Agenda Pack - 27 March 2024
North Lanarkshire Council · 27 March 2024
Back to Health and Social Care Integration Joint Board — 27 March 2024 and its agenda
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A meeting of the IJB will be held on Wednesday 27th March 2024 at 2-4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB ( 27th September 2023) For Approval Attachment Chair 4. Minutes IJB PFA (21st February 2024) For Approval Attachment Chair 5. Matters Arising/ Action Log For Review Attachment Chair 6. Chief Officer Update For Noting Verbal R McGuffie Strategic Planning & Development 7. Alcohol & Drugs For Noting Attachment M Dendy 8. Medical Assisted Treatment (MAT) Standards For Noting Attachment M Dendy 9. Staff Health & wellbeing For Endorsement Attachment M Dendy 10. Strategic Academic Partnerships Report For Noting Attachment R McGuffie 11. IJB Directions Letters For Approval Attachment R McGuffie Performance & Finance 12. Long Term Financial Plan 2024-2034 For Approval Attachment A Kilburn
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13. 2024-25 Delegated Health and Social Care Budget For Approval Attachment A Kilburn Governance & Policy 14. IJB Integration Scheme 2024 – Update following Consultation Period For Approval Attachment S Anderson 15. Annual Chief Social Work Officer Report For Endorsement Attachment A Gordon 16. NRS - Public Records (Scotland) Act (PRSA) For Noting Attachment R McGuffie 17. Reporting duties for local authorities and integration under Health and Care (Staffing) (Scotland) Act 2019 For Noting Attachment S Anderson 18. Risk Update For Approval Attachment S Anderson 19. Mental Health Hospital Based Clinical Complex Care For Approval Attachment R McGuffie For Noting 20. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 21. Date of Next Meeting 19th June 2024 9.30am-12pm For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 24th January 2024 at 10am-11.30am Present: Voting Members: Councillor Claire Barclay North Lanarkshire Nominated Councillor Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Michael McBride (Chair) North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Amanda Kilburn Chief Finance Officer North HSCP Ross McGuffie Chief Officer, North Lanarkshire HSCP Maddie Halliday Chief Exec, VANL Third Sector Rep Stakeholders: Harry Robertson Carer Representative Elizabeth Seaton Carers Together OFFICER IN ATTENDANCE: Stacey Anderson Support Services Project Manager Stacey Connor (Minutes) Governance Support Manager Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Colin Lauder (Deputy) Director of Planning, Property & Performance Trudi Marshall Nurse Director NLHSCP Cathy McGinty NHSL Partnership/Staff Side Rep Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) Maggs Thomson Head of Health North HSCP Maria Williamson Senior Manager, Quality Assurance APOLOGIES: Paul Carey Audit Scotland Dr Kenneth Dagg Secondary Care Medical Practitioner Diane Fraser Head of Adult Social Work Services Jann Gardner Chief Executive NHS Lanarkshire Alison Gordon Head of Children & Families & Justice Services CSWO of NLC James Muir NHS Lanarkshire Nominated Non Exec Director
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2 Fiona Owens Audit Scotland Dr Josephine Pravinkumar Director of Public Health John Watson Employee Representative NLC Unison ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB (22nd November 2023) The previous minutes were agreed as an accurate reflection of the discussion. 4. Matters Arising/ IJB Action Log There were no significant matters arising. Ross McGuffie provided the committee on actions contained within the rolling action log as follows: Item 1 Strategic Commissioning Plan- The community nursing review is on the agenda for the February IJB PFA committee. Item 2 IJB Self-Assessment Report - Audit Scotland have restarted a new programme which was paused due to the introduction of the national care service, it is planned to re start the self-assessment. This will be a topic at a future IJB liaison session. Item 3 Mental Health Strategy- This was discussed at 8th December IJB liaison session so will be removed. Item 4 Risk Management Strategy - This was discussed at 8th December IJB liaison session so will be removed. Item 5 Improving Cancer Journey- An update paper will be shared at a future committee; 1st cohort of staff is now in post with 2nd cohort being recruited to. The committee noted the updates.
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3 5. Whole System Winter Plan 23/24 This report provides an update on and confirms support for the planning arrangements being put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months– with particular recognition of the uncertainties and potential impacts that still remain relating to inclement weather, Covid 19, influenza, financial pressures, cost of living issues and other concurrent risks against the backdrop of major pre- existing system-wide pressures Planning for Winter 2023/24 commenced in August 2023 and, as in previous years, is undertaken in accordance with national guidance. Whilst the winter plan will be a Lanarkshire wide plan, it is being structured in two main parts for 2023/24. This is to recognise the significant work underway currently as part of Operation Flow 2 – which is aimed at maximising flow through acute hospitals and associated care pathways. 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. To enhance patient safety and staff well-being, the three priority areas agreed as continuing to underpin Operation Flow were noted to be: Managing Demand across our system Maintaining a positive admission and discharge balance Maximising Outflow Ross McGuffie advised what actions have been progressed to support Power up which has included: Testing the REACT processes as part of the new Front Door Target Operating Model to increase streaming of patients to the right part of the system in UHH and UHW. The testing has helped to ensure that processes are tested and staff confidence is increased prior to Go Live Maximise the availability of Senior Clinical Decision Maker in the Flow Navigation Centre as part of the new care model to support direction of patients to the right place and at the right time. The new care model was launched on 1 November 2023 Increase ‘Near me’ consultation and ‘Call before you Convey’ between Hospital @ Home and SAS to increase efficiency and capacity within the service Completing the bed base modelling for UHW and UHH sites to inform future planning and consideration of reconfiguration of the bed base to manage demand
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4 Undertaking focused improvement work within Medicine for Older Adults – UHW to maximise flow across the acute site and offsite beds Fast tracking access to interim care beds at Cumbernauld Care Home to create acute capacity Undertaking a review of all inpatients categorised as Hospital Based Complex Clinical Care (HBCCC) to determine if appropriately coded and placed or if another care location is more appropriate to meet their needs. Colin Lauder added operation flow has been ongoing for a year, this month now appointed 93 WTE staff to support the work. The frailty network has been established in particular to support unscheduled care, undertaking frailty assessment at the front door. Cllr Burgess asked is there any worries around flu vaccination uptake reduction. Ross McGuffie replied there has been a UK wide impact where there has been reduced impact which is also the same across the board for all vaccination programmers. Catherine McGinty advised staff have worked hard to encourage patient up take of vaccines and through delivering additional clinics. Cllr Burgess advised British Judo will contact Ross McGuffie directly to share some work they have undertaken on falls prevention; this was noted. Cllr Kelly queried has there been an increase on flu/ covid cases and any impact of this on staff and any particular recruitment challenges. Ross McGuffie replied there has been spikes over the last few months but not the same as previous periods during the pandemic. As part of the Winter plan a review and learning exercise will be undertaken that staff can contribute to. There are ongoing recruitment challenges particular in the independent sector. Progress is being made but it is taking time, we are gradually building up the workforce. Philip Couser asked how do we review impacts of the plan particularly for quantitative and qualitative data. Ross McGuffie advised this year we have refreshed the plan totally rather than just updating previous plans, we are in a different place with operation flow. There are a range of performance matrix’s which are reviewed weekly so can adapt and maxmise resources available. Colin Lauder added already starting to considering next year’s winter plan. Maddy Halliday noted we have a commitment to invest in longer term population health and inequalities and it would be helpful to have a link with the winter planning work and longer term population health for the 3rd sector especially for unpaid carers. Ross McGuffie noted happy to build these comments into the review when it is undertaken. Maddy Halliday added waiting to have a meeting to input into Lanarkshire plan. Colin Lauder added on Monday the NHS board considered future population health needs and have further session planned. Cllr Barclay noted the importance of wrap around care to support discharges, in the majority of cases this works but there are some cases where patients have been discharged and there is not home care and adaptations in place to support. Some patients have contacted Cllr Barclay directly to advise this.
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5 Ross McGuffie replied to Cllr Barclay to advise that when we receive any feedback via care opinion or other methods look to where improvements can be made but he would also be happy to receive any additional information she has. Ross McGuffie acknowledged that we need to get the right balance of care to not over provide to further disable people but also provide support required to assist recovery. Morag Dendy advised undertaking a current recruitment exercise to support recovery for patients and to ensure support is in place fast. The IJB: Note 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. 6. Winter Resilience Update Ross McGuffie shared a presentation with the committee to outline some of the key performance matrixes of the winter plan in relation to covid, flu and respiratory cases and also emergency department performance against 4-hour target. In summary: System is more stable than last year Front door and hospital sites are still challenges Overall occupancy remains over 100% Demand for support discharge remains high in Lanarkshire High demand for side rooms Cllr Kelly queried what are the projections of demand on the system will it sustain at this level or reduce. Ross McGuffie advised starting to look at Easter planning, in terms of projections covid, flu etc. but we are heading in the right direction for a reduction. Trudi Marshall added making sure we have the right care for patients going into off sites bed which is not right at present, so considering what model to use going forward. We need to ensure that decisions are clinically driven. Brian Moore asked has there been an impact of the interim care beds in Cumbernauld care home. Ross McGuffie advised have 15 beds identified for interim care in Cumbernauld care home which has been helpful. They are currently being using for delays of choice (e.g. if patients are waiting for a space in a preferred care home) and it has helped flow. Care home liaison team has worked jointly with social work team to support this. Colin Lauder added it has been a challenging winter but through partnership working starting to make a difference. The committee noted the update.
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6 7. National Care Service Update An Independent Review of Adult Social Care (IRASC) was published in February 202. The Review, chaired by Derek Feeley, a former Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland made 53 recommendations including the creation of a national care service (NCS) In August 2021 consultation on a National Care Service for Scotland was launched. The National Care Service (NCS) Bill was published in June 2022 and provided for the establishment of a NCS, under the responsibility of Scottish Ministers. The Bill provided for the transfer of listed social care and social work local authority functions, staff and assets to Scottish Minters or newly established local care boards. Call for Views on the Bill opened in July 2022 and closed in September 2022. The North Lanarkshire Integration Joint Board considered the response on the 21 September 2022. The Bill is currently at Stage 1 of the process, which aims to review the general principles contained within the Bill. The Health, Social Care and Sport Committee is the lead Committee, supported by seven others, in reviewing this stage, which is due for completion by 31st January 2024. Stage 2 will then allow MSPs to propose amendments to the Bill, which will then be debated and voted on at the Lead Committee. Any amendments agreed will then be used to develop a new amended version of the Bill for publication and consideration at Stage 3. Stage 3 allows MSPs to propose further amendments which will be debated and decided on in the Debating Chamber, and at this stage all MSPs can vote on them before final debate and vote on whether to pass the Bill in entirety. There are a number of changes proposed for inclusion at Stage 2 of the Bill process, which will impact on the IJB. This includes retaining and reforming the existing Integration Authorities rather than forming Local Care Boards; potential for independent chairs for IJBs; potential for direct funding for some elements; retention of Public Bodies Act elements allowing IJBs to employ staff; and importantly the shared accountability agreements supporting the local partner bodies to retain current functions and employment of staff. Brian Moore suggested if we undertake another self-evaluation we should compare ourselves against key learning points outlined within the report. It would also be useful to get updates in terms of progression of national digital platform to share information across Health and Social Care. Ross McGuffie advised will look at comparison when undertaking the planned liaison session and will bring an update for electronic records which has need ‘Mosaic’ being procured to manage this. RMcG
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7 Maddy Halliday reminded the committee that we have representation of 3rd sector and services users currently, which should continue with the future NCS. Morag Dendy replied this representation strengthens voices through those with lived experience and if this were to change it would be raised at a national level. The IJB note the update on the NCS bill and will received further updates when they are available. 8. Risk Ross McGuffie noted will consider updating the current risk held on the National care service. Maddy Halliday stated there is a specific risk in relation to the financial challenges for the 3rd sector which has deteriorated, an update will be provided soon; this was noted. Stacey Anderson advised as agreed with the approval of the IJB risk management strategy at the next PFA a risk and focus dashboard will be tabled to offer a deeper dive. RMcG 9. Date of Next Meeting 27th March 2024 2pm-4.30pm
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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st February 2024 2pm-4.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Michael McBride North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director James Muir NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Cathy McGinty NHSL Partnership/Staff Side Rep Harry Robertson Carer Representative Elizabeth Seaton Carers Together John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager John Boyd Audit Scotland Stacey Connor (Minutes) Governance Support Manager Nauman Dar (Shadowing) NHS Lanarkshire Nominated Non Exec Director Mark Dell Communications Manager Trudi Marshall Nurse Director North HSCP Fiona Owens Audit Scotland Dr Josephine Pravinkumar Director of Public Health Apologies: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Paul Carey Audit Scotland Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddy Halliday Chief Exec, VANL Third Sector Rep Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Dr Lucy Munro Medical Director North HSCP
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2 Maggs Thomson Head of Health NHSCP ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA (18th October 2023) The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Ross McGuffie updated the committee on the action log as follows: Item 11 Financial Plan Provision of Smoke Alarms –Have procured additional alarms this week which will work with the current system and the new system for smoke alarms. An update will come to a future meeting. Item 18 IJB Self-Assessment Report- No update. Item 23 Risk Register- This will be discussed at a future liaison session, Item 24 Performance Report- A report to update on SWISS progress will be tabled at the May PFA. 5. Chryston Hub Update The report was shared with the IJB PFA committee to provide an update on the development and delivery of Chryston Community Health Clinic. The build Programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. A Service Level Agreement (SLA) continues to be in place and as of January 2024 a notice of cessation is now formally lodged with GG&C. This exposed H&SCNL to a £392k financial gap if services where to be delivered within the known funded establishment and skill mix of the NHS Lanarkshire service model.
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3 The intention was to decommission Muirhead Clinic, however NHSL has offered this accommodation to another service and the site responsibility will transfer to SLH&SCP at the end of January 2024. The IJB has already approved additional funding (£212K) to support double running costs for one quarter to allow safe transition of repatriated services. There is however some comfort that the £392K funding gap previously identified may not be required. It was noted the committee will hold a future meeting at the new Chryston hub to allow members to have a walk round of the Health facility and also the school within the hub. Details will be shared in due course. Ross McGuffie noted that an updated capital plan for Primary Care linking with council services as well will be developed. Phillip Couser asked what work are we doing to look at new ways of working in the community hub and also have staff from GGC been transferred over as part of the Health Board boundary change. Ross McGuffie advised work is being done to look at the future operating models working with councils particularly creating synergy with the teams based in the same locations. Working with education colleagues to look at CAMHS and immunisation programs developing. Currently discussion is ongoing with HR colleagues to look at some Mental Health teams staff moving across. Cllr McBride advised Police Scotland may also become involved in future hubs across the community. Ross McGuffie advised there is a partnership agreement penned that will allow staff across the different agencies to use facilities and enhance partnership working. The IJB PFA: 1) Note the active and ongoing progress with the delivery of this capital programme. 2) Note the progress with the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and their associated Health and Social Care Partnerships (HSCP’s) 3) Note the previously identified financial gap reported Feb 2023 and work to date to progress towards final conclusion. 6. Hospital At Home The report tabled outlined the current Hospital at Home service provision, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. Hospital at Home (H@H) was initially set up as an Admission Avoidance service by NL H&SCP in 2011. The service covers all areas of North Lanarkshire and areas of South Lanarkshire (excluding Camglen) With prior endorsement from the (then recently retired) Cabinet Secretary for Health, all areas of Scotland were to introduce a H@H service. Having created the first H@H Service in 2011, the task for Lanarkshire was to
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4 provide full geographical coverage by the service, and expand our virtual bed capacity in already existing localities In 2022 the H@H service undertook a large scale project to introduce the service and provide 12 virtual beds in the Clydesdale locality within South Lanarkshire, and to extend the operating hours of the whole service. In February 2022 the service participated in the organisation’s “Firebreak” process and used the opportunity to test the value in extending their operating hours to later in the evening and weekends. This was evaluated with the learning and outcomes used to inform future decision making and service changes. As part of Health Improvement Scotland (HIS) non‐recurring funding programmes, they financially supported the recruitment of 2 Band 5 RGNs to administer the infusion of IV Furosemide to identified Heart Failure patients. This was with the intent that these patients, as identified by Heart Failure nurses as being clinically safe to remain at home for infusion, would no longer need to occupy an inpatient bed for up to 5 consecutive days for infusion only purposes. These patients are still clinically responsible to the Heart Failure service and H@H are responsible for the infusion only. Phillip Couser queried if the geriatric recruitment something we are still progressing. Ross McGuffie advised still progressing this but there is ongoing work to consider how the service can run. Trudi Marshall advised H@H in Lanarkshire was the first in Scotland so went with consultant led model to manage anxieties of it being a new service, but now we are in a different space where we can consider going with Advanced Nurse Practitioners (ANP) staff. Phillip Couser also asked do we have occupancy activity data. Ross McGuffie advised we have data but it is not a fixed number as it is not against a set number of beds and even with consultant led model it is still a far cheaper model in comparison to traditional hospital beds. Cllr Burgess noted he has some community intelligence of young men passing away with heart attacks recently he asked has this been raised anywhere else. Dr Pravinkumar advised covid and flu cases have decreased recently so doesn’t appear to link to this but there is no further intelligence. Brian Moore queried around the funding source for the service. Ross McGuffie advised this has been funding though non-recurring source to date and currently awaiting confirmation in the new financial year of funding continuing. The IJB PFA agreed following recommendations: (1) In line with the Scottish Government initiative to implement a Hospital at Home service in every Board in Scotland, that NHS Lanarkshire shall expand their service provision to the Clydesdale locality within South Lanarkshire.
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5 (2) In line with the Board’s Unscheduled Care strategy, that Hospital at Home should seek to expand their operating hours to increase virtual bed capacity. (3) To ensure that the service is achieving maximum efficiency and operating in line with the Boards strategic objectives, a Rapid Strategic Review would be undertaken. 7. Health Care Resettlement for Asylum Seekers & Refugees Across Lanarkshire Ross McGuffie spoke to the report which provided an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. The report also provided an update on the work of the healthcare resettlement team that was developed as a response on an interim basis to support those arrivals. In December 2021 the Home Office and Mears established an emergency contingency accommodation for single male asylum seekers at a hotel in East Kilbride. The Scottish Government in conjunction with COSLA committed to support Ukrainian people coming to live in Scotland via the Homes for Ukraine scheme and The Super Sponsor scheme. In May 2022 welcome hubs were set up within 2 hotels in Lanarkshire with a further 4 established in June 2022 with the Scottish Government extending the hotel contracts until March 2024. Ross McGuffie advised there is a Health Improvement manager and admin staff in post to undertake health needs assessment for this population. Currently down to 1 hotel (Bruce hotel) with roughly 70 men still awaiting housing, have also linked with tower programme via North Lanarkshire council to help progress. Ross McGuffie noted his thanks to the teams that have been involved. Cllr Burgess questioned has there been a rise in Tuberculosis cases linked to the programme. Dr Pravinkumar advise nationally there has been a discussion around routine screening been undertaken as there has been a slight increase. There has been a TB network established which is coordinated through Public Health Scotland. Dr Pravinkumar will share additional information with the committee to offer assurance. The IJB PFA noted the report and requested further updated when available. JP 8. Care Home Support Following communication from the Cabinet Secretary on 17th May 2020 there were additional requirements for the Executive Director of Nursing, Midwifery and Allied Health Professionals within NHS Lanarkshire (NMAHP) which included:
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6 • Providing professional oversight and clinical leadership and support ensuring health needs of care home residents are met. • Outbreak management • Oversight of testing and review of test results, and supporting the development and implementation of a range of testing approaches for care homes. • Conduct assurance visits and monitor information trends from safety huddle providing professional and clinical advice on provision of health care needs. • Support compliance with IPC whilst monitoring trends and escalations via safety huddle. • Support education and training in care homes in IPC measures. There are 86 care homes across Lanarkshire, 28 within North Lanarkshire and 58 within South Lanarkshire. There are approximately 3600 residents and 3200 staff working within the care home sector. Lanarkshire HSCPs have already began evolving their arrangements in collaboration with care homes, focusing on improvement, sustainability and viability, considering the learning and experience of the pandemic and the strong, positive relationships built between our local partners and the care home staff, residents and their families. The 2022 National framework has been development through a session involving staff, care inspectorate and commissioned services. Cllr Barclay asked has this collaborative work been fast tracked due to the pandemic. Trudi Marshall advised prior to covid there was a very small number of staff to support care homes but with national funding being available this has helped to expand the service as a whole. By working in collaboration with the care home provider’s outcomes have improved. Funding is due to stop at the end of the financial year and risk implications will need to be considered as well as options for future funding. Brian Moore asked are all care homes engaging with our staff. Trudi Marshall advised majority are engaging but for those who are not we approach the care inspectorate to assist in engagement. The well-being work within care homes has been really welcomed by the service. Ross McGuffie noted unhappiness is around the national care home contract and that some areas have done more than others. The IJB PFA agreed to consider the professional oversight and clinical leadership that is provided to the care home sector. 9. Community Nursing Review Community Nursing is a planned service that is delivered in all six localities and provides nursing care to people that cannot leave their homes to access nursing care within health centres.
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7 It provides this service to all age ranges and people can have a one off intervention or be on caseloads for a significant period of time. Anyone can refer into community nursing services including patients and carers. This service was last reviewed in 2006 therefore a review of community nursing within North Lanarkshire HSCP was commissioned by Nurse Director, Health & Social Care North Lanarkshire on 20 August 2023 with the aim to develop a model which meets the needs of our changing demographics and also to support improved workforce planning with clear career progression pathways. The report also outlined the vision and purpose of the service. We are currently testing out Single Point of Access which will tie into future models of care. Section 5.3.4. of the report outlined the new training programme for District Nurses, have also created own internal training programme which is now all work based learning rather than staff taking time out. Phillip Course queried if there has been enough investment to the service. Trudi Marshall advised Morse roll out has concluded and all staff have ipads now which has been an investment to the service. Have been looking at care assurance for quality of care within district nursing caseloads too. Still need to consider other digital investments that could be used within the service for preventative and proactive work. James Muir asked what other methods can we use to measure that the training programme has gone well. Trudi Marshall replied it has been successful in stabilising the workforce and that we review recruitment and retention in tandem, particularly through the practice development team undertaking surveys with trainees. It was noted that although we train staff but they then move to other services or Boards. Cllr Burgess asked is there a period of time that staff need to remain in the role before they move on. Trudi Marshall advised the previous programme of training would cost £48k per staff member whereas now costs roughly £1200. NHS Lanarkshire policy is that staff who complete higher education should remain in post for 2 years; would consider using the policy depending on the situation. Brian Moore asked what is the extend of the work staff which other Health and Social Care staff could undertake and is there national work reviewing the DNs workforce and role. Trudi Marshall advised in Lanarkshire there is differences even locally, have established a community nursing group for Scotland to benchmark across the service to bring this into line. Brian Moore asked when will an update come back to the committee; Trudi Marshall noted should be in next 6 months. The IJB PFA considered progress of Community Nursing review as recommended.
