategic oversight for population mental health to ensure the highest quality of support, care and treatment and avoid inappropriate access issues, delays during periods of transitions that can lead to isolation or confusion when people don’t know where to go and to improve care management and all round communication to, with, and, on behalf of the person. Workforce 3.26 The National Workforce Strategy for Health and Social Care in Scotland has five pillars, Plan, Attract, Train, Employ, Nurture15. In Lanarkshire we want the reputation of being an exemplar employer that attracts excellence by being excellent. We want to attract candidates who share our ambitions and values and gain their commitment to working with us by ensuring that their experience of the recruitment journey is a positive one. We want to be clear on our future workforce and the skills and competencies to delivering quality health in an evolving health and social care environment, with effective workforce planning that will ensure that we recruit the right staff with the right skills to deliver reform. (source: Widening Access and Participation to Employment Strategy 2023/2026, Our Health Together, Living our Best Lives) 15https://www.gov.scot/publications/national-workforce- strategy-health-social-care/Page 43 of 218
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36 3.27 As referenced in the national MHW Strategy, the national aim is to support the development of a mental health and wellbeing workforce which is diverse, skilled, supported and sustainable. This will support the Scottish Government’s Mental Health and Wellbeing Vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. Whilst NHS Education Scotland16 (NES) holds data for a range of NHS Scotland workforce (for reasons unknown, mental health as a job family not reported on by NES) and Scottish Social Services Council17 (SSSC) and other professional bodies hold the data on relevant workforce who contribute to mental health and wellbeing of the population as a high proportion of their workload, there is currently no single source of data for the mental health and wellbeing workforce in Scotland. Given the scope of the mental health and wellbeing workforce, we recognise that there is a burning need to consider where there are data gaps and take appropriate and proportionate actions to address these. 3.28 The thinking in the national strategy, mental health and wellbeing workforce plan18 aligns with our Pan Lanarkshire partnership over the course of this strategy. The core mental health and wellbeing workforce consists primarily of those who provide frontline mental health services, interventions and treatments for all age groups and from various sectors. These are staff who are specifically employed in services within statutory organisations, the independent sector or the third sector to support mental health and wellbeing. This includes, but is not limited to, staff in mental health services (such as mental health nurses, psychiatrists and psychologists), third sector mental health support, social work staff who provide mental health support and Mental Health Officers, GPs, mental health pharmacists, paid peer support link workers, psychotherapists, counsellors, psychological therapists, and Allied Health Professionals who provide mental health interventions and support. 3.29 The wider mental wellbeing workforce19 with a role to promote good mental health for all and in prevention to improve the quality of life for all. These include roles in the public services, third, and independent sectors that, although not directly employed in or providing mental health services, support treatment and recovery. Access in communities to these types of organisations has an important role in supporting someone’s mental health and wellbeing and play a significant role in promoting good mental health for all. Examples include but are not limited to, employers; wider areas of health, community link workers; police officers; community group leaders; faith leaders; school staff and youth workers. 3.30 The mental health workforce has experienced recruitment and retention issues for a number of years now resulting in deficits in psychiatry and mental health nursing. Psychology is seeing a resurgence of applicants and is growing a positive reputation as a preferred place to work in Lanarkshire. The collaboration with partners has also developed capacity in other areas of the system to engage earlier, provide earlier and easier access and sign post to preventative and proactive interventions reducing demand and possibly impact on mental exacerbations. Urgent care 24/7 pathways are now more responsive and refer people with mental health concerns to in-out-of- hours primary care and community mental health supports and also specialist and secondary care mental health provision thus avoiding inappropriate presentations and ensure the person is seen by the right person first time. 16https://turasdata.nes.nhs.scot/media/j0vdmiul/workforce-report-june-2022-formatted.pdf 17SSSC-workforce-data-report-scottish-social-service-sector-report-on-2022 18https://www.gov.scot/publications/mental-health-wellbeing-workforce-action-plan-2023-2025/ 19https://www.gov.scot/publications/mental-health-wellbeing-workforce-action-plan-2023-2025/ Page 44 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 37 The aim of our current and future cross cutting and inter agency approach to MHW Workforce is to apply the 3 P model (Promote, Prevent and Provide): 3.31 One P is to Promote good mental health and wellbeing for the whole population, and improving understanding and tackling stigma and discrimination with: • Employers • Community services (ranging from sports organisations, community wellbeing initiatives, citizens’ advice, housing) • Faith organisations • All health and social care workers in all settings This workforce will be included in relevant aspects of training to enable support at the point of care. 3.32 Organisations with a workforce trained to apply a two P approach to Promote good mental for all and Prevent mental health issues occurring or escalating whilst engaging in a whole system approach to tackling the underlying causes and inequalities via primary prevention (detect, distress, assess risks, signpost support) to: • All health, social care and social work staff • Unpaid carers • Police Officers • Scottish Ambulance Service An inclusive approach to training with access for unpaid carers. It is envisaged that resource plans will need to be agreed to map the various workforce included at what levels from awareness to complex requirements for job requirements. Workers in front facing roles in communities, justice, early years and education settings, who support the wellbeing of service users, and Secondary prevention (early intervention, further signposting; recovery support) via: • Counsellors in a variety settings including schools further and higher education, and third sector community organisations • Psychological and Emotional Wellbeing Practitioners (NHS24, Primary Care settings) • Chaplaincy, Spiritual and Pastoral care workforce operating in various settings 3.33 There are organisations who will be funded, resourced and trained to apply the three P approach to Promote, Prevent and Provide mental health and wellbeing support, care and treatment ensuring people and communities can access the right information, skills, support, services and access to treatments in the right place, at the right time from the right service. Responding to severe and complex mental health as part of multidisciplinary teams, working across health, social care, and third and independent sectors and recovery support: • Psychological and Emotional Wellbeing Practitioners • Community Mental Health Nurses • Psychological Therapies (PT), Interventions and Wellbeing Practitioners • Peer support workers • Allied Health Professionals who work in mental health services • Social workers who work in Mental Health services • Community Mental Health Pharmacists • Psychiatrists • Clinical psychologists • Mental Health Nurses • Allied Health Professionals who work in Mental Health services • Mental Health OfficersPage 45 of 218
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38 3.34 This workforce will feature in the Plan, Attract, Train, Employ, and Nurture aspects of the National MHW Workforce actions. This workforce responds to severe and complex mental health. In Lanarkshire as in the rest of Scotland, core mental health services have and continue to experience deficits in workforce (particularly medical staff). Our mental health workforce development work will be included in the emergent MHW Delivery Plan, 2024 and will consider that the mental health and wellbeing workforce is made up of the core mental health workforce and the wider mental wellbeing workforce. The strategic intent in developing our future MHW Workforce Plan will require commitment and investment to fully deliver against the plan articulated. We will engage NHSL, North and South Lanarkshire councils and other partners where appropriate to develop a financial plan that underpins the delivery and which articulates the benefits to be realised from investment in the community and workforce. Evaluation Framework 3.35 To add to the rigour of our whole system, population approach, at the outset we worked with local evaluation subject matter experts to set out an Achievement Framework taking a Contribution Analysis approach. Our colleagues in evaluation worked with and followed the programme, projects and workstreams over the period of the strategy producing a final evaluation report. See Appendix 2. Sustainability Plan 3.36 In January, 2024, a sustainability framework and plan was developed and produced to sign off, embed, sustain all aspects of the strategic change programme, to inform completion of the work, progress to business as usual, and include any outstanding priorities in the emergent Lanarkshire Mental Health and Wellbeing (MHW) Delivery Plan, 2024-2026. All of the strategic enablers described above have acted as the foundation for rigorous and robust systems and process for consistency across the MHW Programme 2019-2024. In absence of this work the programme would have lacked knowledge of root cause, ability to identify priorities, track, monitor and measure improvement to inform the data and intelligence approach required for the transformational levels of work achieved within the programme described below. Page 46 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 41 4. Strategy Programme Delivery Good Mental Health For All 4.1 Our approach to promoting good mental health for all incorporated the collective actions/programmes of work undertaken by the community planning partners and is delivered by multi-agency Good Mental Health for All groups in North and South Lanarkshire Delivery Plans. 4.2 The key aim of this was work is to promote good mental health for everyone and address the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellness and wellbeing, and continue to challenge all forms of stigma around mental health as priorities across Lanarkshire. 4.3 The Covid19 Pandemic was stressful for many and put a significant emphasis and spotlight on the relationship between mental and physical health. The impact was not experienced equitably. Those least able to draw on protective factors (good health; financial wellbeing; affordable housing; employment; being able to work from home; support home schooling) were less equipped to deal with the impact. It exacerbated long- standing inequalities in being able to thrive in the face of adversity. 4.4 The longer-term impact of the pandemic is likely to widen these inequalities further unless significant action is taken. This has taken on a new urgency with the emerging cost of living crisis, compounding the threat and further widening the gap. 4.5 The Good Mental Health for All Delivery Plans cover six key areas: 1. Mentally healthy infants, children and young people; 2. Mentally healthy later life; 3. Mentally health environments and communities; 4. Mentally healthy employment; 5. Reducing the prevalence of suicide, self- harm, distress and common mental health problems, and 6. Improving the quality of life of those experiencing mental health problems, including the promotion of recovery, stigma reduction and physical health improvement. Key Achievements - a sample of the work 4.6 Over the period of the strategy a broad range of partnership programmes have been developed to mitigate the impact on the known risk factors to good mental health; exposure to trauma, isolation, deprivation and inequality, physical ill health and impairment, unemployment and debt. 4.7 Evidence indicates that where people have the tools to manage their own health – including being supported to do so, such as through social prescribing, community networks, consistent social connections – that their wellbeing may be improved. GIRFEP promoted a move towards proactive engagement earlier, prevention and recovery models focused on assets, strengths and self- care and self-management. Page 49 of 218
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42 4.8 The Good Mental Health for All workstream worked with all local and national partners delivering an ongoing programme of work focussing on challenging stigma and discrimination. A few examples of the programme are set out below. • 12 NHS Stigma Free Champions have been trained by Stigma Free Lanarkshire • 14 Understanding Stigma Workshops have been delivered by champions • 152 Participants attended • The Leaders of North Lanarkshire Community Planning Partnership committed to ensuring their workplaces and communities are free from mental health stigma and discrimination by signing a pledge to action, creating social media videos with key messages and creating a podcast series • 4 Leaders’ workshops delivered – attended by 76 Leaders from NHSL, Police Scotland; NLC; VANL; Fire and Rescue • Launch of a Justice Services Pilot in South Lanarkshire (November 2022) focusing on workplace culture: delivering targeted workshops; leaders messaging video; champions programme; and a comprehensive evaluation programme to determine the impact of the SFL/SLC partnership 4.9 The Priority Outcomes for the North and South Lanarkshire Suicide Prevention Action Plans are: • People at risk of suicide feel able to ask for help, and have access to skilled staff and well-coordinated support. We will continue to deliver the Living Works Training programme including ASIST, Safe TALK and Suicide TALK. • People affected by suicide are informed and know how to seek help Suicide Prevention. We will continue to develop and create a coordinated approach to public awareness campaigns, which maximises impact. • Suicide is no longer stigmatised • We provide better support to those bereaved by suicide. Upskill 3rd sector partners to support communities affected by suicide. • Through learning and improvement, we minimise the risk of suicide by delivering better services and building stronger, more connected communities. We will identify and facilitate preventative actions targeted at risk groups. 4.10 Suicide Prevention Lanarkshire delivers the three suicide prevention training sessions: Suicide TALK; Safe TALK; ASIST Training provided in 2023: • 140 People attended 2-day ASIST in South Lanarkshire (included some North Participants from Voluntary Sector) • 90 People attended 2-day ASIST in North Lanarkshire • 126 people (across North and South) have attended new Ask, Tell Training includes Tackling Poverty Officers, Voluntary Sector, CPP organisations) • 86 People have completed Suicide ALERT (North Lanarkshire) • 119 People have completed Scottish Mental Health First Aid (North and South Lanarkshire) • 14 People have completed Safetalk (North Lanarkshire) • 10 Ask, Tell Sessions; 4 ASISTs; 2 Scottish Mental Health First Aid; 1 Safetalk; 1 Suicide Alert planned for the remainder 2023 • Mental Health Improvement and Suicide Prevention Training Pathway (co-ordinated and strategic Framework) in development Multi-Agency, Pan-Lanarkshire Training Sub-Group and Trainer Network have been established in 2023 Page 50 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 43 4.11 Two Annual Recovery Events have taken place that have brought people with lived experience together to share stories of recovery and explore what recovery means to them. For many these have been the first opportunity to connect with others face-to- face since before the pandemic. Feedback on these events has included: “Inspiring and humbling to open up and release your feelings “It has sparked inspiration for helping others and making a positive difference in High Schools (Coatbridge High School) “Without a doubt, helped my recovery” “Mental Health is a destination, not a process. It’s about how you drive, not where you’re going” 4.12 Distress Brief Interventions (DBI) is an innovative way of supporting people in distress. DBI consists of two parts, with Level 1 seeing trained front-line health, police, paramedic and primary care staff help ease any individual. They then ask the person if they would like further support and, if they agree, they are referred to the DBI service with a promise of contact within the next 24 hours to start providing further face-to-face support. Level 2 is provided by commissioned and trained third sector staff who contact the person within 24-hours of referral and provide community-based problem solving support, wellness and distress management planning, supported connections and signposting. • To date 9,316 people across Lanarkshire have accessed third sector (Level 2) support. Between Oct 2021 and Sept 2022 this averaged at 189 referrals per month. • The most common source of referrals: - A&E departments (40%); - followed by Primary Care (21%); - Psychiatric Liaison Service (18%); - Police Scotland (13%); - Scottish Ambulance Service (3%) • 79% of appropriately concluded cases engaged in DBI support. Of those, 76% engaged in further support beyond the first supportive intervention. The most common presenting problems included: Depressed/Low mood (65% of referrals), Stress/Anxiety (56% of referrals). Suicidal thoughts (40% of referrals) Distress Brief Intervention (DBI) is a national programme which provides a framework for creating a consistent, collaborative, connected, compassionate and effective response to people experiencing distress • 11,953 referrals have been made for Lanarkshire residents since DBI began in June 2017. This currently averages at around 220 referrals per month. • 55% of referrals are female, 45% are male. • 82% of clients live in the five most deprived deciles • 34% of referrals have come from A&E, 25% were referred from primary care, 20% from psychiatric liaison service, 13% from Police Scotland, 3% from education, 3% from Scottish Ambulance Service • 81% of appropriately concluded cases engaged in DBI support. 72% of those engaged in further support beyond the first supportive intervention • 67% of clients reported depression/low mood, 65% reported stress/anxiety, 38% reported suicidal thoughts, 7% had taken an intentional overdose, 12% reported self-harm. • The median distress rating before DBI was 8/10. After DBI 4/10. The DBI, NHSL Pilot ended on 31st March 2024. It was agreed that one commissioned service, Lifelink, would deliver DBI Pan- Lanarkshire. This service commenced on 1st April 2024. Page 51 of 218
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44 4.13 Well Connected is Lanarkshire’s social prescribing programme. Well Connected makes it easy for people to take part in and benefit from activities and services that we know can improve well-being. The Well Connected programme has been shown to help people by: • Improving self-confidence & self esteem • Reducing low mood • Reduce feelings of stress • Helping people deal with some of the problems that are causing low mood such as money worries, loneliness & unemployment • Helping people develop positive ways of coping with the challenges of life • Increasing opportunities for social contact • Learning new & useful skills • Improving community spirit • Increasing the number of people taking part in arts, leisure, education, volunteering, sports & other activities Community Mental Health and Wellbeing Fund (CMHWB) In 2023/2024 a further £946K (VANL) and £707K (VASLAN) were awarded during Phase 3 of the CMHWB Fund. 95 projects benefitted. These included refugee, BAME and carer projects. The Fund also received successful bids supporting gypsy travellers and LGBTQ+ communities. Well Connected Well Connected is Lanarkshire’s aims to make it easier for people to engage in activities known to promote mental health and wellbeing. Well Connected resources are available in Polish, Urdu and Ukrainian Digital Therapy (developed by NHSL’s Psychological Services) • Of the 275 people who completed digital CBT, 30% reliably improved through self- directed digital therapy • Sleepio (first line treatment for insomnia) had 838 account registrations with 758 (90%) going on to start treatment. • Daylight (CBT for anxiety and worry) had 545 account registrations with 379 (70%) going on to start treatment. The significant uptake and engagement has helped so many to achieve a meaningful connection with so many, tackling loneliness, social phobia, depression, low mood, and helping to build confidence and improve relationships. These engagements connect people to the system of care that in some instances may save their lives. However, this type of service is not funded within mainstream budgets. Funding for the staff creating these innovative and new ways of working has been optimised from a variety of areas including Health Improvement and HSCP commissioning over the period of the strategy. Due to tight budgets and despite many discussion, the MHW Strategy Board Partners has not found a sustainable budget to sustain this work into 2024/25 and as such this work will be reduced or end. This represents a risk for those people whom this type of grassroots, hyper local route into supports and services is successful. 4.14 In October 2021, as part of the Scottish Government’s Recovery and Renewal Fund to support the delivery of the Mental Health Transition and Recovery Plan, the Minister for Mental Wellbeing announced £15 million funding for 2021/22 for a new Communities Mental Health and Wellbeing Fund for adults (the Fund) to help tackle the impact of social isolation, loneliness and mental health inequalities made worse by the pandemic. Page 52 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 45 In April 2023, it was formally announced by the Cabinet Secretary for NHS Recovery, Health and Sport that £15 million for a third year of the Fund was made available for 2023/24 and has been renewed again for 2024/25. The Fund is aimed at tackling priority issues such as suicide prevention, social isolation and loneliness, prevention and early intervention - and addressing the mental health inequalities exacerbated by the pandemic and the cost crisis including a particular focus on needs of ‘at risk’ target groups locally such as people with a long term health condition or disability, people from a minority ethnic background and lesbian, gay, bisexual, transgender and intersex (LGBTQI+ ) communities and many others. The Fund has been successfully delivered through VANL and VASLAN - Third Sector Interface (TSI) groups working together and building upon existing partnerships to ensure that support to community based organisations is directed appropriately and in a coherent way. Each regional TSI has overall accountability for the spend at local level and for working in collaboration with Integration Authorities and other existing local partners. The table below is an example of the volume of income generated and the breadth of the allocation in terms of initiatives, projects and crucially the number of beneficiaries. North Lanarkshire South Lanarkshire Phase 1 (2021/22) • Total funding allocated: £1,057,983.50 • Number of projects funded: 53 • Average funding awarded per project: £30,000 • Number of beneficiaries: 21,000 • Total funding allocated: £1,057,983.50 • Number of projects funded: 100 • Average funding awarded per project: £10,579 Phase 2 (2022/23) • Funding allocated to community projects: £955,000 • Number of projects funded: 33 • Average funding awarded per project: £28,905 • No of beneficiaries: 16,700 • Funding allocated to community projects: £888,000 • Number of projects funded: 64 • Average funding awarded per project: £13,875 The fund has encouraged local groups to apply and then become involved in local decision making groups such as the LOIPS. An example in Bellshill is Black Asian and Ethnic Minority (BAME) Community ’Pearl Ladies Group’ were supported by subgroup leads to access the fund from VANL and received over £15,000 to provide mental health supports to women from the BAME Community. Page 53 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 47 5. Improving Access To Mental Health Supports and Services (IAMHSS) 5.1 The IAMHSS project has concentrated on specific areas to increase capacity in primary and community settings to ensure the right support is accessible and available at the right time. This project was also responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy 2017-2027. The aim of this work was to align Action 15 with developments implemented through the Primary Care Improvement Fund (PCIF) and existing services to develop an easily accessible, coordinated and effective pathway of support for people with emotional, psychological and mental health concerns. The workstreams included; Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and the development of digital solutions. The benefits included the following supports and services. 5.2 Primary Care Mental Health and Wellbeing Service (PCMHW) model was developed for Lanarkshire with Mental Health Liaison Nurses now covering 91 GP practices and being supported by Lanarkshire Association for Mental Health, mental health and wellbeing workers providing a non-clinical role. The service provides clinical triage and assessment, and both clinical and non-clinical brief interventions and/or support(s) to people experiencing mild to moderate mental health problems of a short-term nature accessed via their GP practice. 5.3 The Assessment Plus Project is now providing guided self-help intervention in 3 localities. Assessment Plus is a guided self- help intervention drawing from a range of therapeutic approaches including Cognitive- Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Compassion Focussed Therapy (CFT). It is facilitated by assessment and formulation of individual patient needs by clinical psychologists to create a person centred plan of care based on guided self-help. Assistant Psychologists then work with the patient to deliver the agreed care plan over a time limited number of sessions. • Between January and November 2022, a total of 11,234 referrals were received: 10,810 for the Mental Health Liaison Nurses, 345 for the Mental Wellbeing Workers & 79 for the Assessment Plus practitioners. 6.6% of patients seen required onward referral to secondary care mental health or addiction services. Feedback from key stakeholders thus far has been very positive.Page 55 of 218
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48 A Short Life Working Group has been established to: • Review and Redesign the current Primary Care Mental Health (PCMH) service model to match capacity with demand, make the most effective and efficient use of resources and to provide a point of referrals for people experiencing mild to moderate mental health presentations. The aim of this work will be to enhance access by developing standard internal referral processes between the PCMH service, Primary Care Occupational Therapy (PCOT) and Community Link Worker (CLW) programmes, Community Mental Health Teams, Mental Health Flow Navigation Centre & Community Addiction Services. There is also ongoing work to redevelop the model for delivering specialist psychological interventions in primary care, as the Assessment Plus Project evolves into a Lanarkshire wide service with a focus on delivering Stress Control, a Cognitive Behavioural Therapy (CBT) based large group intervention with well-established evidence based approach. This improvement will see access routes through self-referral as well as practitioner referrals from across primary and secondary care services. 5.4 The Transforming Mental Health Access in Emergency Departments project worked to review and improve how people presenting with mental health needs and those with diagnosed mental health conditions accessed Emergency Departments. To improve access for the many people with mental health conditions and mental illnesses who often presented directly to Emergency Departments in one of Lanarkshire’s three acute hospitals or could be brought in via the ambulance service, police service or potentially from other care environments. Our Emergency Departments deliver a good service for many people, but are not ideally suited to help people who are experiencing distress due to mental health conditions. The Vision for this workstream was that: • People can get the right help, in the right place, at the right time • Safe, person-centred, effective, high quality care can be accessed by all those who are adversely affected by mental illness • Services are joined up, person-centred and focussed on prevention, social support, early intervention and recovery • Those affected by mental health problems can fully enjoy their rights, free from discrimination and stigma. In 2020, the then Minister for Mental Health produced formal guidance on routes for people with emergency mental health presentations and setting out priorities and expectations for future service provision in this area. This saw the development of mental health assessment services to see people with mental health needs would be seen in ED only to, 1. Provide the assessment of unscheduled mental health needs for anyone presenting in mental health crisis/distress and, 2. Only require referrals or drop offs (by SAS) via the emergency department where physical medical attention was required first or where people present in the emergency department under self-referral* and could be, 3. Taken directly to a more suitable separate mental health area to the emergency department staffed by mental health professionals *e.g. Police Scotland and Scottish Ambulance Service can refer direct to mental health assessment centres. Page 56 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 49 The benefits realised in Mental Health access, supports and services in and via Emergency Departments (incorporated in Unscheduled, Urgent Care programmes) included: • A 24/7 service model has been established and embedded that provides mental health assessments for all unscheduled care presentations out with emergency departments. • The Flow Navigation Centre (FNC) went live in December 2020 and is now fully established in-hours providing an alternative to Emergency Department (ED) triage for a mental health assessment. • Direct links with Psychiatric Liaison Nurse Service (PLNS) for Community Police Triage (CPT) and Scottish Ambulance Service (SAS) triage have been fully established for both in hours via FNC and Out-of-Hours (OOH) at Douglas Street. This was expanded in November 2021 to include British Transport Police. • The Out-of-Hours (OOH) service at Douglas Street has expanded and is now fully embedded enabling patients to be triaged and assessed via telephone, virtual platform, or face-to-face appointment. • Mental Health Advanced Nurse Practitioners (ANPs) now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. • Systematic regular communication between senior staff in EDs, Police and SAS have been established and are progressing well. Links have been established with NHS24 and work is ongoing to map pathways and systems. • A robust governance framework has been established that spans across mental health unscheduled care services. Consistent weekly data is being reported across all work streams regarding Flow Navigation Centre (FNC), Out-of-Hours (OOH) and source of referrals as well as Emergency Department (ED) assessments and missed opportunities where assessment could have taken place out with ED. Annual reports are now compiled to identify benefits and challenges in the delivery of unscheduled care and to provide data to identify further areas for service improvement. Annual Community Police Triage data provides evidence of positive progress, showing an overall reduction of 68% in police attendance at ED. Patient stories have been obtained to reflect lived experience of accessing unscheduled care services. We are continuing to link to the National Redesign of Urgent Care (RUC). Pathway benchmarking against National roadmap has been completed for our service with no major gaps identified. Lanarkshire has been recognised through RUC as having made good progress and to be on track with the implementation of national requirements. 5.5 The aim of the Custody Suites workstream was to provide person-centred, safe and clinically effective healthcare for people detained in police custody. The workstream collaboration set out to develop a range of new ways of working within Custody Suites across the 4 Lanarkshire Custody Suites and develop a new Mental Health and Wellbeing Team staffing model. This work has been aligned to the Unscheduled Care Team, the Primary Care Team, and the Community Mental Health Teams who will continue to provide care for the most unwell people who need specialist input. Advanced Nurse Practitioners (ANPs) have been recruited through Action 15 funding and are providing a valuable mental health assessment resource to support people who present with mental health needs when detained for any period of time. This service has evaluated very well with feedback very positive and achieved awards, one for ‘Policing Partner of the Year’ at the Chief Constable’s Bravery and Excellence Awards at Scotland’s Police College, Tulliallan in February 2024, and another for ‘Outstanding External Partner’ at the Lanarkshire Divisional Police Awards in April 2024. Page 57 of 218
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50 The Impact on Community Police Triage as a result of improvements in unscheduled care pathway is demonstrated in the table below. The has been an overall reduction in the requirement for police or patient to receive Mental Health Assessment via hospital attendance, allowing patient to stay within home environment and receive appropriate access local to Mental Health supports and services. These figures do not include patients who were taken to hospital by police and treated by Emergency Department staff who either deemed them fit to return home or offered them a Distress Brief Intervention (DBI) referral without the requirement for them to be seen by a PLN. Incidents where Mental Health Action required via Lanarkshire PLNS 2023 2022 2021 2020 2019 Number of calls to CTS (% of which assessed and able to remain in home address without need to attend hospital) 1872 (94.55%) 1872 (94.55%) 1016 (98%) 485 (98%) 181 (95%) Number of Patients taken direct to ED and subsequently assessed by a PLN 371 443 635 542 459 Total Number of Patients assessed by PLNS 2243 1833 1651 1027 640 Increase in incidents with PLNS requirement from previous year (since 2019) 24.83% (250.47%) 11.02% (186.41%) 60.76% (157.97%) 60.47% (60.47%) n/a Potential police attendance at hospital reduced by using CTS instead of attending ED 81.45% 73.43% 60.21% 46.15% 26.88% 5.6 The IAMHSS project worked across a number of agencies to develop and deliver the Prisoner Mental Health Workstream North Lanarkshire Integration Joint Board has devolved responsibility for Prisoner Healthcare and provide the leadership and management overview of healthcare support and services delivered in HMP Shotts, the only prison within Lanarkshire. Utilising Action 15 funding, a Mental Health Multi-Disciplinary Team staffing model for Shotts Prison has been developed to ensure the level of care for prisoners reflects the mainstream services offered to the rest of the population. The prisoner population of HMP Shotts now has improved access to a wider range of mental health services, in particular psychological therapies and health improvement, through a match-stepped model of care. Referral pathways have been established, ensuring patient-centred care and communication between specialties is improved with an increased focus on health improvement. Page 58 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 51 A Short-Life Working Group (SLWG) was established Dec 2023 to: • Review the service using the Royal College of Psychiatry Quality Network Standards • Consider the various recommendations from recent external body reports (HMIP / MWC) • Gather feedback from various stakeholders including the patient population/ service users, healthcare staff within the Mental Health and Addictions team and staff within the Scottish Prison Service (SPS). • Produce a paper detailing its findings and recommendations including reconfiguring the Prisoner Mental Health team utilising the Action 15 funding for the unfilled Band 7 Advanced Nurse Practitioner Post. • These recommendations have been accepted by Prisoner Healthcare Programme Board following some additional checks around finance and Senior MH nursing agreement. A new Programme Board is now in place to deliver and monitor progress with the SLWG recommendations. This group will meet quarterly and met for the first time on 20th Feb, 2024. 5.7 The Digital solutions workstream continue to be explored and expanded to help provide more accessible services and enhance patients’ experience. Within Psychological Services, the embedded Digital Psychological Service offers consultation and support to colleagues while at the same time overseeing and expanding the range of online therapeutics that are available, with the aim of improving access to psychological resources for all adults in Lanarkshire. In 2023 there were 37,393 visits to the Lanarkshire Mind Matters website. • More than 12 different evidence-based online therapeutics are now available, including self-referral video and app-based courses, and an expanding range of guided self-help interventions where users can now complete online courses with review and feedback from Psychological Services staff. This include programs for common mental health difficulties as well as ones focused on anxiety and mood challenges in physical health contexts. • In 2023 there were more than 4000 clinician referrals to such online therapeutics, and around 2500 self-referrals to available courses. Referral processes have been further streamlined, and additional online courses will be introduced in 2024-2025. • The Digital Psychological Service is in the process of adopting new strategies which will allow us to gather and analyse outcome data more efficiently than has historically been the case. Expedient data from April 2023-September 2023 suggests that 66% of users of the self-referral Sleepio app saw improvements in insomnia symptoms; 57% of users of the self-referral Daylight app saw improvements in anxiety; and 38% of users across all SilverCloud programs reliably improved. As noted above, SilverCloud delivery is now being augmented by clinician support, and we are interested to see the impact of this. • Near Me video sessions continue to be well utilised even as face-to-face appointments return to pre-Covid levels. Psychology (13,636 video consultations), CAMHS (1878) and Psychiatry (1761) were the top 3 users of the system in 2023. • MORSE20 transition has been completed for all previous Midis users. Work remains underway for remaining services to migrate to MORSE system. • Successful collaboration with Connecting Scotland to provide devices and support to service users. • Digital champions have been identified and regular meetings are in place which are very well attended with good practice being shared. 20Morse gives access to patient information which can be collated from many different systems, providing both historic and current care activities, ensuring that the clinician is fully informed at all times Page 59 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 53 6. Children And Young People’s Mental Health And Wellbeing – (Specialist And Secondary Care) 6.1 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services (CAMHS) and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. 6.2 For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). 6.3 The strategic commissioning of CAMHS for the NHS Lanarkshire area is hosted by North Lanarkshire IJB and managed by North Lanarkshire Health and Social Care Partnership. 6.4 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This new specification focusses CAMHS on the needs of children and families affected by the more complex mental health problems, moving early intervention support to the Schools Counselling Model, Schools Nursing and the Community Wellbeing Framework. In January 2021, the Specialist Children’s Health Services Unit (SCHSU) was formed bringing a consolidated approach to the operational delivery of children’s specialist health services across Lanarkshire. In April 2021, Health and Social Care North Lanarkshire received confirmation of recurring funding via the Scottish Government Recovery and Renewal Fund specific to CAMHS of £3.3 million. 6.5 A CAMHS Recovery and Renewal Programme was established to: • Review CAMHS referral and assessment pathways with a view to implementing the Choices and Partnership Approach (CAPA) model. • Full implementation of the Child and Adolescent Mental Health Service (CAMHS) Specification – Community CAMHS. • Clearance of any backlogs on waiting lists for CAMHS. • Clearance of any backlogs on waiting lists for Psychological Therapies. • Agree a workforce model to utilise the funding provided by the Mental Health Recovery Fund to enable the effective implementation of CAPA • Engage all key stakeholders to achieve consensus and clarity and enhance communication of new ways of working across all CAMHS teams and Neurodevelopmental Pathway. Page 61 of 218