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8 10. Winter Resilience Operation Flow commenced in early 2023, with a 9-day Firebreak taking place that reduced site occupancy by around 15% and supported NHS Lanarkshire to move from black to red status on 6th March 2023. Since then, learning from this intervention has led to the Operation Flow 2 action plan and developments that commenced in summer 2023 with the aim of having the whole system better prepared for winter 23/24. One of the key areas of learning from Operation Flow has been the positive impact of targeted and intensive firebreaks. Early January is always a significant pressure point across the health and social care system following two four-day weekends, so a proactive Firebreak took place from Wednesday 3rd – Friday 12th January 2024. Following the January firebreak, a learning review was undertaken, with a number of highlights noted: • Structured, organised and robust processes • Team working and MDT collaboration • Timely discharge planning • Real time solutions found for challenges • Focus on patient safety and getting the right care in the right place at the right time • Occupancy reduced • Ward beat achievement improved • Increased discharges • Improved weekly performance • Frailty team at front door – 25% avoided downstream moves A number of challenges were also noted that require further exploration and development: Weekend Care Home discharges Reduced referrals and discharges during Christmas week Off-site bed purpose – need clear expectations with staff, patients and families Side room demand due to flu/covid impacting both 8hr and 12hr performance Referral rates, unplanned referrals and cancelled discharges remain high Admin capacity to keep Trak updated Delayed Discharge performance has remained much more stable than in previous winter periods, with strong and consistent discharge rates of over 100 per week being maintained since October and throughout December and January.
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9 Ross McGuffie advised that partners are undertaking review of the winter plan which will be coordinated nationally and will start to embed any learning into the plan for Easter and consider proactive firebreaks. Brian Moore asked from a North perspective is there capacity to reduce delayed discharges further. Ross McGuffie noted the original target was in the 70s which is below the national target, so far largely been able to get there consistently. Next step is to get into 60s with a key focus on home assessment and working with multi-disciplinary teams. The IJB PFA noted the progress made through Operation Flow and the impact so far over the winter period. 11. 2024/25 Budget Briefing John Boyd from Audit Scotland advised will have a draft audit plan shared by the end of March, there are no significant issues to bring to attention of the committee. Awaiting work from NHS and council to influence the plan. Ross McGuffie delivered a presentation to the committee to outline the current financial position. There has been no budget uplift and the pay award for next year has not been included in the below figures. There is a system-wide deficit forecast of £112.5m in 2024/25 • £78.2m for the rest of Health • £17.7m for North • £16.7m for South There has already been some work undertaken in NHS North HSCP on prescribing savings and financial management which has reduced the expected savings. Next steps are: • Continued review of financial planning assumptions for 2024/25 • Review of all current vacancies including length of time left vacant • Financial management of all areas of budgets currently in an overspend position • Continued service reviews including home support and self-directed support packages • Engagement working with key stakeholders, in the transformation of reform process • Collaboration with South Management Team primarily to review hosted services and joint working arrangements across Lanarkshire • Budget proposals submitted for approval • Tracking and reporting on agreed savings plans • Focus on reviewing areas of over spends James Muir requested details of timeline that will enable delivery of firm actions and what is the challenge to meet the savings targets. Ross McGuffie advised need to set a balanced budget by end of the financial year. As part
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10 of the process both partner organisations need to link together, the Council have more experience of managing financial challenges of this scale. Sessions are taking place with senior management teams and a finance board has been established- scrutiny will come from HSCP, NHS board and local authority. Brian Moore noted need to make it clear to new members that we need to set a balanced budget and the implications if we don’t. Stacey Anderson added currently reviewing induction document for new members which includes the scheme of delegation. Cllr McBride requested that the presentation be shared with the group. It was noted there will be a liaison session on 13th March to focus on the budget. The committee acknowledged the financial update. 12. Financial Monitoring The report shared provided a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period 1 April 2023 to 31 December 2023. As detailed in within the report, the IJB projected outturn position, prior to removal of ring-fenced funding, is an underspend of £5.796m, assuming the current trajectory of spend continues until the end of this financial year. A summary of the main variances including financial challenges and key pressures are highlighted below: Employee Costs – underspend of £10.518m There are continuing challenges in terms of recruitment and retention across all service areas. Recruitment plans continue to be progressed to fill vacancies as quickly as possible however this is proving challenging in the current market. Payments to Other Bodies (PTOB) – overspend of £1.229m There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. Independent care homes have a yearly budget to fund 1,361 care plans but at present the number of projected care plans is 1,501 resulting in a projected overspend of £0.708m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,817 estimated care plans for 23/24. In line with the IJB strategy to address the demand pressures within the plan, a drawdown of £2.337m from the social care demand reserve is being used to offset the current projection. An action plan is currently under development which focuses on overdue client reviews and ensuring outcomes and budgets are aligned.
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11 Prescribing – overspend of £0.824m The current overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on actual prescribing data available to September 2023. The forecast will be updated as further data becomes available. Similar to the increase in SDS demand, the prescribing increase was in part forecast and reported in the financial plan and therefore a drawdown of £3.835m from the prescribing reserve is being used to offset the current overspend. Work continues to mitigate this overspend through the savings program and from a non-recurring allocation being issued to fund the pharmacy tariff increase amounting to £1.598m for the IJB. North Lanarkshire Hosted Services – overspend by £2.641m The 3 main areas of overspend within the NL hosted services relate to continence service, children services and prisoner healthcare, due to increases in product costs and additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. There is also an increase in costs linked to the delivery of the new pharmacy contract and drug price associated with prisoner healthcare. Phillip Couser asked where can we realistically close the vacancies gap and manage the impact on temporary staff. He also queried noted if there are seasonal variations in prescribing which show particular patterns. Trudi Marshall noted have a level of vacancies across the system not filled but we don’t want to remove these as there is still a level of unmet need, looking at new roles coming into the system such as assistant practitioners and apprentices. Medical colleagues are also looking at vacancies and manage use of locum staff. Stacey Anderson advised in summer can see peak in patients stocking up on medication for holidays and then around October public health messages increase which encourages prescription uptake. Cllr McBride noted that social care services have a high vacancy level, how is it developing currently. Amanda Kilburn advised awaiting Mental health outcomes funding unfortunately the wrong amount has been allocated and it was only issued last week. In social care its social care mainstream vacancies where the rate is coming down, Amanda Kilburn will provide a breakdown of the figures with the group. The IJB PFA committee: (1) Acknowledged the contents of the report; and (2) Acknowledged the projected outturn for 2023/24 is an underspend of £5.796m. AK
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12 13. IJB Reserves Strategy 2023/24 A paper was shared with the committee to provide an update for IJB reserves. Consistent with a number of other Health and Social Care Partnerships, an underspend was reported to the IJB on 21 June 23 totaling £35.495m and was transferred to reserves. This 2022/23 underspend included funding made available by the Scottish Government to progress policy commitments and national priorities. The reserve balances at 31 March 2023 were £97.946m. This figure comprised of £47.408m earmarked reserves to support the delivery of projects which span financial years and £27.577m ring-fenced monies to enable the IJB to deliver on specific Scottish Government funded programmes. The remaining balance of £22.961m, are risk-based and contingency reserves which are not held to meet any specific liability and offer the IJB some flexibility to deal with unforeseen events or emergencies. When reviewing reserves have identified £10.183m of reserves which are no longer needed for the originally purpose. Would look to move this money into contingency reserves if agreed by the committee. Ross McGuffie added some areas we have not been able to progress and for others funding has come from other sources. Brian Moore asked will Scottish Government look to claw back any spend which has not been spent as planned. Ross McGuffie advised they do not mechanism to claw back on ring fenced contingency reserves. Amanda Kilburn added only clawed back covid funding last year which they allocated and for long covid the reserve sits within the council budget, it was created around 3 years ago and it has never been needed. Cllr McBride noted there has been some discussion around ring fencing certain areas of the council budgets do we need to do the same. Amanda Kilburn advised ring fenced reserves are from Scottish Government, they can only be used for the purpose the outline. Earmarked reserves are created by the HSCP locally to meet areas of demands, if something came up that required funding would create a new ear marked reserve and bring back to the committee for approval. The IJB PFA Committee: (1) Acknowledged the contents of the report; and (2) Approved the proposed realignment of reserves in appendix 1 of the report.
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13 14. Q2 Performance Report The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. Area identified in this report as rated as red are as follows: Cervical screening Childhood Immunisations 6-8 week reviews Reablement and Rehabilitation CAMHS Medical Paediatrics Speech & Language Therapy Dietetics Adult Social Work Ross McGuffie advised performance scrutiny panel has been running for the last few months, it bring in reps from each service which is RAG rated as red or amber for assurance. Brian Moore noted Speech & Language Therapy (SLT) did previously provide a more detailed report. Also for CAMHS we are still not achieving the target set. He asked is there anything the committee should be aware of now. Ross McGuffie advised for SLT there is a programme board to support the service and now getting more accurate data. Ross McGuffie advised for Q3 the CAMHS figure is over 70% and seeing rapid improvement every month in the next cycle of CAPA there has just been a delay linked to reporting cycles. The IJB PFA committee noted the report. 15. Risk Register The report provides a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register.
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14 A full review of the risk management reporting within the IJB has taken place as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. This review included how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session was held at the IJB Liaison Session in November. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. The IJB currently has 17 risks identified on its IJB risk register with 11 risks rated as high or very high. The report outlined a risks in focus for the committee to consider if the current risk score and mitigations are suitable. Brian Moore acknowledged that we need to consider reviewing financial risks as more information becomes available. He proposed to add a recommendations tab in future for the committee to consider updates required for particular risks. Stacey Anderson will add this for future reports. The IJB PFA noted the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. SA 16. Risk It was noted to consider continued funding for hospital at home and financial risks going forward. 17. Date of Next Meeting 22nd May 2024 2pm-4.30pm
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1 ITEM 5 North Lanarkshire Integration Joint Board 2023-24 ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 2. 31.8.22 Item 6 IJB Self-Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Ongoing – future Liaison session topic 3. Improving Cancer Journey R McGuffie Bring back a further update to the Board on the roll out of the programme and Paper to future meeting 4. 24.1.24 Item 7 National Care Service R McGuffie Table update for mosaic electronic records Procurement Review risk currently held for NCS
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1 REPORT Item No: 7 SUBJECT: Alcohol & Drugs TO: Integration Joint Board Committee Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 27 March 2023 1. PURPOSE OF REPORT This report sets out the progress of the Alcohol and Drug Partnership for 2023. This report reflects a sample of the ongoing work being undertaken across North Lanarkshire to reduce harms from substances and improve access to support. This report also sets out the range and scope of investments through the ADP to target support across our communities in 2023/24. This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS (1) Note the content of the report. (2) Acknowledge the progress made towards delivering the ADP strategic objectives and National Drug Mission priorities. (3) Recognise the broad range of supports in place and the programme of work being delivered to reduce harms and prevent deaths from alcohol and other drugs (4) Note the key developments in targeting resources in line with budgets for each priority area. (5) The MAT Standards is not covered in this report as a separate paper has been drafted and submitted for consideration. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. 5.2 The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. 5.3 The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). 5.4 Much of our work involves bringing people together to plan and improve services whilst setting out what needs to be put in place to support change and keep people safe and well. Yes ☐ No ☒ N/A ☐
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3 5.5 We do this by reviewing, monitoring and evaluating the impact of investments targeted towards reducing substance-related harm and improving health and wellbeing. 5.6 NLADP Structure All sub-groups above meet quarterly and report to the ADP Partnership Board. Each sub-group held a planning session in the first quarter of 2024 to map out areas of focus and further development for the next 12 months. 5.7 ADP Priorities o Priority area 1 - Fewer people develop problem alcohol & drug use. o Priority area 2 - People access and benefit from effective, integrated person- centred support to achieve their recovery. o Priority area 3 - Children and families affected by alcohol and drug use will be safe, healthy, included and supported. o Priority area 4 - Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. o Priority area 5 – Less harm is caused by alcohol North Lanarkshire. 5.8 NLADP support team continues to be active within the following networks and forums. Child protection committee Family Support development group Adult protection committee Harm Reduction - Naloxone/BBV/WAND VAW partnership Operational Group Residential Rehab Oversight Group Community Justice Partnership Buvidal Steering Group Reducing Alcohol Harms Groups Improving Child Services Group MAT Standards oversight group Drug Death Prevention Groups MAT Experiential/ MAT Numerical Trauma Informed Network Youth Diversionary Activities Group Experiential Data Collection Group ADP Board Prevention & Early Intervention Treatment Care & Recovery Whole Family Approach Public Health Approach to justice Reducing Alcohol Harms Finance Group
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4 5.9 All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. It will do this by: providing fast and appropriate access to treatment and support through all services improving frontline drugs services (including the third sector) ensuring services are in place and working together to react immediately for people who need support and maintain that support for as long as is needed. increasing capacity in and use of residential rehabilitation implementing a more joined-up approach across policy and practice to address underlying issues. 5.10 Commissioning and perfomance reviews - A programme of extensive and competititve commissiong activities took place via NLADP in 2023, with 5 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 repsonse and assertive outreach service – awarded to Turning Point Scotland 5.11 Performance monitoring reviews have been carried out in the first quarter of 2024 with all 17 additional services or programmes commissioned via NLAPD. 5.12 All commisioned initiatives are required to report to the ADP on a quarterly basis to evidence impact, highlight challenges, risks and mitigation measures, whilst offering assurances the right supports are in place and operating effectively. 5.13 North Lanarkshire ADP Board made the decision to commit to 3 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 recruitmetnand retention, longer- term planning and service stability. 5.14 This approach will allow services to focus on the quality of support being offered to those who need it most with stronger links being build between services. 5.15 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,
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5 Alcohol and Drug Solutions Courts, and; Extended Youth Work Provision and Diversionary Activities via Community Learning and Development (CL&D). 5.16 Drug Death Prevention - Work to refine drug death prevention efforts in 2023 included a full review of the Drugs Death Drevention Group (DDPG) operational workstreams with a full membership update and draft work plan now in place. The DDPG strategic group will now be Chaired by the Director of Public Health. 5.17 A Pan Lanarkshire post was created for a Drugs Death Information Officer to support the functions and processes of the DDPG. 5.18 A DDPG development session was held in February 2024. This was facilitated by Scottish Drugs Forum, who developed the national drug death prevention guidelines. The content from this session will form the basis of a 5 year drug death prevention plan for the DDPG. 5.19 A Naloxone delivery plan is now in place to target training and widen Naloxone distribution throughout 2024. 5.20 The Lanarkshire Drug Trends Monitoring Group (LDTMG) was reinstated in March 2023, having not met since early 2020 due to the pressures of the COVID-19 pandemic. The group provides an opportunity to strengthen linkages and relationships between services through the sharing of relevant intelligence from different parts of the system. 5.21 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. This group is Chaired by Public Health colleagues on behalf of North and South ADPs with broad representation from ADP partners and support staff. This group reports to the ADP Partnership Board. 5.22 Work has been undertaken by NHS Lanarkshire Health Improvement in 2021 to scope national strategies and plans in order to identify key priority themes and actions. From this work four subgroups were initially established to align with the key themes of Rights, Respect and Recovery and to mirror the ADP sub-group structures. 5.23 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. 5.24 NLADP, as part of the Reducing Alcohol Harms group conducted a survey to understand the impact of alcohol consumption on individuals and communities in 2023. This information will inform future actions that will be taken forward
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6 with communities and partner agencies in 2024 to tackle any issues relating to alcohol use. In total, 1367 people in Lanarkshire took the survey with over 100 people involved in follow up focus groups from June to September 2023. There is a development session being held on 26th March to share feedback from the consultation and to facilitate discussions that will shape key actions for 2024 for the ADP, Public Health and Heath Improvement. There is broad representation from services, community members and those with lived and living experience for this session. 5.25 Following the ADP stakeholder event in 2023, a commitment was made to NLADP hosting an Alcohol summit in this financial year to re-focus our collective efforts to tackle harms from alcohol across our communities. We have a commitment from national colleagues who spoke at the Stakeholder day to support the event including Alcohol Focus Scotland (AFS), Scottish Health Action Alcohol Problem (SHAAP) and Scottish Families Affected by Alcohol and Drugs (SFAD). There was broad support for such an event with the 127 people in attendance. 5.26 NLADP has given its full support to a joint statement to the Health, Social Care & Sport Committee on MUP, advocating for an increase to 65p as part of our links to national alcohol forums. This recognises: • The extensive and robust evaluation by Public Health Scotland which estimates that it has reduced deaths caused solely by alcohol by 13.4%. • That’s an estimated 156 families each year who have been spared the loss of a loved one. • Hospital admissions are down by an estimated 4.1%, reducing the pressure on our NHS. • MUP has also narrowed alcohol health inequalities. 5.27 Failure to raise MUP to 65p will result in an estimated 800 more deaths, and almost 10,000 additional hospital admissions at an estimated cost of £11 million to our hospitals. 5.28 NLALP submitted a joint response with NHSL Public Health colleague to the alcohol licensing policy statement consultation led by NLC in 2023. This led to a commitment to re-establish the local licensing forums with calls being made via NLADP for volunteers and members to support his work across our communities in 2024. From the consultation NLC acknowledged this needs a full overhaul and will refresh the alcohol licensing policy statement in 2024, this will be published later this year. 5.29 Residential Rehab - 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.
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7 5.30 Residential rehab is now offered more consistently as part of the treatment and care offer in North Lanarkshire There’s been an increase in the number of referrals, assessments and placements to a range of rehab settings across Scotland. NLADP support team have embedded appropriate reporting and monitoring systems to reflect this submitting returns to the Scottish Government on a quartleryl basis. The North annual budget is £318,728. As of month 9, £294,391 was spent on rehab placements. Since tracking started, 41 referrals for assesment have been made to the multi– disciplinary team and of those, 38 individuals have gone to residential rehab placement. Alcohol is the most common factor for those attending residential rehab (55% of all referrals) Placements have been allocated on the following basis 76% Male and 24% female placements. 5.31 The residential rehab operational and oversight groups will reconvene in February 2024 to review placements, data and lived experience feedback and will report back to the ADP partnership board in March 2024. 5.32 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. 5.33 The funding allocated to family support from SG is now committed to the stand- alone adult family support service launched in December 2023 (delivered by Phoenix Futures). Additional support is funded via by Barnardo’s, North Lanarkshire Council family programmes and Test of Change match funding for early learning centres provision from 2023 – 2026. 5.34 Workforce Development - The ADP support team continues to support local services to improve their offer targeted relevant training and learning opportunities. In 2023, 516 people attended training over 20 different courses and learning events. 5.35 Website Development - The ADP launched a new website that acts as a central source of information, advice and support relating to alcohol and drug use and details services currently operating locally and nationally. 5.36 The site was developed based on feedback from people with lived and living experience of substance use, and key services, to ensure that the content available is suitable and relevant. www.northlanadp.org 5.37 ADP stakeholder event - The ADP hosted an annual stakeholder event in December 2023 bringing partners together to connect with the services being
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8 offered locally, to hear from national organisations shaping the policy landscape and to engage in discussions on ADP priorities for the next 12 months. 5.38 In total, 127 people attended the event including people with lived experience, families and young people engaging with support services. 5.39 Health and Wellbeing events - Throughout 2023, NLADP co-hosted 4 health and wellbeing events across North Lanarkshire, as part of a series of 6, aiming to bring local partners, people and communities together to connect with each other and learn about our work. 5.40 Each events had a different feel having been led locally by key services and people from in the area. Over 100 organisations have been involved with 289 people attending across all 4 events below: Cumbernauld 24th May Wishaw/Newmains 19th July Coatbridge 14th September Motherwell 26th October 5.41 NLADP will host two more health and wellbeing events in 2024. A full evaluation report will be published in April 2024. 5.42 Alcohol (and other the drugs) local support fund - A new fund was made available through North Lanarkshire ADP to support organisations to build capacity and support local people through prevention efforts, reducing crisis and promoting recovery across all six localities. Organisations could apply for up to £10,000. 5.43 NLADP is keen to reinforce the rights-based approach and build a better understanding of the health and social needs and experiences of individuals, families and marginalised populations through this fund. 5.44 The fund was initially supported via VANL early in 2023 however, due to a number of challenges in delivering this fund, VANL and NLADP both agreed the ADP would take this back in house. All awards from the fund will be made by the end of March 2024 with each successful bidder having 12 months to deliver. 6. CONCLUSIONS NLADP continues to deliver on the National Drugs Mission objectives and ADP strategic priorities targeting resources appropriately and measuring impact. The ADP has appropriate structures and governance arrangements in place to support decision making around spend and offering best value. The right mechanisms in place to offer assurances that as much as possible is being done to tackle harms from substances and reduce deaths.
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9 Each sub-group is accountable to the ADP finance group and Partnership Board, and each have clear priorities to take forward in 2024. There is a wide variety of supports in place for individuals and families who are impacted by substance use. The current commissioning approach will support efforts to improve the quality and availability of support across statutory and community/voluntary services. There is a strong focus on learning and development across the ADP linked to listening to stakeholder views and involving those with lived and living experience across each area of work and sub-groups. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL In the budget statement on 19th December there was acknowledgement that the system is under significant pressure as a result of the ongoing impacts cited as Covid, Brexit, high inflation and other factors. There was some acknowledgment this may mean taking difficult budgetary decisions to ensure we are investing in the right approaches that will have the biggest impact.
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10 Work was carried out by the ADP Strategic Lead and finance colleagues to review ADP budgets and to set out a financial forecast until the end of the National Mission (2026/27) offering assurances that budgets were in place to meet our financial commitments. This was reviewed and scrutinised by the North ADP Partnership Board and finance groups in January 2024 as follows: Annual spend plans. 23/24 £2,888,785 24/25 £2,105,503 25/26 £1,912,123 Programme for Government (PfG) funding has been awarded since 2018 to ADPs, the PfG budget in 2023 was £1,083,675. Due to the short-term nature and no guarantees this would be protected as a recurring budget, this has been used to support Test of Change initiatives. It has been confirmed PfG will be protected in 2025 as part of Board Baseline budgets. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national Regular stakeholder engagement takes place through the ADP. Yes ☐ No ☒ N/A ☐
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11 outcomes subgroup structures with people with lived and living experience (including families) involved in shaping the decisions around tackling alcohol. and drug related harms. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☒ N/A ☐
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12 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following. Yes / Date added ☐ No ☐ N/A ☐
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13 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 8 SUBJECT: Medical Assisted Treatment (MAT) Standards TO: Integration Joint Board Committee Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 27 March 2024 1. PURPOSE OF REPORT This paper sets out the progress made towards implementing the Medication Assisted treatment (MAT) standards in North Lanarkshire for 2023. The current position for each standard is set out below with an updated status on each standard required for national reporting in April 2024. This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Acknowledge the significant progress made towards delivering the Medication Assisted Treatment Standards (MAT) throughout 2023. (3) Note the current status of MAT Standards implementation and the position for this year’s national benchmarking report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Scottish Government initiated the Medication Assisted Treatment (MAT) Standards in 2021 with the expectation of MAT being fully implemented by 2024. North Lanarkshire ADP and relevant integrated authorities are required to work towards the national drug mission objectives which includes the delivery of the MAT Standards. A national benchmarking report was published by Public Health Scotland on 23rd June, 2023 showing progress made across Scotland on a RAG status basis. Lanarkshire was in a good position to implement the MAT standards with more work required to fully embed the 10 standards across all localities. North Lanarkshire RAG Benchmarking position 2023: MAT 1 = Amber MAT 2 = Green MAT 3 = Amber MAT 4 = Amber MAT 5 = Amber This paper sets out the progress made in more detail and highlights the position for North Lanarkshire, based on evidence due to be submitted to Public Health Scotland, for the 2024 benchmarking report. In order to meet green status there’s a requirement to provide numerical data, evidence standard operating procedures (SOPs) in place, and report on experiential feedback gathered through interviews with those in services, practitioners and families Yes ☐ No ☒ N/A ☐
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3 National progress on MAT Implementation as of 1st April 2023 5.2 A Pan-Lanarkshire oversight group meets quarterly with a north delivery group meeting monthly to monitor and progress the MAT standards delivery plan. This group Chaired by the Head of Health and includes reps from the MAT delivery team from Public Health Scotland. The ADP is required to report on progress to the Scottish Government on a monthly basis. – A Project Lead was recruited in May 2023 to oversee all MAT deliverables over the next 2 years. – Operational MAT leads were identified to maintain progress on each standard. – A peer support worker was recruited to support the experiential elements of the MAT standards delivery. – All experiential evidence is gathered by fully trained peers from the Recovery Community to engage with those in contact with services. 5.3 MAT 1. All people accessing services have the option to start MAT from the same day of presentation. Standard met – Expected Green. ‒ The Urgent Care Response Team launched in March 2023. This was initially supported by 3 Advance Nurse Practitioner’s (ANPs) with 2 further posts in North as part of a Pan-Lanarkshire approach. ‒ In total, 390 referrals were made for MAT in North Lanarkshire via the Urgent Response Team from April 2023. ‒ In December 2023, 81% of people referred for MAT were assessed within 24 hours, the target is to reach 75% of referrals within in 24 hours. ‒ A decision was reached in January 2024 to move to a North specific approach linking the local Addiction Recovery Teams (ART); to
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4 enhance capacity and improve access for those requiring same day access to MAT. MAT 2. All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. Standard met – Expected Green. – Standardised approach in place setting out choice offered to individuals across all services - SOPs/guidelines in place. – Leaflet/promotional content developed for individuals accessing treatment, setting out all choices. – NHSL continues to grow the focus on choice with the ongoing expansion of clinics offering different treatment options. MAT 3 & 5 are now linked. All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. All people will receive support to remain in treatment for as long as requested. Standards 3 – Provisionally Green. – A local near-fatal overdose response system is in place. This system links with the Scottish Ambulance Service, tier 2 support services including the active recovery community. – The Crisis Outreach Team was commissioned via the North ADP to provide Overdose response, assertive outreach capacity and crisis support (linked to housing service as part of the rapid rehousing transition plan). – Since the service became operational (December 2023), 170 people have been reached across all 3 elements of the combined service operated by Turning Point Scotland (TPS). – NHSL Harm reduction team works closely with TPS and the Scottish Ambulance Service to ensure suspected overdose patients are linked to the response team within 72 hours (standard requirement). – MAT 5 data sets are now complete and in place with final snap shot data collections tested. – Exit planning – supported/unsupported discharge data still required for review and improvement plan is in place. MAT 4. All people are offered evidence-based harm reduction at the point of MAT delivery. Standard Implemented – Provisionally Green. - All locations now offering three core harm-reduction measures (take- home naloxone and overdose awareness, injection equipment provision and blood-borne virus testing) at follow up MAT appointments. - Harm reduction kits provided to all sites with Injecting Equipment Provision/Wound care/Dry Blood Spot Testing - staff guides within to ensure consistency all across teams.
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5 - Experiential data gathered suggests people have access to harm- reduction interventions and there is widespread awareness of naloxone. MAT 6 & 10 are now linked. The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low-intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. Standard in progress – Amber. – A Pan-Lanarkshire multi-agency steering group is in place and a training plan is being rolled out in conjunction with the development of appropriate training resources for all frontline staff. – A trauma walk through was delivered by Addiction Psychology Service (APS) for the North Addiction Recovery Teams (ART) to highlight improvements for the patient experience. – Some constraints exist due to release time for staff to complete training linked to this standard, this is limiting the roll out of the workforce development plan. – There are now 4 Turas hosted modules available to expedite the delivery of the training plan. MAT 7. All people have the option of MAT shared with primary care. Standard Not Implemented – Red. – NHS Lanarkshire took a strategic decision over 15 years ago to centralise provision of MAT in a GP-run Community Prescribing Service to ensure equity of access. – These arrangements have worked well and are funded from FHS budget (£0.55m in 2022/23). In addition, a MAT dispensing and pharmaceutical care service is funded via community pharmacy (£2.016m) alongside a needle exchange scheme (£0.05m). – Following discussions with the GP subgroup, there is a strong preference to retain a special interest GP approach as there is neither the capacity nor skillset within most practices to reverse our approach. – Prescribing within community pharmacy may be an option but will require further maturity and development – A task and finish group has been created to guide MAT 7 compliance within our existing infrastructure, focussing on a range of options to review and improve the offer to meet MAT 7 – Medical Director has met with MAT Joint Chairs and locality service managers North and South to discuss the approach moving forward MAT 8. All people have access to independent advocacy and support for housing, welfare and income needs. Standard met – Green. – Review carried out across all services with key actions, recommendations required to standardise referral pathways, baseline data and reporting arrangements to evidence MAT 8.
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6 – Commissioned advocacy services are in place in North Lanarkshire via ADP funding and clear pathways now exist across treatment and care services. MAT 9 is linked to MAT1. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. Standard in progress – Provisionally Amber - A steering group was established and joint working between mental health and addiction services (including commissioned services) is in place. - A Pan-Lanarkshire forum was established to develop a protocol outlining the expectations for the holistic, joined up care of people with a co- occurring mental health condition and problem substance use. - There is a delivery plan for this standard in place and more wide-spread and routine screening for Mental health concerns now takes place across all key services. 6. CONCLUSIONS 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. North Lanarkshire is in a much stronger position than this time last year. The appropriate measures are now in place to drive forward the additional improvements required to fully embed all standards across all localities in 2024. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐
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7 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL MAT standards Annual budget £309,606, of which £268,036 has been allocated to the fixed-term posts set out above and delivery of MAT standards 1-10, in keeping with the current delivery model. The majority of MAT standards funding is tied to posts as set out above. Additional Injecting Equipment Provision and Naloxone costs have now been linked to this budget for 2024 as well as equipment and supplies for the day to day running of the Urgent Care Response team. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Yes ☐ No ☒ N/A ☒
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8 Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☐ N/A ☒
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9 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy DendyM@northlan.gov.uk Yes / Date added ☐ No ☐ N/A ☐
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 9 SUBJECT: Staff Health & Wellbeing TO: Integration Joint Board Committee Lead Officer for Report: Morag Dendy Head of Planning & Performance, University Health & Social Care, North Lanarkshire (UHSCNL) Author(s) of Report Sharon Rodgers Organisational Development Programme Manager, University Health & Social Care, North Lanarkshire (UHSCNL) DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Sharon Rodgers OD Programme Manager (UHSCNL) ☒ Reviewed By: Morag Dendy Head of Planning & Performance, (UHSCNL) ☒ Endorsed By: SLT November 2023 ☒
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2 3. RECOMMENDATIONS It is recommended that the IJB committee: 1. Endorse the staff health and wellbeing approach outlined within this paper. The initial phase of the programme includes, identifying and working with a number of teams across the partnership to identify need and agree a bespoke approach with teams. 2. Review findings and recommendations from initial phase to be presented in March 2025. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background Feedback within the organisation and at a national level, demonstrate the need to support the health and wellbeing of staff within health and social care. Absence rates within the Partnership (both NHSL and NLC) are higher than average. Higher turnover of staff coupled with a candidate driven market continue to impact staffing levels within teams. (Figures November 2023) Partnership (NHSL) Partnership (NLC) Absence rates 6.67% (NHS Scotland average 5.94%) 6.26 FTE average days lost per employee within Health & Social Care (3.86 FTE average days lost per employee NLC) Increase in 25% absence for HSC staff from 22/23. Absence reason Stress / anxiety Mental health Staff turnover 9.62% Not available Vacancy Rate 3.04% Not available Both NHSL and NLC have created staff health and wellbeing strategies. The Scottish Government established a national wellbeing champions group to share best practice. A UHSCNL working group has been established to identify priorities within the partnership, whilst aligning with both NLC and NHSL staff wellbeing strategies. The working group will not create a strategy. Yes ☐ No ☒ N/A ☐
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3 To support the SHWB work, two posts have been funded on a two year fixed term contract. Both posts will support the Health & Wellbeing work within UHSCNL. NHSL Staff Health & Wellbeing Officer (Band 6) in post, August 2023 NLC Health & Wellbeing Officer (Grade NLC10), recruitment process in progress 5.2 Typical Organisational Approach to Staff Wellbeing Many organisational staff health and wellbeing initiatives take the form of gifts (fruit bowls, walking challenge etc.), information, toolkits, and training. Although these offers can be appreciated by staff, the impact tends to be short lived with limited impact. Long term wellbeing in the workplace stems from knowing your work matters (sense of purpose), feeling a sense of belonging in your team, knowing you have trust, autonomy, and flexibility. 5.3 UHSCNL approach to staff health and wellbeing In recognition that teams have different needs and priorities, work will begin with individual teams to gain insight and to work with managers and teams to agree and plan next steps. Within the initial phase, eight teams will participate in the health and wellbeing work. To gain insight into what impacts health and wellbeing, participating team managers will conduct stay conversations. A stay conversation is a short one-to-one discussion which asks three questions: What makes you want to stay? What would make your job better? Is there anything that might make you want to leave? The main purpose of the stay conversation is to gain insight into what is important for staff and teams. Many organisations are adopting stay conversations as an alternative to exit interviews to support retention and improve employee experience. The manager collates themes and a follow up focus group is conducted by organisational development (OD) to deepen understanding and identify priorities within the team. Giving another avenue for staff to share their views. To support managers have insightful and safe stay conversations, all participating managers are invited to attend training. 5.4 Ongoing Support OD will work in partnership with the participating manager to agree a plan and next steps, working with relevant support teams as required.
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4 To support adult learning and introduce change that sticks, it is important to approach development and change in small, bite-sized chunks, to support learning / change and to not overwhelm already busy teams. 5.5 Measure Impact Measure impact via key indicators including sickness absence levels, staff turnover, vacancy rates and regular ‘temperature checks’ with staff. Both impact and feedback will inform further work across the partnership. 6. CONCLUSIONS The initial phase of the programme will work with individual teams across the partnership. Identifying need and to work with the team and manager to agree and implement bespoke change / plan / development / support. Measure impact of work via key indicators (retention, absence, regular wellbeing check-ins with team). The learning from the initial phase will inform further work across the partnership to continue to support health and wellbeing. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐
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5 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. High Ross McGuffie, Chief Officer 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved Presented work at a number of forums to provide key stakeholders Yes ☐ No ☐ N/A ☒
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6 with information on how to participate in work. ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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7 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy DendyM@northlan.gov.uk
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 10 SUBJECT: Strategic Academic Partnerships Report TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Professor Eamonn Brankin, Associate Medical Director, Strategic Academic Liaison) DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ This paper has been prepared by Eamonn Brankin, Associate Medical Director and has been reviewed by the NHS Lanarkshire Planning, Performance and Resources Committee. 3. RECOMMENDATIONS The IJB is asked to: 3.1. Review the content of the paper 3.2 Note the ongoing developments and progress between NHS Lanarkshire, North Lanarkshire Council, South Lanarkshire Council, the Health and Social Care Partnerships and the three formally recognised strategic academic partners: Glasgow Caledonian University (GCU), University of Strathclyde (UoS) and University of West of Scotland (UWS).
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 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. 5.2 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 to develop this approach with the other two Universities as we continue to develop our strategic academic approach. 5.2 University Departments 5.2.1 Just before the onset of the pandemic, three of our departments successfully attained University Departmental status from Glasgow Caledonian University. These departments include: • University Department of Stroke Care at University Hospital Monklands • University Department of Psychological Services (pan Lanarkshire) • University Department of Podiatry (pan Lanarkshire) 5.2.2 Notably, the University Department of Podiatry is the first of its kind in the UK, marking a ground-breaking achievement for the GCU/NHSL partnership. These departments continue to thrive, with a notable increase in Podiatry applications, rising from five at band 5 last year to twenty-two in the current year. The renewal consideration for the university departmental status is scheduled for 2024, and each department is actively working on its renewal documentation with the hope of a successful outcome. 5.3 Honorary Appointments 5.3.1 To enhance our collaboration with universities, several Honorary Appointments have been conferred, showcasing our commitment to fostering strong ties. 5.3.2 Notable appointments include Professor Patricia Graham, Head of Psychological Services, receiving an honorary chair from the University of Strathclyde, and Health and Social Care Partnership Chief Officers, Ross McGuffie and Soumen Sengupta, being honoured with chairs at Glasgow Caledonian University. Yes ☐ No ☒ N/A ☐
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3 5.3.3 Additionally, Mrs. Janice McClymont, Head of Occupational Therapy, earned an honorary fellowship at GCU, with previous awards for Mrs. Margot Russell, Mr. Peter McCrossan, and Mrs. Claire James renewed for an additional three years. Professor Cindy Chew, Consultant Radiologist at University Hospital Wishaw, received an honorary chair at the University of Glasgow. 5.4 Partnership Working 5.4.1 There has been continued development of the strategic academic partnerships with Allied Health Professions (AHPs) between NHS Lanarkshire, Glasgow Caledonian University (GCU), and the University of Strathclyde (UoS) has leading to various developments. This progress not only encompasses ongoing collaborations with established academic partners but also sheds light on efforts with other academic institutions where formal organisational partnerships are still in the process of being established. 5.4.2 Within GCU, significant student placements are provided by all the AHP professions with the exception of Spiritual Care. Each of the NHSL Heads of Service for the services listed below is involved in each GCU course programme Board, which provides a quality assurance mechanism for each course. Professional Group Total Dietetics 13 Occupational Therapy 68 Orthoptics 16 Physiotherapy 156 Podiatry 18 Radiography 37 Total GCU Placements 308 International Students 5.4.3 In partnership with GCU, NHSL provided two international postgraduate placements for students from the United Arab Emirates in diagnostic imaging. Through this arrangement, two NHSL radiography staff benefit as they can obtain master’s modules to accrue credits toward an MSc. Academic Homes 5.4.4 Some universities are adopting the Academic Homes approach for better clinical/academic career opportunities, fostering collaboration, and developing capacity in the four pillars of practice. The Funding Agreement, supported by the NMAHP Practice Development Centre with GCU, facilitates AHP staff's postgraduate module undertakings. AHP Students Employment Opportunities within NHS Lanarkshire
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4 5.4.5 Opportunities for AHP students to join the NHSL Staff Bank have been shared with GCU and the University of Strathclyde. GCU has been influential in promoting part-time paid employment opportunities for AHP students via the NHSL Staff Bank. The current 2023/24 opportunities assist staff with recruitment and staffing challenges, which in turn aids the Board in various ways. A prime example of helpful assistance given by GCU students was to the podiatry service, where the students have been carrying out diabetic screening. AHP Lecturer Practitioners 5.4.6 The number of AHP lecturer practitioners has reduced due to financial pressures and reorganisation at GCU. Only one specialist podiatrist remains in this role, working both as a diabetic specialist practitioner and a lecturer in diabetes and vascular issues. 5.5. Future Areas for Exploration with GCU 5.5.1 The Director of AHPs and the Vice Dean of the School of Health and Social Care at GCU meet regularly to discuss workforce, recruitment and development ideas. In partnership with NHSL, GCU is keen to explore creative ways to share simulation resources and expertise of the AHP professions within Lanarkshire. Work is ongoing to link GCU to the Lanarkshire Care Academy by promoting NHS Lanarkshire as a preferred employer. 5.5.2 Professor Dawn Skelton, Professor of Ageing and Health within the Centre for Living School of Health and Life Sciences at GCU, is a respected expert in ageing and frailty. Prof Skelton was a great asset in developing the NHSL Falls Strategy and has been assisting in developing the forthcoming NHSL Rehabilitation Strategy. 5.5.3 Post winter, development sessions are planned between GCU and leads within the Health and Social Care Partnerships to develop new areas of joint working within community health and social care areas, taking advantage of the recent strategic partnership agreements. 5.6 University of Strathclyde Practice Placements 5.6.1 Speech and Language Therapy (SLT), Orthotics, and Prosthetics departments continue to host student placements for both courses. Number of student placements provided 2022/23: Professional Group Total Orthotics and Prosthetics 5 Speech and Language Therapy 25 Total University of Strathclyde Placements 30
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5 5.6.2 The head of orthotics is an external examiner for the fourth-year BSc. orthotic and prosthetic degree course. Sports and Physical Activity BSc students 5.6.3 In the academic year 2022/23, a 50-hour placement experience was established for Year 3 BSc Sports and Physical Activity students at Strathclyde University. This placement focused on promoting physical activity in alignment with the Active Hospitals initiative at the UHW site. Collaborations were forged with the Falls team and Health Improvement. 5.6.4 Building on the success of the previous year, the plan is to replicate these placements in the academic year 2023/24 and potentially extend the initiative to host Year 4 students for their final year projects. 5.6.5 A memorandum of agreement facilitated students' identification of areas of interest during the 2022/23 placements, spanning the Falls team, MSK clinics, and health improvement. The goal for the upcoming academic year is for fourth-year students to design an activity program supporting the Active Hospital initiative at UHW. Post-graduation, some students pursue the fast- track Physiotherapy MSc program, specifically designed for those with a postgraduate degree, supported by NES. Pharmacy 5.6.6 Over 2022/23, 60 student placements were delivered, totalling 292 days of input within Pharmacy in NHS Lanarkshire. 5.6.7 Within the Undergraduate programme, this focused on: Development of Experiential Learning Primary care placement frameworks to support facilitators in practice. This framework was developed by the prescribing team in primary care and has now been adopted nationally. Prescribing team involvement in the delivery of year 2 clinical skills training Prescribing team input into University of Strathclyde Experiential learning handbook review. This includes review of learning outcomes and suggested activities. Involvement in facilitating workshops Involvement in Entrustable Professional Activities research project 5.6.8 In the Postgraduate programme, the focus was on: Pharmacist undertaking MSc including research project PHD student – substance misuse Assessment of OSCE for independent Prescribing Course Involvement in teaching for Independent Prescribing Course – substance misuse
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6 5.7 Research Collaboration, Service Review & Evolution with the University of Strathclyde. 5.7.1 Dr. Gillian Sweeney, Specialist Occupational Therapist, leads a research collaboration with the University of Strathclyde focusing on "Future Rehabilitation: Validation of an intensive, individualized stroke rehabilitation service delivered through technology." The initiative addresses the significant incidence of strokes in Scotland and aims to enhance recovery through intensive functional practice. 5.7.2 University Hospital Wishaw has established an in-patient Technology- Enhanced Rehabilitation Gym (TERG), replicating the Strathclyde University TERG. The unit opened on November 8, 2023, with plans to create a smaller- scale version within the Blantyre Life facility. The TERG has garnered interest, hosting visits from NHS Lanarkshire leadership. 5.7.3 The proposal suggests setting up a TERG at the Blantyre care hub, enhancing accessibility for transitional step-down beds, technology-enabled homes, and community-dwelling stroke survivors in South Lanarkshire. Funding for this development is under review. 5.7.3 A collaboration between the Department of Speech and Language Therapy (SLT) at Strathclyde and the Lanarkshire SLT service review is underway. Discussions are ongoing to develop a lecturer practitioner post in conjunction with Strathclyde, showcasing the commitment to advancing services through research collaborations with various university partners. 5.8 Strategic Discussions 5.8.1 Discussions continue with a range of key universities including University of the West of Scotland; University of Glasgow; Queen Margaret University; Edinburgh Napier University; Robert Gordon University; and Herriot Watt University; around both student placements and furthering areas of potential joint development. 5.9 Future work 5.9.1 While much of this report focuses on developments from within NHS Lanarkshire, future reports will be more balanced as the strategic partnerships with the HSCP and Local Authority come to fruition. 5.9.2 Since moving forward with the development of MoUs, we have already started a number of developments with both Glasgow Caledonian University and University of Strathclyde covering areas such as frailty, dementia and pharmaceutical development. 6. CONCLUSIONS 6.1 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
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7 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. 6.2 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. 6.3 Over the year ahead, the focus will be on finalising the agreements with the University of Strathclyde and continuing to develop the relationships and opportunities for the HSCP and Local Authority, while continuing on the existing path within NHSL. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL
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8 This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT N/A Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes ☐ No ☐ N/A ☒
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9 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS NHS Lanarkshire – Strategic Academic Partnership Report (Period Covering June 2022- November 2023) Full Report. 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 11 SUBJECT: IJB Directions Letters TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 1.2 This report seeks the approval of the IJB in regards to the issue of the directions to each partner for 2024/2025 in line with the Strategic Commissioning Plan and the IJB Financial Plan. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐
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2 2.1 This paper has been prepared by the Support Services Project Manager and has been reviewed by the Chief Officer and Chief Financial Officer. 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: 3.1.1 Approve the issue of the directions to North Lanarkshire Council for the financial year 2024/2025 attached at Appendix 1 3.1.2 Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2024/2025 attached at Appendix 2 4. VARIATIONS TO DIRECTIONS? 4.1 The directions to each partner for 2024/2025 are detailed within Appendix 1 and 2 of this report. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board is required to issue a direction to Lanarkshire NHS Health Board and North Lanarkshire Council in respect of the delivery of integrated functions and how resources are to be allocated for the resultant services. 6. CONCLUSIONS 6.1The letters of direction are attached at Appendix 1 and Appendix 2 and, following the approval of the IJB, will be issued to North Lanarkshire Council and Lanarkshire Health Board by 31st March 2023. 6.2The focus for the year ahead will be on implementation of the programme of work of the IJB’s Strategic Commissioning Plan 2023-26. 6.3 The financial resources available are detailed in Annex 4 of each direction. The budget for 2024/25 is indicative at this stage. A range of estimates have been agreed by the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions Yes ☒ No ☐ N/A ☐
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3 of North Lanarkshire Council in respect of the preparation of the IJB Financial Plan 2024/2025 which will be updated during the course of 2024/2025 when costs and additional funding, as appropriate, are confirmed. As part of the detailed budget setting process, the financial allocations to each partner will therefore be finalised by the IJB Chief Financial Officer, in consultation with the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions for North Lanarkshire Council. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.2.1 A comprehensive performance framework is established across the health and social care partnership to monitor progress in respect of the achievement of agreed outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.3.1 Budget monitoring reports will be submitted to the Performance, Finance and Audit Committee and the IJB in accordance with the Financial Regulations. Yes ☒ No ☐ N/A ☐
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Financial Risk High Chief Finance Officer 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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5 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1- Letter of Direction to North Lanarkshire Council Appendix 2 - Letter of Direction to NHS Lanarkshire. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 Appendix 1 Councillor Jim Logue Leader of North Lanarkshire Council 31st March 2024 Dear Councillor Logue As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct North Lanarkshire Council to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2024/2025 is therefore set out in Annexes 1, 2 and 3. North Lanarkshire Council is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (a) The Integration Delivery Principles (b) The Integration Scheme (c) The Strategic Commissioning Plan 2023 - 2026 (d) The National Health and Wellbeing Outcomes (e) All Legal and Regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2024/2025. The budget allocation for the delegated functions is outlined in Annex 4 and reflects the financial planning principles agreed at the IJB on 27th March 2024. The detailed budget setting process for the financial year 2024/2025 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2024.