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54 Delivery of the Programme is co-ordinated and monitored by the CAMHS & NDS Recovery and Renewal Programme Board, chaired by the Medical Director of Health and Social Care North Lanarkshire and supported by a Professional Adviser from the Scottish Government. 6 main workstreams were established to achieve these objectives: • Neurodevelopmental Service • Choices & Partnership Approach (CAPA) Implementation • HR & Workforce • Communication and Engagement • eHealth • Capital/Strategic Planning 6.6 The Neurodevelopmental Service was included in the new Specialist Children’s Health Services Unit (SCHSU) which was established in January 2021 bringing a centralised approach to the operational delivery of children’s specialist health services across Lanarkshire. The unit includes the Neurodevelopmental Service (NDS) which was piloted from 2019. From May 2022, with the appointment of a Clinical Manager and allocation of Scottish Government funding, the service has become fully operational. • The main focus of this workstream is to progress towards full implementation of the national NDS specification. • Nationally there is an expectation that Neurodevelopmental Service will deliver an assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Foetal Alcohol Spectrum Disorder (FASD), Developmental Coordination Disorder (DCD) and Tourette’s and tic disorders. This will be delivered locally via highly specialist multi- disciplinary staff. • A Neurodevelopmental Service Steering Group has been established. • A Service Model was trialled, evaluated and adjustments made to the current delivery of services. • Universal workshops are being delivered on a weekly basis across North & South Lanarkshire. There is additional provision of workshops via Third Sector services HOPE in North Lanarkshire and ARCH in South Lanarkshire. • A website is being created and social Facebook, Instagram & X (Twitter) provide ongoing supports, advise and signposting. • A contract is in place with an external company to provide face to face neurodevelopmental assessments and post diagnostic interventions as part of the Health Board’s access, delivery and waiting time reduction plans. • A waiting list and database cleanse are underway. • There are currently two tests of change: - In South Lanarkshire: A Whole School Approach to Neurodevelopmental Assessments - In North Lanarkshire Council: ensuring a positive transition from primary school to secondary school for young people with a neurodevelopmental profile • The next tasks are to review the service, implement MORSE, align current work to the National Specification, schedule Intervention Groups for Anxiety Management and Life Skills as well as Participate in Essence D Trial with Glasgow University. • There are number of key issues: - High referral rate - Long waiting list with complex children as longest wait • Limited staff space within the North Lanarkshire base at Newmains Health Centre. Access to clinical space also remains challenging at Udston 6.7 The Choices & Partnership Approach (CAPA) Implementation Workstream progressed CAPA, a service transformation model that combines collaborative and participatory practice with service users to enhance effectiveness, leadership, skills modelling and demand and capacity management. Page 62 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 55 A crucial working group was established to review the CAPA approach and design and implement the aspects of this way of working required for CAMHS in Lanarkshire as follows: • A series of workshops took place, attended by representatives from the Directorate for Mental Health at Scottish Government, and outcomes of these cascaded to staff across the service and support services. These workshops included CAPA engagement sessions for the CAMHS management team, a CAPA Master Class for CAMHS clinicians and a separate information session for HSCP leaders. • Further workshops/away days for locality teams took place in November and December 2022. • CAMHS in Lanarkshire visited CAMHS colleagues in NHS Grampian to establish a supportive network and learn lessons from their implementation of the CAPA model. • An exercise took place to review locality capacity in each team across CAMHS with a view to building a capacity calculator that facilitated modelling and forward projections of numbers of new/return (Choice and Partnership) appointments that would be required to meet Waiting Lists and ongoing demand. This task showed results that demonstrated the number required across each locality/team. A follow up exercise reviewed skill mix and job plan/clinic templates were produced. • CAPA was rolled out at the end of January 2023. A CAPA calculator/timetable was designed and implemented to provide an even spread of choice and partnership appointments across teams, with regular review (every 12 weeks) of capacity against demand to allow enhanced/ sufficient capacity for new/return patient appointments, with the correct ratio for staff groups to ensure waiting time management. A CAPA booking system is now in place for all locality CAMHS teams. • TrakCare went live on 1st May 2023 with partnership appointments being booked from April. • A number of CAPA Team Away Days have taken place and CAPA choice assessment proformas and patient CAPA letters are now in use. • A waiting list initiative launched in August 2022 has resulted in a significant reduction in CAMHS the waiting list. Lead Clinicians and Team Coordinators have met to start planning implementation process for peer discussion groups. 6.8 Work has been completed with the Scottish Government Mental Health directorate to analyse CAMHS workforce capacity (based on current funded establishment) against demand (numbers of referrals per head of population). This work included: • A review of staff lists was carried out during January and February 2023 to produce an accurate staffing position within all teams. Standard Operating Procedure were also developed to support the maintenance of this information which will ensure ongoing accurate staffing information within each team. • A dedicated HR Recruitment Team continues to support CAMHS clinicians to enable them to free up time to undertake clinical activity. This is in place until March 2024. Videos, including walk-round videos of the new CAMHS premises, were added to recruitment information packs. These promote the benefits of working within NHS Lanarkshire CAMHS and offer dedicated contacts for further discussion. • Dashboard information is available to all managers to view current staffing data including turnover, sickness, vacancy levels, supplementary staffing usage. Training has been provided to managers to ensure they are confident to navigate and use the workforce dashboard effectively. • Work Targeted recruitment events have been carried out via social media platforms which have been supported by the Communication and Recruitment Teams. Page 63 of 218
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56 6.9 CAMHS Communication and Engagement work included: • Extensive staff engagement took place to ensure that leaders and frontline staff were on board with the direction of travel and that their experience and knowledge informed the development of new ways of delivering services. • The programme also had a dedicated engagement officer to support and lead on engagement activities and events. The engagement activities have included attendance at various children’s, young people’s and families’ forums and networks as well as organising stakeholder engagement events with Community and Voluntary Sector groups and local communities. This work has resulted in ongoing opportunities for children, young people and their parents/carers to be involved in service re-design. • A brand new CAMHS logo, designed by New Lanarkshire College students, was launched in 2023. • Updated and enhanced CAMHS website presence. • A long-running social media service-user awareness campaign was undertaken to explain the waiting list initiative and advise parents/carers how appointments would be made through extended staffing hours. 6.10 Work was also carried out to review systems and process, such as eHealth and digital. These included: • New routes of referral were opened up internal to the NHS to improve access (SCI Gateway for CAMHS went live on 1st November 2022). • CAMHS went live on NHS Lanarkshire internal patient management system (TrakCare), on 1st May 2023 with partnership appointments being booked from April 2023. TrakCare will provide much improved data which provide the Service with a better understanding of capacity versus demand and will enable better planning and leaner pathways for children and young people. It will also facilitate reporting on 18-week RTT performance to Public Health Scotland. • The final area of work will be to move the current paper records to an electronic patient record (MORSE). MORSE will release time for clinicians and administrative staff as well as enhance information governance security. Interfaces between systems are also key to streamlining the flow of information between electronic referrals, appointments and record systems. A high level plan has been developed and a MORSE Group established for the implementation/ deployment of MORSE to CAMHS. • MORSE group was established to work through the operational documentation which will look at case standards/audit tools 6.11 Work was carried out on Capital/Strategic Planning to explore facilities and Care environments. • The new South Lanarkshire CAMHS facility within Udston Hospital opened to patients on 5th September 2022 and is now fully operational, supporting CAMHS, the Eating Disorders team and the Neurodevelopmental Service. We have received positive comments from the children, young people and their families. Work is ongoing to develop artwork that will complement the space. • An official opening of the new Udston Hospital took place with Maree Todd MSP, Minister for Social Care, Mental Wellbeing and Sport, opening the facility. Local elected members, MSPs and MPs were given tours of the facility to enhance their understanding of the service; the improvements being made; and the opportunities afforded by the new facility. • This facility is in addition to the remaining satellite clinics within South Lanarkshire health centres which ensure local access for those who are unable to travel. Page 64 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 57 • Monies have been identified for the refurbishment of the North Lanarkshire estate to bring it to same standard as the Udston site. The Design Team have produced updated designs for the refurbishment of Airbles Road and Coathill CAMHs outpatient and staff base that have been signed off by the operational team. The tender package was complete and returned and work is ongoing to review associated costs and work programme for access to current operational live sites. A business case is under development and will be updated with final costs following the close of the tender. 6.12 A waiting list initiative commenced at the end of August 2022 to provide additional sessions to complete new patient assessments both in and out of current working hours. • Since then more than 600 patients have been taken from the waiting lists. • The waiting list initiative ended as we moved into a business as usual phase and we are operating at around approximately 200 children waiting to be seen for Choice appointments which are booked 4 to 6 weeks in advance. • As anticipated, compliance with the 18- week Referral to Treatment target dipped due to the focus on seeing individuals who had already breached the target; however, compliance with the target is now improving steadily (see figure 3.13 on page 33). • The Waiting List validation exercise was successful in reducing the CAMHS waiting list by 15%. (NB. When contacted some young people either no longer wanted treatment or did not opt in to remain on the waiting list). Figure 6.1 CAMHS Total Referrals by Calendar Year Page 65 of 218
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58 6.13 Delivering improvements for children and young people’s mental health and wellbeing is embedded in the North and South Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Robust progress has been made in offering a range of programmes of work with a focus on prevention/early intervention and promoting positive mental health and resilience. All practice is underpinned by The Promise, GIRFEC and UNCRC approaches. Funding from the Children and Young People’s Community Mental Health and Wellbeing Programme is being provided for the delivery of community mental health and wellbeing supports and services for children, young people and their families. This is supporting the development and provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government guidance has been clear that funding is to be used for new or enhanced services. Project officers are in place in both local authorities and gap analysis, benchmarking and co- production of services has been undertaken. https://www.nhslanarkshire.scot.nhs.uk/ services/childrens-services/mental-health- services-and-resources-directory/ 6.14 Key developments in North Lanarkshire include: Access to Information In line with the availability of accessible information regarding children and family supports and services within North Lanarkshire Council, GIRFEC in NL website is live and the section on supports and services is populated and updated. Recruitment is underway for a resource worker who will maintain this site. To complement both North & South council websites; a Pan Lanarkshire CYP Mental health and resources Service Directory has been developed and shared with the workforce and as a next step; is being digitalised onto NHS Lanarkshire’s website to ensure it can be accessed by all. A quality assurance process is in place to update the Directory bi-annually with a planned launch date of January 2024. Children’s Services Planning The survey results of the Strengths and Difficulties Questionnaire (SDQ) administered by Education in North Lanarkshire build a picture of children’s mental and emotional wellbeing in North Lanarkshire from 2017, through the experience of the COVID 19 pandemic and the initial stages of recovery up to this point. The findings initially presented show more children showing increased health and wellbeing needs in 2021 by comparison with 2017 but that a similar picture has emerged between 2021 and 2023, despite significant social and economic pressures facing families at the present time. Based on SDQ analysis, an action plan will be formulated at Cluster level to focus on those young people who are reporting higher concerns in a bid to improve wellbeing and resilience in a targeted manner. The SDQ will be repeated in later years to enable tracking and monitoring around health and wellbeing of children and young people. Impact evaluation and analysis is ongoing across all funded supports via the Mental Health and Wellbeing Support and Services Framework for children and young people, this will determine how the funding is being targeted from March 2024. Mental Health is a priority in the integrated Children’s services plan for 2023-2026. Page 66 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 59 Children and Young People’s Mental Health, Wellbeing and Resilience Task Group The framework for NL Children & Young People’s Mental Health, Wellbeing and Resilience Supports and Services aims to provide early intervention and prevention services for children and young people (CYP), the Scottish Government has invested significantly in Community Services to provide support for CYP where CAMHS (Child & Adolescent Mental Health Service) isn’t the right service but they still need help and support. These might be services that are available in school through school counselling, through the community or through youth work or a specialist third sector organisation. Half of all adult mental health problems begin before the age of 14, so it’s clear that to successfully address inequality, much more must be done to support mental health from a young age. A number of supports have been established in relation to Community Mental Health Framework funding with data to demonstrate provision fulfilling gaps core NHS services do not and should not provide. This investment in new ways of working and building proactive evidenced based approaches in community and individual mental health capacity include: • Living Life to the Full (CLD), available in each school & community within North Lanarkshire. • Family support for children impacted by neurodevelopmental difficulties continues to be provided by NL Carers Together. • Let’s Introduce Anxiety Management (LIAM) – Educational Psychology continue to offer expertise, leadership and support to teachers and other key staff to deliver this programme and address anxiety. • Mentoring through sport – Active and Creative Communities. • Empowering Clusters model commissions support and services based on local need, through the Community Solutions programme. Initial evidence suggests that this has been largely successful and a full evaluation of impact is being finalised. • Family Wellbeing Practitioner Pilot based in 2 clusters, to divert referrals from CAMHS and has been working effectively. • School counselling is accessed within each cluster, positively, there has been a notable increase in self- referral rates over the last year. Anxiety is the most common presenting reason for accessing counselling. • Kooth is live across NLC, providing free online counselling, mental health and emotional wellbeing for children and young people. Anxiety, Self-Harm and Suicidal thoughts are the top 3 presenting issues for use of Kooth. There is acknowledgement that reach needs to be improved and a programme of engagement and communication is underway. • Intensive Support for care experienced young people, who have left care– Education and Families. • A counselling support for care experienced young people (age 16-26) is hosted within Intensive Services and is provided by The Exchange. This is both self and agency referral and is resulting in a good uptake from care experienced young people. • NHSL School nursing offering support via the emotional and wellbeing pathway and in collaboration with the cluster model approach. Page 67 of 218
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60 Ongoing work in the area of Suicide and Self- Harm Prevention Includes: • Training to support the implementation of the Lanarkshire Lifelines resource and Critical Incident procedures continues which will support with the emerging issue of self-harm. • Increasing action is being taken to link CMHWB funding, Distress Brief Intervention and Suicide Prevention into local planning. • Biannual reports are prepared for Scottish Government with regards to the impact of the Community Mental Health Framework funding and services. Further detail on specific programmes of work in the period of January to June 2023 can be accessed here: Children’s MHW reporting Through needs-assessment for Whole Family Wellbeing funding, Education and for the new Children’s Services Plan, mental health and wellbeing will continue to be a priority. Additional family support will be available to improve access to support for those who need it most. The gap for 16-26-year-old care experienced young people to access Health services is being addressed by the addition of 2 nurses who have now been appointed and are based within Intensive services. Throughcare and Aftercare Nurses – Aftercare Northlan A gap in Neurodevelopmental family support has been identified for both pre and post- diagnosis. A test of change is due to take place in 2 Education clusters, which will focus on Primary 6 pupils who are on the Neurodevelopmental waiting list. The Test of Change will involve pupils being assessed and followed through their transition to high school, with periods of support to the families involving Education, the Neurodevelopmental Service and Family Support workers. Potential funding has become available for digital preventative and proactive interventions and resources through the Peaceplus programme. NHS Lanarkshire and partners within Education and Families have been involved in discussions around this, with various options being considered for a pan Lanarkshire intervention. 6.15 Key developments in South Lanarkshire include Access to Information Feedback and engagement with young people in South Lanarkshire highlighted a need for improved access to information about mental health and wellbeing supports. This has been supported in a couple of ways. Within an education setting, a “Wellbeing Warrior” group has been established which is a network for young people to connect and share with SLC about young people’s views around mental health and wellbeing. In addition, we worked with staff and young people to design a website providing information, and to signpost resources. This was started through collating information about local third sector organisations relating to mental health and wellbeing. VASLAN updated their locator tool (locator.org.uk) with this information. Services provided by South Lanarkshire Council and NHS Lanarkshire were pulled into a spreadsheet, and this information was shared with colleagues in NHS Lanarkshire and North Lanarkshire Council/Health and Social Care Partnership. Young people were clear that they wanted a website that met their needs, and based on the collated information, this was created in conjunction with them. They identified topics they felt young people required support on, and were central in supporting the layout, formatting and design of the website. Page 68 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 61 South Lanarkshire Children’s Services Planning Engagement and Co-Production of Services In line with the increased focus on the UN Convention on the Rights of the Child (UNCRC), and recognition of the importance of including young people in planning and participating in service design, a large amount of engagement has been completed with young people. To support this, a large scale survey was co-designed with young people and focus groups were completed with young people, including a number of at- risk groups. The views of over 3500 young people were sought and fed into a report with a number of recommendations including: • Increase capacity for mental health supports within primary schools • Exploration of peer support programmes • Easier access into services – clear pathway to access support • Look at more universal supports available within our communities • Focus on increased supports for families. • Improved signposting / advertising of services • Ensure groups which are at higher risk of experiencing mental health difficulties are able to access appropriate mental health supports • Ensure teachers are aware of supports with regard to signposting • Review mental health curriculum and supports within schools • Establish reference groups for parents/ carers and young people We continue to engage with children, young people and families about mental health and wellbeing needs in the community. An engagement group has been established to ensure that the voice of young people continue to be heard when planning supports/services. We continue to engage with the workforce and families around the Whole Family Wellbeing Fund, and engagement events have helped to shape priorities for Whole Family Wellbeing Steering Group. Family Support Hubs have been launched across the 4 localities of South Lanarkshire. The focus of the work is to provide earlier intervention and holistic support to families to prevent escalation to statutory social work. Referrals have been received from Police Scotland, Education Resources, NHS Lanarkshire, housing, community groups and families. Initial feedback has been very positive. Celebrating Mental Health A Young Person’s Conference with a focus of Mental Health and Wellbeing took place during February 2023. The focus was on sharing good practice, signposting resources and linking in third sector and other partners with presentations and conversations about mental health and wellbeing supports. Additional speakers included Kevin Stewart, MSP, Minister for Mental Wellbeing and Social Care. The event was co-produced by South Lanarkshire Youth Council with South Lanarkshire Council and NHS Lanarkshire Health Improvement. Additional feedback and young people’s views fed into Children’s Services planning. Feedback from the event was very positive, and this is planned to be an annual event. Third Sector Links Ensuring connection with the Third Sector has been a priority. A renewed focus of this will start with additional support and capacity within VASLAN (South Lanarkshire’s Third Sector Interface) within 2024. This is to ensure engagement with children, young people and families is meeting needs and to ensure that the crucial role the third sector play in supporting mental health and wellbeing is recognised. Page 69 of 218
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62 Children’s Service’s Plan (2023-2026) An outcome of the Children’s Service Plan 2023-2026 is that every child and young person will be able to access support which helps improve their mental health and emotional wellbeing. This will be delivered through the following workstreams: • Improve maternal and infant mental health • Improve support offered to children and young people who may be at risk of self- harm and suicide • Improve whole school approaches to mental health and wellbeing • Improve visibility and accessibility of community mental health supports and services • Develop staff professional learning and development to ensure their own and others’ wellbeing is established Supports and Services In relation to feedback and ongoing with engagement with young people, a range of supports, interventions, services have been implemented or adapted. • Kooth has been launched and had much success in South Lanarkshire, with the service frequently performing at or over capacity. This service has reached over 1000 children and young people. When asked whether they would recommend the service to others, 98% of respondents have stated that they would. • School Counselling continues to be accessible in every South Lanarkshire school for children aged 10+. • Theraplay play therapy is continuing to be offered to children aged 5-9. • Emotional Wellbeing Programmes run by Action for Children including CBT-based resilience workshops aimed at primary pupils and a rolling programme of The Blues programme for targeted secondary school pupils. • Mental Health Awareness Raising Workshops for pupils, staff and parents are being delivered by SAMH through primary and secondary schools. These are also being offered to wider SLC services and to other Third Sector organisations. Over 5000 people have attended workshops, and feedback has been very positive. • Peer Supporters Programme workshops are being rolled out across South Lanarkshire secondary schools by SAMH. This is to train and support senior pupils about wellbeing and knowing when to seek additional support, with a view to providing advice and support to their peers. • Improved signposting / advertising of services A website is under development to provide children/young people and their families with appropriate information regarding mental health, and to signpost to wellbeing supports/services. • Establishing reference / engagement groups has been a continued priority. Secondary school pupils have supported us in identifying needs and services. The group have named themselves the “Wellbeing Warriors” and the group is made up of representatives from across the authority. • Family support has continued to be offered at a range of levels. This includes through the Family Support Hubs, as well as through SAMH workshop support. • Staff training and Workforce Wellbeing. Staff have highlighted the critical role that continued professional development and workforce wellbeing have on children and young people. Training on a variety of topics including Attachment Informed and Trauma Sensitive Practice, Emotion Coaching and Lifelines Lanarkshire and ASIST continue to be provided to staff across South Lanarkshire. An exploration of different Workforce Wellbeing models is underway, with several different models currently being trialled and evaluated. Page 70 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 63 Suicide Prevention and Self-Harm Lifelines Lanarkshire The multiagency guidance for working with children and young people who may be at risk of suicide and/or self-harm continues to be rolled out across South Lanarkshire at the following levels: • Informed Level Awareness Raising. Briefings continue to be provided at the strategic level and the practitioner level across South Lanarkshire Children’s Services, including for all staff in Education Resources via the annual Child Protection training update. A 30-minute online course has been developed to support all staff who work with children/young people in South Lanarkshire. • Skilled Level Training. Half day in-person training for key staff who work with children and young people in a more direct/ enhanced way has been developed and delivered to secondary school staff and is being rolled out to key primary school staff. Training for staff who work in additional support needs educational settings is being developed. Multi-agency training has been developed and delivered to partners in Education Resources, Social Work Resources, NHS Scotland and Police Scotland. Page 71 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 65 7. Specialist & Secondary Mental Health Services All key areas of work and progress, emergent plans are set out below. Older Adult Inpatient Provision 7.1 Hospital Based Complex Clinical Care (HBCCC) HBCCC is for people who need care and treatment that can only be given in hospital or specialist NHS unit. It is provided free of charge by the NHS when the nursing care and other daily healthcare needs of the person are assessed by a multidisciplinary team and deemed to be complex, specialist, unpredictable and intense. This area of service provision is currently under review (May 2024). The overall objective of future improvement work or service change in this area will be to optimise NHS Lanarkshire contracted HBCCC bed provision to establish a high quality, person- centred, effective and safe model of hospital- based complex clinical care that will meet the needs of people with complex nursing care needs such as progressive late stages of dementia. Our proposed approach would recognise: • the demographic trend predicting that in the next 20 years the number of people who are over 65 will rise, with an even greater increase of people in the oldest age groups. (trajectory for the next 20 years is that there will be an increase of 50% in the number of people living with dementia over the age of 65). As a result, it’s likely that numbers of people with a diagnosis of dementia in Scotland will also rise. • The need for a robust fact finding and audit process would enable a full and robust assessment of the HBCCC requirements and enable a plan to deliver sustainable high quality care and treatment to people with complex clinical care needs. • The need to establish an inclusive approach to continue to include all key stakeholders in the design and development of the of this future work. This work will be incorporated into Lanarkshire’s Dementia Delivery Plan to support delivery of the national Dementia Strategy, Everyone’s Story 2023. This emergent work will bring new opportunities for multi-disciplinary team-based working and a range of services provided that will benefit people with dementia, families and Carers. Review of Adult Rehabilitation and Recovery 7.2 A review of the Community Rehabilitation Team model has been completed and a new nursing model is now embedded in practice. An initial discussion on access to beds at Cleland Hospital has taken place. We need to clarify what we are looking to deliver in terms of rehabilitation provision to feed into the work of the Older Adult Inpatients workstream. To assist in this, data is required on Cleland admissions & discharges. Mapping of Glencairn and Community Rehabilitation referral and assessment processes has been completed. A new referral form is now in place with a single point of referral. The pathway to community rehabilitation is now live and Planned date of discharge (PDD) is in place. Page 73 of 218
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66 South Lanarkshire Integrated Community Mental Health Teams (CMHTs) 7.3 South Lanarkshire CMHT funding and staff transferred from the previous hosted arrangements with North Lanarkshire to enable the integration of Community Mental Health services within South Lanarkshire HSCP. A Clinical & Professional governance structure agreed by Mental Health & Learning Disabilities Clinical Governance Group & South Lanarkshire Support, Care & Clinical Governance Group. Perinatal and Infant Mental Health 7.4 A successful funding bid was made (in Sept 2020) to the National Perinatal and Infant Mental Health Programme for the development of a whole-system model for perinatal mental health care that enables women, their partners and families to be supported in their own communities; the establishment of a multi-disciplinary Community Perinatal Mental Health Service; and the establishment of a designated multi- disciplinary NHSL maternity and neonatal psychological intervention service. Separate funding was also granted to enable the development of shared strategic goals and agreed pathways for indicated high risk infants and their parents who are not currently accessing clinical services; the development of a model of infant mental health provision; and the establishment of a designated multi-disciplinary and multi- agency Infant Mental Health Service. The Perinatal and Infant Mental Health Programme Board Delivery Plan also includes actions in relation to the development of infant mental health services. These include: ‘develop a model of infant mental health provision to meet the wider need across families experiencing significant adversity, including infant development difficulties, parental substance misuse, domestic abuse and trauma’ with a focus on the period from conception to aged 3 years. Perinatal Mental Health Service: The PNMH service was set up with a vision that Women and their partners and families receive the support they need in their own communities to ensure they experience optimal health and wellbeing, including mental wellbeing, during the perinatal period, so that their children get the best possible start in their lives. The progress to date is detailed below. • Dedicated specialised community perinatal mental health team have been established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. • Education and training models have been rolled out. • Clinical Quality Group set up. • Clinical pathways established to ensure timely and equitable access for women to specialist perinatal mental health services. • Systems are in place to ensure that professionals working in universal services with women and their partners and families can access consultation, information and advice in a timely manner. • Systematic engagement with lived experience and the Community and Voluntary Sector is in place – ensuring feedback is incorporated into service design and there is improved access to Community and Voluntary Sector services. • Information materials and a webpage have been developed to provide access for women and their partners/families to timely information to help them to make informed choices. • Data collection is in place to measure access to service and impact of service and development of a system of continuous quality improvement.Page 74 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 67 Infant Mental Health Service: The progress to date is detailed below. • Multi-agency, multi-disciplinary Infant Mental Health (IMH) team established • Clinical model developed. • Multi-disciplinary multi-agency IMH training programme in place for all agencies including third sector • Infant Mental Health Easy Access Telephone Advice Line & Consultation System established for Health Visitors • NHSL LearnPro Foundation level module on Infant Mental Health: When to be Concerned for all NHSL staff working with infants and their parents • A Pan-Lanarkshire Multi-Agency Infant Mental Health Observational Indicator Set [birth to 3rd birthday] has been developed. • Systematic engagement with lived experience and third sector in place has been undertaken – ensuring feedback incorporated into service design Lanarkshire Maternity and Neonatal Psychological Interventions Service: The progress to date is detailed below. • Funding secured from the Scottish Government until 2023 for a Maternity and Neonatal Psychological Interventions (MPNI) Service and a MNPI Team has been recruited. • Induction and training programme for new staff developed with reference to the NHS Education for Scotland Perinatal Mental Health Curricular Framework, and ‘Essential Perinatal and Infant Mental Health’ e-learning resource. • Clinical model and pathways developed to ensure timely equitable access. • Systematic engagement with those with lived experience and the Community and Voluntary Sector and feedback incorporated into service design, information leaflets and website. • Experts by Experience consultation organised for Neonatal Parents. Continued links with Maternal mental health participation officers. • Increased access to Community and Voluntary Sector services for service users • Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement Page 75 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 69 8. Psychological services 8.1 NHS Lanarkshire Psychological Services aims to improve the psychological wellbeing of people in Lanarkshire, and to make a positive difference to people’s lives. This summary focuses on the work of Adult Psychological Services. Within NHS Lanarkshire, Psychological Services (PS) is part of the Mental Health and Learning Disabilities Directorate. They comprise of 10 locality-based Adult Psychological Therapy teams (PTTs) as well as 14 wide-ranging Pan-Lanarkshire specialist services. These include PS for Adults with Learning Disabilities (PSALD); Psychological Therapies for Older People (PTOP); Forensic Clinical Psychology Services; Clinical Health Psychology Services; Addiction Psychology Services (APS); Neuropsychology; Primary Care Psychology; EVA Psychology, Veterans First Point (V1P), Digital Psychological Services; and Psychological Services Staff Support Team (PSSST). 8.2 In addition to other smaller specialist services within PS, psychological provision is also embedded in other clinical services not managed under PS (e.g. Perinatal Mental Health and Brain Injury). PS provide a professional leadership role for such staff, in addition to providing professional leadership and maintaining professional links with colleagues delivering psychological therapies in Child and Adolescent Mental Health Services (CAMHS). 8.3 PS aim to improve psychological wellbeing of the people of Lanarkshire through direct clinical work and through working indirectly. Direct work includes the delivery of evidence-based psychological therapies. A psychological formulation of people’s experience is developed collaboratively with the person and the therapist (or sometimes with a person’s family or carer). This supports an understanding of their strengths and difficulties, which enables consideration of what may support them to cope differently. Psychological therapies involve establishing collaborative goals and can help people to make changes in areas such as the way they think about things; how they respond and cope with their difficulties and distress; and how they relate to others. Psychological therapy is a collaborative space to explore emotions in a safe and confidential setting. They are effective and proven therapies delivered by trained, accredited and supervised practitioners. PS are multi-professional, comprising Clinical and Counselling Psychologists and other therapists. A range of evidence-based psychological interventions are offered within a tiered, matched care model. Our mode of delivery includes: individual therapy, group-based psychological interventions, online CBT, and other evidence-based digital therapies. 8.4 Indirect work can include informing patient care within multi-disciplinary teams, supporting colleagues to deliver psychologically informed care, encouraging the promotion of psychologically informed services, and supporting staff wellbeing. PS staff also strive for quality via a strong governance, evaluation and research focus, and placing quality improvement methodology at the heart of all service development. Page 77 of 218
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70 Over the period of the strategy PS have: • Continued to strive to increase timely access and work towards meeting the National Referral to Treatment Target for Psychological Interventions, alongside optimising and progressing the quality of service delivery. We have closely monitored Demand, Capacity, Activity and Queue (DCAQ) data and engaged in trajectory planning alongside our data analyst. This has been carefully used this to consider (trauma informed) service initiatives. • Made significant efforts to maintain a culture of optimism across PS, and to respond to challenges by supporting colleagues, but also looking for possible opportunities. Services have utilised research and QI skills of staff to consider service developments and service redesign. For example, PTOP colleagues have used a QI approach to move to an early assessment and formulation based approach. Close relationships across services mean that learning from QI projects has been readily shared, and successful developments can be replicated. • Worked collaboratively with those accessing services and aspired to have greater involvement of experts by experience in service design and delivery. A Lived Experience Interest Group has been established, with representation from statutory and third sector organisations including peer workers, with an initial focus on exploring ways to embed expert by experience involvement in service design and delivery. • Prioritised opportunities to improve services and ensure quality. A research lead has been appointed to provide leadership, improve access to research expertise and opportunities for psychological services staff, and support embedding research within clinical roles and services. As part of this research agenda, PS hosted a research conference to provide staff with an opportunity to celebrate the research undertaken within NHS Lanarkshire PS, and also hear from eminent researchers in the field. We have developed close working relationships across a range of Universities in Scotland. • Aligned with wider strategy and developments within the profession, including the ongoing refresh of the Psychological Therapies Matrix by NHS Education for Scotland, providing a guide to the delivery of evidence based psychological therapy in Scotland. A number of PS staff have been directly involved in this work. This sits alongside the Scottish Government’s launch of the new National Specification for the Delivery of Psychological Therapies and Interventions in Scotland. All of this work aims to ensure ready access to high quality evidence based care, the involvement of those accessing services in decision making about their care, and the delivery of good outcomes. • Restructured the Psychology management team to provide strong leadership across services and ready accessibility of senior colleagues within the profession. This included the creation of Heads of Specialities Roles which include a “portfolio” of services and alignment of work streams, one being ‘Strategy’. The Psychological Leadership Team has also been revitalised. • Initiated development of the role of PS within primary care. The work of Assessment Plus has been reconfigured to a new Primary Care Psychology service. Initially this is taking a focus on the delivery of large scale group community interventions (in progress). • Contributed to the development, delivery, evaluation and educational governance of MSc and doctorate programmes across various universities. Clinicians within PS have provided teaching at Universities across Scotland. The Service also has SLAs in place for doctoral trainee psychologists (and MSc) trainee psychologists. PS has provided formal clinical practice placements to approximately 43 NES- funded clinical psychology doctoral, MSc and EPP (Enhanced Psychological Practice) trainees each year. Page 78 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 71 • PS has greatly expanded the availability of digital options available to people, through the expanded use of ‘near me’ video conferencing, and the development of the bespoke PS website (Lanarkshire Mind Matters). A number of digital programmes can be accessed by self-referral. This increases the availability of lower intensity therapy overall, and increases choice for individuals. 8.5 Much of this work will continue into the next MHW Delivery Plan for Lanarkshire, 2024- 2026. Additionally, PS will aspire to improved access to psychological therapy and psychologically informed care in the broadest sense. Priorities will include: Figure 8.1 Psychological Therapies: % of patients who started treatment within 18 weeks of referral, 2017/18 Quarter 1 to 2023/24 Quarter 3 • Assisting with the development of promotion of a psychologically and trauma informed workforce, services, and systems across NHSL and beyond. This will be guided by the National Trauma Transformational Programme and involve close working with our local Transforming Psychological Trauma Implementation Co- ordinator (TPTIC). • Continued focus on staff wellbeing – both ensuring the wellbeing of PS staff, but also promoting and supporting the wellbeing of the wider workforce (in keeping with above). • Increased presence in Primary Care and reaching more people in the Community via easily accessible large scale evidence based psychoeducational groups • Consideration of further embedding the Psychological workforce within multi- disciplinary mental health teams. • Involving experts by experience in service design and delivery • Promotion of psychological formulation to assist service design and delivery • Integration/alignment of other key strategy and guidelines (psychology specific and otherwise) within the delivery plan e.g. Medication Assisted Treatment (MAT) standards, National Specification for the Care and treatment of Eating Disorders • Establishing a baseline of the National Specification of the Delivery of Psychological therapies and interventions, and identifying a plan for change (where relevant and applicable) 8.6 In the current climate of significantly challenging financial pressures, and staffing shortages (within PS, but also our colleagues in wider MDTs) it seems imperative to not only focus on ‘what’ our priorities are, but ‘how’ we achieve these. Thus, PS make a profound commitment to adhering to the core values of NHS Lanarkshire. We will endeavour to strive for excellence; meet all challenges with curiosity; and thrive on the secure base of true cohesion, consistency, collaboration, and kindness that surrounds our whole system. Ultimately we will work to nurture psychological safety throughout. Page 79 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 73 9. Communication and Engagement 9.1 During the development of the Strategy, a Communications and Engagement (C+E) group was established to inform and influence an inclusive approach to the design, development and delivery of MHW in Lanarkshire. The membership of the group was mainly representatives of people with lived experience, voluntary and community groups. A reference group approach was agreed to strengthen the voice and contributions of non-statutory stakeholders. Consistent with Scottish Government guidelines, early and consistent engagement of people with lived experience, carers and the voice of the workforce featured throughout the work. The Strategy communication and engagement group had a key accountability role, was given an equal role alongside the Strategy Board in informing and contributing to every aspect of the strategy design and development to ensure that: • All communication and engagement was inclusive, coordinated across all relevant groups and partner organisations and that all messages were in plain English, transparent and consistent • There was ongoing meaningful involvement firstly with those with lived experience, and also in groups and communities impacted by inequities in mental health and wellbeing • The right systems and supports were in place to enable effective engagement and participation between all stakeholders involved in strategy implementation 9.2 The voice of lived experience had a pivotal role in developing the scope and scale of the strategy and a full approval role and oversight over the content. This was valued by C+E group members as extremely transparent and meaningful by the membership. The membership was representative of NHS and social care staff, people with lived experience, carers, and community and voluntary sector organisations to act as a key reference group to hold the partners accountable for GIRFEP. Communication and Engagement (C+E) Plans for all Strategy projects/workstreams were informed, reviewed and sign off by the group. The frequent C+ E update reports were useful in highlighting emerging issues and could be used to escalate responses. A workshop to review the role of the Group moving into the final stages of strategy delivery and beyond was held. The following was agreed at the workshop: The group to remain in place to support and inform projects/workstreams with communications and engagement ideas and identify channels through which activities can take place. A live Communications and Engagement approach and supporting plan required to: • Keep stakeholders engaged and informed, to follow up with projects on progress, challenges, etc. and be assured that communications plans are being acted upon. • The format of C+E groups meetings to be more flexible, allowing for workshop-type sessions and sharing of information and ideas. • Planning for the development of the next strategic plan to engage widely on how to continue the co-creation process. Page 81 of 218
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74 • Communications and Engagement group meetings to be used as a platform for identifying and sharing new groups for engagement, etc. • The group is Chaired by a member of the Strategy Board who has a broad overview of all the activities/projects underneath. The Chairperson should either be, or be supported by, a communications professional. • Communications and Engagement meetings/workshops to be opened up to any Strategy Board ‘Lead’, allowing them to drop in and ask questions request help/support. • Ensure any future strategic plans are aligned with existing NHS Lanarkshire and Health and Social Care Partnership engagement structures and other related strategies. • Equality Impact Assessments should be carried out going forward to review strategy delivery and any future work to help in identifying themes for these. Success of the communications and engagement approach was ultimately judged by successful delivery of all of the overall programme objectives. A varied cohort of services, teams and individuals all contributed to this. The impact of the communications and engagement plans are measurable through evaluating the achievements and benefits, the outcomes measured through contribution analysis and evaluation process. This approach used the following aims set out in 2018 with the communications and engagement group: • Demonstrate all stakeholder engagement with- the process: Measures: Number of people involved by type and organisation, meeting/event (s) feedback. Visits to NHSL website • Positive response to process Measurement: Comments from patients/ carers, staff/partnership feedback, public, social media feedback. No/few complaints. • Breadth and reach of coverage Measurement: Capture newspaper, website, intranet, social media etc. coverage. Meeting/ event attendances. • All relevant stakeholders identified Measurement: Completion of EDIA. Representation and participation on Communications and Engagement Sub Group. • Involvement of those with lived experience Measurement: Clearly evidence feedback from those with lived experience • Successful completion of Lanarkshire the Strategy Measurement: Document produced. Document positively received. Scottish Health Council support and reporting. The role of Carers and Carer’s organisations in our engagement has been so informative and influenced a lot of the work in the design and development of the strategy. GIRFEP acknowledged the sizeable contribution unpaid carers make to the health and care system as care providers and took an inclusive approach to all event planning, strategy development, training to engage and reflect the needs of carers in the supports and services developed over the period of the strategy. Still, more can be done to support Carers, people with lived experience and families to make sure what matters to them is prioritised in our plans and demonstrates that shared vision of services that works best for them. See Communication and Engagement report for more detailed information - Comms and Engagement mental-health- wellbeing-strategy-2019-2024/ For additional information about the strategy, patient stories, videos, photos, documents, visit our dedicated mental-health-wellbeing- strategy web page Page 82 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 77 10. Resource and Investment 10.1 Spending on mental health by the NHS in Scotland has reached £1.3 billion in 2021-22, compared to £1.1 billion in 2019-20 and £0.7 billion in 2007-8. This represents an increase in the proportion spent on mental health to 8.8% of total spending by NHS Boards, taking us further towards our ambition to increase spending on mental health services to 10% of the total frontline NHS spending. 10.2 It is worth recognising that as well as funding core mental health NHS services, in recent years a proportion of these funds have seen Third Sector community and voluntary organisations commissioned to promote, prevent and provide supports and services to people in Lanarkshire. 10.3 Supporting and improving mental health and wellbeing is a significant public health challenge that requires a coordinated response from a wide range of organisations. As recognition of the importance of good mental health and wellbeing has grown over the years, so has investment. Key Facts: Funding and investment in mental health services has increased significantly since 2017. However, we know that the causes and impact of poor mental health continue to affect people’s life circumstances. The cost of living crisis has had a range of adverse health impacts on individuals and households and those with the lowest incomes are suffering most as they spend proportionately more of their income on essentials that are seeing the largest rises (food and utilities) and they are less likely to have savings to provide a buffer. • £8.8 billion was the reported cost of poor mental health to the Scottish economy in 2019. • NHS Boards spent £1.2 billion on adult mental health in 2021/22 • Councils spent £224.7 million on adult mental health in 2021/22 • The Scottish Government’s Mental Health Directorate budget is £290.2 million in 2023/24 Accessing the right supports and services when required remains confusing, slow and complicated for many people. As part of the Lanarkshire’s commitment to engaging and working closely with communities and the third sector, the strategy design, development and implementation was carried out, resourced and funded in collaboration with all Partners. 10.4 Taking a whole system multi-agency approach has enabled this strategy implementation to utilise and optimise investment from a range of sources across partner organisations. The Strategy Board worked as a partnership across mental health and wellbeing over the period of the strategy and welcomed the investment in: • NHS24 mental health hub and resources, expansion of distress brief interventions, investment in a range of hyper local initiatives. Page 85 of 218
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78 • Additional Mental Health funding from Scottish Government to Lanarkshire (2019-2023) saw improvements in mental health in primary care, custody suites, emergency departments as a result of the Action 15 monies. These funds have now been mainstreamed as part of the NHS budget devolved to HSCP’s • The continued roll out of the Communities Mental Health and Wellbeing Fund for Adults (the Fund) established by Scottish Government in October 2021 has seen approx. £1m allocated to North and South TSI’s. - The Communities MHW Funds for adults received funding for a third year of funding (£15 million) was announced in April 2023. - The Fund has a strong focus on prevention and early intervention, and aims to support grass roots community groups in tackling mental health inequalities and challenges such as social isolation and loneliness, suicide prevention, poverty and inequality. Year 3 will see a continued focus on responding to the cost-of-living crisis. • The Scottish Government, Children and Young People’s MHW fund allocated additional funds to North and South Lanarkshire Children’s Service Planning which has seen investment in community and school based supports and services 10.5 The MHWS Board in Lanarkshire committed to open transparency of resourcing and joined up our efforts in service of population mental health and wellbeing. 10.6 This has proven successful in many areas; however, the challenge still remains as all agencies continued to work within a financially constrained environment with the risk that mental health and wellbeing is not sustained or prioritised across Partners going forward. 10.7 The joined up work reported in this strategy review has been progressed to get it right for every person (GIRFEP) and can be viewed as evidence of making a difference in communities and for individuals. 10.8 The Strategy Board and all workstreams are convinced that to avoid further regression or delays in access we must continue as a whole system to invest in population mental health and wellbeing across the system. 10.9 We understand more now that poor mental health is both a cause and a consequence of social inequality and acknowledge that any reversal to reactive funding will again lead to a further exacerbation of inequalities in mental health. 10.10 There is a growing concern across local stakeholders regarding the effects of current and future financial constraints in and across public services on population mental health. Workforce availability and finance will be real constraints with efficiency, workforce planning and development, employability initiatives and creative recruitment being important themes. 10.11 The Financial Framework requirements for delivery of population mental health recognises that, as the current financial challenges are likely to continue over the next few years, it is even more important to ensure that investment is effectively targeted to deliver sustainable and high-impact services and support. 10.12 The next phase of work to develop our MHW Delivery Plan will have to take account of the financial constraints and implications for supports and services. Page 86 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 81 11. Evaluating Impact Achievement Framework 11.1 An outcomes-focused Achievement Framework has been developed (Appendix 1) for the Mental Health and Wellbeing Strategy that links the contributions made by projects and workstreams to outputs and the achievement of short and long term outcomes. We noted in our strategy that as GIRFEP was implemented, people in Lanarkshire would see campaigns to promote ways of improving our mental wellbeing, changes and improvements to the way they access mental health support and services, new ways of working, observe new staff roles, a programme of work to tackle mental health stigma and discrimination, increased interventions to support prevention and early intervention as well as every effort to improve services for people with severe and enduring mental health conditions. Ultimately, the strategy set out with an ambition to change the culture in Lanarkshire and improve people’s physical wellbeing and mental health. Unrelated to the strategy development and intervention, Mental Health has had a greater emphasis since the pandemic in 2020 with more people understanding their own mental health needs. Performance Framework 11.2 A short-life working group has developed a performance framework, consisting of a set of output measures aligned with the Achievement Framework, to assist in monitoring service delivery and directing future planning and investment (Appendix 2). These will include Key Performance Indicators (KPIs) that are currently in use for reporting at national and/or Board or Partnership level. 11.3 A prototype performance report is currently being collated based on these. Once this has been achieved a process will be established to enable quarterly production of this report. This review report forms part of a suite of documents related to the design, development, delivery and implementation of the MHW Strategy. Other relevant documents include: • Communication and Engagement report 2019 • MHW Evaluation reports • Equity Diversity Impact reports • National MHW Strategy 2023 and associated documents Page 89 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 83 12. Sustaining Improvement 12.1 Supporting and improving mental health and wellbeing continues to be a significant public health challenge that requires a coordinated response from a wide range of organisations. Our health improvement research states ‘The right to health includes the right to access health services but also the wide range of things that help us live in good health – the ‘social determinants of health’ which includes; safe and affordable housing, access to education and employment, good social support, a decent and fair family income, safer communities and positive childhood experiences’. 12.2 Our next steps and progress must continue in the knowledge that our health, including our mental health is determined by the conditions in which we are born, grow, age, live and work. Almost every aspect of life shapes health and longevity – our jobs and homes, access to education, the quality of our surroundings and whether we experience or live with poverty. 12.3 There is evidence in this report that we are beginning to shift thinking, increase resources for promotion and prevention where supports and early interventions are accessible and meaningful at the time of need, to further recognise the capacity gaps in proactive support and care and putting in place work that results in improved sustainable positive outcomes, including: • Continued investment and improvements in NHS Inform, NHS24 111 mental health specific response and the Mental Health hub. • Improved and increased access to support via Distress Brief Intervention continue to enable a responsive service. • The use of Scottish Government funding (Action 15) to recruit mental health professionals into multi-disciplinary teams and creating primary care and mental health wellbeing teams. • The progress in developing perinatal mental health support, improved emergency access to mental health supports and services through improvements in urgent care in the community with increased and direct access avoiding emergency departments. • Community Police Triage data provides evidence of positive progress, showing an overall reduction of 68% in police attendance at ED. Patient stories have been obtained to reflect lived experience of accessing unscheduled care services. • New mental health initiatives have been established in response to the Community Mental Health and Wellbeing Funds, increasing community based projects and time limited initiatives, access to treatment and support, while pre-existing programmes have been expanded. • Psychological therapies and counselling are becoming more readily accessible for people with mental health problems, • Children and young people have greater access to mental health information, signposting and support and treatment via schools and community orgs • Specialist services have been enhanced by the strategy work including CAMHS improvements, Eating disorders as well as in Perinatal and infant mental health Page 91 of 218
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84 12.3 Our stakeholder reflections include many positive experiences with the design, development and ongoing success of the Strategy. Feedback notes that the success in some way was made easier through the early development of shared commitment and pledges from all sectors, the robust and well organised Governance and programme management arrangements and also the diversity of delegated leadership throughout the period of the strategy. 12.4 There is a fear that a lot of funding is year to year and temporary risking maintaining benefits and gains made during the period of the strategy. 12.5 People’s experience and feedback tell us that they want and need to be given a choice in how they receive support; how they access services and, digital cannot be the default. Moving forward we must continue to address inequality of access for people who experience mental health conditions; in particular, those with learning disabilities and autism; LGBTi plus communities, and people with complex or unrecognised diagnoses, all continue struggle to access treatment and support. Our challenges include consistent, sustainable supports and services that are accessible, consistently available at times required and work in a trauma informed way with people and not against them. People continue to experience stigmatising responses when accessing support and services. All sectors will be required to support the profile and priority of population mental health to shift culture, beliefs and promote understanding. 12.6 The scale and pace of investment in new mental health capacity via grass route community organisations and in primary care may not meet current demand. This will result in delays in access and inevitably we will return to system pressures of increasing demand on specialist and secondary care mental health services. 12.7 Accessing mental healthcare is still more difficult for some people, with deprivation as the single biggest driver of mental health inequalities, and we know that people living in poverty carry a higher risk of poor mental health, fewer opportunities to improve their life circumstances, as do those who are unemployed and/or socially isolated. Many people also face the additional barrier of digital exclusion, meaning it is harder to access available on-line advice, support/ interventions and services. 12.8 The everyday challenges and circumstances added to real discrimination and stigma continue to act as a significant barrier to taking steps to engage and feel worthy of support. People living in these circumstances are three times more likely to end up in hospital for mental health issues than those in more affluent areas with the ability to seek out opportunities for help. We have found that with the right inclusive and non- judgemental people can thrive and progress to recovery. 12.9 The NHS cannot address population mental health alone, and the work within this strategy demonstrated how this might be carried out across organisations and in communities. It is critical that efforts, priorities, funding and investment continues in other sectors such as community and voluntary organisations, housing, social work, education, and employability support services, to address and prevent some of the causes of poor mental health. 12.10 Awareness has been raised, in some area transformation has occurred throughout the period of this strategy, experience gained, great joint working. 12.11 Building on the success of the strategy implementation and the lessons learned, the next phase of work will encompass areas not fully realised from the 2019-2024 MHW strategy, identifying new areas of local work. 12.12 The next steps commenced in February 2024 to proactively agree our approach with the IJB and Partners. Our self-assessment against the Scottish Government/COSLA MHW Strategy, published June 2023 and the associated documents including the Delivery Plan, published November 2023 will result in clear priorities for Lanarkshire MHW Delivery Plan (2024-2026). Page 92 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 87 13. Next Steps 13.1 We must do all we can to ensure we maintain any gains achieved throughout the life of this strategy. Yet we must still do more to invest in increasing mental health supports and services. 13.2 Our future work will contain the development of MHW Delivery Plan for Lanarkshire 2024- 2026 and will; • Ensure Mental Health and Wellbeing is embedded in all of our work to help public agencies work together with the community to plan and deliver better supports and services which make a real difference to people’s lives. • Continue to see Mental health and Wellbeing of the population as a priority with and across our Community Planning Partnerships in Lanarkshire. • Continue to develop evidence-based approaches to addressing the existing and emerging causes and challenges that result in improvements for people’s mental health and wellbeing. • Promote real and meaningful joint working with all partner organisations • Continue to optimise all available resources in all sectors to ensure effective use of resources • Align our future work on developing the MHW Delivery Plan for Lanarkshire with the integrated approach of Getting it Right for Every Child (GIRFEC) and the Place based work, ‘Getting it Right for Everyone’ principles and GIRFE Practice Model • Ensure alignment with the recently published Scottish Government/COSLA Mental Health and Wellbeing Strategy (June 2023) and associated evidence based documents to undertake a self-assessment against the national MHW Strategy Delivery Plan (Nov 2023) • Reinforce our whole system approach to working together, we will also align to the Scottish Government/COSLA Mental Health and Wellbeing Workforce Action Plan to ensure we have a diverse, skilled, supported and sustainable workforce across all sectors. 13.3 It is only with a whole system, whole person, mental health and wellbeing emphasis across all policy and in practice we will see an impact in people’s life circumstances, life styles, improved choices, opportunities and quality of life. A healthy community derives from a range of factors: stable jobs, good pay, access to high quality healthcare when required, quality housing and education. 13.4 Finally, based on our self-assessment we will co-create our Lanarkshire MHW Delivery Plan 2024 – 2026 with an emphasis on: • Prioritising mental health inequalities, • Promoting early interventions and increasing access • Preventing mental health conditions • Providing safe and effective community, specialist and secondary care mental health care and treatment where and when required. Page 95 of 218
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88 Alzheimer Scotland https://www.alzscot.org/ Association for Post-Natal Illness https://apni.org/ Breathing Space https://www.breathingspace.scot/ Centre for Mental Health https://www.centreformentalhealth.org.uk/ Choose Life https://tellmystory.org/ Enable Scotland https://www.enable.org.uk/ Public Health Scotland mental health information https://www.healthscotland.scot/health-topics/mental-health-and-wellbeing/ overview-of-mental-health-and-wellbeing Public Health Scotland mental health indicators https://www.publichealthscotland.scot/our-areas-of-work/health-and- wellbeing/prevention-of-mental-ill-health-and-improved-wellbeing/mental- health-indicators/overview/ Mental Health (care and treatment) (Scotland) Act 2003: Code of Practice Volume 1 https://www.gov.scot/publications/mental-health-care-treatment-scotland- act-2003-code-practice-volume-1/ Mental Health Foundation https://www.mentalhealth.org.uk/ Mental Welfare Commission for Scotland https://www.mwcscot.org.uk/ NHS Mental Health Information https://www.nhs.uk/mental-health/ Royal College of Psychiatrists https://www.rcpsych.ac.uk/ Samaritans https://www.samaritans.org/ Scottish Association for Mental Health (SAMH) https://www.samh.org.uk/ Scottish Government: Mental health https://www.gov.scot/policies/mental-health/ Scottish Recovery Network https://scottishrecovery.net/ See Me Scotland https://www.seemescotland.org/ Young Minds | Mental Health Charity for Children and Young People https://www.youngminds.org.uk/ Appendix 1 Mental Health: useful links Page 96 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 89 Appendix 2 Evaluation Achievement Framework What we start with: Time Funding Expertise Leadership Staffing Communication Governance Evidence base National policy What we will do: Consult with key stakeholders Create a Mental Health & Wellbeing (MH&WB) Strategy Implement the MH&WB Strategy. Actions will include: • Increasing mental health service provision in community settings • Ensuring all staff are trained in current practice • Ensuring capacity to manage MH&WB issues meets demand • Providing integrated services, including shared information • Focusing on early intervention and prevention, where possible • Communicating widely, publicising all aspects of this work What outputs we will measure: No. complaints related to access to different parts of the service Waiting times/list size for different services No. Emergency Department mental health referrals Feedback from service users – possibly develop a generic survey (including access and information) No. people from SIMD 1 & 2 accessing mental health services No. people accessing mental health & wellbeing resources (including online, DBI, voluntary sector) No. staff achieving all mandatory training requirements No. people accessing income maximisation resources No. reports of reduced isolation and loneliness No. people engaging with mental health & wellbeing events What we will achieve in one to two years: People have access to the services that meet their needs People have access to the information they need Staff have the knowledge they need to deliver MH&WB services Lanarkshire people are aware of MH&WB issues Lanarkshire people are aware of the impact of MH&WB on their own and others’ lives What we will achieve in two to five years: People have enough resilience to manage life events and trauma People maintain their independence, avoiding hospital admission where possible, and achieving timely discharge following any admission People feel more connected to their local communities and have adequate social networks Having mental health issues is viewed no differently to having physical health issues Lanarkshire people are comfortable talking about mental health What we will achieve in the longer term: Lanarkshire people have good MH&WB Lanarkshire communities are compassionate Lanarkshire people have a good quality of life Inequalities in MH&WB are reduced or eliminated Page 97 of 218
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90 Appendix 3 Evaluation evidence slides Interviews with Project/Workstream Leads: GMHFA Workstream ‘has come a long way’ but risks ‘diluting itself too thin’ due to cutting ‘across everything’ IAMHSS Good progress but some areas have experienced difficulties CYP (North + South) Handover of early intervention work has gone well and good locally- focused work being done Specialist Services ‘if the work isn’t already completed, we are heading towards it’FIGURE 1 Progress aided by: Progress limited by:Mixed Commitment and buy-in from higher levels to ethos of work Planning + support resources e.g. project management, quality improvement, strategy board, leadership etc. Partnership working + good engagement / whole system - lack of control re delivery Funding + for recruitment, spending priorities - short-term limits developments Events + learning and networking - difficulty attending all, risks loss of influence COVID-19 + service reviews, uptake of digital - impact on MH, strategy pause Recruitment issues - initial and retention Data collection not standardised, varied activities, access to delivery partner data North – South variation Lack of accommodation - slowing roll-out in PC Limited awareness of MH services - need to build stakeholder knowledge Digital resource development - limited and mixed availability THE SIZE OF THE STRATEGY MAKES EVALUATING OUTCOMES A CHALLENGEPage 98 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 91 Example of outcome evidence People have access to the services / supports that meet their needs GMHFA 20/21 NL people receiving 3rd sector support reported reduced isolation and lonelienss on 7,237 occasions ‘I had nobody … calls make my week’ GMHFA 21/22 25% SL CMHWB fund beneficiaries were lonely or socially isolated GMHFA Apr-Sept 22 645 people registered with Calm Distress online programme GMHFA Oct 21-Sept 22 2268 people accessed level 2 DBI support IAMHSS Jan-Dec 22 Of 8,946 people engaging with PCMHW service, 16% referred to counselling, 7% online MH programmes, 4% 3rd sector support worker the service made ‘an amazing difference’ IAMHSS May 22-Feb 23 70 people engaged with Assessment Plus IAMHSS Apr 22-Feb 23 462 people engaged with non- clinical MH&WB Workers IAMHSS Jan-Dec 22 25,500 MH Near Me consultations IAMHSS Jan-Dec 22 1390 assessed by PLNS after community triage 1446 received MH assessment after community police triage 332 accessed MH care in custody IAMHSS 19-22 Capacity doubled for new psychology appointments for prisoners CYP Jul-Dec 22 1366 NL children accessed school counselling CYP Aug-Oct 22 Kooth online MH support available to all SL children CYP 21- 22 53 CYP MHWB fund projects supported 1811 NL children. 1656 felt healthy, 1452 safe, 1462 active CYP 21- 22 8 CMHWB projects directly support SL young people Spec. Services Jan 23 18 new perinatal MH assessments per month Service ‘gave me the confidence to get out with my baby … something I had huge anxieties about’ Spec. Services Dec 22 250 people engaged with Maternity & Neonatal Psychological Interventions service 1-2 year outcome People have access to the services/supports that meet their needs FIGURE 2 Page 99 of 218
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92 Summary of outcomes Outcomes were the strategy implementation demonstrates evidence of making a contribution towards achieving 1-2 year outcome People have access to the services/supports that meet their needs 2-5 year outcome People feel more connected to their local communities and have adequate social networks Longer-term outcome Resources are used more effectively and efficiently 2-5 year outcome People maintain their independence, avoiding hospital admission where possible, and achieving timely discharge following any admission SUMMARY OF OUTCOMES WE HAVE EVIDENCE WE’RE MAKING A CONTRIBUTION TOWARDS ACHIEVING Longer-term outcome Lanarkshire people have a good MH&WB 1-2 year outcome People have access to the information they need 1-2 year outcome Staff have the knowledge they need to deliver MH&WB services 1-2 year outcome Lanarkshire people are aware of the impact of MH&WB on their own and others’ lives Longer-term outcome Lanarkshire communities are compassionate Longer-term outcome Inequalities in MH&WB are reduced or eliminated NEW OUTCOME Reasonable range and quality of evidence (x3) Some good evidence for other outcomes, but not enough Also not evaluated alternative explanations for results, so no confidence to claim achievements are due to the strategy i.e. might they have happened anyway? FIGURE 3 Page 100 of 218
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Review Report / Mental Health and Wellbeing Strategy September 2024 93 Outcomes where we need more evidence than we have 1-2 year outcome Lanarkshire people are aware of MH&WB issues 2-5 year outcome Having MH issues is viewed no differently to having physical health issues Longer-term outcome Resources are used more effectively and efficiently 2-5 year outcome Lanarkshire people are comfortable talking about MH 2-5 year outcome People have enough resilience to manage life events and trauma OUTCOMES NOT EVIDENCED AS YET Longer-term outcome Lanarkshire people have a good quality of life Should we have more focus on perceptions of MH&WB in the general population? OUTCOMES WE NEED MORE EVIDENCE FOR Lanarkshire people have good MH&WB 1-2 year outcome Lanarkshire people are aware of the impact of MH&WB on their own and others’ lives Longer-term outcome Lanarkshire communities are compassionate Longer-term outcome Lanarkshire people have good mental health & wellbeing Longer-term outcome Inequalities in mental health & wellbeing are reduced or eliminated 2-5 year outcome People maintain their independence, avoiding hospital admission where possible, and achieving timely discharge following any admission 2-5 year outcome People feel more connected to their local communities and have adequate social networks Proposed approach: Focus on general public’s perceptions of MH&WB, then compassionate communities Gather evidence on inequalities, resources, MH&WB, independence, resilience Begin to explore any alternative explanations for results FIGURE 4 Page 101 of 218
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94 Appendix 4 Timeline Strategy Design to Strategy Production 2018-2019 Partnership and Whole System Approach to Lanarkshire Mental Health and Wellbeing Strategy 2019-2024 October November December January February March Secure NSS Programme Management Support 10 Oct - 26 Nov Governance paper drafted to set out the programme organisation and governance arrangements 1 Nov - 6 Dec Initial write up of templates Commence assembiling Strategy 14 Jan Dev & Eng Workshops 21 Jan - 8 Feb 1st draft 25 jan - 11 Feb Ongoing engagement 11 - 22 Feb First Development Session - outline Vision Statement agreed Second Development Session - LIST analyst presentation of Mental Health prevalence data 01 02 03 04 05 MHWSG Meeting (1) 6 Dec 2018 MHWSG Meeting (2) 11 Jan 2019 MHWSG Meeting (3) 9 Feb 2019 MHWSG Meeting (4) 4 Mar 2019 1st full draft to 4 Mar 2019 NJJB 18 14 13 15 1609 10 April May June July August September 06 07 08 11 12 MHWSG Meeting (5) 11 Apr 2019 1st full draft to SLIJB 16 Apr 2019 MHWSG Meeting (6) 11 May 2019 MHWSG Meeting (7) 12 June 2019 Final Draft Developed MHWSG Meeting (8) July 2019 MHWSG Meeting (9) Aug 2019 NHS Board 28 Aug 2019 SLIJB for 10 Sept 2019 NLIJB for approval 24 Sept 2019 Further engagement 8 Apr - 24 May Final Draft Strategy Production Progress through for reporting endorsement and approval October 20 Strategy Launch 24 Oct 2019North Lanarkshire Partnership Board 24 Sept 2019 NLIJB 24 Sept 2019 North Lanarkshire CMT 24 Sept 2019 North Lanarkshire Policy & Strategy Committee 24 Sept 2019 19 17 Page 102 of 218
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How to request content in an accessible format If you need information on this website in a different format like HTML, accessible PDF, large print, easy read, audio recording or braille contact us by email at info@lanarkshire.scot.nhs.uk or call our General Enquiry Line on 0300 30 30 243. When you contact us and please tell us: • the web address (URL) of the content • your name and email address • the format you need, for example, HTML, audio CD, braille, British Sign Language (BSL) or large print, accessible PDF Health information in different languages and formats – including BSL, Easy Read and translations can also be found on https://www.nhsinform.scot/translations Page 103 of 218
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? Ref MD/CR Date ☐ Yes ☒ No 18/02/25 Whole System Winter Planning and Resilience 2024/2025 From Morag Dendy, Chief Officer / Head of Planning, Performance and Quality Assurance E-mail dendym@northlan.gov.uk Telephone Executive Summary This paper is coming to the Committee to provide an update on and confirm support for the planning arrangements being put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months, with particular recognition of the uncertainties and potential impacts that remain relating to inclement weather, influenza and other respiratory illnesses, norovirus and other winter viruses’ financial pressures, cost of living issues and other concurrent risks against the backdrop of major pre-existing system-wide pressures This paper has been prepared by the multi-agency, multi-disciplinary winter planning group alongside the key action areas of Operation Flow. It has been presented to the NHS Lanarkshire Board and North Lanarkshire Integration Joint Board. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the extensive planning undertaken to date; the range of ‘early warning systems’ in place to seek to identify any issues and mitigate; accordingly, and the variability of a series of scenarios which mean that the winter plan will require to be constantly reviewed and flexed to meet any emergent issues. The Plan for North Lanarkshire Priority Enhance participation, capacity, and empowerment across our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities Programme of Work Resilient People Item 3 Page 105 of 218
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1 Background 1.1 Annual whole system planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Lanarkshire Health and Social Care system, in common with that across Scotland, continues to face significant challenges. 1.2 Planning for Winter 2024/25 commenced in August 2024 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). 1.3 Given the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as, and should be understood to be, a dynamic plan and one that is highly likely to be subject to change over the coming months as it reacts to any emergent issues. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific exercise took place on 14 November 2024 to test system-wide planning. Additionally, work undertaken in previous years by NHS Lanarkshire to take account of the increasingly likely eventuality of several concurrent risks which may well align to create increased system pressure has also been utilised as part of the wider winter planning process. These risks include, inter alia, increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages across a number of sectors and grades across the Health and Social Care sector; public health impact of cost-of-living crisis/fuel costs and subsequent demand on health and care services; inclement weather and available finances. National Guidance / Scottish Government Correspondence 1.4 National guidance was published on 24 September 2024 and is attached as Appendix 1. The guidance sets out the national expectations for those areas that local winter plans would be expected to address. 1.5 The four winter planning priorities outlined follow a journey through the health and social care system: • Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. • Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. • Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. • Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting Scotland’s unpaid carers. Page 106 of 218
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1.6 Thereafter there was a request that a winter preparedness self-assessment be prepared which was also undertaken by the multi-agency group and duly submitted to Scottish Government by the due date of 16 October 2024. The self-assessment is attached as Appendix 2. 1.7 Some funding has been made available centrally in 2024/25 to support winter planning as well as some monies managed internally as part of the respective financial plans to anticipate winter pressures. Following discussion between the NHS Lanarkshire Director of Finance and the two Chief Financial Officers of the IJBs, funding to manage the impact of winter and ongoing pressures has been identified. 1.8 Funding sources include nationally provided Unscheduled Care monies and financial plans of the NHS Board and the two H&SCPs. In total, it is anticipated that circa £4.0m will be utilised in funding all the additional services which will be provided, and this can be funded from the available budgets. Approach to Winter Planning 2024/25 1.9 Whilst the winter plan will be a Lanarkshire wide plan, it is structured in two main parts. This is to recognise the significant work underway as part of Operation Flow, which is aimed at maximising flow through acute hospitals and associated care pathways. Continuation and emphasis of aspects of this work will form the basis of the winter planning for acute hospital services. 1.10 All other aspects of the Lanarkshire wide winter plan, including the input of Flow Navigation Centre +, have been undertaken via the multi-sectorial/multi-agency winter planning group. Representation from acute services/Operation Flow/FNC+ forms part of the wider group to ensure all necessary synergies are recognised and planning is appropriately integrated. 1.11 As well as the national guidance referred to at 1.4, there was also a debrief of the Lanarkshire winter plan for 2023/24 and that has also been considered as part of the planning for winter 2024/25. Operation Flow: NHS Lanarkshire’s Whole System Unscheduled Improvement Plan Supporting Winter Planning 1.12 The key objective for Operation Flow remains that patient safety is enhanced, and staff wellbeing improved through a reduction in hospital occupancy and maintaining sustained improvement across all key performance metrics. This remains a commitment during the winter period. This will be achieved by: • Managing demand across the system • Maintaining a positive admission and discharge balance • Maximising outflow 1.13 Creating the right conditions for the success of the winter plan is essential. Consequently, preparation has included reviewing and finalising Target Operating Models (TOMs) and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation. System readiness is also underpinned by the delivery and implementation of the detail of the site and HSCP level action and improvement plans. Page 107 of 218