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7 The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019 and has been revised again for 2024. The directions correspond to the revised responsibilities delegated to the IJB which exclude Children and Family Services and Justice Services. In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high- level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank North Lanarkshire Council for the continued support during this period of significant change. We will continue to ensure that Elected Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Michael McBride, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Des Murray, Chief Executive, North Lanarkshire Council; Jann Gardner, Chief Executive, Lanarkshire Health Board.
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8 DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: NORTH LANARKSHIRE COUNCIL 31 MARCH 2024 1. The North Lanarkshire Integration Joint Board is required to give Direction to North Lanarkshire Council on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1 April 2019. 2. The North Lanarkshire Integration Joint Board is required to set out in writing how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used. 3. North Lanarkshire Council must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs North Lanarkshire Council: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and programme of work as set out in Annex 2; c. that the carrying out of all functions will be delegated to North Lanarkshire Council on the express understanding that North Lanarkshire Council will delegate those functions to Officers of the Council in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them.
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9 Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2024 1 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 2 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 3 Section 27(1)(a), (b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 4 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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10 FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Column A Enactment conferring function Column B Limitation National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45 (Recovery in cases of misrepresentation or non-disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 (Powers of Secretary of State.) So far as it is exercisable in relation to another integration function. Section 8 (Research.) So far as it is exercisable in relation to another integration function. Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function.
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11 Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Column A Enactment conferring function Column B Limitation Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Section 27ZA
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12 (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) So far as it is exercisable in relation to another integration function. Column A Enactment conferring function Column B Limitation Section 80 (Enforcement of duty to make contributions.) Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of
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13 assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions. Column A Enactment conferring function Column B Limitation The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Section 12 (Investigations.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.)
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14 Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Column A Enactment conferring function Column B Limitation Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation outwit Scotland.) Section 6 Deferred payment of accommodation costs.) Section 14
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15 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co-operation.) Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.) Section 259 (Advocacy.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Column A Enactment conferring function Column B Limitation Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.)
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16 Section 6 (Duty to consider importance of providing advocacy and other.) Section 7 (Visits) Section 8 (Interviews) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk) Section 18 (Protection of moved person’s property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.) Section 43 (Membership.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.) Column A Enactment conferring function Column B Limitation
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17 Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self-directed support.) Carers (Scotland) Act 2016 (b) Section 6 (Duty to provide Adult carer support plan Section 21 (Duty to set local eligibility criteria) Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers)
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18 Column A Enactment conferring function Column B Limitation Section 35 (short breaks services statements) Part 2 Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services; h) Care home services; I) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services;
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19 q) Re-ablement services; R) Smart technology, equipment and telecare. NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 and the Programme of Work are both available on the following web-site: https://hscnl.org.uk/about-us/ The progress report and the update in respect of the Programme of Work for the North Lanarkshire Health and Social Care Partnership is available on the following web-site: https://hscnl.org.uk/about-us/ The report outlining the Winter Planning and Enhanced Supports for North Lanarkshire Health and Social Care Partnership is available on the following web- site: att97950.pdf (northlanarkshire.gov.uk) The relevant meeting is 24th January 2024. SCHEME OF DELEGATION TO OFFICERS OF NORTH LANARKSHIRE COUNCIL ANNEX 3 This is the Appendix 1 referred to in the foregoing Authorisation of the Chief Officer to Officers of North Lanarkshire Council Column A Enactment conferring function Column B Limitation Column C National Assistance Act 1948 Section 48 (Duty of Councils to provide temporary protection for property of persons admitted to hospitals etc.). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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20 The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Provisions relating to performance of functions by local authorities.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Research.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AZA (Assessments under Section 12A – assistance) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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21 Section 12AA (Assessment of ability to provide care.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AB (Duty of local authority to provide information to carer.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13A (Residential accommodation with nursing.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13B (Provision of care or aftercare.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Home help and laundry facilities.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29
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22 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Chief Social Work Officer Chief Accountable Officer Head of Housing Property Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 3 (Assessment by local authorities of needs of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C welfare enactments within the meaning of Section 16 and which have been delegated. Head of Adult Social Work Services Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in Section 16 of that Act) which are integration functions. Chief Social Work Officer Chief Accountable Officer Head
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23 of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Investigations.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Column A Enactment conferring function Column B Limitation Column C Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44
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24 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered social landlord for housing purposes.) Only in so far as it relates to an aid or adaptation. Head of Housing Services Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 5 (Local authority arrangements for of residential accommodation outwit Scotland.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 Except in so far as it is exercisable in relation to Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Care and support services etc.) the provision of housing support services. Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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25 Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 33 (Duty to inquire.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 34 (Inquiries under Section 33: Co-operation.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 228 (Request for assessment of needs: duty on local authorities and Health Boards Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 259 (Advocacy.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Head of Housing Services The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Co-operation.) Chief Social Work Officer
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26 Column A Enactment conferring function Column B Limitation Column C Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Duty to consider importance of providing advocacy and other.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Assessment Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Removal Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 18 (Protection of moved person’s property.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Right to apply for a Banning Order.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Urgent cases.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Adult Protection Committees.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 43 (Membership.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 Chief Social Work Officer
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27 Column A Enactment conferring function Column B Limitation Column C (Choice of options: Adults.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Choice of options under Section 5: assistances.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Choice of options: Adult Carers.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Provision of information about self-directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Local authority functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Eligibility for direct payment: review.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under Section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Misuse of direct payment: recovery.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19
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28 (Promotion of options for self- directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services National Assistance Act 1948 Section 45 (Recovery in cases of misrepresentation or non- disclosure) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Matrimonial Proceedings (Children) Act 1958 Section 11 (Reports as to arrangements for future care and upbringing of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 5 (Powers of Secretary of State) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6B (Local authority inquiries into matters affecting children). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27ZA
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29 (Advice, guidance and assistance to persons arrested or on whom sentence deferred) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 78A Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Recovery of contributions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Enforcement of duty to make contributions) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 81 (Provisions as to decrees for ailment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 83 (Variation of trusts) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 86 (Adjustment between authority providing accommodation etc. and authority of area of residence) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children Act 1975 Section 34 (Access and maintenance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Reports by local authorities and probation officers) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Notice of application to be given to local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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30 Section 50 (Payments towards maintenance of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Health and Social Services and Social Security Adjudications Act 1983 Section 21 (Recovery of sums due to local authority where persons in residential accommodation have disposed of assets) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Arrears of contributions charged on interest in land in England and Wales) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Arrears of contributions secured over interest in land in Scotland) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Foster Children (Scotland) Act 1984 Section 3 (Local authorities to ensure wellbeing of and to visit foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Notification by persons maintaining or proposing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Notification by persons ceasing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8
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31 (Power to inspect premises) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Power to impose requirements as to the keeping of foster children) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Power to prohibit the keeping of foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children (Scotland) Act 1995 Section 17 (Duty of local authority to child looked after by them) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Local authority plans for services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 20 (Publication of information about services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 21 (Co-operation between authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Promotion of welfare of children in need) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23
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32 (Children affected by disability) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24 Chief Social Work Officer Chief Accountable Officer Column A Enactment conferring function Column B Limitation Column C (Assessment of ability of carers to provide care for disabled children) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24A (Duty of local authority to provide information to carer of disabled child) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 (Provision of accommodation for children etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Manner of provision of accommodation to child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26A (Provision of continuing care: looked after children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Day-care for pre-school and other children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Aftercare) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 30 (Financial assistance towards expenses of education or training and removal of power to guarantee indentures etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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33 Section 31 (Review of case of child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 32 (Removal of child from residential establishment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 36 (Welfare of certain children in hospitals and nursing homes etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 38 (Short term refuges for children at risk of harm) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 76 (Exclusion orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Criminal Procedure (Scotland) Act 1995 Section 51 (Remand and committal of children and young persons) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 203 (Reports) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 234B (Drug treatment and testing order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 245A
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34 (Restriction of liberty orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Column A Enactment conferring function Column B Limitation Column C The Adults with Incapacity (Scotland) Act 2000 Section 40 (Supervisory bodies) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 (Accommodation more expensive than usually provided) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Deferred payment of accommodation costs) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Management of Offenders etc. (Scotland) Act 2005 Sections 10 (Arrangements for assessing and managing risks posed by certain offenders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Review of arrangements) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Adoption and Children (Scotland) Act 2007 Section 1 (Duty of local authority to provide adoption service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Local authority plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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35 Section 5 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 6 (Assistance in carrying out functions under sections 1 and 4) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Urgent provision) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Power to provide payment to person entitled to adoption support service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Notice under Section 18 local authority’s duties) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Looked after children - adoption is not proceeding) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Adoption support plans) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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36 Section 47 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Family member’s right to require review of plan) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Other cases where authority under duty to review plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Re-assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 51 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 71 (Adoption allowance schemes) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Permanence Orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 90 (Precedence of certain other orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 99 (Duty of local authority to apply for variation or revocation) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 101 (Local authority to give notice of certain matters) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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37 Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 105 (Notification of proposed application for order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adult Support and Protection (Scotland) Act 2007 Section 7 (Visits) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Interviews) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Medical examination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Examination of records etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Right to remove adult at risk) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Children’s Hearings (Scotland) Act 2011 Section 35 (Child assessment orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37
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38 (Child protection orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Parental responsibilities and rights directions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Obligations of local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Notice of an application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 60 (Local authority’s duty to provide information to Principal Reporter) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 131 (Duty of implementation authority to require review) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 144 (Implementation of a compulsory supervision order: general duties of implementation authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 145 (Duty where order requires child to reside in a certain place) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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39 Section 153 (Secure accommodation regulations) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 166 (Review of requirement imposed on local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 167 (Appeal to Sheriff Principal: section 166) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 180 (Sharing of information: panel members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 183 (Mutual Assistance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 184 (Enforcement of obligations of health board under section 183) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 8 (Choice of options: children and family members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of information: children under 16) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4
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40 (The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to North Lanarkshire Council (NLC) for the financial year 2024/25 are as follows: 1. The NLC recurring budget allocations for in-scope social care services and housing services. For 2024/25, the total allocation is £190.677m based on the net budget as at January 2024. This budget will be uplifted as appropriate to reflect the 2024/25 additional funding of £12.138m, subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets, including agreed budget realignments, will be confirmed following the detailed budget setting process for 2024/25. 2. The additional funding highlighted at paragraph 1 allocated to NLC in 2024/25 is to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the uplift of the free personal care rate and the contribution to the payment of the Scottish Living Wage. 3. NLC will implement as appropriate any agreed efficiency savings plans, budget realignments and management actions for 2024/25 as detailed in the IJB Financial Plan 2024/25. 4. Additional funding received in-year by the NLC and NHSL partners which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 5. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2024/25 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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41 Appendix 2 Mr Martin Hill Chair of NHS Lanarkshire Health Board 31st March 2024 Dear Mr Hill, As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct NHS Lanarkshire to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2024/5 is therefore set out in Annexes 1, 2 and 3. NHS Lanarkshire is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (f) The Integration Delivery Principles (g) The Integration Scheme (h) The Strategic Commissioning Plan 2023 - 2026 and Programme of Work (I) The National Health and Wellbeing Outcomes (j) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan and Programme of Work at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2024/2025. The budget allocation for the delegated functions is outlined in Annex 4 and reflects the financial planning principles agreed at the IJB on 27 March 2024. The detailed budget setting process for the financial year 2024/2025 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2024.
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42 The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019 and refreshed in 2024. For completeness, the Health Board are advised that the directions to North Lanarkshire Council continue to correspond to the revised responsibilities delegated to the IJB by North Lanarkshire Council. In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high- level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank NHS Lanarkshire for the continued support during this period of significant change. We will continue to ensure that Health Board Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Michael McBride, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Jann Gardner, Chief Executive, Lanarkshire Health Board. Des Murray, Chief Executive, North Lanarkshire Council;
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43 DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: LANARKSHIRE HEALTH BOARD 31 MARCH 2024 1. The North Lanarkshire Integration Joint Board is required to give direction5 to Lanarkshire Health Board on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1st April 2019. 2. The North Lanarkshire Integration Joint Board is required to set out in writing6 how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used7. 3. Lanarkshire Health Board must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions8. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs Lanarkshire Health Board: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and commissioning summary as set out in Annex 2; c. that the carrying out of all functions will be delegated to Lanarkshire Health Board on the express understanding that Lanarkshire Health Board will delegate those functions to Officers of the Health Board in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them.
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44 Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2024 5 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 6 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 7 Section 27(1)(a), (b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 8 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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45 FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function The National Health Service (Scotland) Act 1978 Column B Limitation All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB ((Functions of Health Boards outside Scotland); section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal medical or dental services); section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 (care of mothers and young children); section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation); section 55 (hospital accommodation on part payment);
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46 section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses); section 75B (reimbursement of the cost of services provided in another EEA state); section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114; The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135;
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47 The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183; The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. Except functions conferred by— section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co-operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital);
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48 section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer); section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall); section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions).
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49 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36. Part 2 Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours’ period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004; and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine;
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50 (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided out with a hospital in relation to an addiction or dependence on any substance. 10. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 11. The public dental service. 12. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C (2) of the National Health Service (Scotland) Act 1978. 13. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 14. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 15. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 16. Services providing primary medical services to patients during the out-of- hours period. 17. Services provided out with a hospital in relation to geriatric medicine. 18. Palliative care services provided out with a hospital. 19. Community learning disability services. 20. Mental health services provided out with a hospital. 21. Continence services provided out with a hospital. 22. Kidney dialysis services provided out with a hospital. 23. Services provided by health professionals that aim to promote public health.
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51 NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 is available on the following web-site: https://hscnl.org.uk/about-us/ SCHEME OF DELEGATIONS ANNEX 3 That the carrying out of integrated functions that relate to the services set out in 1 and 2 below will be delegated to Officers of Lanarkshire Health Board by the Chief Executive of Lanarkshire Health Board at his discretion, in accordance with all applicable legal requirements; 1. Accident and emergency services provided in a hospital; 2. Inpatient hospital services relating to the following branches of medicine: • General medicine; • Geriatric medicine; • Rehabilitation medicine; • Respiratory medicine; • Palliative care services provided in a hospital; That the carrying out of integrated functions that relate to the services set out in 3 to 29 below will be delegated to Officers of Lanarkshire Health Board by the Chief Accountable Officer for the Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 3. Inpatient hospital services relating to the following branches of medicine: • Paediatrics; • Psychiatry of learning disability; • Inpatient hospital services provided by general medical practitioners; • Services provided in a hospital in relation to an addiction or dependence on any substance; • Mental health services provided in a hospital except regionally or nationally organised forensic mental health services.
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52 4. District nursing services; 5. Health Visiting; 6. Allied health professionals in an outpatient department, clinic, or out with a hospital; 7. Public dental services; 8. Primary medical services; 9. General dental services; 10. Ophthalmic services; 11. Pharmaceutical services; 12. Primary care out-of-hours; 13. Geriatric medicine; 14. Palliative care; 15. Community learning disability services; 16. Kidney dialysis services provided out with a hospital; 17. Services provided by health professionals that aim to promote public health; 18. Care Home Liaison; 19. Community Children’s Services; 20. Dietetics; 21. Psychology; 22. Sexual and Reproductive health and Blood Borne Viruses; 23. Speech and Language Therapy; 24. Prisoner Health Care; 25. Podiatry; 26. Mental Health and Learning Disability services; 27. Community Paediatrics; 28. Continence Services; 29. Addiction Services. That the carrying out of integrated functions that relate to the services set out in 30 to 38 below will be delegated to Officers of Lanarkshire Health Board by the Chief
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53 Accountable Officer for the South Lanarkshire Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 30. Community Dental Services; 31. Diabetes Services; 32. Health & Homelessness; 33. Primary Care Administration; 34. Palliative Care; 35. Physiotherapy; 36. GP Out of Hours; 37. Traumatic Brain injury; 38. Occupational Therapy. BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to NHS Lanarkshire (NHSL) for the financial year 2024/25 are as follows: 1. The NHSL recurring budget allocations for in-scope health care services including hosted services. For 2024/25, based on the budget as at January 2024, the total allocation for directly managed services, including hosted services, is £608.296m. This also includes the notional set-aside budget which was increased in 2022/23 by budget adjustments of £1.382m from £69.120m to £70.502m. It also includes non- recurring funding as at January 2024. The financial allocation will also be subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets will be confirmed following the detailed budget setting process for 2024/25. Non-recurring budgets will be adjusted as appropriate as part of this exercise. 2. NHSL will implement as appropriate agreed efficiency savings plans in 2024/25. 3. Additional non-recurring funding received in-year from NHSL which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 4. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2024/25 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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54 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements
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55 11 Date direction will be reviewed
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1 REPORT Item No: 12 SUBJECT: Long Term Financial Plan 2024-2034 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, NL HSCP Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 27 March 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report advises the IJB of the long-term financial outlook for North Lanarkshire IJB as set out in the attached Long Term Financial Plan 2024–2034. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge the assumptions and context of the financial plan; and (2) Approve the Long Term Financial Plan 2024-2034. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Long Term Financial Plan (LTFP) outlines the financial outlook for the next ten years, highlighting the challenges facing the IJB in maintaining financial stability whilst achieving the strategic commissioning priorities. The LTFP therefore provides an overview of the financial planning assumptions in relation to projected cost pressures arising from demographic growth, legislative and policy developments, employee costs and inflation alongside potential partner funding contributions in future years. 5.2 This LTFP addresses the North Lanarkshire IJB 2022/23 Annual Audit Report Action Plan which recommends that the IJB should develop a longer term financial plan to demonstrate the longer term financial sustainability and help support longer term strategic planning and decision making.
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2 6. FINANCIAL OUTLOOK 6.1 Looking into 2024/25 and beyond, it is anticipated that the public sector in Scotland will continue to face a number of challenges in the years ahead. There is significant uncertainty over what the scale of this is likely to be and it is therefore important that the IJB plans for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner over the coming years. 6.2 In addition, it is clear from North Lanarkshire Council and NHS Lanarkshire financial outlook, that both partners anticipate they will be subject to significant pressure over the coming years with a further period of constraint and reduction in core funding. In this context, there is a greater risk that future uplifts in funding to the IJB similar to that provided in previous years may not be deliverable. 7. FINANCIAL PLAN 2024/25 7.1 The Medium Term Financial Plan 2023/24–2025/26 (MTFP) was approved by the IJB in March 2023. Due to the continuing changing financial environment, the IJB’s financial planning arrangements remains subject to active review to update and refresh the assumptions as new financial information and certainty becomes available. The MTFP 2024/25 assumptions have therefore been carried forward and updated in the LTFP using the most up to date information available at time of writing. 7.3 The recurring pressures between the MTFP and the LTFP have increased by £2m to a total of £22.856m due to increased costs associated with the pay awards for staff employed by NLC. 7.4 The recurring savings target of £22.856m will be split equally between 2024/25 and 2025/26 as shown in the table below. Long Term Financial Plan Recurring Pressures 2024/25 2025/26 Total £m £m £m Management Actions 11.428 11.428 22.856 7.5 It is recognised that service redesign and savings plans take time to implement, therefore, to mitigate this risk to the IJB, contingency reserves may be needed to fund the gap until the full savings can be realised. Updates tracking savings achieved against target will be presented to the board throughout the year as identified savings options are implemented. 7.6 A review of all earmarked reserves was completed during January 2024 and approved by the PFA Committee on 21 February 2024. The outcome of the review increased contingency reserves by a total of £10.183m. This added to the present balance brings the current contingency reserves to circa £25m and will continue to allow the IJB to manage anticipated pressures until recurring savings targets are fully implemented. 8. FINANCIAL CHALLENGE 8.1 In view of the current scale of uncertainty, and in line with previous financial plans, potential outcomes have been considered over optimistic, envisaged, and pessimistic projected positions.