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1.14 The specific actions agreed include: 1.14.1 Delivery of the Acute Sites Minors Improvement Plan to maintain sustained performance of 90% daily across the Flow Group 1. 1.14.2 Implementation of the Front Door TOM across all 3 Acute sites. This will ensure consistency across all Front Door processes and pathways and a reduction in unnecessary waits / delays for patients. The actions for the TOM implementation include operationalisation of REACT to maximise streaming of patients to the right part of the system (including direction to other locations of care); scheduling of minors and ambulatory care patients; and appropriate referral to other hospital-based specialties within the agreed timescales as outlined in the TOM. 1.14.3 Improving flow at the Front Doors is also dependant on maintaining a positive admission and discharge balance across the acute and non-acute bed base. Work continues to embed the NHS Lanarkshire flow foundation bundle which includes achieving ward beat, setting PDDs, maximising prenoon discharges, x 3 times daily structured board rounds to support discharge planning and using criteria led discharge when a Senior Clinical Decision maker is not available. This improvement work has been further enhanced by the development of an Optimal Discharge Planning TOM that outlines which discharge planning pathway (1 – 4) a patient should be allocated to. This supports the ward staff to identify at an earlier stage if patients will require assessment from social work and social care teams to ensure their safe discharge. Significant work has been undertaken to raise awareness of the key principles of the TOM, however further training and education is required to support implementation. 1.14.4 Refresh of the Operation Flow Handbook – to provide further clarity across all disciplines, roles and responsibilities in relation to flow improvement across our system. 1.14.5 Weekly review, using a ‘criteria to reside’ methodology for all patients not in delay with a LOS of 14 days plus, to determine the discharge planning actions required. 1.15 There will be continual oversight of the delivery and implementation of the actions through the Core Oversight Board and Executive Flow Oversight Board, alternating on a weekly basis, utilising all appropriate data as well as multiple daily reviews of system operating issues and actions being reviewed and revised as necessary. Discharge Without Delay 1.16 Work continues in embedding the Discharge Without Delay programme and its related aspects, e.g. Planned Date of Discharge; consistent roll out of Home Assessment services North and South; increased numbers of people being supported to die at home via ‘pathway 4’ and further work with third sector providers. 1.17 These elements have also been incorporated into the Optimal Discharge Planning TOM. 1.18 Both of North and South Lanarkshire HSCPs have seen a reduction in the number of delayed discharges and in turn, there is an increase in the number of people who are being supported to be rehabilitated at home. This is often to a level of being able to Page 108 of 218
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manage their own care independently or, in some instances, with a reduced level of care than may have been originally assessed when in the hospital or first referred. 1.19 Both HSCPs also work closely with ‘Lanarkshire Carers’ as well as a range of voluntary organisations such that increased levels of support are available to carers to support them to be able to continue to undertake their caring roles. Flow Navigation Centre + Plus (FNC+) 1.20 The work of the FNC will play a major role as part of the wider system response to managing winter pressures in 2024/25 and as part of the preparation for winter, the service has moved to larger accommodation in Kirklands Headquarters. This has allowed the expansion of the team and further collaboration with partners. 1.21 A dynamic multi-disciplinary team is now in place to support clinical decision making. The team consists of registered nursing staff, consultant geriatricians, emergency department consultants and SAS Advanced Nurse Practitioners (ANPs). This will ensure good coverage to manage all calls received and to thereafter be able to support patients to receive the right care as timely as possible with a positive experience. Plans are being developed to expand this team further to include pharmacists, Allied Health Professionals and palliative care services. 1.22 This also includes maximising the use of systems such as ‘Consultant Connect’ and ‘Near Me’ such that as far as possible, there can be shared approaches agreed to the management of patients between NHS 24, SAS, primary and secondary care services. 1.23 A range of other supports is also available to manage specific patient groups, e.g. access to frailty services, expanded Hospital at Home (H@H) and Outpatient Antibiotic Therapy (OPAT). 1.24 The tendering process for virtual ward capacity has now been completed and plans are underway to introduce the capacity for up to 400 virtual beds, building on the success of the existing Frailty H@H service in Lanarkshire. This virtual system will enable electronic patient records to be accessed and shared by all involved in a patient’s care; update patient reported outcomes; wearable technology for continuous and intermittent monitoring; ability to engage via telephone; messaging and video calls directly with patients. 1.25 The initial focus of these beds will be to reduce occupancy across the acute sites, swiftly moving to admission avoidance across specialties such as respiratory, cardiology and gastroenterology. Social Care Provider Sustainability 1.26 Independent providers of social care in Scotland, notably care homes and care at home providers, have highlighted the continued difficult operating environment in which they operate. There are increasing numbers of jobs in the ‘unqualified’ sector that means care jobs are not as attractive as they once were and accordingly, vacancy pressures continue to be a concern for several providers. 1.27 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider environment and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care Page 109 of 218
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workforce challenges) and statutory/legal parameters. On a Lanarkshire-wide basis, support for Care Homes is overseen by the pan Lanarkshire Care Home Assurance and Support Board (CHASB). The Care Home Collaborative Group reports to the CHASB. Its purpose is to support quality improvements to enable the implementation of the “My Health, My Care, My Home healthcare framework for adults living in Care Homes”. The Care Inspectorate participate in both of these meetings. General Practice and Pharmacy opening 1.28 As in previous years, a local enhanced service to support general practices over the peak winter period has been agreed. This will see up to 74% of the GP practices in Lanarkshire opening at some stage over the Public Holidays on 26 December 2024 and 2 January 2025 as well as Saturday 28 December 2024 and thereafter on all the Saturdays during January 2025. The practices involved have been supported in communicating this to their respective patient lists. Similarly, the respective details will be shared with NHS 24, the Primary Care Out of Hours Service (PCOOH) and FNC+ such that as many people as possible can be diverted to their own GP practice during these typically very busy times for the wider ‘unscheduled care’ system. 1.29 There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, PCOOH Service, FNC+ and Emergency Departments where possible. General Practice sustainability 1.30 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. 1.31 This was the subject of previous presentations to the NHS Lanarkshire Board which included describing the work ongoing to address capacity and demand, most notably, through the Primary Care Improvement Plan (PCIP). 1.32 As part of the regular reporting to Scottish Government on system pressures through the winter period, there are weekly updates on the numbers of practices that are unable to provide the full range of services that they would under ‘normal’ working conditions. Primary Care Out of Hours Service (PCOOH) 1.33 The new clinical model operating in the Lanarkshire PCOOH service has assisted the Service to move to a more multi-disciplinary workforce and competency-based model of care, thereby reducing the number of occasions when alternative arrangements require to be introduced. 1.34 This multi-disciplinary team will be enhanced over the winter period to ensure additional staff are available to manage the increased demand that can be anticipated across the peak activity periods in winter. Contingency Arrangements for Additional Deaths 1.35 Whilst there is no reason to assume that there will be above average mortality rates when compared to other winters, as part of the routine contingency planning required every winter, additional mortuary capacity will be available over the winter period. Page 110 of 218
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1.36 As part of the Lanarkshire LRP arrangements, there is also scope to work with local undertakers to increase the frequency of funerals, burials and cremations should the need arise. Flu and Covid 19 Vaccine Programme 1.37 Following final advice on the winter flu and Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), vaccines are being offered to the following groups: 1.37.1 Flu and Covid vaccines The groups below are eligible for both COVID-19 and flu vaccines this winter: • Residents in care homes for older adults • Those aged 65+ • 6 months-64 at COVID clinical risk • Staff in care homes for older adults • Frontline health and social care workers • Pregnant women at any stage of pregnancy (first, second or third trimesters) 1.37.2 Flu vaccine only The groups below are eligible for their flu vaccines this winter: • 18-64 years with an eligible flu-only clinical risk condition • Carers (including unpaid and young carers) • Non-frontline NHS workers • Household contacts of those with immunosuppression • Asylum seekers living in Home Office hotel or B&B accommodation • Those experiencing homelessness • Those experiencing substance misuse • All prisoners within the Scottish prison estate • Those living in long-stay residential care homes or other long stay care facilities 1.38 The programme is well advanced, and this year is utilising a range of ‘pop-up’ clinics in health centres, clinics and various local community facilities; local pharmacies for the >75s; hospital outpatient departments at weekends and three ‘mass vaccination centres’ at Muirhead Clinic, Braidfute retail centre (Lanark) and Eddlewood Community Centre in Hamilton. (Venues previously available for mass vaccination centres have largely been given back to their original use and no longer available.) In addition to this, there is a range of services designed to offer vaccines to any who are in geographical areas or part of a thematic/ethnic group where take up of vaccine may be lower than for the general population. Carers Support 1.39 Funding from the Carers (Scotland) Act 2016 allocation 2024/2025 has been used to enhance operational services for carers across both Partnerships. This included monies from this funding being directed to support ongoing work with carers, with a particular emphasis on the Self-Directed Support (SDS) agenda; and a strengthened internal capacity within the HSCPs to enable frontline staff in managing increasing demand with regards to supporting carers. This has seen a sharp increase in the Page 111 of 218
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number of carers being identified and therefore able to be signposted to the respective supports. Staff Wellbeing 1.40 NHS Lanarkshire’s Health and Wellbeing Strategy will form an integral part of the system wide winter plan. The emphasis will be on providing a working environment in all areas across Health and Social Care where staff are able to enhance and maintain their personal and professional wellbeing and to reach their full potential in a culture that provides space, time and support for self-care. 1.41 The ‘Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded fully and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to manage the dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 1.42 Council employees can also access a range of materials to support health and wellbeing through the respective employee programmes. Adverse Weather 1.43 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both North and South Lanarkshire Councils have policies in place in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 1.44 A series of actions is open to the organisations, individually and in collaboration, in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations. CONCLUSIONS 1.45 A range of implementations and reviews have taken place to ensure the right conditions for the success of the winter plan. Preparation have included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation to support continuous patient flow and care 3. Measures of success 3.1 In moving from prototypes to practice, it is essential to determine and agree performance measures. How do we know we are making a difference and how might we measure this through performance outcomes. Given prototype development has reached the stage to be tested operationally, it requires further discussion with people in their communities and operational staff to further agree the detail. Page 112 of 218
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3.2 This operational testing will determine how we will know that the getting it right for everyone overarching principles, and the practice solutions identified through prototyping will make a difference. Performance measures require to identify whether the issues people have raised through the co-design process are resolved and that people experience improved outcomes. 4. Supporting documentation 4.1 Appendix 1 National guidance, published 24 September 2024 4.2 Appendix 2 Self-assessment Morag Dendy Chief Officer / Head of Planning, Performance and Quality Assurance Page 113 of 218
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5. Impacts 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality- and-fairer-scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts been discussed and agreed with Finance? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? A number of funding sources are being utilised to cover the cost of the additional services being introduced to support enhanced staffing and services across the peak winter period. For the majority of services, they will operate from mid-December through to mid-March. • Funding sources include nationally provided Unscheduled Care monies and financial plans of the NHS Board and the two H&SCPs. • In total, it is anticipated that circa £4.0m will be utilised in funding all the additional services which will be provided, and this can be funded from the available budgets. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts been discussed and agreed with People Resources? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts been discussed and agreed with Legal and Democratic? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact 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 ☒ Page 114 of 218
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If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☒ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? • Work is well underway at both local and national levels on the public messaging in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. North and South Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. • There has also been an expansive series of communications to seek to support as many people as possible take up the offer of vaccines – whether flu, Covid or both. This has also been accentuated for frontline health and social care staff. • The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Learning from recent months and years has underscored the need for continued multi-disciplinary team working to better meet service demands; and the need for a cohesive whole system approach to delivering health and social care going forward. Page 115 of 218
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The experience of recent years has emphasised the interdependencies between primary care (including independent contractor services), community care, secondary care, and social care; and shown that one component of health and social care delivery being overwhelmed with demand can have consequential knock-on effects on the other component parts of the system. • Given the foregoing, even with mitigations in place, there is a significant risk that the systems across NHS Lanarkshire and beyond will be under extreme pressure over the winter period. This risk has been moved from ‘medium’ to ‘very high’ on the IJB 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 116 of 218
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Health and Social Care Winter Preparedness Plan 2024/25 Appendix 1 Page 117 of 218
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2 Contents Joint Foreword by the Cabinet Secretary for Health and Social Care, Neil Gray and COSLA Spokesperson for Health and Social Care, Councillor Kelly ........... 3 Learning from Last Winter ......................................................................................... 8 A Continued Approach ............................................................................................. 10 Working in Partnership ......................................................................................... 11 Improved Data Collection and Reporting ........................................................... 12 Winter Engagement ............................................................................................... 12 Winter Preparedness Checklist ........................................................................... 12 Our Priorities for Winter 2024/25 ............................................................................. 14 Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. ................................................................. 15 How we will jointly deliver this priority: .............................................................. 15 Protecting people through the delivery of vaccination programmes that reduce serious illness, hospitalisation and mortality....................................... 19 How we will jointly deliver this programme: ...................................................... 20 Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. ................................................................................................... 22 How we will jointly deliver this priority: .............................................................. 22 How we will support this plan with effective communications: ...................... 23 Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, and social care and social work services, protecting planned and established care, to reduce long waits and unmet need. ........................................... 24 How we will jointly deliver this priority:..............................................................24 Protect planned care with a focus on continuing to reduce long waits. ........ 26 How we will jointly deliver this priority: .............................................................. 26 Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting ............................................................................................ 27 How we will jointly deliver this priority: .............................................................. 27 Additional Resources ............................................................................................... 30 Summary and Escalations ....................................................................................... 31 Page 118 of 218
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3 The value and importance of our health and social care services has never been public services. Most if not all individuals across Scotland will interact with health and social care services at some point in their life, and we are committed to ensuring that everyone experiences consistently high-quality care when they do. This plan sets out how we as COSLA and Scottish Government will jointly seek to address the exceptional pressures facing our health and care services over the winter, to support local systems to deliver quality services. However, we cannot understate how challenging the environment is for our health, social care, and social work services, with the demand on the system rising, and the complexity of support many people require increasing. Last year we committed to moving from annual winter planning to year-round surge time and are increasingly sustained. , we talked about how we had started the planning process earlier than ever before. Now we have gone a step further, moving towards this as a continual process in which our key partners including in the independent, third and voluntary sectors are equal partners who can shape this planning activity. We have engaged more widely than ever before as part of this process. This is not simply a one-off change, but a commitment to more effective partnership working; a process where we listen and respond year-round, building and adapting our plans to ensure they most accurately reflect diverse needs and facilitate preparedness for whatever surges we may face. To those who have contributed to this goal and this plan, a genuine heartfelt thank you, we hope that you can see your contributions and your voice reflected within this document. Ultimately, what we have heard is important, and what this plan is about, is people. The people who access our health, social care and social work services but also the people who work tirelessly to ensure that those services deliver the best possible standard of care. mental health, as well as their right to live independently in their community, has been the overarching focus in the development of this plan. Despite this planning now being a continuous process, we are clear that winter is a specific period of increased pressure, in which people require additional support from our health, social care and social work services. Increases in respiratory illnesses, such as flu, covid and RSV, as well as weather-related injuries from falls and accidents, make what is already a challenging environment in which to deliver services even more difficult. As we have outlined, this plan is about people, and it could not be realised without our incredibly dedicated and hard-working workforce. We know that those who work in the NHS, our local authorities, care homes and care at home services, and community based organisations work incredibly hard year-round, but particularly in Page 119 of 218
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4 winter, to make sure that everyone gets the safe, timely care they need in the appropriate setting. This workforce protects, cares for and nurtures the wellbeing of the people of Scotland, and it is right that this plan outlines actions taken to support these individuals so they can continue to care for our population. unpaid carers, ensuring that those who provide critical care to their loved ones are appropriately cared for. A key element of this winter plan is ensuring that people are cared for in the right place at the right time. This begins with the prevention work to keep people well, and keep them from needing hospital care, this includes work underway in our social care system, the hard work of volunteers and unpaid carers, our extensive vaccination programme and utilising our primary care system effectively. Within our hospitals, this plan targets key priorities critical to an efficient and resilient system, such as admission, a steady and consistent flow through the system and the joint efforts of our health, social care and social work systems to ensure timely discharge. Our hospitals provide specialist high quality, safe, clinical care, and while the vast majority nearly 97% of people are discharged without delay, some people remain in hospital after it is clinically necessary. People who will not sleep in their own bed tonight and who will have poorer outcomes as a result. We must do everything in our power to ensure that people receive the support that is right for them, in the right place, at the right time, and that there is strong collaboration and leadership across health, social care, and social work to ensure a timely and safe discharge from hospital. Beyond the hospital setting, this plan clearly articulates our priority of supporting possible. This may be in a care home, through our dedicated care at home services or through self-directed support, all of which play a vital role in seeing this priority realised. Whilst we should not underestimate the additional challenges that winter can bring to our increasingly pressured health, social care and social work services, the priorities set out in this plan support systems to ensure that appropriate preparations are in place. By working together as a whole system, we can continue to deliver safe, timely and high-quality care for people across Scotland, supporting them to live healthy happy lives. Page 120 of 218
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5 Introduction This Winter Plan represents a whole system approach to addressing a surge in demand for health, social care and social work services. Whilst it is recognised that over recent years there has been increasing and sustained pressures on our health and social care system, there are also periods, such as winter, where demand increases even further. Winter is not the only period this can occur and surge pressures can happen at any time; therefore we are transitioning to year-round surge planning and the measures outlined in this plan are applicable throughout the year as well as the winter months. However, we also recognise there are unique challenges for health and social care services throughout the winter period that result in increased pressure on our services, including increased respiratory infections, higher risk of slips and falls, and staff absence. Insofar as is possible, systems should adopt a preventative approach to managing pressures and to mitigate and reduce harm by ensuring people who need health, social care and social work services are receiving the right care, in the right place, at the right time. We also recognise that pressures on the system are not confined to increased demand but are increasingly exacerbated by the position of public finances. Our partners across health boards, local authorities, Integration Joint Boards and the third and independent sector are all facing extremely challenging financial pressures, and it is within this context that we are setting out a national approach to supporting local systems to address some of these challenges, whilst recognising the impact that the current financial position has on our ability to achieve sustained improvements. has been on enhancing partnership working across health and social care, going further in our engagement, with a particular focus on working alongside our independent, third and voluntary sector partners, recognising the significant contribution they make within our communities. plan enabled us to save more than 50,000 unnecessary ambulance journeys for individuals. By the end of 2023/24 we had created 495 older people and acute Hospital at Home beds across Scotland, which supported over 14,400 people without them needing ambulance attendances, emergency care or to spend time in hospital. This service provides additional support for the system at periods of peak pressure, for example last winter more than 1,700 individuals were supported by older people / acute adult hospital at home in January 2024 alone, providing them with critical care when it was needed most. This represented a 54% increase on provision in January 2023. We also know the crucial role that community supports play in keeping people well and enabling people to live independently, preventing many individuals from requiring hospital care in the first place. Public Health (PHS) Care at Home statistics tell us that in 2022/23, 89,620 people received 37.7 million hours of care which was an increase from the year before. We have strengthened and embedded a person-centred and person-led approach to the development of this Plan as well as our work at a national level, with the aim of equipping our health and social care services to deliver safe, timely and high-quality care by working collaboratively with all parts of the system. This focus on people is Page 121 of 218
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6 critical to ensuring that individuals human right to the highest attainable standard of mental and physical health and their right to live independently as part of a community are upheld and that every person in Scotland can continue to expect high quality care, despite the incredible pressures on the system. Whilst this plan provides a national overview, it also seeks to address the specific operational pressures experienced and support our local partners to continue to provide the specific services required by their local population and deliver the high- quality care that individuals rightfully expect. We know that the delivery of these services requires close partnership working across multiple agencies and organisations. We and our partners work hard to include delivery partners, including those in the third and independent sectors, in the planning and preparedness activity but there is always more we can do to ensure that all partners are active members of this process. From dashboards created last year, we are using data to better understand local variations, to determine local and national actions and target interventions where there is greatest need. Our approach to surge planning incorporates ongoing improvements and continues work to maximise capacity and improve flow through all parts of the system. It also utilises effective monitoring of enhanced data to bolster our understanding of the resilience of the system. Key components of our approach towards a more resilient health and social care system and, in turn healthier communities: An approach that is whole system, prioritising prevention, improving system flow and embedding a home first approach. Leadership at all levels, both nationally and locally, supported by appropriate governance arrangements. Preparedness checklist for local systems. Community capacity and surge capacity planning. Continued use of and development of the data and dashboard to inform improved surge reporting and modelling work year-round. Winter vaccination programme including roll out of the new Respiratory Syncytial Virus (RSV) vaccination programme for older adults aged 75-80 and infant protection via maternal vaccination. Continued monitoring of performance of Primary Care system. Protecting planned care through increased use of day surgery units. Reducing the time people spend in hospital by delivering optimal discharge planning based on Centre for Sustainable Delivery (CfSD) evidence. Reducing delays through the delivery of our Hospital Occupancy and Delayed Discharge Action Plan and actions under our Joint Mission to Reduce Delayed Discharges. Working together, through our Joint Statement of Intent Commitment, to overhaul the current mechanism of eligibility criteria to ensure an approach to social care support that is based on human rights and needs, whilst also recognising that community waits for care and support and assessment are inextricably linked to challenges with workforce and finances. Page 122 of 218
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7 Supporting our vital workforce in both health and social care, as well as unpaid carers across Scotland. Supporting people to live well in the community, through the provision of high- quality care, in care homes and care at home services and through investment in care and support, including self-directed support and support for unpaid carers. Page 123 of 218
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8 As in previous years, we undertook a comprehensive exercise to understand the lessons learned from last winter, which focused on the development, delivery, and governance of the published actions. This work has informed and shaped our planning this year. We have met with valued partners from across the NHS, Local Authorities, Health and Social Care Partnerships (HSCPs), the third, independent and voluntary sectors to listen to their concerns and identify gaps in last winter plan. We have implemented many of the requested changes and will continue to work alongside those most affected by the plan, to make necessary improvements, so that our plan can best reflect the current context and support our system. Local systems, and the individuals and organisations that work within it to deliver health and care to our most vulnerable individuals, worked hard to meet high levels of demand and ensure people received care when they needed it most. However, we know that complex challenges remain and there is still work to be done to ensure people can access the timely care they need in the appropriate setting. Last winter and in previous winters, we have seen unacceptable waits for ambulances, assessments and care packages, long ambulance queues and delays in A&E departments, and hospitals more broadly. We have experienced high levels of hospital occupancy, delayed discharge and unmet need within our communities, as well as increased demand for GP appointments and for social care packages and assessment. We know that all aspects of our health and social care system are interconnected. Increased pressure in one part of the system is not isolated but impacts more widely across the whole system. Increased occupancy within our hospitals for example can increase length of stay and impact on levels of delayed discharges. This also leads to poorer outcomes for individuals which in turn can have a knock on impact on the demand for social work assessment and, in particular if an individual has a prolonged hospital stay, the level of care they require when they do leave hospital. It is important to recognise the significant impact longer lengths of stay have on individuals, causing deterioration, reducing independence and in some cases resulting in life-changing decisions such as admission to institutional care. We have also seen that these are not limited to the winter period with increased pressure on our health and social care system at all times of the year. This has, since the Covid-19 pandemic, regularly continued throughout the summer months and we have, this year, seen delayed discharges remain at peak levels long after they would normally begin to reduce. It is also important to note that Covid has not gone away, but simply added to the pressures experienced, at points this summer we have seen over 600 hospitalisations from Covid, Scotland wide. These pressures are only exacerbated by challenges with workforce availability, demographic and population issues, and budget constraints. Page 124 of 218
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9 This all indicates that we will enter this winter with a health and social care system under more extreme pressure than ever before. This has provided the context for the development of this plan and the initiatives contained within. Critically, the report highlighted that to be effective, planning for periods of surge should be a year-round and not limited to the winter months. That is why this year, we have a dedicated team responsible for working across the health and social care system to determine actions to be implemented and delivered throughout the year, to build resilience and capacity in our systems. Page 125 of 218
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10 Despite these challenges, the feedback received did highlight several key strengths of the planning process in 2023/24. The improvements to the data available to local systems and new dashboards were highlighted as particular assets, which provided an overview of the performance of both the health and social care systems throughout winter. This also provided the Scottish Government and COSLA with key oversight data to identify where support could be most effectively targeted. Actions driven by our Whole System Oversight and Planning Group such as our Delayed Discharge and Hospital Occupancy Action Plan were also welcomed, and this work has been embedded and built upon by the new Joint Mission to Reduce Delayed Discharges. Similarly, increased monitoring through the winter preparedness checklist and local self-assessments ensured partners were better informed and prepared than in previous years. The quarterly self-assessment returns from local systems provided a national overview of whole system discharge planning that required focus. Assurances were also provided by local systems in relation to service delivery, resourcing and business continuity over winter. Given the pressures experienced within the system and the increasing levels of delayed discharges, there has been enhanced scrutiny and assurance of local areas progress in relation to their performance against national objectives, with a focus on supporting those local areas experiencing the most challenge. Over a third of areas now have delays per 100,000 which are below their pre-pandemic levels and many more are on track to deliver this goal by October. We will continue to work closely with local systems to maintain this positive progress and will target improvement activity in those areas that are struggling to replicate this trajectory. At the heart of these efforts is a collective need to improve the experience and outcomes of individuals who access health, social care and social work services across the entire patient journey. Partners referenced the international recruitment pilot undertaken in social care as providing vital support for employers and critical learning. Although this has not been without its challenges with previous Home Office changes presenting barriers for the sector. Moving forward, the Scottish Government have committed to further funding which will enable the Centre for Workforce Supply Social Care (CWSS), in NHS Education for Scotland (NES) to continue to support Adult Social Care Organisations in Scotland in their efforts to recruitment internationally by continuing the universal support offered through the established networks12. We continue to build and develop upon lessons learned, maintaining the key benefits and approach to planning from previous years in the following key areas: 1 2 Page 126 of 218
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11 To deliver on our commitment that people receive the right care, in the right place at the right times and have access to high quality services, we have continued to strengthen our joint governance and assurance mechanism between the Scottish Government and COSLA, working closely with Chief Executives from health boards, local authorities and Chief Officers represented through Health and Social Care Scotland. We continue to work with local systems to support them to make necessary changes to drive forward improvement programmes such as the work of the CfSD around over-14-day hospital stays as well as the Delayed Discharge and Hospital Occupancy Action Plan, and to monitor the resulting impact. These programmes and actions are vital to free up capacity as we head towards a period of higher demand, ensuring people and families are seen to when they need it most. The Collaborative Response and Assurance Group (CRAG), co-chaired by the Cabinet Secretary and COSLA Health and Social Care Spokesperson, provides assurance and escalation for joint decisions on the deployment of options that support the resilience of health and social care. This membership and frequency of the group has recently expanded to support increased activity under the joint mission to reduce delayed discharge, engaging system leaders from across health, social care and social work and supporting improvements in performance and practice around discharge. The Whole System Oversight and Planning Group has made a significant contribution to tackling delayed discharge and supporting the health and social care system to be better prepared for surges, such as winter. Throughout the year they have supported planning for anticipated surges and peak leave periods, driven the Action Plan and promoted best practice in Discharge without Delay principles, such as setting a planned date of discharge. They continue to play a vital role as part of the expanded CRAG mechanism. In order to progress the medium- and long-term improvements the work of the Whole System Strategic Improvement Group and the Joint Social Care and Social Work Workforce Taskforce are both driving change in the resilience of the social work and social care sector, working closely with our statutory, third sector and independent partners. Local leaders and services have already begun their planning for winter and are maximising the capacity of systems to meet the increased pressures experienced over this period. We will continue to work closely with NHS Health Boards, Local Authorities and HSCPs to support them in this planning and preparedness activity, and to ensure those that require care and support whether that be at home, in a community health setting or a GP practice, a hospital or a care home are able to access it. It is also vital that effective partnership working extends beyond our statutory partners to effectively involve our independent and third sector partners, who play a critical role in supporting people across Scotland. We will work to ensure that their Page 127 of 218
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12 expertise, leadership and knowledge is valued, trusted and respected and that they are engaged in national and local planning and delivery in an open and transparent way. The contribution that they make should never be underestimated and the specialist support and advocacy they provide must be recognised within our response to surges. Last year a whole systems dashboard was developed, in partnership between PHS, National Services Scotland (NSS) and Scottish Government, which has improved oversight and knowledge of health and social care. The dashboard is being used routinely for situational awareness and has been a key component of planning for periods of high demand In addition, to support winter and surge planning. To further support local systems a Social Care Dashboard has also been developed which provides a more granular level of detail on various elements of social care. Work was undertaken and published on how these products were received and how to improve them for winter 2024/253 with an aim to merge the two dashboards. Recent changes to the TURAS Care Management have reduced the data burden on Care Homes, providing a picture of available beds, occupancy and the pausing of some duplicate data collections, standardising data on care homes within the Care Home data review framework. Through the WSOPG, local areas have also been undertaking regular self- assessments against the key standards contained within the Delayed Discharge and Hospital Occupancy Action Plan, supporting whole-system benchmarking. Critical to whole system surge planning is better engagement with systems, providers and key stakeholders. They can offer rich intelligence and insight to help shape the plan and actions based on lived experience and knowledge of what works well. We have strengthened stakeholder engagement and partnership working to ensure we incorporate that expertise into improvements for this year. The Winter Preparedness Checklist aligns with the priorities set out in this Winter Plan and covers four key areas against which we asked Health Boards and HSCPs to provide an assessment of preparedness for their local systems: Section 1: Overview of Preparedness and Business Continuity Section 2: Urgent and Unscheduled Health and Social Care, and Planned Care Section 3: Primary Care, Mental Health and Social Care Section 4: Health and Social Care Workforce and Staff Wellbeing We will be using the outputs of this checklist along with the Hospital Occupancy and Delayed Discharge Action Plan self-assessment returns, dashboard data and other 3 Page 128 of 218
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13 factors to create a holistic system assurance overview and provide targeted and tailored support to those areas identified as having scope to improve and increase resilience. This approach also encourages benchmarking across and within the system, and identification and sharing of best practice between areas. Page 129 of 218