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3 8.2 Using the above range of scenarios, current projections for the life of the plan include a wide range of assumptions in respect of key cost pressures and demand. On the basis of this projected outlook, and subject to active review over the coming months and years, the Chief Finance Officer (CFO) recommends that the IJB progresses with a financial planning strategy based on the envisaged scenario. 8.3 The LTFP is based on a range of demand and cost pressures which could be faced by the IJB over the long term. These assumptions are informed by both the local and national context for which there remains significant and real uncertainty. 8.4 Detailed below are the main areas of cost pressures which will be subject to ongoing review: Future funding allocations Future pay settlements Cost of living crisis and inflation Contractual pressures and the living wage commitments Demand led services including deprivation and health issues Prescribing costs and availability 8.5 It is therefore essential that the IJB continues to focus on the longer term financial challenge and where appropriate generate reserves to help: Address future pressures on the assumption that the financial position is more than likely to remain challenging. To provide temporary funding to drive transformation. To build contingency reserves which will be crucial in ensuring the financial sustainability of the partnership in the medium term. 8.6 Looking beyond the financial year and into the term of the financial plan, it is inevitably more difficult to forecast. It is important the IJB adopts a plan, not just in the delivery of strategic outcomes and services, but also from a financial perspective to ensure risks to the financial sustainability of the IJB are identified early, even though there may be uncertainty over the specific timing, scale, and ultimate effect. 8.7 On this basis, the IJB should continue to plan for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner. Looking to the future, a significant level of savings and redesign will be necessary to continue to deliver sustainable and modern services which meet the needs of service users and their families. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐
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4 Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges High Amanda Kilburn National Set-Aside Budget High Ross McGuffie Hosted Services Medium Ross McGuffie Prescribing Activity and Costs Very High Ross McGuffie Third and Voluntary Sector Low Ross McGuffie Ineffective Governance Arrangements Medium Ross McGuffie 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the NL IJB. □ Provide stakeholders with information on how to get involved □ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs □ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis.
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5 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings □ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10. BACKGROUND PAPERS None. 11. APPENDIX IJB Long Term Financial Plan 2024-2034 Appendix 1 Chief Finance Officer Members seeking further information, please contact Amanda Kilburn on 07816 126362.
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Appendix 1 North Lanarkshire Integration Joint Board Long Term Financial Plan 2024/25 to 2033/34
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2 Contents Page 1. Introduction 3 2. Executive Summary 3 3. Purpose 4 4. National Context 5 5. Local Context 5 6. Reserves Strategy 7 7. Financial Planning Assumptions 7 8. Financial Sustainability Approach 9 9. Key Risks and Uncertainties 10 10. Financial Plan for 2024/25 11 11. Estimated Impact of Cost and Demand Pressures for 2024/25 – 2033/34 12
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3 1. INTRODUCTION The North Lanarkshire Integration Joint Board (IJB) was established as a corporate body by Scottish Government and became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. It is a joint venture between NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC). The IJB has responsibility for the strategic planning and commissioning of a wide range of services within North Lanarkshire. The North Lanarkshire University Health and Social Care Partnership (UHSCNL) is responsible for the operational delivery of the IJB strategic directions. This includes the service we are required to provide, the funding allocated and the monitoring of performance. The services include: Accident and emergency services provided in a hospital; Inpatient services related to general, respiratory and rehabilitation medicine; Palliative care services; Community health services including Lanarkshire wide hosted services; and Social care services. 2. EXECUTIVE SUMMARY The IJB Long Term Financial Plan 2024/25 – 2033/34 (LTFP) sets out the financial outlook for the next ten years, highlighting the challenges facing the IJB in maintaining financial stability whilst achieving the strategic commissioning priorities. The LTFP therefore provides an overview of the financial planning assumptions in relation to projected cost pressures arising from demographic growth, legislative and policy developments, employee costs and inflation alongside potential partner funding contributions in future years. The IJB is required to set a balanced budget. The aspiration to prepare a budget covering a longer term will support the development of strategic savings and ensure the available resources are allocated effectively across competing priorities. This aspiration however is dependent on the certainty of the financial settlements from the Scottish Government. Both partners have a proven track record of managing budgets effectively over many years. A clear strategy is required to ensure the IJB continues to remain financially sustainable over the life of this plan whilst committing to transforming services through the Strategic Commissioning Plan Programme of Work. To prepare this financial plan, a co-ordinated and strategic approach across the partnership has been adopted with both partners including the cost pressures in relation to their delegated functions. The likelihood of ongoing financial constraints is high and the IJB and both partners will need to make difficult decisions in the years to come. The whole system approach and working collaboratively with carers, third parties and independent providers is essential. This also requires to be supported by an effective communication strategy to ensure public confidence is maintained. A range of outcomes will continue to be analysed and the financial planning assumptions updated as the most likely scenarios emerge for future years. The Scottish Government aspiration to move to multi-year settlements in the future is welcome and would reduce the uncertainty which is currently impacting on strategic commissioning activity across the health and social care partnership.
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4 3. PURPOSE The adoption of the longer term approach for financial planning enables the IJB to plan the delivery of service changes across financial years through modernising services, investing in new technology, and in developing its partnerships to provide longer term benefits. This approach enables the required changes to services to be delivered in a more planned, holistic manner, mitigating the need for reactive cuts to services. With limited resources and increasing pressures on UHSCNL services it is clear we need to adapt and change to be more efficient, responsive, and sustainable. We therefore need to adopt a co-productive approach that fully involves communities in decisions ensuring an approach that supports and empowers them when a different model of service delivery is proposed. The strategic planning approach encompasses a longer term 10 year look forward that seeks to identify the challenges facing the partnership and the opportunities we have to address them. The current plan comes to an end in 2026 and will be refreshed at this stage. The LTFP makes a number of assumptions and will support the IJB to deliver the following outcomes: Align with the Strategic Commissioning Plan and Programme of Works to: o Continue to focus on prevention, early intervention and tackling inequalities; o Do the right thing first time; o Support people through a whole family approach; o Develop and support a workforce for the future; o Improve mental health and wellbeing; Work alongside partners to achieve common goals; Provide sustainable services to support transformation and local communities; and Maintain a balanced and transparent budget. Engaging with Partner Bodies Supporting Transformation Financial Planning Budget Setting Process Strategic Commissioning Plan
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5 4. NATIONAL CONTEXT IJB’s operate in a complex, challenging and changing environment where national issues can have an impact on what and how services are delivered along with the financial resources, they have available to meet this. The LTFP has considered a number of key issues, some of which are outwith the IJB’s control, and those internal issues which the IJB has the ability to influence. Both internal and external influences need to be considered with key variables modelled to guide the IJB decisions about the future. External Influences (outwith the IJB’s control) Increase in demand; Interest rate fluctuations; Level of funding from partners and Scottish Government; National pay agreements; Supply chain issues associated with the wider economy; Further financial and economic impacts and potential future pandemics; National Care Service. Internal Influences (within the IJB’s control) Community engagement, partnership working and co-production of service delivery models; Working to clear priorities as set out in the Strategic Commissioning Plan; Transformational change programmes to improve outcomes; Effective people planning and wellbeing; Use of robust performance data to drive improvement; Use of digital technologies to improve services and reduce cost; Effective risk management to keep risk levels within tolerance; and Effective financial planning to ensure best value for the resources available. 5. LOCAL CONTEXT North Lanarkshire IJB delivers and commissions a range of health and social care services to our local population. This is funded through budgets delegated from both NHSL and NLC. The resources available to the IJB in 2023/24 to take forward the commissioning intention in line with the Strategic Commissioning Plan, are circa £809m. Included in the above is a ‘Large Hospital Service’ (Notional Set Aside) budget totalling £74.58m. This budget is in respect of those functions delegated by the Health Board which are carried out in a hospital within the Health Board area. The Set Aside resource for delegated services provided in acute hospitals is determined by apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJB based on postcode. The IJB is responsible for the strategic planning of these services but not their operational delivery. Also included is £40.85m which represents a number of delegated services where South Lanarkshire IJB acts as the lead host on behalf of North Lanarkshire IJB. The value consumed by North Lanarkshire equates to 52% of South Lanarkshire IJB hosted budget.
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6 These budgets are resourced as shown and will become the base year for the LTFP less any non-recurring funding: There are multi-faceted factors that impact on this budget and the demand for health and social care services across North Lanarkshire which include: North Lanarkshire is the 4th largest area in Scotland. It is also the 5th most populated with a population of 341,400. Between 2002 and 2021, the 25 to 44 age group saw the largest percentage decrease (-10.7%), in contrast the 75 and over age group saw the largest percentage increase (+41.6%). Although the population is projected to increase by a net 0.3% by 2028, an increase of 21.8% is projected in the age group 75 years and over. 34% of North Lanarkshire’s data zones are within the 20% most deprived in Scotland, a growth of 2% from Scottish Index of Multiple Deprivations (SIMD) 2016 statistics. The number of people income deprived in North Lanarkshire is 50,897, a reduction of 3% from SIMD 2016 data. The number of employment deprived working age people has also fallen from 29,585, in SIMD 2016 data to 24,796 in SIMD 2020. Across North Lanarkshire 11% of the working age population is employed deprived. Whilst many older people are expected to enjoy better health than their predecessors did at an equivalent age, they will still have significant health needs, living with potentially multiple and complex conditions. The impact of this will be a steadily increasing demand on our health and social care services, including home care support, care homes, increases in demand for community-based healthcare, equipment and adaptations and an increased demand for GP services and medication. There remains significant ongoing pressure in all health and social care systems across Scotland. High demand and patient acuity, coupled with increased flu and covid numbers in recent months has placed even greater demand on our system. In Lanarkshire, there is a genuine whole-system focus to our resilience response and there has been a tremendous effort across the whole system, including third and independent sectors, communities, carers, and public partners in the continued response to increased pressures and demand. North Lanarkshire IJB Funding Available 2023/24 24% North Lanarkshire Council £196.50m National Set Aside 74.58m 9% 62% South Hosted Services £40.85m NHS Lanarkshire £496.94m 5%
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7 6. RESERVES STRATEGY The IJB has the same legal status as a local authority and is therefore able to hold reserves under section 106 of the Local Government (Scotland) Act 1973. A reserves strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The use of reserves must be prudent and controlled and are generally held for the following purposes: To create a working balance to help cushion the impact of uneven income flows; To create a contingency to cushion the impact of unexpected events or emergencies; To create a means of building up funds, to meet known or predicted liabilities; To fund non-recurring costs and to help with payment profiles straddling more than one year; and To enable the implementation of longer-term savings proposals. Following approval of the Reserves Strategy 2023/24 by the Performance, Finance and Audit Committee in February 2024, North Lanarkshire IJB reserves are summarised below: SUMMARY Balance at 31 January 2024 £m Ring-Fenced Reserves 10.036 Earmarked Reserves 30.854 Risk-Based Reserves 14.834 Contingency Reserves 11.053 TOTAL 66.777 7. FINANCIAL PLANNING ASSUMPTIONS Financial planning requires assumptions to be made about future demand and cost pressures which could be faced by the IJB and our partners. This LTFP focuses on the likely cost pressures that we can reasonably expect over the next ten years. These assumptions have been informed by the local and national context within which we operate. It is widely expected that the public sector in Scotland will continue to face a very challenging financial outlook for the foreseeable future. Whilst the provision of recurring investment and non-recurring reserves will help, there remains significant uncertainty over increasing cost pressures and what the scale of the likely reduction in available funding will be over the term of this plan. It therefore remains important that the IJB ensures sufficient flexibility to manage in a sustainable manner the position which emerges over the coming years, with the likely scenario that a significant level of further recurring savings will be required. Consequently, the IJB’s financial planning arrangements remains subject to active review using a scenario-based approach in recognition of the significant uncertainty over rising costs and the scale of variability in the potential funding available to the IJB in future years. The following key variables have been considered in preparing this 10 year plan: Antic ipated Scottish G overnment Funding Levels The Scottish Government financial settlement for both partners will significantly influence the funding contribution each partner can make to the IJB. The Scottish Government has historically provided one year funding settlements which has impacted on the ability to plan over the longer term with certainty. Single year settlements have required assumptions in the LTFP from year 2 to 10.
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8 For financial year 2024/25 another one year settlement was provided in December 2023, however there is still a commitment from Scottish Government to move to multi-year settlements in the future. Ass umptions on Infl ation Inc luding Pay Inc reases Consumer price index (CPI) and retail price index (RPI) inflationary increases are assumed for a range of contractual commitments and purchasing of supplies and materials. The UK has experienced unprecedented inflationary increases and fluctuations making future assumptions challenging in the current economic environment. A significant cost pressure relates to the National Care Home Rate Contract (NCHR) which is negotiated annually. The level of increase for future years is unknown but it is prudent to assume, based on past year trends and the on-going cost of living crisis that this is likely to increase significantly over the life of this plan. Health and social care services including independent home support are also commissioned. Increases in the Scottish Living Wage significantly impact on the cost of these services and service level agreements. Employee costs represent a large portion of IJB net budgets with any increase in pay awards impacting directly on current and future cost pressures. In relation to this plan, an estimated 3% has been assumed for staff employed in NLC, to reflect the 2024/25 pay award expected to be managed within IJB resources. In line with previous years, full funding is expected for pay uplifts to NHSL staff. In the event of an uplift greater than that estimated and no additional government support, the forecasted gap could potentially change materially. Consideration is also given to the challenges of recruiting and whether pay settlements are keeping pace with industry standards. As future pay agreements are confirmed, these assumptions will be updated in the model. Ass umptions on Inc reased D emand for Ser vic es In c luding Presc ribing Health and social care services are experiencing increasing demand due to demographic growth, an ageing population, complexity of care needs, deprivation, and health issues. This increase has been factored into the financial plan over the 10 year period to ensure that costs are adjusted in line with forecast demand, however, close monitoring is required to ensure that demographic growth is in line with assumptions made. If investment in this area is insufficient over a number of years, this could destabilise services whilst an over- provision of growth would mean the resources available would not be effectively allocated in line with need and priority. The amount and cost of drugs prescribed usually increases year on year. The price of drugs is set nationally and influenced by factors such as supply and demand, currency movements and patents. Prescribing activity is a clinical decision made by a qualified health professional. At the time of writing, the current prescribing budget is projected to overspend by year end 2023/24. Based on this trend, a volume and price uplift has been included in future projections to mitigate against deteriorating health within our population and the continuing uncertainties experienced in supply and demand due to fluctuating market conditions. Inve stment in Local Priorities Inc luding IT Improves and U pgrades A range of local priorities are included in the LTFP including digital and IT technology improvements, investing in home support, tests of change pilots and continued recovery from the pandemic. Depending on when the cost commitment is expected to be incurred and expected duration, the cost pressures will be recognised in the year it is forecast to materialise. Identifying recurring funding solutions for all commitments will be necessary, however it is recognised that savings plans take time to implement therefore to mitigate this risk to the IJB, earmarked reserves will be needed to fund in the short to medium term until the full recurring funding solution can be realised.
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9 Savings D eliverable from Transformational C hange Opportunities to redesign services, remove duplication and achieve efficiency savings have been implemented over the last number of years and therefore, it is becoming increasingly challenging to deliver further savings on a recurring basis. However, in order to remain sustainable in future years, the IJB will need to make significant changes to its operating model, by continuing to explore new ways to deliver services that better meet the needs of the people in the community. The focus of a whole system approach is to reduce inequalities, build community capacity and resilience and thereby decrease demand for services in other parts of the system. Legislative and National Polic y D ec isions There are a range of legislative and policy developments which have and are continuing to be implemented across the partnership. These include the Carer’s Act, Alcohol and Drug Partnership, Primary Care and Mental Health developments. To date, additional funding has been made available by the Scottish Government to take these policies forward and it is assumed that the expenditure will be contained within the funding available. Recognising this, no variation in the cost projection is therefore considered, however, if future funding from Scottish Government is withheld or withdrawn, the financial forecast could change. National policy decisions such as the National Care Service bring further long term uncertainty to this plan. Developments in these national decisions will be followed closely to ensure implications for the IJB can be reflected in future planning assumptions as soon as possible. This is not an exhaustive list of variables which need to be reviewed, however, the assumptions identified above are considered to be the core issues which require to be included in this plan. Adjusting for these key variables will give the IJB a robust approach to ensuring the board remains financially and operationally sustainable, and in doing so ensures that it meets its statutory obligations, its policy aspirations, and the needs of our local communities. 8. FINANCIAL SUSTAINABILITY APPROACH The financial sustainability approach considers a range of interventions. The IJB ambitions are set out in the Strategic Commissioning Plan and further detailed in the Programme of Work. The following key principles underpin these strategies: Effic ienc y The IJB has a statutory duty to deliver best value in its use of public funds which requires the cost of services to be kept under review. Sources of income which are available to fund services should also be secured and maximised including external grant funding and service user contributions. Ser vic e Red esign and Innovation In line with the ambitions of the Strategic Commissioning Plan, service redesign and innovation involve changing the way in which services are planned and delivered, and working in partnership with stakeholders, our users, and carers to better support them to achieve their personal outcomes and aspirations. Redesign opportunities also need to take into consideration digital, telehealth, telecare, and e-health strategies. Shifting the B alanc e of C are A whole system approach to service redesign and savings options is critical to achieve a balanced budget in future years. One area of immense pressure is the management of delayed discharges which is an essential consideration going forward to deliver future cost reductions.
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10 New ways of working in this area is continuing and proving successful under ‘Operation Flow’ which brings together not only health and social care services but also acute services as the whole system works towards shifting the balance of care where possible, from hospital based to community without unnecessary delay. This however is dependent on capacity being available in community care which is currently proving challenging. Ser vic e Prio ritisation and Reduc tion It is important to note that some services delivered across the health and social care partnership are difficult to transform or reduce as our users are dependent on these services to support their daily living. The scale of the financial challenge will require the IJB to consider prioritising, reducing, or even stopping some services to stay within the funding available. As demand is expected to continue to increase, it is likely that a reduction in service levels will be required to ensure a balanced budget. Presc ribing Effic ienc ies and Medic ines Manageme nt Mitigating the risk of the rising costs of primary care medicines will remain an important focus for the IJB. A range of measures locally and regionally are in place ranging from reducing waste and inefficiencies to changing prescribing practices and culture to help control prescribing volumes, thereby reducing costs. Work is also underway implementing a range of alternatives to prescribing medicines and engaging our users in self-management and prevention measures. Realistic C are and Realistic Medic ine Our users have a key role in deciding what care and treatment best meets their needs. It is therefore important that individuals are better informed about what they can realistically expect from health and social care services. Limited resources should be directed to achieve realistic goals and manage expectations of what future services can deliver. Early Inter vention and Prevention There is a strong body of evidence that early intervention and prevention is cost effective. Increased emphasis on prevention is an important element of the transformation of services. Recovery approaches which are peer led also provide unique and personalised support opportunities for self-management and community capacity building. Providing our users with the correct service at the right time, first time is critical in avoiding unnecessary and prolonged interventions. 9. KEY RISKS AND UNCERTAINTIES Given the current political climate and the associated economic uncertainty, it is important to note that projections made within this LTFP may potentially be subject to significant variation. The assumptions applied to income and expenditure models are based on the best information available at the time of writing. These include but are not limited to: Future funding levels from our partner organisations and Scottish Government. Our ability to recruit and retain quality staff to continue to deliver services and manage increasing demand. Continued increasing costs and raising inflation including future pay awards. Unexpected shortage of supplies and materials. Increasing level of complex care packages materialising that are currently unknown. Volatility of the external care market and the support required in order to provide stability.