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14 We have continued to develop upon the priorities winter preparedness plan, to strengthen our approach to whole system planning and delivery. In keeping with our commitment that the focus of this plan is people, we have adjusted our priorities this year to reflect how people experience our health and social care system. This approach recognises that pressures in one system area can have a knock-on effect on other parts of the system, and meaningful action should consider how services are interdependent on each other. At the heart of our four priorities for winter, are three key principles which ensure we retain our focus on the individual. These are: 1. Person centred and person led care as embodied through the Getting it Right for Everyone Principles, which aim to ensure a personalised way to access care and support. Ensuring that people are at the centre of decisions that affect them. 2. Strong leadership and partnership working across the whole system. 3. Implementing local and national actions we know work to improve the patient journey, and ultimately which improve outcomes for individuals, such as Discharge Without Delay principles The four winter planning priorities outlined follow a journey through the health and social care system. Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and Page 130 of 218
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15 Social care and support services, social work and Unpaid Carers, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated approach is critical year-round but particularly over winter. Health and social care professionals operate in numerous community settings, operated by public bodies, independent providers and third sector organisations. These professionals work with thousands of people across Scotland, helping them to stay well, flourish and live independent lives year-round and particularly in the winter period, reducing the pressure on our health and social care system and ensuring that individuals continue to receive the best possible care in challenging circumstances. Proactively support people at highest risk in our communities to keep well and prevent the need for hospital care, supporting the community services which deliver this critical work. This includes: Supporting the health and social care professionals working in every care home and care at home service, who maintain the health and wellbeing of thousands of people across Scotland by taking forward activity under the Joint Social Services Taskforce (JSST) which has the most valuable impact on the social care and social work workforce in partnership with NES, the Scottish Social Services Council (SSSC), Social Work Scotland, Coalition of Care and Support Providers in Scotland (CCPS) and unions. Enabling the delivery of high quality, effective and personalised care in care homes across Scotland, with dedicated health and social care professionals providing a safe and nurturing environment. We ensure that the best care is provided through a range of improvement activity, and the Healthcare Framework. The Health and Social Care Standards set out what should be expected when using health, social care or Page 131 of 218
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16 social work services in Scotland and these underpin the Care Inspectorates inspection frameworks456. Providing excellent care for individuals in their own homes through dedicated care at home services, which provide care tailored to the needs of almost 90,000 people across Scotland7, enabling people to live as independently as possible in their own homes. Ensure there is clear communication at a national level that a care package may be - home care, either long term or to support reablement, or it could be a mix of home care; digital technology and aids and adaptations or in some situations, just digital or aids and adaptations. Supporting individuals to live their lives in ways that are meaningful to them, maintaining their own and their carers health and wellbeing through self-directed support and support for unpaid carers COSLA and Scottish Government recently published the Self Directed Support (SDS) Improvement Plan to support progress of implementation of SDS so that people consistently experience choice and control over their care. The provision of free personal and nursing care payments to over 10,000 adults across Scotland8. Critical to this is the strong partnership working between Integration Authorities and local providers and third sector interface. Writing to all local areas in advance of winter to reassure them of the flexibility available in the statutory guidance, when considering the employment of a family member as personal assistant under SDS option 1. This will support local decision making and development of processes which will mitigate, manage or reduce risks when it is in the best interests of the supported person to employ a family member with Power of Attorney (POA) / guardianship as a personal assistant. Ensure that existing programmes of work being progressed by Digital Health and Care (DHAC) and COSLA are utilised fully to support system pressures, including Maximising the benefits of the shared Alarm Receiving Centre (ARC) - the shared ARC is now live with several HSCPs and 7 more to be onboarded over the next few months. The shared ARC is a cloud- based common platform for ARCs across Scotland supports the required shift towards more proactive and preventative approaches to supporting citizens, including the integration of Telecare data to support assessment, anticipating need, and supporting early interventions. With standardised data, telecare providers can anticipate citizen needs and tailor interventions, accordingly, ensuring timely and targeted support. 4 5 6 7 8 Page 132 of 218
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17 Use data more effectively to support early intervention using the Telecare Information Framework (TIF). Through the adoption of this data set, telecare service providers will gain access to valuable insights that support early intervention and preventive measures. By leveraging data analytics, providers can proactively identify individuals at risk and intervene promptly, ultimately improving outcomes and enhancing citizen wellbeing. Through the Mental Health and Wellbeing Strategy we will ensure we have the right activity in place to meet changing need this winter and in coming years, with a strong focus on prevention and early intervention, to allow people to access care in the most appropriate setting or pathway. Through the Mental Health and Wellbeing Delivery Plan, continue to build on work underway to improve unplanned and urgent mental health care, including for those in mental distress, by utilising a multi-agency response and alignment with the national rollout of the Distress Brief Intervention (DBI) programme and; Support Boards providing access to a mental health clinician 24 hours a day, seven days a week. Embed the Time, Space, Compassion principles. Increase access to existing and developing services by developing a mental health unscheduled care resource pack by Autumn 2024. Continue to increase awareness of available pathways into support and care through developing tailored messaging for specific population and equalities groups in 2024. Continue to invest in the Enhanced Mental Health Pathway and promote partnership working to increase Police Scotland and Scottish Ambulance Service (SAS) access to local clinical support. Take an evidenced based approach to improvement work to better understand how people are accessing and receiving unplanned mental health care, ensuring that improvements to unplanned and urgent care are underpinned by robust data, including person demographic data. published in Autumn 2023, and the subsequent Police Scotland actions on mental health. Through the multi-agency Partnership Delivery Group (PDG) on mental health and policing established to drive forward activity aimed at improving outcomes for people in mental health need, as well as those experiencing distress or crisis, publish a Framework for Collaboration supporting partnership working at a local level for police, health, social work, social care services and across public and third sectors, in the Autumn, as well as a cross-sector Action Plan before the end of 2024, which will detail how long-term ambitions are to be achieved. A national review of Psychiatric Emergency Plans by the Mental Health Unscheduled Care Network by November 2024, followed by the development of national guidance in 2025 to ensure reasonable consistency across 14 Health Boards. Maintain consistent engagement with Boards, sponsored bodies and key groups such as Primary Care leads, National Out of Hours (OOH) oversight Page 133 of 218
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18 group, SAS and NHS 24 to continually monitor the performance of the Primary Care system through regular performance reporting on: GP capacity and resilience OOH availability SAS and NHS 24 performance Report on-going performance to Ministers and highlight any issues through CRAG, escalating and taking any action as appropriate. Provide ongoing support through the Scottish Dental Access Initiative (SDAI) to facilitate the opening of new or expansion of existing General Dental Services (GDS) dental practices to register new NHS patients for care, by engaging with boards to understand local issues and facilitate local solutions, such as Public Dental Service (PDS) providing alternative care to patients who cannot access GDS. Ensure the Primary Care system is as resilient as possible heading into winter and that people are able to access the care they need, in their community, where appropriate. One such example is the SAS Integrated Clinical hub, which helps to direct patients to the most appropriate point of care, without automatically directing them to A&E. Build resilience in social care through the invaluable work of our Local Authority and Health and Social Care Partnership resilience leads and existing Resilience Partnerships to facilitate effective business continuity planning, emergency preparedness and development of our resilience infrastructure. Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and OOH. Health Boards ensure that there is adequate provision of NHS Pharmaceutical Care services and support to local health care needs, including winter. Health Boards and local contractor committees continuing to work collaboratively to address any pressures across local community pharmacy networks such as cluster working. Community pharmacies continue to provide appointment free access to pharmacists and the wider pharmacy support team for advice and treatment for minor ailments and every day common clinical conditions. Ensuring that patients continue to have access to the prescribed medicines and services such as NHS Pharmacy First and a range of Public Health Services. Work to embed the Getting It Right For Everyone (GIRFE) principles through our , which has been co-designed with partners and people with lived experience. This will support Health and Social Care professionals to provide holistic support to people, alongside the My Health, My Care, My Home healthcare framework for adults living in care homes9. 9 Page 134 of 218
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19 DHPs are made by local authorities to eligible individuals where they need help with their rent or housing costs. Eligible individuals can find out how to apply by visiting mygov.scot or contacting their local authority.10 Protecting people who may be most impacted by severe illness, hospitalisation or death from RSV, Covid-19 and flu, through vaccination, is a key means of reducing demand on our health and social care systems. The new RSV programme, launched in August 2024, demonstrates the value of vaccination. This programme will be offered to pregnant women to protect babies and to older adults aged 75-80 RSV is the leading cause of emergency respiratory admissions to hospital in Scotland in infants, with 1,516 children aged under one hospitalised with the virus last year. There were also over 1,000 cases of RSV recorded in adults aged 75 and over in Scotland between October 2022 and September 2023, with more than half (535) having to spend time in hospital as a result. It is therefore anticipated that a successful programme will help to reduce these numbers. We also want to see as many eligible people as possible protected from Covid-19 and flu this winter. Our eligible cohorts continue to be guided by independent advice from the Joint Committee on Vaccination and Immunisation (JCVI) who assess who is most at-risk from these viruses, and therefore would benefit from vaccination. Our adult Flu and Covid-19 vaccination programme will launch for winter, with all those over the age of 65, residents in care homes for older adults and all those in a clinical risk group, eligible for both vaccines. Both vaccines will be offered at the same appointment for efficiency. This winter, the JCVI does not advise an offer of Covid-19 vaccination for frontline health and social care workers, staff working in care homes for older adults, unpaid carers and household contacts of people with immunosuppression. However, they do say that Health and social care service providers may wish to consider whether vaccination provided as an occupational health programme is appropriate, and ahead of such considerations, health departments may choose to continue to extend an offer of Covid-19 vaccination to frontline health and social care workers and staff working in care homes for older adults in winter 2024. Under this flexibility, Scottish Government has decided to offer frontline health and social care workers, including all staff working in care homes for older adults, Covid-19 vaccination this winter. important that we do everything we can to ensure those who are eligible for the vaccine, including frontline staff, take it up if they wish. We will work with partners including Public Health Scotland to promote and encourage uptake. 10 Page 135 of 218
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20 Unpaid carers and household contacts of the immunosuppressed will remain eligible for flu vaccination this winter, but will not be offered Covid-19. The primary aim of the national Covid-19 vaccination programme remains the prevention of severe illness (hospitalisations and deaths) arising from Covid-19. As currently available Covid-19 vaccines provide limited protection against mild and asymptomatic disease, the focus of the programme is on offering vaccination to those most likely to directly benefit from vaccination, particularly those with underlying health conditions that increase their risk of hospitalisation following infection. transmission of the infection and support the resilience of the health and care system, particularly during the winter months. Alongside this, it will be important for us to continue to closely monitor rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. In addition to vaccination and infection prevention, social connections, exercise and meaningful activity are vital for the wellbeing and quality of life of everyone, but in particular those living in a care home. It therefore remains fundamentally important that people living in care homes remain connected to their loved ones even in infectious outbreak situations in line with PHS Covid-19 Guidance. Work with Boards to introduce the new year-round maternal RSV vaccination programme from 12 August 2024 to protect infants. Offer the flu vaccination to all school age children in Scotland, including secondary school pupils as part of the seasonal child flu programme. Promote child flu vaccination uptake, especially in children aged 2-5 years, to ensure they receive the earliest protection to help stop the virus spreading. To have maximum impact, early completion of vaccination amongst this group is essential. Work with Boards to vaccinate all cohorts as advised by JCVI as part of the seasonal flu and Covid-19 vaccination programme. Frontline health and social care workers will be eligible for both Covid-19 and flu vaccination, but we will work with PHS and Boards to assess a return to peer-to-peer flu vaccination delivery models in clinical settings. Boards will continue to offer frontline Health and Social Care Workers the opportunity to drop into any community clinic, without the need to book, but workers can also book via the online portal and the national vaccination helpline if they would prefer. Although frontline Health and Social Care Workers are eligible for both Covid- 19 and flu this winter, they will be more active promotion of flu vaccination uptake in that group, as well as non-frontline NHS worker groups, to help build resilience within the health and social care system. Continuing to encourage high vaccination uptake for both Covid-19 and flu, within care homes and care at home providers specifically is vital. Page 136 of 218
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21 Focus on key messaging to encourage uptake of the winter vaccination programme, with a focus on the individual properties and benefits of each vaccine, to target vaccine hesitancy and inclusion: There will be no national Flu Vaccine Covid Vaccine (FVCV) marketing campaign in winter 2024 and no paid for media or marketing activity Instead, PHS Comms will develop an inhouse creative for a predominantly digital campaign for all eligible groups. There will be specific focussed assets designed to reach those who support vaccination but are hesitant or are not prioritising getting vaccinated11. PHS will develop more clinical flu and Covid-19 messaging for the frontline Health and Social Care Worker group. All PHS FVCV assets and toolkits will be distributed via established stakeholder networks. There will be a PHS led seasonal child flu programme updated national marketing campaign - . Replenishing covid test stocks at regular intervals to meet projected demand. As a positive test is required to access Covid-19 treatments for those eligible, additional orders of new tests can be placed in line with demand. Continue to work with partners such as PHS, to ensure the delivery of a robust respiratory surveillance programme that quickly identifies signals or trends that are of concern and provide infection prevention and control advice and guidance as required. Continue to work with Executive Board Nurse Directors, and other professional leads, such as Chief Social Work Officers, Chief Officers and Care Homes to collaborate on the delivery of person-centred safe care and support to Improve the health and wellbeing of people living in care homes in line with the Healthcare framework for adults living in care homes.12 Continue to work with local partners to support people living in care settings to remain connected to their loved ones. 11 12 Page 137 of 218
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22 For many, Emergency Departments may not be the best place for their healthcare needs and our Urgent and Unscheduled Care Collaborative improvement approach is not only better for people but reduces pressure on acute and primary care services too. This includes maximising admission avoidance through initiatives such as reducing conveyance of people from care homes where it is clinically appropriate, expanding hospital at home services and discharge to assess. The principle of right care, right place, right time does not just apply to health care however, we know that it is also important to apply this principle to social care and social work assessments, as assessments are most effective when completed in a own home. Occasionally during period of exceptional demand, individuals it is also important for people with lower or moderate levels of risk to be signposted to lower level support. Everyone in need of emergency mental health care must receive that support quickly, and wherever possible, close to home. People presenting with stress and/or distress are often conveyed to hospital when there can be community-based alternatives that support the patient as well as the system as a whole. This will also ensure that people seeking mental health support receive the right care, in the right place, at the right time, regardless of where, or what time of day they present there should be no wrong door. To ensure that people receive the most appropriate care and are empowered to support themselves and those they care for, the Scottish Government and HSCPs are continuing to deliver communications programmes to increase awareness of high-quality accessible healthcare information. A multi-agency communications group provides an expert forum to agree key messages and develop national and local communications plans to ensure the public is well informed. Continue to work with Healthcare Improvement Scotland and Boards to expand the Hospital at Home Older People's service to improve the resilience and efficiency of services that will enable people to be treated at home, where appropriate. Providing alternatives to hospital attendance and admission through the enhancement of local Flow Navigation Centres which provide virtual access to the A&E team to support patients to be seen in the right clinical care setting. Reduce ambulance turnaround times by improving front door processes and optimising services such as Flow Navigation Centres and the Integrated Clinical Hub which provide care for patients at or near home, reducing pressure on A&E departments. Produce a scoping report in summer 2024 on the feasibility of implementing an additional safe space as an alternative to people being conveyed to an Page 138 of 218
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23 Emergency Department when in a mental health crisis and the use of Emergency Departments as a legal place of safety. Develop and optimise accessible and effective pathways and referral routes to enable OOH services to redirect as appropriate. Ensuring appropriate public messaging such as the NHS 24 winter messaging campaign as well as up to date information on NHS inform is delivered throughout the winter period so that people know how and where to access all primary care services. Increase awareness of the key sources of information that will support the public with their care needs, whether that information is delivered in person (for example, through social workers, care home and care at home providers, community pharmacists or local GPs), via the telephone (NHS 24 on 111 for physical or mental health concerns) or digitally (nhsinform.scot, the NHS 24 online app, Care Information Scotland or local council websites).1314 Resources developed by Scottish Government, PHS and NHS 24 will be available online for any stakeholders to use through their own communications channels such as social media accounts, e-newsletters or in- venue signage to support local activation. Increase awareness of the role for Home First and delivery of services (such as Hospital at Home or assessments for longer-term care needs) at home through media relations, social media and operational communications. Collaborative working across Boards, Local Authorities, Primary Care Contractors, providers, carer centres and Partnerships to consistently redirect and signpost people to the appropriate service for their needs, whether through national, regional or local communications. 13 14 Page 139 of 218
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24 Both COSLA and Scottish Government recognise that actions and improvements to maximise capacity are best and most sustainably delivered in an integrated and co- ordinated way across the whole system. Local Authorities, Boards and Integration Authorities, together with the voluntary and independent sectors, and indeed with our communities, integral to the successful integration of health and social care to deliver better experiences and outcomes for the people who access services. We recognise the challenge in increasing capacity across the system during periods of sustained pressure and are committed to working with all partners to do everything we can to support local systems to meet demand and deliver high quality services. We have maintained our national focus on addressing pressures across the whole system and reducing levels of delay from hospital, with enhanced oversight and assurance arrangements to ensure targeted support where systems need it most. Behind every delayed discharge, is a person who will not sleep in their own bed tonight. Critically our focus on these delays is centred around ensuring the best possible care for that individual. Each delayed discharge has been clinically assessed, and a determination made that hospital is not the best place for them to receive the ongoing care that they may need. If a person is kept in hospital longer than clinically necessary, their outcomes and overall health will be affected. lack of discharge planning, awaiting an assessment, to difficulty in ensuring a suitable care package is in place, or to legal challenges that may be experienced where an individual does not have the capacity to make decisions for themselves. There is also significant variation across the country. Our new mission to reduce delayed discharge is focusing in on this variation, supporting local systems to improve their performance and ensuring that good practice is replicated to give each person the best experience possible. This also requires us to focus attention to the 6000 people awaiting a social care assessment, highlighting the significant challenge ahead in addressing levels of unmet need in our community which inevitably impacts on levels of delay in hospital. Support the First Minister and COSLA Mission to Reduce Delayed Discharges: Continue to deliver a whole system approach in improving system flow and reducing delays in services for mental health, learning disabilities and adults with incapacity. Support people to live well in the community, only being admitted as an inpatient when necessary and discharged in a timely manner. Page 140 of 218
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25 Embed good practice discharge processes, such as the Discharge without Delay principles, as set out in the Hospital Occupancy and Delayed Discharge Action Plan. Deliver effective discharge planning for patients admitted to acute or community hospitals to protect established care at home packages, allowing discharge without further delay for assessment. As part of the CRAG, work in partnership with Health Boards, HSCPs, Local Authorities, the third sector and people with lived experience to reduce mental health, learning disability and adults with in-capacity delays and improve system flow. This will be delivered through a dedicated multi-agency working group, which will focus on deploying targeted improvement and performance support to local systems to reduce delays, as well as generating an evidence base regarding the medium and longer term interventions required to address systemic challenges. The group will also consider approaches to reducing inappropriate out of area placements identified through the Coming Home work. Continue to work with Health Boards to deliver improvement and implementation of key actions to ensure improved A&E performance. A focus on reducing length of stay over 14 days for non-delayed patients and increasing short stays less than 72 hours to improve occupancy and flow. This will be delivered through the work of CfSD, Urgent and Unscheduled Care Collaborative Programme, actions include: Increased senior decision makers at front door, which will support prompt decision making. Strengthening the patient discharge processes. Discharge without Delay through daily, or twice daily where appropriate, ward-rounds with senior-decision-makers. Daily multi-disciplinary team (MDT) board rounds with a plan for every patient, every day. Whole-System MDT reviews of long-stay patients. Continue to make progress on delivery of commitments within the Joint Statement of Intent, with our shared aim continuing to be to improve the experience and outcomes of people who access social care support and those who work within the sector. Continue to drive forward wider system improvement through the Scottish Learning Improvement Framework, with joint political oversight through the Whole System Strategic Improvement Group. Monitor performance and delivery of social care response and improvement measures and provide assurance to Scottish Ministers and COSLA on the actions being progressed to improve local performance, our management of winter pressures and sector viability. Design and deliver a programme of improvement work targeted at embedding home first approaches in health and their intersection, in the short and medium-term. Involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, this means engaging with the patient, their families, and carers in hospital discharge discussions to ensure their needs and wants are central to decision-making. Page 141 of 218
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26 Use of home-based assessments such as discharge to assess for all Home Support packages to ensure accurate person-centred assessments, in familiar and homely environments. Over the past few years, Boards have tried, where possible to protect planned care, however they sometimes have had to take the difficult decision to step down planned care in order to deliver emergency treatment. Given the impact this has had on waiting lists, and on patients themselves, we are committed to protecting planned care throughout this winter. Long waits are regrettable, but we are determined to provide Health Boards with the support necessary to drive improvements and will continue to target resources to reduce waiting times, particularly for those waiting longest for treatment. In addition, we are working closely with Health Boards to implement alternative pathways and new models of care which will support patients to be seen more quickly and increase capacity and sustainability. Despite an exceptionally challenging winter period last year, new outpatient activity was up by 2.9% in the quarter ending March 2024 when compared to the previous quarter, and inpatient/day-case activity for the quarter to March 2024 was the highest since the start of the pandemic; the 9th quarterly increase in a row with 63,900 patients seen. We will continue to work closely with the Boards to maximise planned care capacity and where the majority of long waits in some specialities remain, ensure we continue to work hard to reduce these as quickly as possible. Strive to protect cancer care with a focus on continuing to prioritise new urgent suspicion of cancer patients and protect theatres for cancer operating. Work with Boards to maximise capacity, to reduce waits prior to winter 2024/25. Maximise capacity through regional and national working: Maximise theatre capacity including National Treatment Centres through expanded sessions in evenings and weekends. Support Boards, including through the National Elective Coordination Unit (NECU), to maximise clinical validation of waiting lists to identify, where appropriate, alternative forms of treatment. Continue to support Boards in the adoption of Active Clinical Referral Triage (ACRT) and Patient Initiated Return (PIR) to improve patient care and reduce waiting times by eliminating unnecessary face to face attendances. Deliver the actions contained in the Endoscopy and Urology Diagnostic Plan. Encourage the optimisation of digital solutions and standardise pre-operative assessment to reduce the need for unnecessary appointments and cancellations, thereby releasing capacity. Protect planned care through maximising the use of day surgery units including increasing the proportion of procedures converted to day case surgery. Page 142 of 218
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27 Our highly skilled and committed workforce is the cornerstone of our response every winter. We understand the continued pressures that our health and social care workforce, including volunteers and unpaid carers, are performing under, now more than ever. In order to meet demand, we must continue to focus on supporting workforce capacity and retention of staff, unpaid carers, and our third sector partners, and ensuring that we support the wellbeing of staff through challenging periods of high demand. We are pursuing a range of different strategies to nurture the workforce in both health and social care over the long term. Within our health workforce, for example, this includes supporting the expansion of trainee doctor posts, to reflect the changing demands on our health and social care system. IMPACT have recently completed a literature review looking at what best supports wellbeing for personal assistants and their employers, this offers provide useful insight for future planning to support this key social care workforce. The JSST was established to ensure that further meaningful progress can be made in partnership to address pressures, and with a focus on delivery of outcomes which workforce. A key objective of the Taskforce is to identify collective and individual organisational actions required to address the challenges facing the professions through focusing on improvement opportunities across the workforce journey, and identifying where practical changes to practice, working across boundaries, can enable a step change in the delivery of integrated care and service delivery. It is estimated that between 700,000 and 800,000 people provide unpaid care for a relative or friend at home and within other community or residential supports, and so hugely valued unpaid carers, as well as enabling carers to participate in education, training or employment alongside their caring responsibilities, ensuing that carers are able to sustain their caring role with positive wellbeing. We must also continue to support the effective implementation of SDS for people who access support and their carers as the default approach to social care, ensuing people have choice and control over their care and support. Progressing workforce activity through the JSST, including development of paid college placement project which aims to develop and socialise a national paid college placement blueprint for adult social care employers such as Local Authorities, independent sector and third sector. It focuses on expanding successful practices to increase the availability of paid placements for adult social care students during their qualifications. The blueprint is currently being developed and will be implemented in future college academic sessions from 2025. Through Scottish Government funding to NES, fund the CWSS which supports Adult Social Care Organisations in Scotland in their efforts to recruit Page 143 of 218
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28 internationally by establishing network platforms for sharing best practice, networking and discussion within the social care sector. Scottish Government is committed to working with the sector to look at options to improve rates of pay and terms and conditions for the social care workforce and we are currently working with stakeholders to develop sectoral bargaining for the sector to advance this. However, public finances are under unprecedented pressure, and we must balance the fiscal position while the demand for government support and intervention continues to rise. Supporting any retiring staff who wish to continue in employment suitable to them and to the service through the Retire and Return provisions outlined the NHS Scotland Retirement Policy. Supporting staff throughout their career, to manage demands on their time options to help them to balance their lifestyle whilst maintaining and promoting the best possible service to our patients and service users. These include a Flexible Work Location and Flexible Work Pattern Policy. Encouraging Boards to promote part-time work opportunities to their health, social care and social work students, who can help to build short-term capacity as required. Our NHS Scotland Flexible work location and NHS Scotland Flexible work pattern policies provide staff with a range of flexible working options to help balance their lifestyle whilst maintaining and promoting the best possible service to patients and service users. Provide essential wellbeing support to staff across health, social care and social work suffering poor mental health through: Availability of confidential mental health care and treatment for registered staff through the Workforce Specialist Service, as well as psychological therapies and interventions for all staff, supporting staff to treat anxiety, depression and improve issues like difficulty sleeping Additionally the National Wellbeing Hub continues to offer a range of self-service resources for staff15. Further, NHS 24 deliver the National Wellbeing helpline, offering a 24/7 compassionate listening service. These wellbeing provisions provide important intervention options for staff suffering poor mental health, improving the likelihood of these staff returning to, or remaining in work for the longer term, and improving the quality of care they are able to provide. Ensure people who provide unpaid care are supported in their caring roles and supported to look after their own health and wellbeing alongside engaging in education, training and/or employment. We are implementing our National Carers Strategy to drive forward long-term changes to improve the lives of unpaid carers across Scotland. It sets out a cross-government approach to carers issues, including through social care, social security policies and supporting carers in employment and education. 15 Page 144 of 218
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29 Supporting local carer centres and young carer services to build capacity and ensure all carers can access consistent and up-to-date information. We will work with stakeholders to improve the availability and range of short breaks. We will continue to work with local service commissioners, Shared Care Scotland and others to promote greater availability and choice of short break support in different areas. Continue to explore how volunteers can provide support in both discharge from hospital, in assisting people to attend appointments, and consider appropriate use of established local and national volunteer partnerships. We will also explore how the National Volunteering Hub can be best utilised to support the health and social care system to manage pressures over the winter period. Page 145 of 218
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30 The Warmer Homes Scotland scheme, delivered by Warmworks, was re- launched on 02 October 2023 with more funding and help for households to receive a climate-friendly heating system. People can contact Home Energy Scotland to check their eligibility and receive advice on additional support. Applications are assessed by Home Energy Scotland (HES) against the eligibility criteria. For more information, visit the Home Energy Scotland website or telephone 0808 808 2282 (Monday to Friday 8am-8pm and Saturday 9am-5pm). Cost Of Living website has a range of resources including how to get in touch with your local council for help with energy and bills, and has specific advice for older people or those who are disabled, including links to support organisations and information about the benefits that they may be entitled to. The Care Information Scotland website summarises unpaid carers rights to information, advice and support, alongside details of social work departments and local carer centres to find out more about what is available locally. My Power of Attorney website provides information on the importance of POA Page 146 of 218
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31 This Winter Preparedness Plan sets out the actions being implemented across the health and social care system in order to prepare for the increase in demand and pressure we expect to see over winter 2024/25. These actions are being adopted as part of a business as usual approach to local planning for surges in demand and complement local surge/escalation and capacity plans. To support this, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures) and maintain a flexible response covering whole-system winter pressures. Working on a local basis, monitoring will continue, and health and care organisations will utilise their established governance and response structures. Page 147 of 218
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Return Due: 16 October 2024 Board NHS Lanarkshire Partnerships North Lanarkshire, South Lanarkshire # Area Progress Status Partial No Yes n/a Please select Health Board from drop down above 1 Complete Complete 0 0 10 0 Board Chief Executive Jann Gardner Chief Officers Claire Rae, Soumen Sengupta 2 Complete Partial and/or No 7 0 12 2 3 Complete Yes 0 0 17 0 Number of integration partnerships 2 Submitted by Craig Cunningham 4 Complete Partial and/or No 1 0 10 0 Approved by Jann Gardner Date of approval 14-Oct-24 WHOLE SYSTEM CHECKLIST RETURN - AREA DETAILS SUMMARY DASHBOARD Appendix 2 Page 149 of 218
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Section 1 Progress Status Complete Manual dropdown - use this box to track your progress 11 10 Overall Status Complete Automatic status Subsection # Statement Response Rationale for response rating Words Overarching principles 1.1 There are sufficient mechanisms in place to support the collaboration and co- operation with other Boards and Partnerships in the delivery of health and care. Yes There is a mutual Aid agreement in place. Other stakeholder groups will be in place across various disciplines. Information may be sought from the various divisions. Effective resilience partnership arrangements are in place as demonstrated during Operation Flow and respective 'firebreaks'.. 40 1 Overarching principles 1.2 Plans have been developed through joint working between the Board, associated HSCPs, and other key partners (i.e. Primary Care practitioners, SAS, Scottish Prison Service, care at home and care home providers etc.). a) It is clear to all parties how plans will be delivered through joint mechanisms. Yes The Lanarkshire-wide winter planning group is multi-agency and covers all aspects of service provision. It encompasses both H&SCPs as well as having representation from the two Councils. The Lanarkshire wide LRP is also closely associated with the winter planning group and will have a dedicated winter planning BCP session (Winter Breach) on 14 November 2024. 64 1 Overarching principles 1.3 Winter Planning includes demand, capacity, and activity plans across all health and care delivery (including urgent, unscheduled, social care and planned care provision). a) Projected staffing levels in your acute wards and community hospital wards are sufficient for the winter period; if no, please provide further detail. Yes The planning process is closely aligned to the work currently ongoing in relation to Operation Flow. This is builds upon effective understanding of demand and an associated series of developments intended to meet same. Both H&SCPs are also part of the Operation Flow process and this includes demand management. 49 1 Resilience preparedness 1.4 Planning for winter reflects identification of surge capacity to ensure capacity is made across the health and care system to allow new emergency admissions to be accommodated. Yes The basis of the plans this year will be to create 'suge' by utilising additional staffing to increase flow through the system as opposed to the creation and subsequent staffing of surge beds. This is the case both in relation to inpatient NHS beds as well as additional interim beds in care homes. This process evaluated well as part of the winter debrief. 63 1 Resilience preparedness 1.5 Business Continuity Management arrangements are in place and regularly reviewed, exercised, and updated. These are in accordance with Civil Contingencies Act 2004 for Category 1 and 2 organisations and other guidance including: a) NHS Scotland Standards for Organisational Resilience 2018. b) Preparing For Emergencies: Guidance for Health Boards in Scotland. Yes BCP arrangements are reviewed across all service areas, ranging from BCPs in the H&SCPs through to major incident plans in each of the three general hospitals. This includes the respective responses associated with Cat1 and 2 arrangements. As above, a dedicated session to test current BCPs is scheduled for 14 November 2024. 52 1 Resilience preparedness 1.6 Plans have identified potential disruptive risks to service delivery and associated mitigation responses. These incorporate lessons identified from Winter 2022/23 in addition to concurrent risks. Resilience Teams are involved in winter preparedness to ensure that business continuity management principles are embedded as part of year-round capacity and service continuity planning. Yes Resilience Teams from NHSL, NLC and SLC are standing members of the Winter Planning Group. NHSL Resilience Group check disruptive weather planning arrangements as per the Disruptive Weather SOP. Arrangements are also in place across SAS and the Roads Departments of the respective Councils to ensure arrrangements are in place to ensure patients are able to access essential hospital services during any period of severe weather disruption. Winter planning arrangements also take account of the debrief from WInter 2023/ 24. A winter planning event, Winter Breach 24, is being organised to take place on 14 November with the aim of raising awareness of preparations and dependencies for severe weather across Lanarkshire and testing the Lanarkshire LRP severe weather protocol. 118 1 Resilience preparedness 1.7 Business Continuity plans take into account critical activities across the NHS Board / HSCPs spectrum of activity and include analysis of the risks of disruption and their actual effects and demonstrate that planning has been based upon the likelihood and impact of worst-case scenarios. Yes As above, BCPs are updated and there is a Winter Breach event every year such that various scenarios are tested in terms of system resilience. These include loss of power, inclement weather, terrorist attacks and so on. 37 1 Resilience preparedness 1.8 Business continuity plans include response(s) if a clinical system outage occurs and the steps required to ensure continuity of services. Yes There is a series of BCP arrangements bespoke to specific systems such that alternative arrangements can be set in place pending resolution. 22 1 Communications 1.9 Local communication plans: A review has been undertaken of communication channels to ensure that key messages about winter planning are clearly and consistently delivered to all parties, involved. This includes : a) Key partner communication protocols b) OOH information including four day festive period c) Surgery hours & access arrangements General practices contingency plans for respiratory disease outbreaks d) Signposting to Scottish Government assistance for households struggling to meet their energy bills. e) Service-linked communications issued, whether online or printed format, include content or text highlighting where public can access information on which service is right for which medical need, such as nhsinform.scot/right-care Yes A local comprehensive communication plan will be in place to ensure the local population remains informed and supported over the winter period, using multiple communication mechanisms. Messages will focus on staying well over the winter period and where Lanarkshire residents can seek appropriate care and highlighting the care that is on offer within the community, including during public holidays. Areas of focus will include, but not be limited to: winter preparedness (including Ready Scotland website), vaccination reminders, GP and pharmacy opening hours, services provided by pharmacies and other community based care, promotion of self-care and NHS Inform website, communications of the public and staff vaccination programme. 117 1 Step up / Step down care 1.10 Boards and HSCPs can evidence plans to increase the provision of intermediate care to impact positively on patients and services over the winter; and work towards building sustainability for the future. Yes A number of services can be 're-prioritised' to support additional intermediate/rehabilitation care beds if required. This will be directly linked to the daily flow and demand figures. 27 1 Page 150 of 218
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Section 2 Progress Status Complete Manual dropdown - use this box to track your progress 11 16 Overall Status Partial and/or No Automatic status Subsection # Statement Response Rationale for response rating Words Urgent & Unscheduled Care 2.1 To ensure Right Care is provided in the Right Place, a 24/7 Health Board Flow Navigation Centre is in place to offer rapid access to a senior clinical decision maker as well as the option of appointments via Near Me. Yes Through Operation Flow a new FNC Target Operating Model has been agreed that allows NHS Lanarkshire's FNC to operate 24/7 with a Senior Clinical Decision Maker rostered 8 am to 8 pm each day. Due to current staffing constraints, there can be periods where there is not full coverage. In addition to this the FNC has a SAS ANP rostered 8 am to 8 pm to support CBYC. This also supports a hybrid SCDM model with SAS Practioners and Consultants (ED and Acute Medicine) to support direction of patients to the right care and in the right place. This resource will take time to recruit to the organisation and will not be fully available for Winter 2024/25. A Frailty Consultant is also rostered each afternoon Mon- Friday to facilitate direct access to frailty units. Near Me is available within our FNC and is utilised as required. We have a number of pathways developed that are now being implemented to support scheduling of attendance at ambulatory care units. Training of the nursing workforce in the FNC is also underway to further enhance their decision making skills. 186 1 Urgent & Unscheduled Care 2.2 Effective communication protocols are in place to support whole-system situational awareness of emerging pressures. Monitoring of key indicators across the system forms the basis of huddle discussions. This ‘early warning system’ should highlight areas of concern and drive action to maintain or regain a balanced system. Yes In place through our x 3 daily huddles. An action and responsibility framework has been developed, along with action cards underpinned by a summarised ladder of escalation which clearly defines the level of escalation and the actions required by the relevant key disciplines and staff groups. 46 1 Urgent & Unscheduled Care 2.3 Robust communication processes are in place across each hospital site, following Discharge Without Delay (DWD principles) including morning hospital- safety huddles, focusing on the day's activity and current status, and afternoon huddles, setting Planned Date of Discharge and using this to predict capacity and demand for the next day. a) There is a Home First / Transition Team in place to support hospital discharge and Discharge to Assess; please provide further detail. Yes Whole system communication is in place through the whole system calls and site huddles. We have developed an Optimal Discharge planning Target Operating Model (TOM) to support good discharge planning across our bed holding areas. The TOM is underpinned by the FLOW foundation bundles and a Home First Assessment Approach. A training and education plan supported by P&D, OD, Practice Development and Quality Improvement is being developed to support sustainable implementation of the TOM. We have developed a flow foundation bundle which comprises of a set of simple rules to enhance flow across our assessment areas and wards, including acute and off site areas. This consists of: Planned Date of Discharge (PDD) setting; criteria led discharge; criteria to reside assessment for every patient; structured board rounds x 3 daily; and daily ward beat for each ward. We audit process implementation on a weekly basis and are transitioning to auditing outcome measures also. 153 1 Urgent & Unscheduled Care 2.4 Emergency Physician in Charge (EPIC), Flow Co-Ordinator roles are in place where possible to provide dedicated leadership in Emergency Departments. A Discharge Co-ordinator is in place in each ED to act as a single point of contact (SPOC) to arrange rapid discharge from ED and take responsibility for co- ordinating community support. Partial EPIC roles and Flow Co-ordinator roles are in place across all our 3 departments as staffing levels allow. Our SW team and discharge teams support early discharge from our EDs but there isn't a dedicated discharge facilitator in each ED. 40 2 Urgent & Unscheduled Care 2.5 Pathways are in place which provide care closer to home through pathways such as Hospital at Home for Older People; Respiratory Rapid Response and Out-patient Parental Antibiotic Therapy (OPAT); and supported by appropriate digital interventions such as Remote Consultation by phone and Near Me and Remote Monitoring, call before convey with SAS and flow navigation hub working to maximise virtual/remote Monitoring. Partial H@H frailty and OPAT pathways are operational to support admission avoidance and early discharge. Having concluded tendering process Doccla has been awarded the contract to support up to 400 virtual H@H beds. This system will provide electronic patient records, remote monitoring via a range of intermittent and continous monitoring devices, patient reported outcomes and two way communication with patients including remote video consultations. Initial specialties being explored are Diagnostic virtual step down, cardiology, respiratory and gastroenterology. We anticipate expanded capacity from mid November. We developed our workforce and clinical models to increase hospital @ home capacity. OPAT capacity was increase through funding secured via OP flow and recruitment continues to maximise this resource. We continue to test our Community Respiratory Service (1.0 wte Nurse and 1.0 wte physio specialist). Our pathways and models of care are being developed and expanded through the creation of our interface division and expansion of our FNC to FN + Plus. 157 2 Urgent & Unscheduled Care 2.6 Boards and Partnerships have effective organisation of care across between primary and secondary care so that patients receive high-quality care and the best use is made of clinical time and resources in both settings. This could be through a mechanism such as an Interface Group. Yes Our Operation Flow structures are whole system and therefore facilitate good interface working. A primary/ secondary care interface group has been established within the interface devision that is working on redesigned patient pathways - initial pathways developed are anaemia, headaches and hypertension. 42 1 Urgent & Unscheduled Care 2.7 Escalation procedures are directly linked to a plan which encompasses the full use of step-down community facilities. Yes Yes escalation plans are linked to use of step down. 10 1 Urgent & Unscheduled Care 2.8 Boards and HSCPs have additional festive arrangements, over the four-day public holiday, planned in collaboration with partner organisations such as Local authorities, Police Scotland, SAS and the local Voluntary Sector and in line with recommendations from the Four Day Public Holiday Review. Yes Our Winter Planning structures are whole system. We also have >60% of GPs opening at some point on the two public holidays of 26 December and 2 January as well as Saturday 28 December and all Saturdays in January. 39 1 Urgent & Unscheduled Care 2.9 Patients identified as being at high risk of admission from both the SPARRA register and local intelligence, and who have a care manager allocated to them, will be identifiable on contact with OOH and acute services to help prevent admissions and facilitate appropriate early discharge. Partial Community nursing gets an email each week of all care managed patients that have been admitted. The Integrated Discharge Facilitators on each site also get this list each day. 29 2 Urgent & Unscheduled Care 2.10 Processes are in place to enable patients with respiratory conditions and those who are frail are given the opportunity to have an anticipatory or future care plan. There should be a system in place for identifying these individuals and it should be clear which professional clinical groups will take a lead on having these care planning conversations depending on the persons circumstances. Partial Some respiratory patients are provided with advice re ACPs and use of medication to proactively avoid exacerbation of their illness linked to adverse weather. The establishment of the 3 frailty units with direct admissions where possible will also assist in managing respiratory illness as well as being able to respond pro- actively to patients with ACPs as part of this process. It is recognised that further work is required in developing robust anticipatory care planning across NHS L 87 2 Urgent & Unscheduled Care 2.11 Pathways are in place for patients who are identified as ‘frail’ and those with respiratory or cardiac exacerbations, and these are embedded within primary care services, in and out of hours, as alternatives to admissions. Partial Consultant Connect is available for GPs 'in' and 'out of hours' for profession to professional advice to avoid admission where appropriate and we are committed to enhancing use of technology to suupport admisison avoidance. Consultant Geriatricians have been embedded within FNC to support discussions and virtual consultation where appropriate with opportunities for direct admissions to frailty units on all three sites. We also have a dedicated frailty workstream as part of Operation Flow with a dashboard now operational showing frailty scores of inpatients available on Milan. There is subsequently a wide range of work underway including interface teams on each of the sites and connection with community based Locality 112 2 Urgent & Unscheduled Care 2.12 People living with a respiratory condition have access to a respiratory team 7 days a week, should they become unable to self-manage their condition from home. People with heart failure and those who are living with frailty should be given the opportunity to have an anticipatory or future care plan. Partial A respiratory pilot is underway in one locality and funding has been extended for a further year. This work will form the basis of our respiratory H@H virtual ward pathways which are currently being planned. A heart failure application to access H@H funding was declined. We are currently exploring local funding opportunities and we re currently planning our H@H heart failure virtual ward capacity.. 64 2 Urgent & Unscheduled Care 2.13 Care Homes will be supported with timely access to professional support and clinical advice to enable admission prevention and more planned interventions to keep residents safe in their own home. This includes proactive contact on at least a weekly basis to discuss any residents the care home staff are concerned about and agree a plan of care and interventions if these should be required. Remote consultations via phone or Near Me video consultation should be available. Yes Our Care Home Liaison Team provide professional support and advice to keep residents safe in their own home. Consultant Connect is available for GPs for profession to professional advice to avoid admission where appropriate and we are committed to enhancing use of technology to suupport admisison avoidance. The vast majority of care homes are also covered by the GP Care Homes LES which means there is a dedicated GP practice looking after all the residents in these homes. 78 1 Urgent & Unscheduled Care 2.14 For Health Boards with Major Trauma Centres (Grampian, GGC, Lothian, Tayside), to incorporate into their winter surge plans, assurance of sufficient safe staffing on MTCs (both adult and paediatric) to ensure Scottish Trauma Network MTCs will continue to deliver high quality, integrated, multi-speciality care to severely injured patients. Further consideration is also required for those Boards with Major Trauma Units to similarly support safe staffing. n/a N/A 1 1 Urgent & Unscheduled Care 2.15 Where admission is necessary, ensure there is a mechanism and/or agreements in place with primary care and secondary care clinicians to minimise delays in pathway, and avoid multiple discussions that can lead to delays; recognising that in periods of increased demand, general practice may not have the functional capacity to follow the usual processes such as pathways for admission. Yes Consultant Connect in place and use being promoted via Operation Flow and our Winter planning processes. We are scoping if we can patch calls from our FNC direct to consultant connect. We are keen to undertake a test of change for direct access to determine if we can reduce delays for patients. All requests for direct admissions are managed via our FNC who will add to expect lists, order transport and discuss directly with SCDM if required 77 1 Planned Care 2.16 Plans are in place to maintain activity over winter for planned care, including outpatients and inpatient / daycase, diagnostics, imaging and cancer, with plans considering the impact of increased unscheduled admissions on planned care activity. Planned care activity will not be paused or cancelled routinely – if Health Boards need to consider this as part of their business continuity / escalation plans it needs to be discussed and agreed in advance with Scottish Government. Yes Ortho protected beds at UHH aligned to an SOP detailing the identification/ criteria for patients suitable to board to ward 7. Establishing a 23-hour care unit at UHM. Work underway to fully embed Active Clinical Referral Triage (ACRT) & Patient Initiate Returns (PIR) within clinical pathways. 45 1 Planned Care 2.17 Health Boards are considering opportunities to maximise capacity through Pooled Lists - locally for high volume specialties and pooled lists regionally / nationally for those patients waiting the longest. Yes Working across sites to ensure the utilisation of capacity within the services as a whole to sustain NOP & TTG standards. Continue to ensure full utilisation of Outsourcing capacity GJNH and Independent providers. 33 1 Planned Care 2.18 Health Boards are making use of the National Elective Coordination Unit (NECU) to support admin and clinical validation. Yes Working in partnership with NECU to progress validation campaigns for all services to support the management of waiting lists including diagnostic services (MRI & Ultrasound). 25 1 Planned Care 2.19 For those Health Boards with National Treatment Centres (NTCs), plans are in place to enhance and maximise use of the NTCs through winter and beyond. n/a N/A 1 1 Planned Care 2.20 Discharge: close partnership working is in place, including the third and independent sector, to ensure that adequate care packages are in place in the community to meet all discharge levels. Yes Partnership discharge planning progressed through ward based flow bundles including MDT discussions supporting PDD and associated actions. There is also significant social work presence in each of the hospitals to ensure rapid access to necessary assessment, advice and focus on all action areas. The development of the Optimal Discharge TOM has further facilitated strong partnership working in relation to discharge planning. Partnership discharge planning progressed through ward based flow bundles including MDT discussions supporting PDD and associated actions. There is also significant social work presence in each of the hospitals to ensure rapid access to necessary assessment, advice and focus on all action areas. 105 1 Digital assets 2.21 Plans are in place to support the availability of Near Me video consultations to optimise estate and workforce capacity. Partial Enhacing the use of 'near me' is included in new Front Door Target Operating Model and we plan to increase use during Winter 24/ 25. 25 2 Page 151 of 218
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Section 3 Progress Status Complete Manual dropdown - use this box to track your progress 11 11 Overall Status Yes Automatic status Subsection # Statement Response Rationale for response rating Words Primary Care 3.1 Plans are in place to support General Practice (and where necessary other independent contractors) to manage provision of core General Medical Services (and sustainability more widely) over the winter period. Specific reference should be made to contingency arrangements where practices are unable to open (or provide General Medical Services) due to staffing or other reasons. Health Boards and HSCPs should ensure that where services are reduced or unavailable they support the practice with communications to patients including alternative arrangements. Yes There is a dedicated GMS sustainability group which meets weekly to consider any GP practices which are in difficulty such that associated resources can be brought to bear where at all possible to provide support to the respective practice. This includes providing staff from other areas of NHSL to give tailored support depending on the nature of the sustainability issues/staffing difficulties. Throughout such processes, comms plans are provided to support the practice and the associated patient group. Advice has also been obtained from the respective medical defence organisations to re-assure GPs tha they can work to t ' hb i /b dd ' ti t f id ti t 105 1 Primary Care 3.2 Maximising Multi-Disciplinary Teams (MDTs) Plans explicitly reference the use of MDTs within OOH services; indicate where increased use of MDTs are in place. This includes increasing capacity of senior clinical and non- clinical leadership, use of multidisciplinary teams and availability of professional-to-professional advice across acute and community. Yes The service has increased MDT staffing, with recruitment of senior ANP, trainee Paediatric NP's and SAS Advanced Practitioners on a seconded basis. The service will recruit qualified ANPs when academic year complete end September 2024. Sessional Pharmacists who posses the necessary non-medical prescribing qualifications to process medication requests undertake sessions within the PCOOH service at peak times (weekend dayshifts and public holidays) to alleviate pressures on GP colleagues; this initiative is entirely separate of community pharmacy. Whilst plans include the utilisation of MDTs, this may be tempered by the availability of the relevant qualified staff for the PCOOH service. 99 1 Primary Care 3.3 Executive level overview and oversight for Out of Hours (OOH) A Primary Care OOH winter plan has been signed off at Executive level, with clear escalation processes in place. There is Board Executive level oversight of OOH to support resilience, explore other operational solutions and agree appropriate escalation plans during the winter period given its essential role as a “front door” service Yes A specific plan for additional cover for OOH over the winter period is being prepared and forms part of the wider winter plan. There is an executive lead as well as escalation processes being in place. Specific work continues with NHS24 with a view to increasing dispositions to community pharmacy and not OOH services. This also involves ongoing discussion with community pharmacies in the context of the increasing pressures on community pharmacy. NHSL comms team will continue to issue specific comms signposting service users to other self care options to reduce footfall to EDs and PCOOH service. 97 1 Primary Care 3.4 Link with wider winter plans and engagement with SAS and NHS 24 to improve system resilience. The plan puts Primary Care OOH within the context of winter readiness preparedness, as part of the urgent/unscheduled care landscape and whole system local planning, including community and social care responses through urgent care resource hubs/flow navigation centres (FNCs), or equivalent. Yes SAS are also key partners in our winter planning group and have effective liaison with our OOH service. P2P referrals are also a key feature of the service. Both SAS and NHS24 have representation on the OOH National Operations Group meeting and there is a dedicated NHS24/OOH partnership group convening on a regular basis. In addition to this, up to 74% of GPs across Lanarkshire are opening at various stages such as 26/12, 28/12, 2/2 and the subsequent Saturdays throughout January 2025 to assist in managing demand that may otherwise have fallen to OOH or A&E to manage. 98 1 Primary Care 3.5 NHS Board Directors of Dentistry engage with NHS 24 to ensure they have sufficient capacity in place to meet any potential increased demand for out of hours care during the winter period Yes Public Dental Service representatives meet regularly with NHS 24 on Regional and one-to-one basis to review past demand vs capacity and discuss any measures/ mitigations and current pressure 'pinch points'. This information is used to inform decisions on clinic opening times and additional stand-by useage. Director of Dentistry meets weekly with PDS representatives to receive updates on issues of concern with OOH/ NHS24. 63 1 Primary Care 3.6 Provision of OOH dental services Plans reference provision of dental services; services are in place either via general dental practices or out of hours centres. This should include an agreed escalation process for emergency dental cases, i.e. trauma, uncontrolled bleeding and increasing swelling. Yes Plans include the current template for Next Day Care via GDS practices Mon-Fri as well as OOH clinics via GDS/ PDS staff mix on health board premises at weekends. In addition, PDS unregistered weekday clinics are run to remove burden of pressures resting solely with NHS24/ OOH. There are outcomes agreed with NHS24 for cases triaged as emergency at NHS24 eg. 1 hour outcomes or ED referral for those requiring specialist OMFS surgical/ medical assessment and management. 77 1 Primary Care 3.7 Working with mental health services HSCPs should have clear arrangements in place to enable access to mental health crisis teams/services 24/7, including availability of professional to professional advice for out of hours services, particularly during the festive period Yes Psychaitric Liaison Nursing Service provides access to MH assessment via the three Acute Sites ED services 24/7. 17 1 Primary Care 3.8 Increased level of professional-to-professional advice Boards and HSCPs have increased, where possible, the availability of professional to professional advice across acute and the community to ensure the patient receives right care in the right place at the right time. Yes Maximising P2P advice through a range of measures is a key feature of Operation Flow. This includes maximising the coverage and use of a fully functioning FNC as well as extending the reach of Consultant Connect. There is also 24/7 access from NHS 24 to Psychatric Liasion Nurse as well as Police Scotland Triage via the service based at Douglas Street clinic. The stress/distress pathway with SAS and Police is also well established allowing for providing community based responses without the need for conveaynce to hospital/A&E attendances. 86 1 Primary Care 3.9 Working with social care OOH Plans demonstrate consideration to social care services and where possible close links are in place for emergency respite, community alarm services and home care provision. OOH Plans will identify how Care Homes will be supported with timely access to professional support and clinical advice (particularly in the OOH period) to enable admission prevention and more planned interventions to keep residents safe in their own home. Yes Emergency Social work services are available across both North and South Lanarkshire HSCPs and the respective communication measures in place. Home visiting continues by the OOH clinicians. Care homes are directed to contact the OOH service via the FNC obviating the need to go through NHS24 thereby removing associated delays. Public Health/ Health Protection is also available to provide advice for control of outbreaks in Care Homes. Additionally, our PH and Care Home team provide pro-active advice to Care Homes in relation to a range of factors, eg infection control to try to minimise any infections and mitigate their subsequent impact. 100 1 Primary Care 3.10 Winter readiness plans consider the needs of those living with a mental health, learning disability, neurodiverse or dementia diagnosis, including the needs of carers. Yes Community Learning Disability Teams ensure there are indivudal plans of care are in place that support patients, carers and other providers of services. Similarly. CMHTs ensure effective comms such that all patients are aware of who to contact in the event of crisis - including over the winter period. 49 1 Primary Care 3.11 Plans to ensure appropriate staffing levels include consideration of mental health services and the need to maintain support for service provision and patient rehabilitation (such as suspension of detention), including for forensic mental health patients. Yes Winter plan will be in place for all mental health services, including inpatient and community forensic services, which will ensure sufficient numbers of staff are available to be able to maintain all core services and have the ability to meet respective need. Again this will include all mental health services, including forensic services. 53 1 Primary Care 3.12 The discharge partnership working plans include consideration of those requiring mental health supports and/or being discharged from a mental health setting, including the unique support package needs of those leaving forensic inpatient settings or with complex care needs. Yes The winter plan for mental health services referred to above includes the availability of staff who will be linked to discharge planning from all ward settings, including adult mental health, mental health of old age, forensics and learning disabilities. 40 1 Primary Care 3.13 Plans ensure continued access to dementia diagnosis services for both inpatients and those in the community, ensuring people have care and treatment appropriate to their needs and any potential dementia-related issues are recognised and addressed. Yes Consultant run clinics as part of the Older Adult Community Mental Health Teams will continue across winter. Patients within specialist MH wards will also have access to MDT with a specialist input around dementia diagnosis. 35 1 Primary Care 3.14 Plans are in place to ensure data is available to monitor the performance and capacity of primary care and mental health services throughout the winter. Yes There is a suite of data that is used to measure overall performance across both primary care and mental health services and these will continue across the winter period. In relation to primary care, as well as the weekly sustainability meetings referenced above, there is also a weekly proforma issued toask that any specific isses are ntoified proactively. In relation to mental heath services, measures 84 1 Prisons 3.15 Plans are in place to ensure that the delivery of prison healthcare, including mental healthcare, is maintained and that there are appropriate levels of healthcare staff in prisons to deliver efficient and effective patient care. Yes The Prisoner Healthcare service within HMP Shotts will has a sustainable, experienced, and consistent workforce provision which has been covering any gaps in recruitment. This contingency will remain in situ over the winter period. 35 1 Social Care 3.16 Care at home assurance boards and care home assurance arrangements are in place to ensure all risks in care provision are recorded and appropriate mitigating actions are put in place. Yes We have established boards that meet regularly - we track all risks and take active action to mitigate risks where possiblework. 21 1 Social Care 3.17 Capacity to deliver key public protection functions is in place e.g. child and adult protection, MAPPA (Multi Agency Public Protections Arrangements) Yes Established processes and services in place to deliver key public protection functions. 31 1 Page 152 of 218
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Section 4 Progress Status Complete Manual dropdown - use this box to track your progress 11 12 Overall Status Partial and/or No Automatic status Subsection # Statement Response Rationale for response rating Words Workforce 4.1 Appropriate steps are being taken to support recruitment of staff on an ongoing basis within recognised financial parameters, utilising the full range of potential contractual arrangements including (but not limited to) Permanent, Sessional Worker, Bank or Fixed Term contracts (or a combination of these). Work undertaken with local college and HEI student workforce to offer holiday shifts and regular part time contracts can be evidenced. Yes Open external bank registered nurse recruitment is ongoing. Streamlined internal staff bank recruitment process continues. Recruitment of students to bank is ongoing and use of fixed-term contracts as a recruitment option for winter pressures is well enshrined within NHSL. 39 1 Workforce 4.2 Boards and HSCPs are continuously deploying the range of tools available to them to support efforts aimed at staff retention. For Boards, this is including but not limited to those set out through DL (2022) 30: DL(2022)30.pdf (scot.nhs.uk) to enable those staff who have retired to return to work on a part time basis should they wish to do so. Yes Retire and return policy is well embedded within NHSL. The Board had a pre- existing retire and return policy to encourage those colleagues retiring to return to a similar or their current post.We also actively email colleagues leaving the organisation 2 weeks before their last working day to invite them to complete an exit survey to capture more insight into why people leave NHSL. As referenced elsewhere, the whole-system staff health and wellbeing programme is well established and is also supportive to staff recruitment and retention. 85 1 Workforce 4.3 Plans are in place for appropriate levels of staffing across the whole system to facilitate efficient and effective patient care, ensuring consistent effective discharge planning takes place over 7 days and the holiday periods. This requires sufficient senior medical and other senior clinical decision makers to facilitate decision- making, and pharmacists to prepare timely discharge medications. For HSCPs, this includes sufficient social work staff and others associated with discharge planning. Partial All managers have been asked to ensure there is effective staff planning to ensure there is sufficient numbers of staff at weekend and public holidays to support flow. Work is currently ongoing to populate rotas seeking to ensure an appropriate level of coverage. As mentioned in Section 3, specifically in Primary Care, over 70% of GPs across Lanarkshire are opening at various stages across the 26th Decmeber and 2nd January public holidays as well as on Saturday 28 December and the subsequent Satyurdays throughout January 2025. 86 2 Workforce 4.4 A strategy is in place for the deployment of volunteers over winter, making appropriate use of established local and national partnerships. Investment in and funding of local voluntary and third sector organisations to support care@home teams and provide practical support to people who are ready for discharge, and across the wider community can be evidenced. Yes Both North and South H&SCPs have invested significantly in voluntary organisations to be able to support the wider statutory sector to ensure that a range of support is available that helps initially to avoid admission to hospital as well as being able to support some patients earlier discharge home. 49 1 Workforce 4.5 Staff are appropriately supported to access the range of available local and national staff wellbeing resources. This includes Primary Care independent contractor staff. Yes Over and above our existing communication with teams, during October we will be raising awareness of local and national staff wellbeing resources. This will be via weekly staff bulletins, social media and cascade information for managers and team leaders. We will be promoting the Your health matters website where details of the three main staff support services (Occ Health, Psychology and Staff Care) are available. 65 1 Workforce 4.6 In relation to potential adverse weather, Boards and Partnerships have contingency plans in place covering staff disruption to manage the impacts – for NHS this is specifically according to DL(2022)35.pdf (scot.nhs.uk). Staff are fully aware of the contingency plan. Yes There is a recognised adverse weather policy in the NHSL suite of HR policies. This is communicated to all staff as part of the comms plan and additionally, there is early warning of any weather warnings via LRP colleagues. In such circumstances, there is an alert email as part of the comms plan which also refers staff to the respective policy. Colleagues in North and South Lanarkshire Council's also have robust adverse weather contingency plans in place and will undertake complementary comms and resilience arrangements to maximise the 'public sector' response to any adverse 98 1 Seasonal outbreak 4.7 COVID-19, RSV, Norovirus, Seasonal Flu, Staff Protection & Outbreak Resourcing All patient-facing (i.e. “frontline”) Health and Social Care Staff (including Primary Care independent contractor staff) and ALL NHS workers have easy and convenient access to the seasonal flu vaccine and that: a) staff are able to drop in to any community clinic without needing to make an appointment b) peer to peer vaccination for flu is facilitated, where practicable, to bring the vaccine as close to the place of work for staff as possible. c) information and guidance is provided to staff on how to book appointments via the online portal or the National Vaccination Helpline and that they can drop in to any clinic without needing to book. d) Information and guidance / promotional materials are provided to staff on the benefits of vaccination for both themselves, their colleagues and their patients. (Full details on the programme can be found in the annual flu CMO letter.) Yes The Covid and Flu Winter programme for 2024 commenced with Flu only vaccinations WC 16th September for under 5’s and adults later in the programme. Covid will be offered to those eligible alongside their Flu vaccine from WC 7th October, including H&SW staff. Plans in place for Health and Social Work staff to be vaccinated on acute and community sites through SALUS clinics, with ongoing development of peer vaccinations. Where capacity allows, H&SW staff will be offered drop ins alongside the clinics running across acute and community sites. - Information and guidance has been issued nationally and locally through all Lanarkshire email with booking instructions and available on the website. NHSL computer log in screens also changed to inform staff. - Work is continuing with a number of staff to support peer vaccination where possible. Regular review will be undertaken to assess rate of uptake across all sites such that any areas requiring targeted work can be identified and the associated uptake rate improved where possible. 163 1 Seasonal outbreak 4.8 Plans take into account the predicted surge of Covid-19 as well as other viruses including seasonal flu, RSV and Norovirus activity that can happen between October and March and have adequate resources in place to deal with potential outbreaks and the impact these have on services (health and social care inclusive of primary care) across this period. Yes Winter preparedness planning is in place to re-circulate information and education on respiratory illnesses such as Influenza, COVID-19 and RSV. Infection Prevention and Control Education sessions will be delivered on loose stools management including norovirus. This will be done within acute hospitals & H&SCPs. Whilst the plan takes account of the potential for additional demand due to seasonal flu, it is not possible to say that there will be adequate resources to deal with it internally without impact on other services, e.g. planned care, without knowing the extent of any flu/other illness surge. Plans are also in place across our paediatric services such that they are more able to manage any surges in RSV activity. 114 1 Seasonal outbreak 4.9 Adequate resources are in place to manage all potential increases in Covid-19 including possible new variants with increased severity, RSV and seasonal flu that might coincide with norovirus, severe weather and festive holiday periods. Debriefs should be undertaken following significant outbreaks or end of season outbreaks to identify lessons and ensure system modifications to reduce the risk of future outbreaks Yes Plans are in place for discussions to take place for any COVID 19 and other winter illness outbreaks that might occur during festive holiday periods. Clinical staff, IPCT, Domestic Staff. Occupational Health and Safety and Microbiology are included in these discussions. Depending on severity and possible concurrence, it may be necessary to stand down non-urgent service delivery. There are well established ‘escalation plans’ and associated services which will be prioritised and continued across health and social care. Debriefs will be arranged should any significant events occur to identify learning to reduce future risks. 93 1 Seasonal outbreak 4.10 To help detect early warnings of imminent surges in activity, Boards routinely monitor PHS weekly publications, showing the current epidemiological picture on COVID-19, RSV, Norovirus and influenza infections across Scotland, and PHS Whole System Model Winter outputs. Yes The Health Protection Team have processes in place to monitor PHS outputs and those produced by UKHSA for the wider picture across the UK. Members of the Health Protection Team attend regular national meetings with PHS on influenza and COVID activity. The Health Protection Team also use local data to monitor local trends. During the winter season weekly outputs are produced and shared internally. Health Protection Scotland weekly publications are disseminated to IPCT and Microbiology IPC and fed back to sites at local level to monitor for possible early warnings of a surge in activity. The information is also accessible to Public Health colleagues. 104 1 Seasonal outbreak 4.11 Boards must ensure that staff have access to and are adhering to the national guidelines on Preparing for and Managing Norovirus in Care Settings Yes IPCT will provide information to all staff to raise awareness of how to access relevant guidance. As part of winter preparedness planning promotion of the National Infection Prevention and Control Manual will be done during drop in visits and by utilising other communication methods such as the NHSL Screen Saver and hospital newsletters. 53 1 Page 153 of 218
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Strategic Commissioning Plan 2023-26 and Programme of Work Update North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref MD/CR Date 18/02/25 From Morag Dendy, Chief Officer (Planning, Performance and Quality Assurance) E-mail dendym@northlan.gov.uk Telephone Executive Summary The report provides Committee with a mid-cycle update on the implementation of the Strategic Commissioning Plan 2023-26 and its associated Programme of Work. Each item within the Programme of Work is included in the appendix with a summary position on its current status and a RAG assessment. Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Acknowledge the current status of the Programme of Work, as contained within Appendix 1 of this report. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities Programme of Work Resilient People Adult Care and Social Work Committee Item 4 Page 155 of 218