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11 Changing political factors which influence the UK and Scottish Government priorities and policy initiatives. Introduction and impact of the National Care Service. The IJB maintains a strategic risk register and both partners maintain operational risk registers. Strategic and operational risks are regularly monitored and updated by the board and senior management to mitigate against key risks and uncertainties. 10. FINANCIAL PLAN FOR 2024/25 Using a range of scenarios, current projections for the period highlight potential cost pressures ranging from £36.269m to £40.597m in 2024/25. Based on these projections, and subject to clarification over the coming months, the Chief Finance Officer (CFO) recommends that the IJB progress with a financial planning strategy based on the envisaged scenario: E stimated C ost Press ures in t he Short Term Contractual Pressures 13.082 Demand Pressures 4.897 Pay Pressures 8.353 Local Cost Pressures 4.458 Prescribing 7.097 Total Pressures 37 . 886 Financ ial Strategy to Address C ost Press ures for 20 24 /25 The IJB will address the estimated recurring funding pressures highlighted above using a combination of actions as shown below: Additional funding to uplift the living wage, including the associated cost within the National Care Home Rate Contract for 2024/25. Realigning unallocated budgets to fund a portion of the NLC pay pressure. Use of agreed reserves to fund additional cost pressures within prescribing and demand as highlighted in the financial plans. On-going analysis and review of all remaining reserves to identify those no longer required. Reducing costs in pressure points through a mixture of efficiencies, redesign, and management actions. Regular tracking and reporting of savings targets to ensure plans are implemented within the agreed timeframe. Agree a two year plan to fully fund cost pressures on a recurring basis*. *It is recognised that service redesign and savings plans take time to implement therefore, to mitigate this risk to the IJB, contingency reserves may be needed to fund the gap until the full savings can be realised. Updates tracking savings achieved against target will be presented to the board throughout the year as identified savings options are implemented. Type of Pressure on Base Budget - Envisaged Outlook 2024 /25 £m
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12 North Lanarkshire I JB 2024 /25 Financial Plan 2024 /25 Total Total Pressures - Envisaged Outlook 37 . 886 Financial Strategy to Address Funding Pressures: 2024 /25 £m Use of Reserves -4.467 In Year Re-Profiling of Cost Pressures -0.050 Reduction in Employers Superannuation Contribution -8.170 Additional Funding Including Living Wage Uplift -13.771 Management Actions -11.428 Total Financial Strategy - 37 . 886 11. ESTIMATED IMPACT OF COST AND DEMAND PRESSURES FOR 2024/25 – 2033/34 The table below gives an estimated impact of cost and demand pressures arising from employee costs, inflationary cost pressures, demographic growth and demand, local cost pressures and legislative and policy developments for the next ten years. Unlike the Medium Term Financial Plan, it does not include a financial strategy to address these cost and demand pressures or any mitigation to reduce the gross cost through budget uplifts; recurring savings plans or funding from other sources. Type of Pressure on Base Budget - Optimistic Outlook 2024 /25 2025 /26 2026 /27 2027 /28 2028 /29 2029 /30 2030 /31 2031 /32 2032 /33 2033 /34 £m £m £m £m £m £m £m £m £m £m Contractual Pressures 12.999 8.510 8.761 9.018 9.284 9.557 9.839 10.128 10.427 10.734 Demand Pressures 4.197 4.323 4.453 4.586 4.724 4.866 5.012 5.162 5.317 5.476 Pay Pressures 8.353 8.520 8.690 8.864 9.041 9.222 9.407 9.595 9.787 9.982 Local Cost Pressures 4.458 0.882 0.882 1.782 1.782 1.782 1.782 1.782 1.782 1.782 Prescribing 6.262 6.450 6.643 6.843 7.048 7.259 7.477 7.702 7.933 8.171 Total Pressures 36 .269 28 .685 29 .429 31 .093 31 .879 32 .686 33 .516 34 .369 35 .245 36 .145 Type of Pressure on Base Budget - Envisaged Outlook 2024 /25 2025 /26 2026 /27 2027 /28 2028 /29 2029 /30 2030 /31 2031 /32 2032 /33 2033 /34 £m £m £m £m £m £m £m £m £m £m Contractual Pressures 13.082 8.651 9.081 9.535 10.014 10.520 11.054 11.606 12.202 12.833 Demand Pressures 4.897 5.068 5.245 5.429 5.619 5.816 6.019 6.230 6.448 6.674 Pay Pressures 8.353 8.520 8.776 9.039 9.310 9.589 9.877 10.173 10.478 10.793 Local Cost Pressures 4.458 0.882 0.882 1.782 1.782 1.782 1.782 1.782 1.782 1.782 Prescribing 7.097 7.338 7.588 7.846 8.113 8.388 8.674 8.968 9.273 9.589 Total Pressures 37 .886 30 .459 31 .571 33 .630 34 .837 36 .095 37 .406 38 .759 40 .184 41 .670 Type of Pressure on Base Budget - Pessimistic Outlook 2024 /25 2025 /26 2026 /27 2027 /28 2028 /29 2029 /30 2030 /31 2031 /32 2032 /33 2033 /34 £m £m £m £m £m £m £m £m £m £m Contractual Pressures 14.258 9.549 10.081 10.646 11.248 11.888 12.570 13.295 14.068 14.891 Demand Pressures 5.596 5.598 5.601 5.603 5.605 5.829 6.062 6.305 6.557 6.819 Pay Pressures 8.353 8.603 8.862 9.127 9.401 9.683 9.974 10.273 10.581 10.899 Local Cost Pressures 4.458 0.882 0.882 1.782 1.782 1.782 1.782 1.782 1.782 1.782 Prescribing 7.932 8.233 8.546 8.871 9.208 9.558 9.921 10.298 10.690 11.096 Total Pressures 40 .597 32 .866 33 .971 36 .030 37 .244 38 .741 40 .309 41 .953 43 .678 45 .487 As previously stated, due to the continuing changing financial environment we are facing, the reliance which can be placed on the financial costings decreases the further into the future the projections relate to. The CFO will continue to update and refresh the assumptions as new financial information, including future funding and savings plans becomes available.
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1 REPORT Item No: 13 SUBJECT: 2024-25 Delegated Health and Social Care Budget TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, NL HSCP Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 27 March 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report describes the financial allocation and budgets made available to the Integration Joint Board (IJB) for 2024/25 by North Lanarkshire Council and NHS Lanarkshire. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Agree to accept the delegated social care budget for 2024/25 in section 9.4 subject to any final adjustments in relation to recurring budget adjustments in March 2024; (2) Agree to accept the delegated health budget for 2024/25 in section 10.4 subject to: any final adjustments in relation to recurring budget adjustments in March 2024; and any further funding allocated by the Scottish Government. (3) Approve a drawdown of reserves, if required, in order to fund any shortfall in funding for 2024/25 and (4) Approve increases to the IJB’s contingency reserves in 2024/25, in order to protect the financial resilience of the IJB. (5) Acknowledge both NHSL and NLC have passed through full budget uplifts when they have been received from Scottish Government. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire IJB is a legal entity in its own right and is accountable for the stewardship of public funds and ensuring that its business is conducted under public sector best practice governance arrangements, including ensuring that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. 5.2 The budget delegated by our two partner bodies, is used by the IJB to commission services, which are delivered by North Lanarkshire University Health and Social Care Partnership (UHSCNL). The principles of the funding allocated by the two partner organisations is set out in the Integration Scheme, however, utilisation of this funding is delegated to the IJB. 5.3 Under the terms of the Integration Scheme, partner organisations should make appropriate arrangements to fund pay awards, contractual uplifts, the impact of demographic changes and determine efficiency targets as part of their respective budget setting processes. 5.4 The role of the Chief Finance Officer (CFO) for the IJB includes both the adherence to professional standards as well as compliance with the Local Government (Scotland) Act 1973. For the IJB this includes the requirement to ensure a balanced budget is set. 6. CONCLUSIONS 6.1 This report sets out the implications of the Scottish Government budget for 2024/25 and provides an overview of the IJB’s budget allocation for 2024/25. 6.2 Over the medium term, significant uncertainty remains, and the IJB will require to continue to plan for a wide range of potential scenarios. During the past number of years, the IJB has taken a medium-term view of its financial position, agreeing transformation and redesign which have ensured a balanced budget year on year. However, the continuing rise in costs and demand, continues to provide uncertainty resulting in challenging times for services and the need for ongoing review and realignment of future transformation and savings plans. 6.3 In this context, it is more than likely that we will need to draw on the financial flexibilities available to the IJB to provide non-recurring support to balance the annual revenue budget position each year over the medium-term. 7. SCOTTISH GOVERNMENT BUDGET 2024/2025 7.1 On 19 December 2023, the Scottish Government published their budget for 2024/25. Included within the budget was the continued commitment to health and care staff who deliver front line services by increasing adult social care workers in the third and private sectors to £12 per hour for those in a direct care role. For North Lanarkshire, this amounts to additional funding of £13.771m. 8. SUMMARY OF 2023/24 BUDGET POSITION 8.1 As reported throughout this financial year, the IJB will deliver an underspend on its core budget. The IJB reported underspend at the end of December, takes into account the ongoing challenges in terms of recruitment and retention across all service areas and the drawdown of non-recurring reserves. These are issues that are being faced by IJBs across Scotland.
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3 8.2 The landscape in relation to additional funding streams released throughout 2023/24 by Scottish Government to a number of priority areas is exceptionally complex with continued uncertainty around the scale and timing of the funding. There is however a commitment by Scottish Government to allocate 80% of ring-fenced funding in the first quarter of 2024/25 which will help to address this issue going forward. 9. DELEGATED SOCIAL CARE BUDGET 2024/25 9.1 Similar to 2023/24 and as previously highlighted, demographic, and socio-economic factors continue to drive significant demand and cost pressures for 2024/25 relating to: Funding for pay awards. Cost pressures arising from contractual arrangements which are subject to renewal. Financial impact of the negotiated application of the increased living wage across the sector. Increases associated with the National Care Home Rate (NCHR) contract. Ongoing pressures on home support service in relation to costs associated with shifting the balance of care, supporting people to live safely at home for as long as possible and facilitating prompt discharge from hospital. Increasing investment in self-directed support packages required to support adults and carers to achieve improved outcomes and live independently. 9.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for social care services in 2024/25 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £26m, including the increase to the living wage. 9.3 At its meeting on 15 February 2024, North Lanarkshire Council approved a recurring net uplift to the social care budget of £12.138m. 9.4 The following table provides a summary of the indicative social care budget 2024/25 from North Lanarkshire Council: 9.5 The CFO recommendation to the IJB is, to note and accept the delegated social care budget offer from North Lanarkshire Council for 2024/25 subject to any final adjustments in relation to recurring budget adjustments in March 2024. 10. DELEGATED HEALTH BUDGET 2024/25 10.1 Similar to social care, demographic and socio-economic factors continue to drive significant demand and cost pressures for our delegated health services in 2024/25 including: Pay inflation and the impact of agenda for change. Inflationary cost pressures across service level agreements on non-pay budgets. Prescribing cost, volume, and short supply impact. Social Care Budget 2024/25 £m Opening Budget 193.710 Delegated Services 2.646 Uplift Scottish Living Wage 13.771 Adjustments to Prior Years Funding from Scottish Government (1.633) Total 2024/25 Budget 208.494
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4 10.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for health services (not including Set Aside) in 2024/25 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £11m. 10.3 As no additional uplift to budgets were received from Scottish Government against mainstream budgets, the NHS Lanarkshire indicative opening budget offer for 2024/25, remains the same as the closing budget in 2023/24. It is anticipated that a formal budget offer will be issued following NHS Lanarkshire board approval. 10.4 The following table provides a summary of the indicative health budget 2024/25 from NHS Lanarkshire: Health Budget 2024/25 £m Mainstream Budget 310.786 Set Aside Budget 74.577 Total 2024/25 Budget 385.363 10.5 The CFO recommendation to the IJB is, to note and accept the delegated health budget offer from NHS Lanarkshire for 2024/25 subject to any final adjustments in relation to recurring budget adjustments in March 2024, and any further funding allocated by Scottish Government during 2024/25. 11. FINANCIAL PLAN 2024/25 11.1 The long term financial plan reflects the economic outlook, adopting a strategic and sustainable approach linked to the delivery of priorities in our Strategic Commissioning Plan. These strategic priorities will continue to provide a focus for future budget decisions, where the delivery of core services must be balanced with the resources available. Our financial plans and reserves strategy focuses on financial sustainability, acknowledging the uncertainty around key elements and the need to redirect resources to support the delivery of key priorities. 11.2 The long term financial plan has estimated recurring funding pressures of circa £23m for 2024/25. A two year savings target will be introduced to address these pressures primarily focusing on reducing costs by a mixture of efficiencies, redesign, and management actions. Regular tracking and reporting of savings targets will be reported to the board through the quarterly financial monitoring reports until full implementation has been achieved. 11.3 It is recognised that service redesign and savings plans take time to implement therefore, to mitigate the risk to the IJB, contingency reserves may be needed to fund the gap until the full savings can be realised. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐
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5 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges High Amanda Kilburn National Set-Aside Budget High Ross McGuffie Hosted Services Medium Ross McGuffie Prescribing Activity and Costs Very High Ross McGuffie Third and Voluntary Sector Low Ross McGuffie Ineffective Governance Arrangements Medium Ross McGuffie 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services
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6 ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 13. BACKGROUND PAPERS None. Chief Finance Officer Members seeking further information, please contact Amanda Kilburn on 07816 126362.
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1 REPORT Item No: 14 SUBJECT: IJB Integration Scheme 2024 – Update following Consultation Period TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, NL HSCP Chief Officer North HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 1.2 The paper details the update of the IJB Integration Scheme 2023 as per legal requirement. 2. ROUTE TO THE BOARD
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2 This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Service Support Project Manager. The paper will also be shared with the North Lanarkshire Council Policy and Strategy Committee and NHS Lanarkshire Board. 3. RECOMMENDATIONS 3.1. The IJB is asked to acknowledge the feedback received as part of the IJB Integration Scheme Consultation Process. 3.2 Confirm that the final draft of the Integration Scheme can now be submitted to Scottish Government for endorsement. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. The Integration Scheme sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. 5.2 Section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014, notes that “the local authority and the Health Board must carry out a review of the integration scheme before the Yes ☐ No ☒ N/A ☐
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3 expiry of the relevant period for the purpose of identifying whether any changes to the scheme are necessary or desirable”. The legislation clarifies the “relevant period” as “the period of five years beginning with the day on which the scheme was approved. 5.4 In September 2018 North Lanarkshire Council set out a new vision for the future direction of the council in ‘We Aspire’. The document set out a plan to revise the Integration Scheme and transfer the discretionary delegated functions for children, families and justice social work services to the newly reshaped Education and Families service within the council. 5.5 Following approval by the respective bodies, the Integration Scheme was updated and submitted to the Scottish Government for approval. 5.6 On 12th April 2019, the Cabinet Secretary approved the integration scheme changes, namely to remove children, families and justice social work. 5.7 In order to meet the 5-year review timeline, a review and update of the North Lanarkshire Integration Scheme for 2024 has taken place and an update of the document is attached. 5.8 The updated Integration Scheme and associated paper was presented to the IJB PFA in Oct 2023, the IJB PFA requested terms referencing to the IJB PFA be standardised, terms should reflect current voting members and also to ensure language is reflective of current position. Therefore, the Integration Scheme was updated in line with this feedback. 5.9. The draft Scheme was reviewed by IJB members at the meeting on 22nd November 2023 and was also presented to the NHS Lanarkshire Board and North Lanarkshire Policy and Strategy Meeting in December 2023. 5.10 In accordance with the approval received from the Integration Joint Board, Policy and Strategy Committee and the NHS Board in late 2023, the revised Integration Scheme underwent a period of public consultation spanning from the 15th of January 2024 to the 11th of February 2024.
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4 5. 11 The consultation process involved the publication of the draft integration scheme on the publicly accessible North Lanarkshire Health and Social Care Partnership Website. Furthermore, it was disseminated through various social media channels, and the consultation document was distributed via email to a diverse audience, including health and social care professionals, users and caregivers of healthcare and social care services, non-commercial providers of social housing, third-sector bodies, and locality representatives. 5.12 Throughout the consultation phase, only a single response was submitted. This feedback emphasised the importance of aligning the 4 Council representatives with residents' voting preferences, rather than solely representing any dominant political party. This consideration is particularly relevant in the context of NLC, where votes were evenly distributed. Additionally, the response highlighted concerns related to the proposed new hospital by NHS Lanarkshire. It pointed out a discrepancy with the IJB Integration Scheme due to the IJB having a focus on health and wellbeing and the responded believing that there are inadequate transport links to the proposed new hospital site which may necessitate the use of cars instead of alternative modes of transportation that could promote increased physical activity. 6. CONCLUSIONS 6.1 The post-consultation phase of the Integration Scheme will be presented to the Integrated Joint Board, the Policy and Strategy Committee, and the NHS Lanarkshire Board for their formal approval. Upon obtaining formal approval, the Scheme will be submitted to the Cabinet Secretary for endorsement. Subsequent to the endorsement, the revised Integration Scheme will be made publicly available on the North Lanarkshire Health and Social Care Partnership website.
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5 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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6 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. 7.5.1 Engagement and participation will be included as part of the consultation framework for the Integration Scheme. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Consultation process as defined in Appendix. Yes ☐ No ☐ N/A ☒
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7 ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of
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8 other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS North Lanarkshire Integrated Joint Board Integration Scheme 2019 Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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9 9. APPENDICES Appendix 1 NL IJB Integration Scheme 2024 Appendix 2 – Integration Scheme Consultation Process CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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11 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 Appendix 1 Health and Social Care Integration North Lanarkshire Integration Scheme 2024 Version Control Version Date North Lanarkshire Integration Scheme 2014 V1 April 2014 North Lanarkshire Integration Scheme 2019 V2 April 2019 North Lanarkshire Integration Scheme 2024 V3 April 2024
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2 Contents 1. Introduction ............................................................................................................................ 4 2. The Parties ............................................................................................................................. 8 3. Integration Model ................................................................................................................... 9 4. Local Governance Arrangements ....................................................................................... 10 5. Delegation of functions ....................................................................................................... 14 6. Local Operational Delivery Arrangements ......................................................................... 19 7. Corporate Service Support ................................................................................................. 21 8. Supporting Strategic Planning ............................................................................................ 21 9. Performance Measurement ................................................................................................. 22 10. Support, Care and Clinical Governance ........................................................................... 24 11. Clinical and Professional Governance Framework ......................................................... 25 12. Chief Officer ....................................................................................................................... 29 13. Workforce ........................................................................................................................... 31 14. Finance ............................................................................................................................... 33 15. Communication, Participation and Engagement ............................................................. 39 16. Information-Sharing and Data Handling ........................................................................... 40 17. Complaints ......................................................................................................................... 42 18.Claims Handling, Liability and Indemnity .......................................................................... 44 19.Risk Management ............................................................................................................... 46 20.Dispute Resolution Mechanism ......................................................................................... 48 Annex 1 – Delegated Functions .............................................................................................. 50
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3 Part 2- Integrated Services ...................................................................................................... 61 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board ........................................................................................................................................ 65 Health and Social Services and Social Security Adjudications Act 1983 ............................ 73 Part 2 -Services currently provided by the Local Authority which are to be integrated ..... 87 Annex 3 – Hosted Services Arrangements ............................................................................ 89 Annex 4 – Health and Wellbeing Outcomes ........................................................................... 91
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4 1. Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. This document sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. The creation of an integrated partnership required North Lanarkshire Council and NHS Lanarkshire Health Board to undertake a significant change agenda with the aim of creating services and supports which build on a solid foundation of success to date. The overall aim of the arrangement is the creation and continuation of a partnership which further improves outcomes for people who use health and social care services and their carers. Therefore, a primary focus of the partnership will be delivering on the nine National Health and Wellbeing Outcomes (hereinafter referred to as the “Outcomes”). of: People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community
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5 People who use health and social care services have positive experiences of those services and have their dignity respected • Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services • Health and social care services contribute to reducing health inequalities • People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing • People who use health and social care services are safe from harm • People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide • Resources are used effectively and efficiently in the provision of health and social care services From a North Lanarkshire perspective, our local vision reflects and underpins the higher level national outcomes. This is evidenced by the progress towards a personal outcomes approach which involves working with people to jointly agree how we support them to meet their aspirations and goals in life. Consequently, this drive towards supporting people to meet their outcomes has resulted in a shared partnership vision based upon:
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6 “Working together to improve health and wellbeing in the community – with the community” In pursuit of this vision, and central to our philosophy, will be the following commitments: • We will focus on promoting health improvement and tackling the underlying causes of ill – health. • We will continue to develop a health and social care system which is integrated around the needs of individuals, their carers and family members. • We will be working with people, their carers and families who have a range of complex support needs to identify the outcomes they want to achieve in life. In doing so, our aim will be to provide care and support to help them realise these outcomes. • We will put the leadership of clinicians and professionals at the heart of service delivery for people who require support and their carers. • We will work with partners in the third and independent sectors to remove unhelpful boundaries and using combined resources to achieve maximum benefit for patients, service users, carers and families. • We will work with a range of agencies and partners to address health and social inequalities and the subsequent impact of this experienced by people in their communities.
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7 The following detail provides information relating to ‘how’ the partnership has been created to deliver against the national outcomes and intentions of the Act. This integration Scheme is the vehicle through which assurance is given to North Lanarkshire Council, NHS Lanarkshire Health Board and the Scottish Government that the intentions of the Act are being delivered by the Integration Joint Board. This Integration Scheme forms the basis of a legal agreement with the Scottish Government and lasts for a maximum duration of five years, after which point it will be refreshed. However, in circumstances where there is agreement between the Parties, this Integration Scheme can be refreshed within an earlier timeframe. This Integration Scheme first came into effect in April 2016, with a refresh of the North Lanarkshire Integration Scheme implemented in April 2019.
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8 2. The Parties North Lanarkshire Council, established under the Local Government etc. (Scotland) Act 1994 and having its principal offices at the Civic Centre, Windmillhill Street, Motherwell, North Lanarkshire And NHS Lanarkshire Health Board, established under section 2(1) of the National Health Service (Scotland) Act 1978 and having its principal offices at Kirklands Hospital, Fallside Road, Bothwell, Lanarkshire (together referred to as “the Parties”) In implementation of their obligations under the Act, the Parties hereby agree as follows: Definitions and Interpretation “The Act” means the Public Bodies (Joint Working) (Scotland) Act 2014. “The Parties” means NHS Lanarkshire Board and North Lanarkshire Council. “The Health Board” means NHS Lanarkshire Health Board. “The Local Authority” means North Lanarkshire Council. “The Scheme” means this Integration Scheme.
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9 “Integration Joint Board” or “IJB” means the Integration Joint Board to be established by Order under section 9 of the Act. “Members” means Members of the Integration Joint Board. “Outcomes” means the Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Act. “The Integration Scheme Regulations” means the Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014. “Integration Board Order” means the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. “Integration Joint Board, Performance, Finance and Audit Committee” (IJB PFA) means the committee which the Integration Joint Board has delegated authority for business relating to performance, finance and audits reports/updates. “Strategic Plan” means the plan which the Integration Joint Board is required to prepare and implement in relation to the delegated provision of health and social care services in accordance with section 29 of the Act. 3. Integration Model In accordance with section 2(3) of the Act, the Parties have agreed that the integration model set out in sections 1(4)(a) of the Act will be put in place for North Lanarkshire, namely the delegation of functions by the Parties to a body corporate that is to be
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10 established by Order under section 9 of the Act. 4. Local Governance Arrangements a. The Integration Joint Board will be responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within this integration scheme. b. The regulation of the Integration Joint Board’s procedures, business and meetings will follow the IJB’s own standing orders which may include additional matters to those set out within the Integration Board Order. c. The Integration Joint Board and the Parties will collaborate and interact in order to contribute to the outcomes however the Integration Joint Board, when established, will have distinct legal personality and the consequent autonomy to manage itself. d. There will be eight voting members on the Integration Joint Board comprising four elected members from North Lanarkshire Council and 4 members from NHS Lanarkshire Health Board. e. The non-voting membership prescribed in the Integration Board Order is as follows;
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11 • The Chief Officer of the Integration Joint Board; • The Chief Social Work Officer of the Council appointed by it in terms of Section 3 of the Social Work (Scotland) Act 1968; • The proper officer of the Integration Joint Board appointed under section 95 of the Local Government (Scotland) Act 1973(a) i.e. the Chief Finance Officer; • A registered Primary Care medical practitioner; whose name is included in the list of primary medical service performers prepared by the Health Board in accordance with the regulations made under section 17P of the National Health Service (Scotland) Act 1978. • A registered Nurse who is employed by the Health Board or by a person or body with which the Health Board entered into a general medical services contract
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12 • A registered medical practitioner employed by the Health Board who does not provide primary medical services. f. Once the Integration Joint Board is established it must appoint, in addition, at least one member in respect of each of the following groups in terms of the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014: • Staff engaged in the provision of services provided under integration functions; • Third Sector bodies carrying out activities related to health or social care in North Lanarkshire; • Service users residing in North Lanarkshire; • Persons providing unpaid care in North Lanarkshire. g. The Integration Joint Board may appoint such additional members as it sees fit. h. The responsibility for appointing the Chair and Vice Chair will alternate between the Parties and the appointments will be made for a period of 3 years. Within this period,
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13 each Party may change its appointment as Chair or Vice Chair at any time and it is entirely at the discretion of the Party which is making the appointment to decide who it shall appoint. i. The term of office of a member of the Integration Joint Board is a maximum of three years. The Integration Joint Board voting members appointed by the Parties will cease to be members of the Integration Joint Board in the event that they cease to be a Non-Executive or Executive member of NHS Lanarkshire or an elected member of North Lanarkshire Council. At the end of a term of office a member may be reappointed for a further term of office. j. The Chief Social Work Officer, Chief Officer and Chief Finance Officer remain members of the Board for as long as they hold the office in respect of which they are appointed. k. Whilst serving on the Integration Joint Board its members carry out their functions under the Act on behalf of the Integration Joint Board itself, and not as delegates of their respective Heath Board or Local Authority. l. In accordance with good practice, it is expected that the Integration Joint Board will establish an audit committee to support the overall governance and scrutiny arrangements. The Parties recognise that the establishment of any committees by
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14 the IJB are a matter to be determined by the IJB. The North Lanarkshire Integrated Joint Board Performance, Finance and Audit committee has been established within North Lanarkshire to fulfil this purpose. m. Detailed protocols and reporting arrangements will be established to ensure the Parties and the Integration Joint Board have free access to all relevant information for the purposes of planning and decision making. 5. Delegation of functions The functions that are to be delegated by the Health Board to The Integration Joint Board are set out in Part 1 of Annex 1. These functions are delegated only to the extent that they relate to the listed services. The services to which these functions relate, which are currently provided by the Health Board and which are to be integrated, are set out in Part 2 of Annex 1. Broadly these are as follows; 5.1 Hospital Services The functions in relation to the hospital services noted below will be delegated in respect of adults and children. 5.1.1 Accident and emergency services provided in a hospital; 5.1.2 Inpatient hospital services relating to the following branches of medicine:
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15 • General medicine; • Geriatric medicine; • Rehabilitation medicine; • Respiratory medicine; • Palliative care services provided in a hospital; 5.1.1 Paediatrics; 5.1.2 Psychiatry of learning disability; 5.1.3 Inpatient hospital services provided by general medical practitioners; 5.1.4 Services provided in a hospital in relation to an addiction or dependence on any substance; 5.1.5 Mental health services provided in a hospital except regionally or nationally organised forensic mental health services. 5.2 Community Services The functions in relation to the community health services noted below will be delegated in respect of adults. • District nursing services;
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16 • Health Visiting; • Allied health professionals in an outpatient department, clinic, or out with a hospital; • Public dental services; • Primary medical services • General dental services • Ophthalmic services; • Pharmaceutical services; • Primary care out-of-hours; • Geriatric medicine; • Palliative care; • Community learning disability services; • Kidney dialysis services; • Mental health services • Continence services • Community paediatrics • Community children’s services • School nursing services • Services provided by health professionals that aim to promote public health;
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17 5.2 .1 The functions delegated by the Council to the Integration Joint Board are set out in Part 1 of Annex 2. The services to which these functions relate are set out in Part 2 of Annex 2 and relate to adult services only. • Social work services for adults and older people • Services and support for adults with physical disabilities and learning disabilities • Mental health services • Drug and alcohol services • Adult protection and domestic abuse • Carers support services • Community care assessment teams • Support services • Care home services • Adult placement services • Health improvement services • Aspects of housing support, including aids and adaptions • Day services • Local area co-ordination
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18 • Respite provision • Occupational therapy services • Re-ablement services, equipment and telecare. 5.3 Annex 3 sets out arrangements for hosted services. This relates specifically to health services which span more than one Integration Joint Board and are subject to Integration Joint Board approval. 5.4 The Integration Joint Board is a Category 1 responder under the Civil Contingencies Act 2004, as per the amendment to the Act in 2021. This ensures that where there is a risk of an emergency which will impact functions delegated to the Integration Joint Board, there will be formal coordinated and appropriate arrangements in place for emergency planning; information sharing and cooperation with other responders; and joined up information sharing and advice for the public. The IJB is represented at the Local Resilience Partnership by the Chief Officer.
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19 6. Local Operational Delivery Arrangements 6.1 The Integration Joint Board meets a minimum of four times per year in public and publishes all agendas, papers and minutes with responsibility for the delivery of integrated functions as set out in annexes 1,2 and 3 and provides operational oversight of integrated services delegated to them. It will do this directly for all services except for those noted in 6.2. The operational role of the Chief Officer is set out within section 8. 6.2 NHS Lanarkshire will retain direct operational oversight of the acute services as set out in annexes 1,2 and 3 and will provide information on a regular basis to the Integration Joint Board about the delivery of these services. 6.3 The Integration Joint Board is responsible for the development of a Strategic Commissioning Plan as per Section 29 of the Act. This plan sets out arrangements for carrying out the integration functions and how these contribute to achieving the Outcomes as outlined in Annex 4. 6.4 A locality model has been developed by the Integration Joint Board to underpin the development of the Strategic Commissioning Plan. 6.5 From an acute hospital service perspective, operational plans for integrated acute service delivery are subject to directions from the Integration Joint Board about the exercise of delegated functions in relation to these services. These will also be informed and directed by the Strategic Commissioning Plan. 6.6 The Chief officer is responsible for directly implementing the Integration Joint
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20 Board’s directions to locality delivery on the ground. 6.7 From an operational and performance management perspective, the Integration Joint Board/ the Integrated Joint Board Performance, Finance and Audit Committee will receive regular reports from the chief officer and other responsible officers of the parties on the delivery of integrated services and will issue directions in response to those reports to ensure improved performance. This includes a range of thematic reports will include, but are not limited to, the following; • Finance Reports • Performance against the National Health and Wellbeing Outcomes; • Regulation and scrutiny activity; • Inspection Outcomes. • Support, Care & Clinical Governance reports to be assured of the delivery of safe and effective services. • Public Protection reports. • Engagement and community co-production reports from each of the Locality Management teams. • Annual staff governance and workforce planning report. • Improvement plans and reports. • Risk reports/management plan.
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21 6.8 The Act requires the Integration Joint Board to publish an Annual Performance Report by July of each year. 7. Corporate Service Support 7.1 The Parties will support the work of the Integration Joint Board by supplying all relevant information, data and corporate support services such as financial, legal, human resources, IT, planning, risk management, audit, administrative etc. for the Integration Joint Board to carry out its functions. This will include information on cross boundary flow into and out with NHS Lanarkshire. 7.2 The current arrangements for providing corporate support services in respect of delegated functions and the associated service provision will be reviewed by the Chief Officer and the responsible officers of the Parties on an ongoing basis. 8. Supporting Strategic Planning 8.1 As outlined in Section 30(3) of the Act, the Integration Joint Board must have regard to the effect that their Strategic Commissioning Plan will have on facilities, services or resources which are used in relation to arrangements set out or being considered to be set out in a Strategic Plan prepared by another Integration Joint Board. 8.2 In assessing the health element of this, the NHS Board will provide the necessary activity and financial data for services, facilities and resources that relate to the planned use of services provided by other Health Boards by people who live within
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22 the area of the Integration Joint Board. 8.3 In circumstances where the NHS Board or the Council intend to change service provision of non-integrated services that will impact directly on the Strategic Commissioning Plan, they will advise the Integration Joint Board of this. 9. Performance Measurement 9.1 Through the development of the Strategic Commissioning Plan, the Outcomes are used to develop a performance reporting framework which underpins the Plan. 9.2 The Parties have established an integrated performance reporting framework which considers and develops a local suite of measures and targets that relate to the provision of integration functions. The measures and targets are aligned to the Outcomes and any subsequent guidance/core suit of indicators. The Parties develop the targets, measures and other arrangements that are devolved to the Integration Joint Board. In developing this, the Parties share with the Integration Joint Board other relevant NHS Board and Council targets and measures which the Integration Joint Board must take account of. 9.3 The Parties, in conjunction with the Integration Joint Board also consider and develop a list of targets, measures and arrangements that relate to the functions that are not delegated which the Integration Joint Board must take account of when it is preparing the strategic plan. 9.4 The work in respect of 9.2 and 9.3 takes into account: 9.4.1 The Outcomes.
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23 9.4.2 Delegated performance targets related to the commissioning and delivery accountabilities of the NHS Board and the Council. 9.4.3 Delayed discharge. 9.4.4 Recovery activity. 9.4.5 Locally agreed outcomes and targets identified through Community Planning and from the Local Outcomes Improvement Plan and attributable to Health and Social Care Outcomes and targets, including Health Improvement, for each of the localities identified and agreed in line with local needs determined for each population. 9.4.6 The Nationally prescribed core suite of integration indicators. 9.5 The reporting of information against this suite of indicators is provided by the Parties to the Integration Joint Board as a means of measuring progress and impact. 9.6 Where responsibility for the target is shared, the Parties set out in a document the accountability and responsibility of each of them. 9.7 Where the responsibility for the targets span integrated and non-integrated services, the NHS Board, the Council and the Integration Joint Board will work together to produce and deliver the measures and targets which assess performance. This will be evidenced through a standing performance item on Integration Joint Board meetings and also picked up through the Integration Joint Board Annual Performance report. 9.8 The Integration Joint Board Performance, Finance and Audit Committee which is accountable to the Integration Joint Board has been established as a decision
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24 making body to provide further scrutiny on matters related to finance, risk, performance and audit matters. 10. Support, Care and Clinical Governance 10.1 The Parties and the Integration Joint Board are accountable for ensuring appropriate support, care and clinical governance arrangements are in place for their duties under the Act. 10.2 The Parties remain responsible for the support, care, clinical and professional accountability of the services which the Integration Joint Board has directed the Parties to deliver and for the services delivered in respect of functions that are not delegated to the Integration Joint Board. 10.3 The Parties remain individually responsible for the assurance of the quality and safety of services commissioned from the third and independent sectors in line with the requirements set out within the strategic plan and any directions issued by the Integration Joint Board that relate to or have an impact on, integrated and non- integrated service provision. 10.4 The Integration Joint Board will have regard to the support, care and clinical framework that is set out in Section 6.6 when developing and agreeing its strategic plan and corresponding directions to the Parties. 10.5 As set out in Section 9 the Integration Joint Board will receive regular reports from professional leadership members for medical; nursing, AHPs; and Social Work to assure itself that support, care and clinical governance requirements are
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25 being met through these existing arrangements and that safe, effective person centred care is being consistently delivered. 11. Clinical and Professional Governance Framework 11.1 The Parties have in place support, care and clinical governance arrangements to provide assurance that the services that are delivered are safe, effective, person centred and focussed on personal outcomes. 11.2 The Parties recognise that the establishment and continuous review of the arrangements for support, care and clinical Governance and Professional Governance are essential in delivering their obligations and quality ambitions. 11.3 In the Health Board this is overseen by the Healthcare Quality Assurance and Improvement Committee, a committee of the Health Board which supports the Health Board in its responsibilities, with regards to issues of clinical risk, control and governance and associated assurance in the area of quality assurance and improvement through a process of constructive challenge. 11.4 The Healthcare Quality Assurance and Improvement Committee is responsible for the development of a strategic approach to quality assurance and improvement across the Health Board, ensuring that quality standards are being set, met and continuously improved for clinical activity. It ensures that effective arrangements for supporting, monitoring and reporting on quality assurance and improvement are in place and working, demonstrating compliance with statutory requirements in relation to clinical governance and authorising an accurate and honest annual
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26 clinical governance statement. 11.5 In North Lanarkshire Council the Chief Social Work Officer holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected members of North Lanarkshire Council in respect of professional social work matters. He/she is responsible for ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services Council. 11.6 The Parties are committed to developing a shared support, care and clinical governance framework for integrated services. The professional leadership of the Parties will work together to develop and agree this support, care and clinical governance framework. In the first instance this will be based on a self- assessment exercise to help identify areas of common practice, provide opportunities to learn from one another and streamline processes. 11.7 The existing process, procedures and reporting structures for support, care and clinical governance of integrated services will be reviewed in light of the agreed support, care and clinical framework. The framework will encompass the following: • Professional regulation, workload and workforce development; • Information assurance; • Service user experience and safety and quality of integrated service delivery and personal outcomes; • Person Centred Care; • Management of clinical risks; and • Learning from adverse events.
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27 11.8 Each of these domains will be underpinned by mechanisms to measure quality, clinical and service effectiveness and sustainability. They will be compliant with statutory, legal and policy obligations strongly underpinned by human rights values and social justice. Service delivery will be evidence- based, underpinned by robust mechanisms to integrate professional education, research and development. 11.9 The Parties and the Integration Joint Board will be asked to approve the framework and will then be responsible for ensuring that it is embedded within service planning, delivery and performance reporting mechanisms. The Integration Joint Board will be responsible for ensuring effective mechanisms for service user and carer feedback and for complaints handling. 11.10 The Area Clinical Forum, Managed Clinical Networks, GP Sub Committee, Area Medical Committee; Medical Staff Committee and any other appropriate professional groups, and the Adult Protection Committees will provide advice directly to the Integration Joint Board or through its professional members. 11.11 The Healthcare Quality Assurance and Improvement Committee and the Chief Social Work Officer (or his/her delegates) will provide advice, oversight and guidance to the North Lanarkshire Strategic Planning Group in respect of support, care, clinical and professional governance, for the delivery of health and social care services and to the localities identified in the strategic plan. 11.12 The Chief Officer will have access to professional advice from the Chief Social Work Officer of the local authority and the Medical Director and the Nursing Director of the Health Board in both their operational role as a senior officer of the parties
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28 and as the accountable officer to the Integration Joint Board. 11.13 Explicit lines of professional and operational accountability are essential to assure the Integration Joint Board and the Parties of the robustness of governance arrangements for their duties under the Act. They underpin delivery of safe, effective and person centred care in all care settings delivered by employees of NHS Lanarkshire and North Lanarkshire Council and of the third and independent sectors. 11.14 NHS Lanarkshire Board is accountable for Clinical Governance. Professional governance responsibilities are carried out by the professional leads through to the health professional regulatory bodies and Scottish Ministers. 11.15 The Chief Social Work Officer in North Lanarkshire holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected members of North Lanarkshire Council in respect of professional social work matters. He/she is responsible for ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services Council. 11.16 The Medical Director and/or the Director of Nursing, Midwifery and Allied Health Professions, through delegated authority, hold professional accountability for the delivery of safe and effective clinical services within NHS Lanarkshire and report regularly on these matters to the Health Board. 11.17 The Integration Joint Board will have three health professional advisors. These members of the Integration Joint Board will be professionally accountable to the
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29 Medical Director and the Nurse Director as appropriate. 11.18 This arrangement does not limit the ability of the Medical Director and/or the Nurse Director to provide advice directly to the Integration Joint Board. Where this advice is offered, the Integration Joint Board must respond in writing and notify the Parties. The Chief Social Work Officer can provide advice directly through their membership of the Integration Joint Board. 11.19 The Chief Social Work Officer, through delegated authority holds professional accountability for the delivery of safe and effective social work and social care services within the Council. An annual report on these matters will continue to be provided to the relevant Council committee and will also be made available to the Integration Joint Board. 11.20 The Chief Social Work Officer will provide professional advice to the Integration Joint Board in respect of the delivery of social work and social care services by Council staff and commissioned care providers in North Lanarkshire. 12. Chief Officer 12.1 The Integration Joint Board will appoint a Chief Officer in accordance with section 10 of the Act. 12.2 The Chief Officer reports to the Council’s Chief Executive and the NHS Board’s Chief Executive. The Chief Officer’s formal contract of employment is with one of the Parties and whichever holds the contract of employment, manages the Chief Officer on a day to day basis.
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30 12.3 The Chief Officer will be operationally responsible with regards to the delivery of the delegated services (as set out in Annex 1 & 2) that do not relate to the acute medicine and Accident and Emergency services provided for within NHS Lanarkshire Hospitals. These services will continue to be operationally managed by NHS Lanarkshire, through the Director of Acute Services, in line with the Integration Joint Board’s Strategic Plan to ensure coherence across integrated and non-integrated hospital service provision. 12.4 The Acute Director will be a single point of managerial responsibility for NHS Lanarkshire hospitals. The Acute Director will provide updates to the Chief Officer on the operational delivery of integrated functions delivered within the acute hospital and the set aside budget on a regular basis. 12.5 The Chief Officer may also have responsibility for managing services that are hosted by the Integration Joint Board across North and South Lanarkshire. These arrangements will be determined by the North Integration Joint Board and the South Lanarkshire Integration Joint Board through the strategic planning process. 12.6 The Chief Officer will be a member of the Corporate Management Teams of the Health Board and Local Authority. 12.7 The Chief Officer will establish a senior management team to oversee day to day operation of the integrated services. 12.8 The Chief Officer’s objectives will be set annually. This will form the basis of the Chief Officer’s performance appraisal with the Council’s Chief Executive and the Chief Executive of the Health Board. 12.9 The Heads of Service will deputise for the Chief Officer as and when required. At
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31 the request of the Integration Joint Board the Heads of Service will carry out the functions of the Chief Officer if/when the Chief Officer is absent or otherwise unable to carry out their functions. 12.10 The Chief Officer has established and maintains effective working relationships with a range of key stakeholders across the NHS Board, the Council, the third and independent sectors, services users and carers, the Scottish Government, trade unions and relevant professional organisations. # 12.11 Current hosted services arrangements are set out in Annex 3. However, with regards to the future shaping of these services from a strategic planning perspective, the Integration Joint Board discusses with relevant neighbouring Integration Joint Boards how these are shaped now and in the future. The Chief Officer takes direction from the Integration Joint Board in respect of this. 13. Workforce 13.1 Human resource services and workforce planning information will continue to be provided by the appropriate corporate human resource functions within the Council and NHS Lanarkshire. 13.2 The Parties, with the involvement of the Chief Officer, will identify appropriate officers to develop a joint Workforce Development and Support Plan. In doing so the officers will be required to consider professional views and previous workforce modelling etc. however, there may be opportunities to adapt these plans when considering an integrated workforce. This will also have to build in consideration
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32 around Third Sector and Independent Sector capacity. The Workforce Development and Support plan will be regularly updated to ensure it remains contemporary. 13.3 An Organisational Development strategy (“OD Strategy”) will be maintained in relation to teams who will deliver integrated services. Through an intense focus on locality modelling, locality based focus groups and action learning sets, we have identified significant potential for harnessing the positivity and enthusiasm of frontline staff to achieve better outcomes for the public, the organisation and the staff. We intend to continue this process combined with other aspects of our plan which focuses on; • Integration Joint Board Development • Key Leaders Development Programme • Integrated Locality Team Development • Wider Stakeholder Development 13.3.1 In all cases, we will endeavour where appropriate, to carry out development work which is inclusive of all partners. Considerable progress has been made to develop an OD strategy, but it will need to be reviewed and revised over time. The Integration Joint Board will be given the opportunity to provide comment on the draft strategy upon its establishment. The strategy will be updated over the period of the strategic planning process. 13.4 Joint HR/OD processes have been agreed by the Parties over a number of years
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33 and many joint policies already exist which will assist in the process of integration. This integration scheme has no effect on these joint policies so, for example, any joint appointments will continue to report to one-line manager, except for the Chief Officer where different provision is made within this scheme. 14. Finance 14.1 Contributions from the Parties for delegated functions to the Integration Joint Board will be overseen by the Chief Officer and the Integration Joint Board Chief Financial Officer. They will develop a resource plan and budget based on available resources. The Integration Joint Board Chief Financial Officer will be responsible for the preparation of the annual financial statements as required by section 39 of the Act. 14.2 The Chief Officer and Chief Financial Officer will develop an integrated budget based on the Strategic Plan and present it to the parties for consideration as part of both of their annual budget setting processes. The Parties will evaluate the case for the Integrated Budget against their other priorities and will agree their respective contributions accordingly. The outcome of this work will be presented to the Integration Joint Board. Following on from the budget process, the Chief Officer and the Integration Joint Board Chief Financial Officer will prepare a financial plan supporting the Strategic Plan. 14.3 The budget will be evidenced based with transparency of assumptions including, but not limited to Pay Award, Contractual Uplift, Savings Requirements etc.
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34 14.4 The method for determining the amount set aside for hospital services will follow guidance issued by the Integrated Resources Advisory Group and be based initially on the notional direct costs of the relevant populations use of in scope hospital services as provided by Information Services Division (ISD) Scotland. The NHS Director of Finance and Integration Joint Board Chief Financial Officer will keep under review developments in national data sets or local systems that might allow more timely or more locally responsive information, and if enhancements can be made, propose this to the Integration Joint Board. If the Strategic Plan sets out a change in hospital capacity, the resource consequences will be determined through a bottom up process based on: • Planned changes in activity and case mix due to interventions in the Strategic Plan; • Projected activity and case mix changes due to changes in population need; • Analysis of the impact on the affected hospital budget, taking into account cost- behaviour i.e. fixed, semi fixed and variable costs and timing difference i.e. the lag between reduction in capacity and the release of resources. 14.5 Each partner will agree the formal budget setting timelines and reporting periods as defined in the Financial Regulations. 14.6 A schedule of notional payments will be provided by the Parties to the Integration Joint Board following the approval of the Strategic Plan and the Financial Plan. 14.7 It will remain the duty of the Local Authority Section 95 Officer and the NHS Board Accountable Officer to monitor and regulate the financial performance of their respective share of the resources available to the Integration Joint Board during each reporting period, throughout the financial year.