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1. Background 1.1 The Integration Joint Board approved the final version of the Strategic Commissioning Plan 2023-2026 at its meeting on 22 March 2023, setting out how the Health & Social Care Partnerships plans and delivers services for North Lanarkshire over the medium term and how these arrangements help to contribute towards achieving the national health and wellbeing outcomes. 1.2 Subsequently, a more detailed Programme of Work was approved by the Board at its meeting on 27 September 2023, setting out in more detail the programmes and activities intended to help transform the health and social care system. 2. Report 2.1 The Integration Joint Board and Adult Care and Social Work Committee have been kept informed of progress for each of the items within the Programme of Work, with specific reports considered by either the Board or the Committee since September 2023. 2.2 Now that we have reached the mid-point of our planning cycle, this report has been compiled to take stock of progress and achievements to date across the entirety of the Programme of Work (PoW). Each of the PoW items are included in Appendix 1 with a summary of the current position and a Red/Amber/Green status assessment. 2.3 As previously reported, the partnership has been adopting a learning as management strategy (also known as Human Learning System) approach, working with partners from Healthcare Improvement Scotland to make learning and experimentation the key force driving our work. This approach to learning has been promoted across the range of programmes and redesign activity as part of this overall Programme of Work. 2.4 A key element of our learning approach has been the development of a Whole System Enabling Approach, often referred to as Back to Basics, which is helping us systematically understand and consider how all parts of the Health & Social Care system interact and influence each other. This approach is referred to throughout the report and is central to our efforts in supporting people to thrive by providing targeted services that are tailored to reflect their diverse needs. Keeping people central to the decisions that affect them helps us plan actions that support positive outcomes for those who access our services. By adopting a “sticky person” approach, which is to identify a lead person not only to assess need but to engage others to ensure the right response where needed, rather than pass on, we can safeguard against long waits, by waiting well and getting to the right response quickly. 2.5 The overall ambition of our Programme of Work and of our Whole System Enabling Approach is to have a system that is streamlined, supports fewer repeat actions and touch points/onward referrals for people and makes best use of resources by using them in a more effective and productive way. This will ensure that not only are we offering people the right support, at the right time and so increasing their quality of life, we are also increasing the quality of experience for staff in work satisfaction. To achieve this across the whole system, each locality will be responsible for their local population, which means decisions will be made closer to people. This approach will help support Page 156 of 218
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robust connections across all local stakeholders to Locality Planning Groups (LPGs), Local Outcome Improvement Plans (LOIPs) and Community Boards (CBs). 2.6 This report offers a mid-cycle stock-take of the partnership’s progress against the commitments made in its Programme of Work. Significant progress has been made and is recognised within the appendix attached to this report. Further work will continue over the next eighteen months to ensure momentum is sustained and key milestones continue to be delivered. 3. Supporting documentation 3.1 Appendix 1 – Programme of Work Status Update (October 2024) Morag Dendy Chief Officer (Planning, Performance and Quality Assurance) Page 157 of 218
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4. Impacts 4.1 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 ☐ 4.2 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? 4.3 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? 4.4 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? 4.5 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 ☐ 4.6 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 158 of 218
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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 ☐ 4.7 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? 4.8 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? 4.9 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? 4.10 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. 4.11 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 159 of 218
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7 Appendix 1 – Programme of Work Status Update (October 2024) 1. Getting It Right For Everyone (GIRFE) The GIRFE Pathfinder is working with staff in localities to take forward the learning from the co-design process and progress the prototypes ensuring these are deployed and embedded within the Whole System Enabling Approach (Back to Basics). The North Lanarkshire Pathfinder will focus on the following prototypes during the next phase of testing: • My plan – a means by which people can record their own information and share with agencies when required. The aim of My plan is to remove any need for people to retell their stories and their circumstances multiple times. This includes living well, ageing well and dying well. • Work is ongoing to embed the GIRFE principles across a variety of approaches that deliver preventative and early intervention approaches and activities. The aim is to improve access to appropriate supports and services by ensuring there are good conversations with people and their families from the first point of contact. Through an enabling approach, we will embed multidisciplinary teams (My team) around the person and their plan. • Our approach to improving the co-ordination of people’s support involves a sticky person as a trusted point of contact who supports people with the coordination of their plan and appointments as an integrated member of a multi-disciplinary team, including when someone receives support from a variety of teams. Areas for further development and design include determining how the sticky person for each person is allocated and how the role might be undertaken by a family member or other non- professional. • Clarity of vision for a community hub involves principles which will support the development of Hubs ensuring they reflect local needs and where people can connect with public services and with local people involved in both service delivery and decision making. The Council has an approved set of hub guiding principles so the we are building upon active work being undertaken in Newmains and St Page 160 of 218
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8 Brigid’s Community Hub, Riverbank and Chryston community hubs. Further development of this prototype includes identifying what community supports and services can be delivered through the hub, in reach and outreach, as well as the development of performance indicators to determine the impact of support on the health and well-being of the communities they serve. • Dementia practice - Additionally, we have agreed to consider staff competencies in supporting people with dementia post diagnosis. We understand that families can sometimes have extended wait on supports and this can be a challenging time so can we consider ‘waiting well’. We will work with staff across Home Support and Integrated Day Services in gathering data re training/development and competencies and whether this meets expectations as required in the Dementia Strategy. • GIRFEC to GIRFE (Moving On) - Working with our Education and Families colleagues to consider this important transition stage in a young person’s life. In what way can this transition be seamless with the right support at the right time. As outlined earlier we require to consider what the prototypes mean in real time. There has been extensive engagement and communication across the HSCP regarding the need for the workforce to get back to basics, have meaningful conversations with people about what is important to them. 2. Frailty Strategy The Lanarkshire Strategy for Preventing and Managing Frailty 2023 – 2028 was approved in November 2023. The implementation of the strategy is ongoing with a particular focus on the establishment of frailty networks, which commenced in November 2023 with the aim of providing a collaboration between the multi-disciplinary teams on our acute sites and the partnerships who have experience in frailty work. This has led to richly informed conversations which has been at the forefront of driving realistic and patient- centred change for the people living in North Lanarkshire. With continued engagement with both North and South Health and Social Care Partnerships, including GP localities, District Nurses and Third Sector organisations, there has been an understanding on how staff work with frailty patients and the challenges around this. It has also ensured more joint working between acute and community teams. Page 161 of 218
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9 3. Home Support Redesign The Home Support Redesign programme continues to focus on the following key elements: Assessment and Planning 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. 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. 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. 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 The recruitment of staff to assessment and planning has been prioritised to support the operational model. The service has invested in dedicated staff to support learning and development through training, including Page 162 of 218
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10 refresher cycles, and investment in workforce development to provide high quality care. 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. Dynamic Scheduling 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. Engagement 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. 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’. 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. 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. Page 163 of 218
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11 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 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 4. Carers Strategy The partnership’s new Carers Strategy 2024-27 was approved and published in May 2024 and the approach continues to be based on the principles of the Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013, promoting a whole system approach that enables people to have more choice and control in their lives. The development of the Carers Strategy gave us the opportunity to undertake extensive engagement and participation activity with carers and supported people. This has resulted in a carer led and carer informed strategy, co-produced with carers and carer organisations locally. The sense of “joint ownership” that has emerged is something that carers, carer organisations and UHSCNL can be proud of. The aspiration is to offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them. Through these initiatives, carers can lead full and meaningful lives, and ensures that people can engage in, participate in, and contribute to the local economy and wider society, should that be their choice. The wider approach also encompasses the principles of Getting it Right for Everyone (GIRFE) and Community Wealth Building. Carers, carer focused organisations and University Health and Social Care North Lanarkshire (UHSCNL) have, over time, developed a very robust carer support infrastructure, and our Carers Strategy 2024-2027 seeks to utilise this to best effect. 5. Care Home Assurance Team In 2021-22, My Health, My Care, My Home (Healthcare Framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for Page 164 of 218
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12 adults living in care homes across Scotland. The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes. To ensure a collaborative approach with implementation of the Healthcare Framework an engagement session took place in April 23 with all key stakeholders including care home staff, care home managers, care home providers, Care Inspectorate, Scottish Care, Health, Social Work and Social Care Staff. Subsequently, a Project Plan was developed and agreed with key stakeholders and Short LifeWorking Groups (SLWGs) were established covering all six core elements: Nurturing Environment The collaborative visit programme has shifted from “doing to” to “doing with” and new initiatives such as the MDT and Hand Hygiene Improvement projects have been built using a collaborative approach. There have been improvements in encouraging and listening to feedback. An example of this has been in working together to address the needs of care home staff training, which resulted in the development of the recently completed 6-month training programme. The newly appointed Practice Development Educator for care homes is currently engaging with staff to collaboratively develop the next programme based on the care homes identified needs and the HSCP’s priorities. This includes enabling routes for care home staff to access planned NHS training has begun. Multi-Disciplinary Team (MDT) We work collaboratively with the care home staff, assisting with care planning and introducing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). The team have now joined up with Social Work to attend the residents’ 4–6-week review in the care home. Prevention The application of Infection Prevention Control (IPC) standards in care homes is well supported. The dedicated IPC team is available for advice, education and guidance. The MDT approach will support the contents of care plans to be reflective of the individuals care needs taking into account health needs, which is often a role that carers complete. The support from CHL will therefore ensure the best start for residents entering care homes ensuring a more comprehensive proactive, preventative approach. Page 165 of 218
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7 Appendix 1 – Programme of Work Status Update (October 2024) 1. Getting It Right For Everyone (GIRFE) The GIRFE Pathfinder is working with staff in localities to take forward the learning from the co-design process and progress the prototypes ensuring these are deployed and embedded within the Whole System Enabling Approach (Back to Basics). The North Lanarkshire Pathfinder will focus on the following prototypes during the next phase of testing: • My plan – a means by which people can record their own information and share with agencies when required. The aim of My plan is to remove any need for people to retell their stories and their circumstances multiple times. This includes living well, ageing well and dying well. • Work is ongoing to embed the GIRFE principles across a variety of approaches that deliver preventative and early intervention approaches and activities. The aim is to improve access to appropriate supports and services by ensuring there are good conversations with people and their families from the first point of contact. Through an enabling approach, we will embed multidisciplinary teams (My team) around the person and their plan. • Our approach to improving the co-ordination of people’s support involves a sticky person as a trusted point of contact who supports people with the coordination of their plan and appointments as an integrated member of a multi-disciplinary team, including when someone receives support from a variety of teams. Areas for further development and design include determining how the sticky person for each person is allocated and how the role might be undertaken by a family member or other non- professional. • Clarity of vision for a community hub involves principles which will support the development of Hubs ensuring they reflect local needs and where people can connect with public services and with local people involved in both service delivery and decision making. The Council has an approved set of hub guiding principles so the we are building upon active work being undertaken in Newmains and St Page 166 of 218
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8 Brigid’s Community Hub, Riverbank and Chryston community hubs. Further development of this prototype includes identifying what community supports and services can be delivered through the hub, in reach and outreach, as well as the development of performance indicators to determine the impact of support on the health and well-being of the communities they serve. • Dementia practice - Additionally, we have agreed to consider staff competencies in supporting people with dementia post diagnosis. We understand that families can sometimes have extended wait on supports and this can be a challenging time so can we consider ‘waiting well’. We will work with staff across Home Support and Integrated Day Services in gathering data re training/development and competencies and whether this meets expectations as required in the Dementia Strategy. • GIRFEC to GIRFE (Moving On) - Working with our Education and Families colleagues to consider this important transition stage in a young person’s life. In what way can this transition be seamless with the right support at the right time. As outlined earlier we require to consider what the prototypes mean in real time. There has been extensive engagement and communication across the HSCP regarding the need for the workforce to get back to basics, have meaningful conversations with people about what is important to them. 2. Frailty Strategy The Lanarkshire Strategy for Preventing and Managing Frailty 2023 – 2028 was approved in November 2023. The implementation of the strategy is ongoing with a particular focus on the establishment of frailty networks, which commenced in November 2023 with the aim of providing a collaboration between the multi-disciplinary teams on our acute sites and the partnerships who have experience in frailty work. This has led to richly informed conversations which has been at the forefront of driving realistic and patient- centred change for the people living in North Lanarkshire. With continued engagement with both North and South Health and Social Care Partnerships, including GP localities, District Nurses and Third Sector organisations, there has been an understanding on how staff work with frailty patients and the challenges around this. It has also ensured more joint working between acute and community teams. Page 167 of 218
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10 refresher cycles, and investment in workforce development to provide high quality care. 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. Dynamic Scheduling 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. Engagement 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. 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’. 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. 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. Page 168 of 218
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11 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 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 4. Carers Strategy The partnership’s new Carers Strategy 2024-27 was approved and published in May 2024 and the approach continues to be based on the principles of the Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013, promoting a whole system approach that enables people to have more choice and control in their lives. The development of the Carers Strategy gave us the opportunity to undertake extensive engagement and participation activity with carers and supported people. This has resulted in a carer led and carer informed strategy, co-produced with carers and carer organisations locally. The sense of “joint ownership” that has emerged is something that carers, carer organisations and UHSCNL can be proud of. The aspiration is to offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them. Through these initiatives, carers can lead full and meaningful lives, and ensures that people can engage in, participate in, and contribute to the local economy and wider society, should that be their choice. The wider approach also encompasses the principles of Getting it Right for Everyone (GIRFE) and Community Wealth Building. Carers, carer focused organisations and University Health and Social Care North Lanarkshire (UHSCNL) have, over time, developed a very robust carer support infrastructure, and our Carers Strategy 2024-2027 seeks to utilise this to best effect. 5. Care Home Assurance Team In 2021-22, My Health, My Care, My Home (Healthcare Framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for Page 169 of 218
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12 adults living in care homes across Scotland. The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes. To ensure a collaborative approach with implementation of the Healthcare Framework an engagement session took place in April 23 with all key stakeholders including care home staff, care home managers, care home providers, Care Inspectorate, Scottish Care, Health, Social Work and Social Care Staff. Subsequently, a Project Plan was developed and agreed with key stakeholders and Short LifeWorking Groups (SLWGs) were established covering all six core elements: Nurturing Environment The collaborative visit programme has shifted from “doing to” to “doing with” and new initiatives such as the MDT and Hand Hygiene Improvement projects have been built using a collaborative approach. There have been improvements in encouraging and listening to feedback. An example of this has been in working together to address the needs of care home staff training, which resulted in the development of the recently completed 6-month training programme. The newly appointed Practice Development Educator for care homes is currently engaging with staff to collaboratively develop the next programme based on the care homes identified needs and the HSCP’s priorities. This includes enabling routes for care home staff to access planned NHS training has begun. Multi-Disciplinary Team (MDT) We work collaboratively with the care home staff, assisting with care planning and introducing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). The team have now joined up with Social Work to attend the residents’ 4–6-week review in the care home. Prevention The application of Infection Prevention Control (IPC) standards in care homes is well supported. The dedicated IPC team is available for advice, education and guidance. The MDT approach will support the contents of care plans to be reflective of the individuals care needs taking into account health needs, which is often a role that carers complete. The support from CHL will therefore ensure the best start for residents entering care homes ensuring a more comprehensive proactive, preventative approach. Page 170 of 218
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13 Anticipatory and Future Care Planning There is a need to raise awareness of ACP’s and to provide education and training for care home staff. A training package is currently being developed by palliative care consultants and the Care Home Practice Development Educator Palliative and End of Life Care We promote various tools to aid residents’ palliative and end of life care needs and provide training to support their use. Urgent and Emergency Care The Flow Navigation Centre (FNC) appropriately refer care home residents to Hospital at Home from 09:00hrs- 17:00hrs. This approach has successfully supported care home residents to remain in the care homes. These hours will be extended over the next few months. 6. Hospital @ Home During 2023, a rapid review of the Hospital at Home service was undertaken, taking into account the immediate plans for expansion and the future vision for Hospital at Home in line with Scotland’s national strategy Horizon 1 (complete) • Extended operating hours to include evening and weekend working • Enhanced interfaces between community nursing, hospital based specialities and more understanding of capabilities across the system. Increased reporting of agreed KPIs • Increased professional to professional advice via consultant connect • Captured learning from Heart Failure Test of Change to inform speciality developments across the service • Explored Flow Navigation Centre being the single point of access for escalation and deescalation Horizon 2 (complete) • Refocused service to admission avoidance • Clearly defined step down criteria for complex cases Page 171 of 218
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13 Anticipatory and Future Care Planning There is a need to raise awareness of ACP’s and to provide education and training for care home staff. A training package is currently being developed by palliative care consultants and the Care Home Practice Development Educator Palliative and End of Life Care We promote various tools to aid residents’ palliative and end of life care needs and provide training to support their use. Urgent and Emergency Care The Flow Navigation Centre (FNC) appropriately refer care home residents to Hospital at Home from 09:00hrs- 17:00hrs. This approach has successfully supported care home residents to remain in the care homes. These hours will be extended over the next few months. 6. Hospital @ Home During 2023, a rapid review of the Hospital at Home service was undertaken, taking into account the immediate plans for expansion and the future vision for Hospital at Home in line with Scotland’s national strategy Horizon 1 (complete) • Extended operating hours to include evening and weekend working • Enhanced interfaces between community nursing, hospital based specialities and more understanding of capabilities across the system. Increased reporting of agreed KPIs • Increased professional to professional advice via consultant connect • Captured learning from Heart Failure Test of Change to inform speciality developments across the service • Explored Flow Navigation Centre being the single point of access for escalation and deescalation Horizon 2 (complete) • Refocused service to admission avoidance • Clearly defined step down criteria for complex cases Page 172 of 218
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14 • Move from medical delivered model to a medical oversight model • Rapid access to diagnostics • Developed and implemented recommendations from Heart Failure learning Horizon 3 – to be implemented by March 2025 • Finalise workforce model for service • Connect Hospital at Home to locality teams (urgent response and nursing) • Agree model for multiple Responsible Medical Officers when the service expands into other specialties • Clarify system wide governance arrangements • Ensure a de-escalation and escalation framework is in place • ANPs undertaking differential diagnosis 7. Home Assessment Team (HAT) The Home Assessment Teams are operational in all localities and are fully embedded within the enabling approaches developed in each locality. Service Model • Standard Operating Procedure agreed and in place. • Workshops held to map pathways, review and agree pan-Lanarkshire referral criteria with all key stakeholders including transfers of care into reablement, mainstream/longer term home support and integrated rehabilitation services. • HAT staff accommodation secured in university hospitals and community. • Induction programme established. 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. Recruitment Page 173 of 218
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15 • Recruitment to HAT ongoing to build capacity across all 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. • It is the intention for existing staff to be able to work flexibly across sectors as required to meet demands. • 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. • Strategic management is also undergoing a review to ensure integration into the new GIRFE/Enabling Approach arrangements. 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 Whole System Enabling approach and the Operation FLOW Optimal Discharge Planning Target Operating Model. 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. Weekly meetings have been established between relevant staff in HAT, Home Support, Reablement and Integrated Rehabilitation Teams to facilitate effective communication regarding individual service users and reablement activity and subsequent goal setting supported by a standard operating procedure. Taking a Whole System Enabling Approach, 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. Page 174 of 218
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16 8. Self Directed Support Transformation 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 Work is ongoing with colleagues involved in the delivery of both local authority and independent sector care at home services to increase choice and control through individualising arrangements and planning with people to meet changing needs flexibly and responsively, understanding the focus on frailty. 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 self directed support. 9. Community Alarm Service The plan for North Lanarkshire Council’s community alarm service is to transition to a new digital service, 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. 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. 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 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 Page 175 of 218
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17 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. 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. 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. 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. 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. 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. The service recognises that the staffing resource has not been reviewed within the community alarm service since its inception, however given the service growth as well as prioritising the move from an analogue to digital solution as well as the introduction of new digital technology it is evident that a review of the staffing structure is required. 10. Community Nursing Review The new Vision & Model for Community Nursing was launched in October 2024. Caseload Complexity Page 176 of 218
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18 New complexity descriptors have been developed using a collaborative approach with the community nursing teams. All staff have received training to ensure a consistent approach to measuring complexity of patients within caseloads. These are now used on a daily basis to describe workload demand and support safe staffing. An audit tool was created to review the overall complexity of caseloads which will be used to aid the fair distribution caseloads and support a review of skill mix within the community nursing teams. Practice Assessors have been allocated to each locality to support the teams. They are working with District Nurses and trainee District Nurses to support improvements in caseload management Care Management & Referral Criteria A collaborative approach to managing patients with complex care needs is being currently taken with nurses working as part of a wider multidisciplinary team in localities. This approach ensures that everyone works together and can quickly respond to complex often unscheduled demand for services. In line with our strategy for preventing and managing frailty, frailty scoring is being introduced to community nursing assessments. Identifying frailty at an early stage will enable staff to plan and coordinate care, support wellbeing and optimise independence. We are also reviewing future care planning and will work in conjunction with GP’s to ensure we proactively plan and coordinate care using realistic medicine principals to achieve the aims of Healthy Ageing and Living Our Best Lives in Lanarkshire. A Community Nursing Referral Centre (CNRC) was established in February 2024 and now takes calls for Wishaw, Motherwell, Airdrie and Bellshill. The other two localities are currently recruiting call handling staff to join the CNRC and hope to be in all localities by November 2024. Roles, Responsibilities and Training An internal District Nursing trainee pathway was developed and has been successfully supporting the training and registration of staff. A review of this training pathway took place to ensure it reflects the new Nursing Midwifery Allied Health Professional (NMAHP) Competency Framework and Queens Nurse Institute Scotland (QNIS) standards. Concerns around a gap in leadership is being addressed by encouraging Team Leaders to attend Leadership and Quality Improvement courses. Page 177 of 218
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19 11. Alcohol & Drugs Partnership Strategy A programme of extensive and competitive commissioning activities took place via the North Lanarkshire Alcohol & Drugs Partnership (ADP) in 2023, with five key services tendered to support the delivery of the National Mission Priorities, including: • Early intervention, prevention and education – awarded to Landed • Individual Placement Support – awarded to SAMH • Adult and Whole Family Support service – awarded to Phoenix Futures • Recovery Community Development – awarded to Recovery Scotland • Crisis, overdose response and assertive outreach service – awarded to Turning Point Scotland North Lanarkshire ADP Board made the decision to commit to three year funding for all new and continuing services from 2023 onwards. This recognised feedback from stakeholders citing challenges faced with previous year on year funding arrangements that impacted on staff recruitment and retention, longer term planning and service stability. A number of test of change projects have been funded/initiated via NLADP, including: • Arrest referral pathways via Police custody centres • Contextual safeguarding for children and young people • Alcohol and Drug Solutions Courts, and; • Extended Youth Work Provision and Diversionary Activities via Community Learning and Development (CL&D). Drug Death Prevention Work to refine drug death prevention efforts in 2023 included a full review of the Drugs Death Prevention Group (DDPG) operational workstreams with a full membership update and work plan now in place. Reducing Alcohol Harms The Reducing Alcohol Harms group has been meeting for the last 18 months and is a multi-agency group with broad representation from the ADP partners. There is a detailed work-plan linked to the RAHG that cuts across whole population measures and targeted local interventions from Licensing, Alcohol Brief Interventions, Health Needs Assessment, education and training and work to target higher risk groups. Page 178 of 218
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20 Residential Rehabilitation An extensive programme of work was led by the ADP support team and the Scottish Recovery Consortium to offer training and support to staff to ensure residential rehab is available to anyone who wishes to be assessed. Residential rehab is now offered more consistently as part of the treatment and care offer in North Lanarkshire Whole Family support NLADP continues to invest in family support linked to the decisions reached via the Whole Family Approach sub-group, led by the national holistic framework, local evidence of need and linked to ADP strategic objectives. MAT Standards North Lanarkshire is on track to meet all MAT standards with the exception of MAT 7. This is due to constraints linked to delivery of MAT across Primary Care. North Lanarkshire is not unique in this. MAT 7 limitation have been acknowledged by the Scottish Government and Public Health Scotland as a national barrier with the majority of ADP areas unable to deliver on this standard. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. 12. Prisoner Healthcare The Adult Health Services Unit (AHSU), in collaboration with Scottish Prison Service (SPS), and on-site staff, successfully undertook a Service Model Review to implement an improved Prisoner Healthcare service to the population of HMP Shotts. This included stabilised staffing models, improved staff training plans, and improved patient centred care for all patients, in particular those with identified existing health needs. Originally commissioned in January 2022, the review covered the following 8 standards: • Standard 1: Effective Management of Resources & Staff Governance • Standard 2 Primary Care & chronic disease Management • Standard 3: Mental Health & Addictions Page 179 of 218
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21 • Standard 4: Medicines Management • Standard 5: Infection Prevention and Control • Standard 6: Person Centred Health and Care • Standard 7: End of Life Care • Standard 8 : Deteriorating Patient The action plan produced from the review made 31 recommendations, all of which are now complete and signed off. A scheduled Healthcare Improvement Scotland inspection took place in May 2022. Several recommendation sfor improvement were categorised under Standard 9: Health and Wellbeing: The prison takes all reasonable steps to ensure the health and wellbeing of all prisoners. The AHSU management team worked well in collaboration with the prisoner healthcare team, and SPS to ensure these actions were addressed in a timeously manner. The team met with HIS a further twice between the initial inspection and August 2023 to review the progress made. In September 2023, HIS officially signed off the plan as complete with no further review required until the scheduled inspection in 2027. Commendations were made at the efforts made to address the recruitment, retention, and overall staffing issue in the prison. Currently, 20 of the 22 recommendations are 100% complete, with the remaining two actions ongoing as part of a pharmacy review. 13. Mental Health & Wellbeing Strategy The success of the Lanarkshire’s Mental Health and Wellbeing Strategy, 2019-2024 is the result of co- production, ongoing engagement, robust planning, trusted collaboration and joint implementation of a system-wide approach to mental health and wellbeing in Lanarkshire, with all partners considered equal. The key achievements of the 2019-24 Strategy have been reported to the Board in a separate report. Given the close alignment between the 2019-2024 Lanarkshire and 2023 national strategies, the Integration Joint Board agreed at its Liaison Session on 8th November 2023, agreed with the proposal that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire Page 180 of 218
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22 Delivery Plan. The Lanarkshire delivery plan will be aligned to the strategic actions set out in the national Delivery Plan, and link clearly to local strategies and plans including both Health and Social Care Partnership Strategic Commissioning Plans, NHS Lanarkshire’s Our Health Together strategy, Children’s Services Plans, the Plan for North Lanarkshire Community Plans and Local Outcome Improvement Plans. Since then, work has been undertaken to: • Establish a sustainability plan to identify any outstanding priorities and actions from 2019-2024 strategy to be carried forward into the new Lanarkshire Delivery Plan; • Assemble a final report on the work carried out over the 2019-2024 Mental Health and Wellbeing Strategy, a Review report of the MHWS 2019-2024 for sharing and publication; • Carry out a self-assessment of where we are in Lanarkshire in relation to the strategic actions set out in the National Mental Health and Wellbeing Delivery Plan; • Engage with stakeholders both at Lanarkshire-wide, including a self-assessment workshop with all stakeholders, presentations and discussion at Lanarkshire Links Quarterly meetings and locality level, via the Community Boards in North Lanarkshire, to identify any further priorities and actions for the Lanarkshire Delivery Plan; • Prepare a draft Lanarkshire MHW Delivery Plan for adoption by the Integration Joint Board, subject to the endorsement of South Lanarkshire IJB, Community Planning Partnerships, North and South Lanarkshire Councils and the Lanarkshire NHS Board; • Propose future governance and leadership for the implementation of the MHW Delivery Plan – set a draft plan and Terms of Reference for Lanarkshire MHW Delivery Board • Stand down current Mental Health and Wellbeing Strategy Board, Executive Group and associated workstreams and close the 2019-2024 programme of work; 14. Speech & Language Therapy The Speech and Language Service Improvement Group was established in 2023 and undertook a scoping exercise with a view to developing a new service model. As a result, areas of priority were agreed, and work streams established: Waiting List This work is progressing well in a testing phase following • review and standardisation of the processes that support patient pathway and inform digital plan. Page 181 of 218
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23 • Agreeing, refining and developing core clinical offerings at Universal, Targeted and Specialist level. • Ensuring workforce have the confidence, resources and knowledge to deliver the core service model Digital Previously, the service had no digital footprint. Trakcare has been implemented since September 2024 and the service is at an early stage of being able to gather evidence from the robust data it can provide. However, early indicators are that this will provide necessary evidence to better understand recording of interventions, where barriers or bottlenecks can occur in pathway. Communications and Engagement Colleagues within the service had already well-established social media platforms and information and education via YouTube that was used to support children and young people and their parents and carers. Support has been provided to extend SLT website to include adult services. This will coordinate all SLT information to one defined space. Members of group are also contributing to development of an app that will support children and families who are supported by local health visitor colleagues. HR and Workforce A review of all posts across the service has been undertaken. Focus of future work is on continued development of relationship with higher education. This will support opportunities for students in training as well as provide development for opportunities for career development of both unregistered and registered roles. Administration and Accommodation This work is at an early stage and will be appropriately informed by evidence now available due to implementation of Trakcare. 15. CAMHS There have been 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery: Page 182 of 218
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24 Neurodevelopmental Service All neurodevelopmental requests for assistance are now channelled via the established Neurodevelopmental Service. This combined three previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. This is a highly skilled workforce and maximum efficiencies within resource are assured. Time limited commission of an external provider has provided additional capacity that facilitated assessments of young people before they graduated to adult service referral routes. Demand for assessment continues to exceed capacity. This has been highlighted nationally and is common across all health board areas. It is advised that national work will influence next steps with neurodevelopmental services. Choices & Partnership Approach (CAPA) This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. HR & Workforce A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. Communication and Engagement An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. eHealth Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. Capital/Strategic Planning Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same. Page 183 of 218
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25 The objectives initially set by Programme Board have been realised and have now progressed to a stage of sustainability of performance and quality assurance that is aligned with national specification. The performance trajectory is positive. 73.91% against an RTT of 90% was delivered in July 2024. Objective analysis by Public Health Scotland colleagues has assured that full delivery of 90% RTT should be realised by October 2024. This is reliant on continuance of funding aligned to a workforce that is responsible for delivery of trajectory. Additional modelling is taking place to provide assurance of patient review list care provision. Whilst not a government recorded or formally reported target, it is a good indicator of patient experience and shifts balance of care from responsive crisis management to planned intervention. Additionally, we continue to work with West of Scotland colleagues to deliver a standard of care provision capable of managing care locally and consistently to facilitate equity with other health board areas. This has included expansion of our unscheduled CAMHS (UCAMHS) model. It has combined the expertise of CAMHS Duty Team, Intensive Treatment Team and Nurse Team. Hours of service delivery will be further expanded in October. This additional capacity and expertise will support avoidance of admission care planning, support safe hospital discharge and manage risk appropriate to environment. The UCAMHS response model is available to all children and young people on both CAMHS and NDS lists who experience deterioration in mental health whilst waiting to be seen or awaiting specific treatment. This service is also open, by referral, to any child or young person previously unknown who has presented with an acute deterioration in mental health with aligned escalation of risk 16. Paediatrics Review In order to deliver the Paediatrics Review programme, five working groups were established: • Communications and Engagement • Accommodation • Transition and Interfaces • eHealth (now Digital) • HR and Workforce • Regional and National Links Page 184 of 218
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26 All are at various stages of progress and have been prioritised according to acuity of clinical challenges that have arisen. Additionally, a sixth group has been established to ensure the modernisation plan is aligned with current financial challenges and potential for saving realisation as well as transformational change. A 3 Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: Horizon 1 • Nursing Care Assurance • Review of Continence Services Horizon 1 work is progressing well. The nursing care assurance work has been led by the Associate Director of Nursing and been supported by NHS Lanarkshire Quality Improvement Team. The standards agreed have been inclusive of contributions made by nurse colleagues who work within paediatric in- patient environment and of community based nurses who support specialist care for children within a clinic, their home and/or school environment(s). The Review of Continence Service has been led by Clinical Lead for Community Paediatrics. This has been more challenging to progress due to clinical demands on colleagues involved, changes within continence aligned workforce and assurance work identified that required address prior to full commencement of work. Despite these challenges, a literature review has been undertaken and review of current service model undertaken with a plan to test new model soon. We expect further projects to be undertaken subject to availability of clinical staff. Further examples of work already being considered is the development of a supported palliative care pathway and review of current acute pharmacy colleague support and its interface with primary care. Prioritisation of work to be undertaken in future will be informed by release of capacity of colleagues who are completing initial Horizon 1 work and colleagues who can be released from clinical activity. Horizon 2 • Sustainability of medical rota Page 185 of 218
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27 This Horizon 2 focus of work emerged quickly as a clinical risk due to unsustainability of Tier 1 and 2 medical rotas that require to be in place to ensure safe function of in-patient care. Tier 1 is junior trainee doctors who provide the foundation of medical intervention within ward. Tier 2 trainees are higher trainee doctors who are working towards becoming a consultant within paediatrics. This is an important trainee rota to fill as it provides a pathway for interested trainees to return in the future as consultants. If numbers are not coming through and/or they do 5 not have a good trainee experience whilst with us, it will have a negative impact on long term recruitment of these specialist colleagues to Lanarkshire. Tier 3 is our consultant level rota. All rotas are inextricably linked and cannot be separated without negative impact on wider system, and at times on individuals. This fragility of rota is due to a culmination of factors which include less availability of trainees being provided by deanery and increasing numbers of trainees who want to work less than full time. This has resulted at times, in increased pressures resulting in use of locums and of requests generated to consultants to act down into senior trainee roles. This negatively impacts on planned community care assessment and review and places an additional burden of stress on an already tired workforce. Due to level of risk identified, additional support was approved by Core management team. Additionally, our Medical Director continues to have dialogue with deanery to assure that we are receiving an equitable offer of trainees. Horizon 3 • New clinical model Clinical capacity will need to be realised from completion of ongoing Horizon work to facilitate taking forward this larger piece of work. Meantime, informal discussions have commenced between nursing and medical colleagues with their respective professional leads. Health and well-being of colleagues during times of significant change have been recognised as a potential barrier and risk to further progression of work. Organisational development colleagues are supporting professional leadership and operational management to appropriately support staff throughout and beyond this programme of work by involving them in “stay conversations” which can also contribute and inform to modernisation plans. Page 186 of 218
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28 The pace of transformational change has been slowed by limited capacity of clinicians to commit time to service improvement work. This is due to clinical demand, which can be variable throughout seasons of year. This will be factored into plans for spring and summer 2025 that will aim to progress work towards delivery of new clinical model, Horizon 3. 17. Community Solutions The Community Solutions Strategy and Investment Plan 2022-25 was approved in 2022 and continues to deliver a range of programmes activities within the third sector, supported by a range of programme evaluation and accountability arrangements. During 2023/24, VANL managed the provision of funding awards to Community and Voluntary Sector (CVS) organisations to deliver services to local people on a range of priority issues: • Anticipatory Care Support • Befriending Support • Carer Breather Fund - Phase Two • Children, Young People and Families Mental Health and Wellbeing Fund - Phase Four • Community Mental Health and Wellbeing Fund - Phase Two • Community Transport • Hospital Discharge Support A future review of funding arrangements will explore the following areas and develop updated investment proposals, which will improve health, wellbeing, and inclusion, whilst reducing demand on public services: • Our Community Connectors’ pilot scheme • Continuation of our effective support for people discharged from hospital provided by the CVS. • Support for unpaid carers – especially short breaks from caring • Strengthening CVS support for physical activity given the significant benefits to health that can be achieved through physical activity and the potential for the CVS to provide further support. • Strengthening volunteer driver support for people attending health and social care appointments, to support access and inclusion more cost-effectively. Page 187 of 218
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29 • Review of anticipatory care and befriending will be supported through a separate complementary process Achievements to note from 2023 and 2024 include: The focal point of the Improving Lives Initiative is a pilot of Community Connectors using the “three conversations” approach to assist people in crisis to help them find support from community and voluntary groups and, if appropriate, refer them to sources of support from the public sector. This includes people with a diagnosis of cancer. Ten connector posts are funded for two years and are employed by North Lanarkshire Disability Forum, which has considerable relevant experience having previously employed advisors to assist people with self-directed support for over six years with national funding. Capacity Building • Carers’ capacity building – North Lanarkshire Carers Together supporting empowerment and engagement of carers • Community & Voluntary Sector Capacity Building – VANL supporting the provision of specialist guidance to CVS organisations that assist children, young people and families. • Volunteering capacity building – VANL continue to promote volunteering within health and social care support roles and liaise with volunteer-involving organisations to improve their volunteer management and support 18. Digital Technology & Systems The digital system transformation activity taking place across the partnership is considerable and the key projects such as Mosaic (the new social work case management system) and Dynamic Scheduling Tool are critical phases and will go Live before the end of this financial year. Each of the project teams continue to work with all stakeholders, including Senior Managers, front line staff and integrated teams across the partnership, to ensure a smooth transition as each product goes live and to ensure the benefits outlined above are realised. Page 188 of 218
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30 Implementing these systems presents not just a shift from legacy systems, some of which are end of life, but also a cultural shift in using digital platforms which allow the service to function differently. The ability to access and generate accurate and real time information to support practitioners, the ability for supported people to access their own data and the enhanced data quality and integration offered by these products will continue to support the service in enhancing staff’s digital skills across a range of settings. As part of the review of the oversight groups for the programme of work, a new Digital & Technology Group has been established for the partnership and will be tasked with pursuing a range of programmes and projects which will introduce and embed a range of new digital systems, technology and equipment across a range of health and care settings. An important part of this work will be ensuring appropriate alignment with the digital developments already in progress within the other programmes of work highlighted in the report, e.g. CAMHS, Mental Health & Wellbeing Delivery Plan, etc. 19. Engagement & Participation Strategy Over recent months a focused effort has been directed towards refreshing the Engagement & Participation Strategy that will serve as the foundation across all areas of our work. The final version of the Engagement & Participation Strategy 2024-27 was approved in May 2024. In the development of the Strategy, we actively engaged with stakeholders; representatives of community- based organisations, supported people, carers, and staff teams. Learning from these sessions has highlighted what is considered good engagement and participation and provided confirmation that the refreshed strategy should: • Be short and user friendly. • Be an overarching strategy that can guide communication and action planning across all areas of services and supports. • Build from the current strategy, including what we have learned and what people have told us. There has been good progress to increase the resource and capacity across community-based organisations to strengthen the voice of supported people, including those harder to reach e.g. BAME, LGBTQI+ and those in more rural communities. Page 189 of 218
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31 We recognise the importance in ensuring that engagement and participation is meaningful and not tokenistic, so the principles of engagement and participation are now included in the Staff Induction programme, both as written information and as a direct input to programme for new social work and social care practitioners. A wide range of stakeholders have been actively engaged in the development of the Strategy through consultation and direct involvement. Promotion to implement the Strategy will be a shared responsibility and will include awareness raising and the development of practical tools to support: • An evidence base on how people experience services and how their experience shapes and improves future development of services and supports. • The voice of supported people in our communities • Increased capacity for early intervention and prevention. • Two-way communication and a strengthened feedback loop back to decision makers • Increased feedback and the role of lived experience in improvement of services and supports. • Increased connections with supported people and communities that are harder to engage with. • Increased awareness about what is important to supported people and their communities. The refresh of our Locality Planning Group arrangements and alignment with the Locality Planning Teams and Community Boards is underway. Once finalised, this will provide sector, locality, and thematic forums, which can be influenced and shaped through engagement and participation with our Communities, Carers and Supported People. 20. Academic Partnerships In the past year, there has been a significant development in the strategic academic collaborations within the Lanarkshire system. With NHS Lanarkshire updating its Service Level Agreements with the University of Strathclyde, Glasgow Caledonian University and University of West of Scotland, work was also undertaken to develop strategic Memorandums of Understanding (MoUs) with both Councils. Through these developments, MoUs have now been agreed with Glasgow Caledonian and both Councils, with the two Health and Social Care Partnerships now granted University Status with GCU. Work continues Page 190 of 218
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32 to develop this approach with the other two Universities as we continue to develop our strategic academic approach. Overall, significant progress continues to be made across the NHS Lanarkshire and the Health and Social Care Partnerships in academic collaboration with partner universities. There has been an expansion not only in the volume of collaborative work undertaken but also in the complexity of projects and in the increasing diversity of links between NHSL and multiple departments and individuals across our strategic partnerships. There is a mutual desire to explore many more projects and areas of innovation that often require short notice decision making associated with modest sums of fixed term investments, though there has also been significant external funding identified over the year. More recently, the University of Strathclyde has signed Memorandums of Understanding with both Lanarkshire councils – consolidating the formal, multi-agency collaboration and continuing to develop the relationships and opportunities for the HSCP and local authorities. 21. Care Academy The Care Academy is a collaborative initiative between NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. The Academy is authorised to work with partners such as local councils, education departments, colleges, universities, the independent sector and third-sector organisations to attract and recruit staff to the health and social care workforce. Four workstreams have been established: Workstream 1 – Attraction, recruitment, retention and wellbeing Developing recruitment strategies to attract prospective candidates to the sector. Engaging and focusing on employee safety, well-being motivation to enhance employee retention. Workstream 2 – Pathways to care for young people Strengthening the reach and impact into the health and social care sector through a vocational education model, aiming to grow a future talent pipeline. Page 191 of 218
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33 Workstream 3 – Adult pathways to care Improving prospects for working-age adults entering the health and social care sector, addressing poverty, and inequality, attracting passive candidates, and facilitating career change opportunities Workstream 4 – Funding and procurement Continually review and assess current and upcoming funding streams and identify potential gaps and opportunities. Explore the potential of community benefits opportunities. It was agreed at the most recent Board meeting to put this workstream on hold until the others are all well established. Incomplete and unlikely to be delivered against agreed timescales – remedial action required. Incomplete and but within acceptable thresholds. Complete or on-track for completion against agreed timescales Page 192 of 218
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref CR/SF Date 18/02/25 Adult Social Care Performance Report – Quarter 2 2024/25 From Claire Rae, Chief Officer, North Lanarkshire HSCP E-mail Claire.Rae@lanarkshire.scot.nhs.uk Telephone 01698 858143 1. Background 1.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. 1.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions. Executive Summary The purpose of the report is to provide an update to the Committee on the performance of key areas of activity within Adult Health & Social Care for the period 01st July 2024 to 30th September 2024 (Quarter 2 2024/25). Recommendations It is recommended that the Adult Care and Social Work Committee: (1) Endorse the improvement actions included within Appendix 2 of the report; and (2) Acknowledge the performance of key areas of activity within Appendix 1 of the report. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (25) Ensure intelligent use of data and information to support fully evidence based decision making and future planning Programme of Work Resilient People Item 5 Page 193 of 218
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1.3 Information from these performance reviews has been supplemented with additional performance information below to offer the committee a wider overview of performance across some key areas of adult social care delivery. 2. Report 2.1 The purpose of the report is to provide an update to the Committee on wider performance of key areas of adult social care delivery, in addition to the performance areas for improvement which have been identified as part of the Chief Executive Quarterly Performance Review for the period 01st July 2024 to 30th September 2024 (Quarter 2 2024/25). 2.2 The performance data for Quarter 2 and associated trend information is included as Appendix 1. 2.3 Areas for improvement and planned actions are agreed and developed on an exception basis (i.e., for those indicators which are amber or red, based on tolerance thresholds). These are detailed as Appendix 2 of this report. 3. Measures of success 3.1 Measures of success are contained within Appendix 1 of this report. 4. Supporting documentation 4.1 Appendix 1: Adult Social Care Dashboard 4.2 Appendix 2: Areas for Improvement 01st July 2024 to 30th September 2024 (Quarter 2 2024/25) Claire Rae Chief Officer North HSCP Page 194 of 218
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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 195 of 218
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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 196 of 218
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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 2023/24 Q1 2023/24 Q2 2023/24 Q3 2023/24 Q4 2024/25 Q1 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 28 31 31 35 Data not available GREEN 2.16 Assistive Technology - Number Of People With Technology (18-64yrs) 631 618 624 632 Data not available 2.17 Assistive Technology - Number Of People With Technology (65+) 825 856 858 905 Data not available 2.18 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 816 1355 2011 527 444 AMBER 2.19 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 70.3% 70.0% 60.8% 61.1% 57.1% RED 2.20 Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 48.0% 58.8% 58.5% 62.6% 58.1% RED 2.21 Balance Of Care - % Of People (Age 65+) 45% 36.7% 34.0% 36.4% 37.1% 37.0% RED 2.22 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 49.9% 53.5% 63.4% 87.1% Data not available ... 4.2 Complaints Processed Within Timescale (NLC) 85% 76.5% (Stage 1) 57.1% (Stage 2) 81.3% (Stage 1) 100% (Stage 2) 92.9% (Stage 1) 100% (Stage 2) 81.1% (Stage 1) 87.5% (Stage 2) 84.6% (Stage 1) 63.6 (Stage 2) GREEN 4.3 Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 22.0 21.9 22.0 22.1 22.2 GREEN 4.4 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 45.8 45.6 45.9 46.3 46.6 GREEN 4.5 Care Home - Average Length of Stay 865 891 835 834 708 789 GREEN 4.6 Number Of People With Self Directed Support 1,000 2093 2092 2089 2054 2114 GREEN 4.7 Number Of People With A Direct Payment 240 342 357 379 355 365 GREEN 6.1 Community Alarm Service Users 75 Years And Over Per 1000 Population Under Review 193.9 196.5 195.8 196.7 195.0 ... ... … 7.21 % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 14.8% 12.7% 20.1% 24.7% 30.6% GREEN 7.22 % Of Adult Protection Investigations Going To Initial Case Conference 20% 10.4% 19.2% 11.9% 12.3% 6.9% RED 7.23 Adult Protection - % Of Referrals With Decision Within 5 Days 60% 77.8% 76.3% 81.7% 80.3% 83.6% GREEN Page 197 of 218
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7.24 % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 74.2% 75.9% 71.5% 66.0% 57.4% GREEN 9.4 Breakeven Position - Projected Outturn (NLC) >=0 4.304m Underspend 3.112m Underspend £3.331m underspend £0.059m underspend £1.270m underspend ... ... ... 9.6 Sickness Absence (NLC) - days lost per person 9.22 6.93 10.29 13.74 3.48 6.34 GREEN Page 198 of 218
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Appendix 2 – Areas for Improvement 1. Reablement and Rehabilitation Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 61.1% 57.1% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 62.6% 58.1% RED Balance Of Care - % Of People (Age 65+) 45% 37.1% 37.0% RED Narrative & Corrective Action During 2023/24, the number of people completing the Reablement process increased, however in 2024/25 there has been a reversal of this trend. The percentage of new or increased HS packages that are Reablement is relatively stable but below the targeted level of 70%. However, the percentage of people with no, or reduced Home Support at the end of the Reablement process has failed to meet the targeted level of performance for some time, with no trend supporting a trajectory toward achieving the targeted level. Additional data/information on Reablement is available from the IRT dataset. Throughout 2024/25, the overall number of IRT/Reablement referrals has decreased, however it should be noted that this decrease follows a notable and significant increase at the start of the financial year. There is no target set for this metric, however it complements the Reablement information presented above and should be considered in the context of a wider system of Reablement, Rehabilitation and Home Support. As the volume of IRT/Reablement referrals decreased, there was a corresponding increase in waits, which is contrary to expectation. Page 199 of 218
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Additional data/information on Reablement is available from the Home Support dataset and is presented below. Throughout 2024/25, the overall number of people starting a HS/Reablement has decreased, however it should be noted that this decrease follows a notable and significant increase during the winter period. There is no target set for this metric, however again complements the other information presented above and should be considered in the context of a wider system. Page 200 of 218
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ANALYSIS OF HOME ASSESSMENT TEAM DATA TRENDS – POSITION AS OF HAT REPORT DATED 8TH NOVEMBER 2024 Referrals Overall Referral Volume: Since its inception, HAT has accepted 2,645 referrals, with October 2024 recording a peak of 147 accepted referrals. This marks the tenth month within the past year where accepted referrals exceeded 100, and the ninth consecutive month of such volume. Geographical Distribution: Wishaw and Cumbernauld each contributed 22% of the total referrals over the past year, while Motherwell and Airdrie accounted for 18% and 17% respectively. Bellshill and Coatbridge have shown increases in recent months, now contributing 9% and 12% respectively to the total overall volume of referrals. Page 201 of 218
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Hospitals of Origin: University Hospital Wishaw has 50% of referrals, University Hospital Monklands in Airdrie at 47%. A small proportion (3%) falls under "Other," which is mostly older cases with unspecified sources and incomplete data. Monthly Referral Trends Seasonal Variations: The average number of referrals per month over the past year is 119, with notable declines in December and January, likely attributable to holiday periods. October 2024 saw the highest monthly total with 147 referrals. Weekly Inconsistencies: Weekly referral rates have averaged around 30, with recent weeks showing an increase, peaking at 42 during the week of 20th November 2023, likely due to the “Firebreak”. Demographics Age and Gender: The majority of referrals (60%) are female, with 40% aged 75-84 years. Only 10% of referrals are for individuals under 65, and none for those under 18. A recent data clean-up has ensured that no unknown ages are recorded. Input Services Service Allocation: 2% of referrals had no input services, which is a slight decrease; data cleansing is identifying older and those cases where there is incomplete data. The majority of referrals (59%) had 1 or 2 services, while 40% had 3 or more services, an increase from the previously reported 35%. Service Utilisation: Home Support remains the most utilised service (86%), followed by Occupational Therapy (62%). Physiotherapy services have notably increased from 20% to 27%. Outcomes Re-admission Rates: Re-admission to hospital at the end of the HAT process remains a concern, with 14% of individuals being re-admitted. This is an unfavourable outcome, indicating potential issues in initial service suitability or adequacy. Service Requirement at Completion: Upon completion of the HAT process, 64% of individuals required no further service, while 36% needed at least one additional service. Of those needing further services, 74% required one service, and 26% needed two or more. Page 202 of 218
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Completion Rates Completion Statistics: A total of 2,504 individuals (95% of total referrals) completed HAT services. Wishaw led with 27% of total completions, followed by Cumbernauld (23%), Motherwell (19%), and Airdrie (19%). Timescales Process Duration: The average time from referral to completion remains at 15.6 days. However, 52% of cases took over 14 days, and 5% exceeded 31 days. While shorter timescales are generally favourable, excessively short durations may indicate inappropriate referrals or premature case closures. Summary Referral Acceptance: There has been a substantial and sustained increase in accepted referrals, particularly from Wishaw, possibly reflecting the development of HAT services in these localities. Service Utilisation: An upward trend in the number of services per referral suggests increasing case complexity. Ensuring appropriate service allocation, potentially through the development and scaling of B2B/Enabling, should be considered. Outcomes and Re-admissions: The stable re-admission rate of 14% should be investigated. Reducing re-admissions by ensuring appropriate initial service allocation and addressing complex needs through B2B/enabling may be a consideration. Completion Times: While shorter completion times are generally positive, a view on whether premature case closures are a factor in re-admission, or have an effect in the wider system should also be considered. Overall, the data shows positive trends in referrals, alongside ongoing challenges in managing and fully understanding completion timescales. ALTERNATE INDICATORS A wide variety of indicators that complement and supplement the Reablement position are available. Consideration should be given to the indicator set presented and whether targets should be reset, particularly in the context of B2B/Enabling. The Balance of Care indicator in the Scorecard reflects the number of people aged over 65, receiving more than 10 hours of Home Support (65+), against the number of older adults in HBCCC and Care Homes. Given the focus on moving support arrangements for Page 203 of 218
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older adults to individual budgets, if the figure were to include the older adults who previously received home support from the independent sector and have since moved to individual budgets, the performance improves significantly. However, the current metric does not reflect this shift and consideration of alternatives may be useful for Executive Leaders. 2. Adult Social Work Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status % Of Adult Protection Investigations Going To Initial Case Conference 20% 12.3% 6.9% RED Narrative & Corrective Action In Quarter 2 of 2024/25, North Lanarkshire Social Work Services received fewer Adult Support and Protection (ASP) referrals than during the same period last year. However, there was a notable increase in the number of Police 'Adult Concern' reports when compared with the same quarter in the previous year. The general increase in volume of Police Adult Concern reports is indicative of the developing role of Police Scotland as a key partner to Social Work Services, however may also represent an unmet need or changing demand within the community. There was significant variation in the monthly referral rates across the six localities. Notably, Cumbernauld saw a 9% increase in referrals from the previous year, while Coatbridge and Bellshill saw significant decreases of 44% and 31%, respectively. Care Home referrals dropped significantly, likely due to collaborative efforts with local care homes to reassess reporting thresholds and provide alternative support options. Police 13% NLC - SW 13% Health 26% Care Home 18% NLC - Housing 4% Fire Service 5% Family/ Public 1% Carer 15% Other 5% REFERRALS IN QUARTER BY REFERRER Page 204 of 218
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Locality Police Adult Concern reports Q2 24/25 ASP Referral (all sources) Q2 24/25 Total activity to keep adults safe Airdrie 165 105 270 Bellshill 102 85 187 Coatbridge 204 114 318 Cumbernauld 295 127 422 Motherwell 139 90 229 Wishaw 226 111 337 Totals 1131 632* 1874** Emotional/Psychological and Physical harm were the most common reasons for referral during Q2, with a notable increase in Self-neglect and Self-harm referrals received. 35 26 36 48 31 34 47 29 27 39 39 30 45 30 41 32 39 40 29 32 34 AIRD BELL COAT CUMB MOTH WISH HQ/SWES Referrals in Quarter by Month and Locality Jul Aug Sep Page 205 of 218
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Out of the 743 ASP referrals received, 10% (72) were redirected to other services, while 27% (206) progressed to investigation. 50% (373) were recorded as No Further Action (NFA) under ASP procedures, although many of these cases still required interventions to promote welfare. The number of ASP investigations carried out this quarter rose significantly to 206, a 76% increase compared to 117 investigations in the same period last year. However, only 6% (13) of these investigations progressed to an initial case conference, a slight decrease from last year's 10%. Key Insights for Q2 2024/25: • There was a decrease in total ASP referrals compared to last year. • There was a notable increase in the number of Police 'Adult Concern' reports. • There is a rise in the number of referrals for Self-neglect and Self-harm. • Despite a significant increase in the number of investigations, fewer progressed to case conferences. EMOTIONAL OR PSYCHOLOGICAL 35% FINANCIAL 9% INSTITUTIONAL HARM 3%MATERIAL 0% PHYSICAL 35% SELF HARM 4% SELF NEGLECT 12% SEXUAL 2% REFERRALS IN QUARTER BY PRIMARY REASON Page 206 of 218
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref CR/MD/PH/LH Date 18/02/25 Revenue & Capital Budget Monitoring Report: Adult Social Care Period 10: 01/04/2024 to 03/01/2025 From Morag Dendy, Chief Officer (Planning, Performance and Quality Assurance) E-mail hendryp@northlan.gov.uk Telephone Paula Hendry, Business Finance Manager, 07471321768 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 3 January 2025 (Period 10) 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 £274.392m and is currently projecting an underspend of £1.396m. This favourable variance is predominantly the result of the non-recurring underspend of £6.9m on pension costs resulting from the reduced contribution rate to the Strathclyde Pension Fund coupled with underspends due to vacancies. This is offsetting overspends within Overtime, Transport Costs and Payments to Other Bodies. This underspend represents a positive movement of £0.919m since the previous committee report resulting from anticipated reductions in spend in relation to home support overtime, equipment and adaptations, slippage in carers and ‘Care at Home’. 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 Item 6 Page 207 of 218
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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 approved Gross Expenditure Budget for the H&SCP – NL (Adult Social Care and Housing) is £274.392m. 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 £5.927m. 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. Both of which being partially offset by higher than anticipated costs in relation to home support staffing costs. 2.2 Property Costs are anticipated to be overspent by £0.276m. This is predominantly due to higher than anticipated spend on Care of Gardens, via the HRA budget, all of which is offset by higher contributions from NLC Housing, shown as income 2.3 Supplies and Services are anticipated to be underspent by £0.413m. This is mainly due to lower than anticipated spend in equipment and adaptations and across ‘other’ supplies. 2.4 Transport and Plant is anticipated to be overspend by £0.548m. This is mainly due to higher than anticipated costs in relation to staff mileage, coupled with estimated running costs associated with vehicles for use across the Service. 2.5 Administration costs are anticipated to be underspend by £0.206m. This is mainly due to in-year slippage in relation to Carers budgets. 2.6 Payments to Other Bodies and Transfer Payments are detailed in Appendix 2. This expenditure accounts for £167.497m of the annual budget and is forecast to have an in-year net overspend of £4.607m (2.8%). This is primarily in relation to anticipated spend in ‘Care at Home’ and Independent Care Homes. These projections are demand led and are based on full year costs for both current clients and those anticipated, therefore projections will alter as the year progresses, updates will be provided in future reports. 2.7 The Service anticipates a total over recovery of income of £0.263m. An over-recovery of £0.175m relates to Care of Gardens as highlighted in section 2.2, £0.136m relates to returned private sector housing grants and £0.066m relates to contributions from NHS Lanarkshire; these are partially offset by an under-recovery of £0.119m which is mainly as a result of lower than anticipated income from charges relating to the Integrated Day Services. Page 208 of 218
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Revenue: Savings 2.8 The Financial Plan of the Health & Social Care Partnership was approved by the Integrated Joint Board in March 2024 which identified an overall cost pressure for 2024/25 of £22.856m of which £11.402m relates to Adult Social Care. 2.9 To address this cost burden the Service has developed a savings delivery plan which aims to deliver this saving value over two financial years: 2024/25 and 2025/26. In order to spread these savings over two years the Service is using the non-recurring pension underspend and reserves to offset the shortfall in year 1. 2.10 The plan includes the following areas: • Reducing current overspends to align with allocated budgets. • Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities • Review of all overtime and agency costs • Review of non-traditional respite, advocacy and community services. • Review of whole system approach to ensure that when people contact the services the response is quick and effective, with a focus on helping people to help themselves first. • Review of all vacant posts. 2.11 Updates on these savings will be provided in future reports however Members should note that the current projected underspend should continue to grow as progress towards the achievement of these savings is made. Revenue: Earmarked Reserves 2.12 The Integration Joint Board have reserves of £24.804m for specific Adult Social Care commitments as detailed in Appendix 3. 2.13 It is anticipated that £6.412m of the earmarked reserves will be used during 2024/25. 2.14 The remaining £18.392m will be carried forward to 2025/26. Of this, £8.539m has been assessed by the Service and set aside for specific projects and initiatives as detailed in Appendix 3. This leaves a balance of £9.853m, specifically for ‘social care demand risk’, which has been earmarked to offset any budget pressures, including shortfalls in savings, and any unanticipated increase in demand. 2.15 All expenditure to be met from reserves are excluded from the outturn position. Capital: Analysis of Significant Variances 2.16 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. 2.17 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. 2.18 Appendix 5 outlines the Service’s total capital budget, outturn position and current contractual commitments. Page 209 of 218
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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 210 of 218
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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 211 of 218
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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 212 of 218
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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 213 of 218
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APPENDIX 1 [1] [2] [3] [5] [6] [7] EMPLOYEE COSTS 94,015,725 88,088,594 5,927,131 FAV 6.3% 466,005 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. Both of which partially offset by higher than anticipated costs in relation to home support staffing costs PROPERTY COSTS 3,163,701 3,439,866 (276,165) ADV (8.7%) (211,888) Higher than anticipated spend on Care of Gardens (Housing) SUPPLIES & SERVICES 7,277,527 6,864,442 413,085 FAV 5.7% 342,348 Underspends in equipment and adaptations and 'other' Supplies areas TRANSPORT & PLANT 1,782,480 2,330,247 (547,767) ADV (30.7%) 25,500 Projected overspend in relation to Internal Transport charges and staff mileage costs ADMINISTRATION COSTS 627,161 421,127 206,034 FAV 32.9% 197,047 Underspends in general admin across the Service and in-year slippage in relation to Carers budgets PAYMENTS TO OTHER BODIES 60,157,662 61,446,075 (1,288,413) ADV (2.1%) (400,917) Please refer to Appendix 2 for analysis TRANSFER PAYMENTS 107,339,864 110,659,161 (3,319,297) ADV (3.1%) 310,744 Please refer to Appendix 2 for analysis CAPITAL FINANCING COSTS 0 0 0 0.0% 0 REVENUE FINANCING COSTS 0 0 0 0.0% 0 OTHER EXPENDITURE 28,858 10,683 18,175 FAV 63.0% 8,478 TOTAL EXPENDITURE 274,392,978 273,260,195 1,132,783 FAV 0.4% 737,317 NLC CONTRIBUTION (208,023,791) (208,023,791) 0 0.0% 0 NLC CONTRIBUTION - HOUSING (2,229,010) (2,404,010) 175,000 FAV (7.9%) 175,000 In relation to higher than anticipated spend on Care of Gardens INCOME FROM HEALTH (58,337,244) (58,404,006) 66,762 FAV (0.1%) (14,440) FEES AND CHARGES (1,418,167) (1,299,109) (119,058) ADV 8.4% 26,172 Lower than anticipated income in relation to charges for Integrated Day Services OTHER LOCAL AUTHORITIES 0 (4,548) 4,548 FAV 0.0% 1,020 BUDGETED USE OF IJB RESERVES (2,706,056) (2,706,056) 0 0.0% 0 OTHER INCOME (1,678,710) (1,815,250) 136,540 FAV (8.1%) (5,737) Overrecovery in relation to returned private sectors housing grants and recharge income from other Council Services INCOME (274,392,978) (274,656,769) 263,791 FAV (0.1%) 182,016 NET EXPENDITURE 0 (1,396,574) 1,396,574 FAV 0.0% 919,332 [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Subjective Analysis Period 10 (01 April 2024 - 03 January 2025) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % MOVEMENT VARIANCE ANALYSIS Page 214 of 218
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APPENDIX 2 [1] [2] [3] [5] [6] [7] Care at Home (SDS Framework 1 & 2) 106,562,781 110,175,333 (3,612,552) ADV (3.4%) 303,955 Demand led activity. Independent Care Homes 47,092,736 49,180,600 (2,087,864) ADV (4.4%) (771,903) Demand led activity. Payments to NHS Lanarkshire 2,348,638 2,305,015 43,623 FAV 1.9% 17,509 Position reflects anticipated in year payments Non Traditional Respite 335,283 99,417 235,866 FAV 70.4% 2,228 Position reflects anticipated Locality demand Other Local Authorities - General 127,909 125,224 2,685 FAV 2.1% (28,334) Position reflects anticipated in-year demand Voluntary Organisations & Payments to Other Bodies - Gen 8,760,015 8,292,816 467,199 FAV 5.3% 337,155 Position reflects anticipated in-year demand Housing Support (RSL's) 777,083 483,828 293,255 FAV 37.7% 6,789 Position reflects projected contract levels Locality Flexibility 218,068 174,291 43,777 FAV 20.1% 38,057 Position reflects anticipated Locality demand Private Sector Housing Grants 1,152,378 1,156,571 (4,193) ADV (0.4%) 0 Position reflects anticipated in-year demand Medical Fees 122,635 104,097 18,538 FAV 15.1% 10,103 Position reflects Service's approach to absence management Agency Fees 0 8,043 (8,043) ADV 0.0% (5,732) Position reflects anticipated in-year payments Other 0 0 0 0.0% 0 TOTAL EXPENDITURE 167,497,526 172,105,236 (4,607,710) ADV (2.8%) (90,173) [4] NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Payments to Other Bodies & Transfer Payments Analysis Period 10 (01 April 2024 - 03 January 2025) Adult Social Care & Housing - INTEGRATED CATEGORY ANNUAL BUDGET PROJECTED OUTTURN PROJECTED OUTTURN VARIANCE % MOVEMENT VARIANCE ANALYSIS Page 215 of 218
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APPENDIX 3 Contract Monitoring Staff 87,351 1,000 86,351 0 87,351 22/23 Saving: Muirpark 27,485 11,911 15,574 0 27,485 Carers Act 2018 - Support 2,595,745 199,226 2,396,519 0 2,595,745 Social Care Demand risk 12,682,932 2,830,368 9,852,564 0 12,682,932 Tech digitial Improvements 389,719 77,829 311,890 0 389,719 Increase Advocacy provider 65,667 46,500 19,167 0 65,667 Discharge to assess/ PDD 109,196 56,596 52,600 0 109,196 Adapations Funding 308,571 308,571 0 0 308,571 Tech Improvements - SWIS 700,000 183,716 516,284 0 700,000 Tech Improvements - Comm Alarms 464,604 154,248 310,356 0 464,604 Tech Improvements - Home Scheduling System 3,698,423 388,276 3,310,147 0 3,698,423 Adult Protection Contribution 50,000 39,715 10,285 0 50,000 MH 2 NL10s 161,633 28,259 133,374 0 161,633 Cost of Living Helpline 359,993 264,845 95,148 0 359,993 HS resilience 656,188 120,252 535,936 0 656,188 Staff Training Academy "grow your own" 1,128,466 431,431 697,035 0 1,128,466 Building Capacity Funding Across The Ip Sector (part of Business Case) The Winter Planning & Enhanced supports Business Case TOTAL 24,804,931 6,412,563 18,392,368 0 24,804,931 1,318,958 1,269,820 49,138 1,318,958 NORTH LANARKSHIRE COUNCIL Revenue Budget Monitoring Report - Status of Earmarked Reserves Period 10 (01 April 2024 - 03 January 2025) Adult Social Care & Housing - INTEGRATED TOTALDESCRIPTION OF EARMARKED RESOURCE Approved Reserve Total 2024/25 2025/26 No Longer Required 0 Page 216 of 218
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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 10 (01 April 2024 - 03 January 2025) Social Work Capital Programme BUDGET MOVEMENTS 2024/25 £ Period Division Thematic Category Page 217 of 218
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APPENDIX 5 Social Work: Integrated Equipment and Adaptations 2,171,323 1,254,559 1,461,593 709,730 2,171,323 0 TOTAL 2,171,323 1,254,559 1,461,593 709,730 2,171,323 0 FINAL OUTTURN OUTTURN VARIANCETheme BUDGET ACTUAL COMMITTED NORTH LANARKSHIRE COUNCIL Capital Budget Monitoring Report - Summary Expenditure by Thematic Category Period 10 (01 April 2024 - 03 January 2025) Social Work Capital Programme UNCOMMITTED Page 218 of 218