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35 14.8 It will be the responsibility of the Local Authority Section 95 Officer and the NHS Board Accountable Officer to comply with the agreed reporting timetable and to make available to the Integration Joint Board Chief Financial Officer the relevant financial information, including the sum set aside in line with 9.4.15, required for timely financial reporting to the Integration Joint Board. This will include such details as may be required to inform financial planning of revenue expenditure. 14.9 The frequency of reporting is set out in the Financial Regulations and will be at least on a quarterly basis. In advance of each financial year a timetable for financial reporting will be submitted to the Integration Joint Board for approval. 14.10 Regular management reports will be prepared in line with the financial regulations which will be agreed by the Integration Joint Board, and will include actual and projected outturns. The existing budgetary control frameworks adopted by each of the Parties will form the basis of generating the required information. 14.11 The Integration Joint Board Chief Financial Officer will manage the respective financial plan so as to deliver the agreed outcomes within the Strategic Plan viewed as a whole. 14.12 The Parties do not expect that there will be a schedule of cash payments, but rather annual accounting entries for the agreed budgets. There may be a requirement for an actual cash transfer to be made between the Parties to reflect the difference between the payment being made and the resources delegated to the party by the Integration Joint Board. Any cash transfer will take place at least annually. Any change to frequency will be jointly agreed by the Integration Joint Board and the Parties.
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36 14.13 The process for managing any in-year financial variations will be detailed within the Financial Regulations and are summarised below: 14.13.1 If the Integration Joint Board’s Chief Financial Officer is advised that a significant change is likely to the Integration Joint Board's overall financial position and the deviation involves a change of policy of the Integration Joint Board or results in revenue implications for future years, a report will be provided for the Integration Joint Board in good time detailing the financial consequences to enable appropriate action to be taken timeously. 14.13.2 If an overspend is forecast on either partner’s in scope budget, the Chief Officer and the Integration Joint Board’s Chief Financial Officer will aim to agree a recovery plan with the relevant partner to balance the overspending budget and determine the actions required to be taken to deliver the recovery plan. If the overspend arises from assumptions in the Integration Joint Board’s strategic plan on the impact of service changes that are not realised as anticipated this should be subject to a report and corrective action. This corrective action may include a recovery plan which should consider revisions to the commissioning of services and / or financial plans to account for the changed circumstances, and the use of any available reserves. 14.13.3 If the recovery plan is unsuccessful then the parties have the option to: • the relevant partner provides additional resources to the Integration Joint Board which is then recovered in future years from subsequent underspends in that partner’s contribution, (subject to scrutiny of the reasons for the overspend and assurance that there is a plan in place to address this) or;
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37 • the relevant partner makes additional one-off adjustment to the resources that it is making available to the Integration Joint Board. 14.13.4 Unplanned underspends that arise due to material differences between assumptions used in setting the budget and actual events effectively represent an overfunding by the Parties with respect to planned outcomes. The circumstances surrounding the action required to address unplanned underspends is set out in the Financial Regulations and Reserves Policy, which will be subject to agreement by the Parties and the Integration Joint Board. The options will include the underspend either being returned to the relevant party in year through an adjustment to their respective contributions, or maintained by the Integration Joint Board to be carried through the General Fund balance. 14.14 The Parties do not expect to reduce them in year payment to the Integration Joint Board without the consent of the Integration Joint Board and the other Party out with the following circumstances Unplanned underspends as defined above and the Financial Regulations and Reserves Policy. 14.15 Where the budget assumed a specific allocation from the Scottish Government which did not materialise in year to the extent anticipated. (The converse of this also applies in that should a specific allocation pertaining to a delegated function exceed the anticipated level, an additional payment to the Integration Joint Board may be agreed). 14.16 Monitoring arrangements will include the impact of activity on set aside budgets. 14.17 The Accounting Standards as adapted for the public sector will apply to the Integration Joint Board. The Code of Practice on Local Authority Accounting in the
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38 UK will be the applicable guidance for their interpretation. 14.18 The financial statements of the Integration Joint Board will be completed to meet the audit and publication timetable specified in regulations (Regulations under section 105 of the Local Government (Scotland) Act 1973). 14.19 Initially, recording of financial information in respect of the Integration Joint Board will be processed via the Local Authority ledger. The means for recording financial information will be reviewed by the Chief Financial Officer to ensure this method remains appropriate giving due regard to the needs of the Integration Joint Board. Should an amendment to this method be required the Chief Financial Officer will consult with both parties and present recommendations to the Integration Joint Board for approval. 14.20 The financial ledger transactions relating to the Integration Joint Board will be carried out prior to the end of the financial year with post year-end adjustments for material information only. Year-end balances and transactions will be agreed timeously in order to allow completion of the Accounts in line with required timescales. This date will be agreed annually by the Integration Joint Board and the Parties. 14.21 From an asset management and capital planning perspective, in the short term, the Integration Joint Board will not be empowered to own capital assets and the regimes of the Parties will apply to capital assets used to provide the delegated services. Ownership of assets and associated liabilities will remain with the Parties. 14.22 The Chief Officer will consider all of the resources which are required to deliver the integration outcomes including the relevant non-current assets owned by the
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39 Parties. The Chief Officer will consult with the Parties to make best use of existing resources. 14.23 Should the Integration Joint Board believe there is a requirement to develop assets in order to facilitate the delivery of the Strategic Plan’s outcomes, then the Chief Officer must present a business case to the Parties for consideration. This should be submitted as part of the partner’s capital planning process. Partnership discussion would be required at an early stage for jointly funded projects. 14.24 Detailed Financial Regulations governing the Integration Joint Board will be agreed between the Parties and approved by the Integration Joint Board before functions and resources are delegated. 15. Communication, Participation and Engagement 15.1 Communication, participation and engagement with all stakeholders is central to the development of the Integration Scheme and is stated requirements as outlined in Section 6 (2) of the Act. The stakeholders who have been directly engaged with to date include: • Health & Social Care Professionals; • Service Users & Carers; • Non Commercial Providers of Health & Social Care; • Non Commercial Providers of Housing; • Independent Sector; • Third Sector; • Staff likely to be affected by the integration; • Other Local Authorities operating within the area of the Health Board.
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40 15.2 The Parties have well-established local arrangements for involving and engaging with service users, carers, patients and communities. These have become embedded within North Lanarkshire and include the Public Partnership Forum. North Lanarkshire Integration Joint Board collaborates with the nationally recognised Third Sector Interface, and as such provides a seat on the IJB in order to develop and coordinate activity with third sector partners. 15.3 This public engagement activity will adhere to national standards for community engagement and participation. 15.4 The Integration Joint Board has an existing participation and engagement plan, supported via access to the corporate/directorate communication teams of both parties and a dedicated communications officer and support from staff who work directly in the field of community engagement/public involvement. 15.5 In preparing its strategic plan, the Integration Joint Board has established mechanisms to seek the views of key stakeholders, including a strategic planning group in accordance with the requirements of the Act. 16. Information-Sharing and Data Handling 16.1 The Parties agree to continue to operate under the existing Lanarkshire Information Sharing Protocol and the agreed procedures for sharing information, which is governed by the Lanarkshire Data Sharing Partnership (LDSP), until such time as any necessary changes are made by the process outlined below. The
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41 Lanarkshire Data Sharing Partnership Board is the key multi-agency forum with current partnership arrangements and includes representation from North and South Lanarkshire Councils, the NHS Board, Police Scotland, Fire Service and Third Sector. All staff employed by the Parties will continue to comply with all current polices and protocols with regards to information sharing. 16.2 The protocol and procedures for sharing information will be regularly reviewed and updated to reflect the new governance arrangements that pertain to health and social care by the Lanarkshire Data Sharing Partnership. The Chief Officer of the Integration Joint Board chairs the Local Data Sharing Partnership: and the revised protocol has been provided to the Parties and the Integration Joint Board. 16.3 The Lanarkshire Information Sharing Protocol is reviewed regularly by the LDSP. If the Parties or the Integration Joint Board have concerns about the Lanarkshire Information Sharing Protocol or agreement, or the processes for sharing information, they may request a review. Any such changes or amendments must be agreed by the Integration Joint Board and the Parties. 16.4 It is the intention to ensure that any resultant information sharing agreement will be established and maintained within legislative or regulatory requirements in place at that time, primarily with respect to confidentiality, data protection and privacy. 16.5 The Parties entered into an information sharing protocol (Scottish Accord on the Sharing of Personal Information – SASPI) in relation to health and social care integration, primarily to support strategic planning, commissioning and service design.
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42 17. Complaints 17.1 The Parties agree the following arrangements in respect of complaints by service users and those complaining on behalf of service users: 17.2 The Parties agree that feedback, comments, concerns and complaints should be viewed with a positive attitude and valued as feedback on service performance leading to a culture of learning from complaints. 17.3 The Parties agree the principle of frontline resolution to complaints wherever possible and have existing mechanisms in place to achieve this. 17.4 The Parties agree that irrespective of the point of contact the Parties will show a willingness to appropriately direct complaints to ensure an appropriate response. 17.5 Due to different legislative requirements the Parties agree that complaints will continue to be dealt with according to the procedures and policies in place for the Local Authority and the Health Board. 17.6 Where complaints cross the boundaries of health and social care the Parties will work together to achieve, where possible, a joint response to a complaint. 17.7 The Parties agree that complaints by patients, service users or carers will be managed and responded to by the lead organisation responsible for the delivery of the service to which the complaint refers in accordance with the procedures and policies in place for that Party, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.8 There are two established processes a complaint will follow depending on the
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43 lead organisation, these are the Statutory Social Work Complaints process; and NHS Lanarkshire’s complaints process. 17.9 These processes, together with the timescales for acknowledgement and response, are widely publicised by the respective organisations. Complaints to North Lanarkshire Council can be made through their website1 using the online form or by telephoning the Council. The arrangements for making complaints to NHS Lanarkshire Health Board are set out on their website2 or can be made by telephoning NHS Lanarkshire Health Board. 17.10 External service providers are required to have a complaints procedure in place. Where complaints are received that relate to a service provided by an external service provider the lead organisation will either arrange for investigation or refer the complainant to the external service provider for resolution of their complaint. 17.11 All complaints will be investigated and responded to according to the lead organisation’s procedure, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.12 The Chief Officer will have an overview of complaints related to integrated functions and will provide a commitment to joint working, wherever necessary, between the Parties when dealing with complaints about integrated services. 17.13 If a complaint remains unresolved through the defined complaints-handling procedure, complainants will be informed of their right to go either to the Scottish Public Services Ombudsman for services provided by the Health Board, or to the Social Work Complaints Review Committee following which, if their complaints
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44 remains unresolved, they have the right to go to the Scottish Public Services Ombudsman for services provided by the Local Authority. 17.14 This arrangement will respect the statutory complaints-handling processes currently in place for health and social care services. This arrangement will benefit service users and carers by making use of existing complaints procedures and will not create an additional complaint handling process. 17.15 Data sharing requirements relating to any complaint will follow the Information and Data sharing protocol set in the Information and Data Handling section of this Scheme. 17.16 Relevant performance information and lessons learned from complaints will be collected and reported in line with the Support, Care and Clinical Governance section of this Scheme. 17.17 A joint performance report will be produced annually for consideration by the Integration Joint Board. 18. Claims Handling, Liability and Indemnity 18.1 The Parties and the Integration Joint Board recognise that they could receive a claim arising from or which relates to the work undertaken on behalf of the Integration Joint Board. 18.2 The Parties agree to ensure that any such claims are progressed quickly and in a manner which is equitable between them. 18.3 So far as reasonably practicable the normal common law and statutory rules
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45 relating to liability will apply, however it is also noted that decisions relating to claims and liabilities will also be subject to any requirements, obligations or conditions of any relevant insurance policies held by the Parties. 18.4 In the event of any claim against the Integration Joint Board in respect of which it is not clear which Party should assume responsibility, the Chief Officer (or his/her representatives) will liaise with the Chief Executives of the Parties (or their representatives) to determine which Party should assume responsibility for progressing the claim. 18.5 Where a claim has been settled by one of the Parties, and it thereafter transpires that liability (in whole or in part) should have rested with the other Party, then that Party shall indemnify the Party that settled the claim. 18.6 Claims regarding policy and/or strategic decisions made by the Integration Joint Board shall be the responsibility of the Integration Joint Board. For such claims, the Integration Joint Board will require to assess the need for, and if appropriate, obtain appropriate insurance cover. It may also require to engage independent legal advice. 18.7 If a claim has a “cross boundary” element whereby it relates to another Integration authority area, the Chief Officers of the Integration authorities concerned shall liaise with each other until an agreement is reached as to how the claim should be progressed and determined. 18.8 Each Party will ensure that appropriate risk financing arrangements are put in place and maintained, to meet the cost of claims and other associated costs. 18.9 Claims which pre-date the establishment of the Integration Joint Board will be dealt
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46 with by the Parties through the procedures that were in place prior to Integration. 19. Risk Management 19.1 The Parties and the Integration Joint Board have an agreed risk management strategy and methodology in relation to Health & Social Care Integration. The shared strategy and methodology ensures: • Identification, assessment, prioritisation and pro-active management of risk related to the delivery of services, particularly those which are likely to affect the Integration Joint Board's delivery of the strategic plan; • Identification and description of processes for mitigating these risks; • Mechanisms in place for risk sharing between the organisations; • Agreed reporting standards. 19.2 The risk management strategy and methodology sets out: • Roles and Responsibilities for managing risk; • How the Parties and the Integration Joint Board prepare risk registers, and arrangements to amend and update such registers; • Risks that should be reported from the date of delegation of functions and Resources; • An agreed risk monitoring framework; • An agreed risk reporting framework to senior management and those charged with governance; • An agreed process for sharing risks between partners; • The process for agreeing changes with the Integration Joint Board;
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47 • Protocols for communication and sharing risk information between the Parties. 19.3 The Parties and the Integration Joint Board will work collectively to support three risk registers: • IJB strategic register. • NHS Lanarkshire operational register for health services, as part of NHS Lanarkshire’s corporate risk processes. • NLC operational register for social work services, as part of North Lanarkshire Council’s corporate risk processes. 19.4 The Integration Joint Board regularly reviews and updates its Risk Register, with more detailed analysis through the Performance, Finance and Audit Sub Committee. 19.5 In addition to the above, the NHS Board, the Council and Integration Joint Board will consider and agree which risks should be taken from their own risk registers and placed on the shared risk register. Where these risk change, the NHS Board, the Council and Integration Joint Board will notify each other of where they have changed. This will be done formally through the risk register reports to Integration Joint Board and its Finance, Performance and Audit Sub Committee. 19.6 A risk sharing form has been agreed with both partners so that joint risks can be identified and shared timeously.
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48 20. Dispute Resolution Mechanism 20.1 In the event of a failure by the Parties to reach agreement between themselves in relation to any aspect of this Scheme or any of the duties or powers placed on them by the Act then they will follow the process laid out below: 20.2 Either Party can invoke this Dispute Resolution Mechanism by serving written notice of their intention to do so on the other Party. Such notice will be deemed to be received on the day following the issuing of the notice. The date following the issuing of the notice is herein referred to as “the relevant date”. 20.3 The Chief Executives of the Health Board and the Local Authority will meet, within 7 days of the relevant date, to attempt to resolve the issue. 20.4 If unresolved, and within 21 days of the relevant date, the Parties will each prepare a written note of their position on the issue and exchange it with the each other. 20.5 In the event that the issue remains unresolved, representatives of the Parties will proceed to mediation with a view to resolving the issue. 20.6 Within 28 days of the relevant date, duly authorised representatives of the Parties will meet with a view to appointing a suitable independent person to act as a mediator. If agreement cannot be reached, then a referral will be made to the President of the Law Society of Scotland inviting the President to appoint a person to act as mediator. The mediation process shall be determined by the mediator appointed and shall take place within 28 days of the mediator accepting appointment.
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49 20.7 Where the issue remains unresolved after following the processes outlined above, the Parties agree that they will notify Scottish Ministers that agreement cannot be reached. 20.8 The notification will explain the nature of the dispute and the actions taken to try to resolve the dispute including any written opinion or recommendations issued by the mediator. 20.9 The Parties agree to be bound by this determination of this dispute resolution mechanism.
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50 Annex 1 – Delegated Functions Part 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board as set out in the Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function Column B Limitatio n The National Health Service (Scotland) Act 1978 All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB( (Functions outside Scotland); of Health Boar ds
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51 section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal services); medic al or dental section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 children); (care of mother s an d youn g section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation);
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52 section 55 (hospital accommodation on part payment); section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses);
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53 section 75B (reimbursement of the cost of services provided in another EEA state); section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the
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54 health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114;
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55 The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135;
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56 The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183; The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards Except functions conferred by—
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57 conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co-operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital); section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer);
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58 section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall);
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59 section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010
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60 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions). Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36.
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61 Part 2- Integrated Services Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours’ period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004;
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62 and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine; (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided out with a hospital in relation to an addiction or dependence on
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63 any substance Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 10. The public dental service. 11. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C (2) of the National Health Service (Scotland) Act 1978. 12. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 13. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 14. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 15. Services providing primary medical services to patients during the out-of-hours period. 16. Services provided out with a hospital in relation to geriatric medicine. 17. Palliative care services provided out with a hospital. 18. Community learning disability services. 19. Mental health services provided out with a hospital. 20. Continence services provided out with a hospital.
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64 21. Kidney dialysis services provided out with a hospital. 22. Services provided by health professionals that aim to promote public health. 23. Health visiting Services – denotes that this is in addition to the statutory list as outlined in points 8-23 above. 24.
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65 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Schedule Regulation 2 Part 1 Functions prescribed for the purposes of section 1(7) of the Public Bodies (Joint Working) (Scotland) Act 2014 Column A Enactment conferring function Column B Limitatio n National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45
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66 (Recovery in cases of misrepresentation or non- disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 So far as it is exercisable in relation to another integration function.
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67 (Powers of Secretary of State.) Section 8 (Researc h.) So far as it is exercisable in relation to another integration function.
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68 Column A Enactment conferring function Column B Limitatio n Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide
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69 information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put
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70 on probation or released from prisons etc.) Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function.
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71 Column A Enactment conferring function Column B Limitatio n Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) Section 80 (Enforcement of duty to make contributions.) So far as it is exercisable in relation to another integration function.
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72 Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.)
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73 Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.)
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74 Column A Enactment conferring function Column B Limitatio n Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions. The Adults with Incapacity (Scotland) Act 2000 Section 10
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75 (Functions of local authorities.) Section 12 (Investigatio ns.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.) Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 Only in relation to residents of
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76 (Statement of resident’s affairs.) establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions
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77 Column A Enactment conferring function Column B Limitatio n The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation out with Scotland.)
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78 Section 6 Deferred payment of accommodation costs.) Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well- Except in so far as it is exercisable in relation to the provision of housing support services.
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79 being and social development.) Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co- operation.) Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.)
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80 Column A Enactment conferring function Column B Limitatio n Section 259 (Advocac y.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.) Section 6 (Duty to consider importance of providing advocacy and other.)
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81 Section 7 (Visits) Section 8 (Interview s) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk)
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82 Section 18 (Protection of moved persons property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.)
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83 Column A Enactment conferring function Column B Limitatio n Section 43 (Membershi p.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.) Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-
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84 directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self- directed Support) (Scotland) Act 2013 . Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self- directed support.) Carers (Scotland) Act 2016 (b)
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85 Section 6 (Duty to provide Adult carer support plan) Section 21 (Duty to set local eligibility criteria)
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86 Column A Enactment conferring function Column B Limitatio n Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers) Section 35 (short breaks services statements)
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87 Part 2 -Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services;
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88 h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services; q) Re-ablement services; r) Smart technology, equipment and telecare.
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89 Annex 3 – Hosted Services Arrangements Hosted Services Proposed Arrangements between North and South Lanarkshire Integration Joint Board. Where a Health Board spans more than one Integration Joint Board, one of them might manage a service on behalf of the other(s). This Annex sets out those arrangements which the Parties wish to put in place. Such arrangements are subject to the approval of the Integration Joint Board but will not be subject to Ministerial approval. Services to be hosted by the South Lanarkshire Integration Joint Board Services to be hosted by the North Lanarkshire Integration Joint Board Community Dental Services Care Home Liaison Diabetes Community Children’s Services Health and Homelessness Paediatrics Palliative Care Dietetics Primary Care Out of Hours Mental Health and Learning Disability Traumatic Brian Injury Psychology Occupational Therapy Continence Services
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90 Physiotherapy Podiatry Sexual Health Speech and Language Substance Misuse Prisoner Health Care
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91 Annex 4 – Health and Wellbeing Outcomes Outcome 1- People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 2- People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. Outcome 3- People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4- Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5- Health and social care services contribute to reducing health inequalities. Outcome 6- People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.
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92 Outcome 7 – People who use health and social care services are safe from harm. Outcome 8- People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Outcome 9 – Resource are used effectively and efficiently in the provision of health and social care services.
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93 Appendix 2 –North Lanarkshire Health and Social Care Partnership Integration Scheme 2024-2029 Consultation Process Key Meetings Integration Scheme was presented for Consultation 18th October 2023- 1st Draft of Integration Scheme submitted to the NL H&SCP Integrated Joint Board Performance, Finance and Audit Committee. 22nd November 2023- 2nd Draft of Integration Scheme submitted to the NL H&SCP Integration Joint Board – Draft approved. 7th December 2023- North Lanarkshire Council Policy and Strategy Meeting 19th December 2023- NL H&SCP Senior Leadership Team Meeting 20th December 2023- NHS Lanarkshire Board Meeting Public Consultation 15th January 2024 to 11th February 2024 The consultation was added to the North Lanarkshire Health and Social Care Partnership Website, NHS Lanarkshire website and circulated via social media channels (Facebook and X) The consultation was also sent to all NL H&SCP news subscribers ( circa 10K).
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94 The Consultation was also emailed to a range of consultees based on North Lanarkshire Health and Social Care Partnership Strategic Planning Group. Consultees included health professionals, users of health care and social care, carers of users of health care and social care, commercial providers of health care and social care, social care professionals, staff of health board and local authority, non-commercial providers of social housings, third sector bodies and locality representatives.
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1 REPORT Item No: 15 SUBJECT: Annual Chief Social Work Officer Report 2022/23 TO: Integration Joint Board Committee Lead Officer for Report: Alison Gordon, Chief Social Work Officer (Education, Families, Justice and Integrated Practice) Author(s) of Report Alison Gordon Chief Social Work Officer (Education, Families, Justice and Integrated Practice) DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ In line with guidance this report is approved through the Council and this approval is exercised both through the Adult Care and Social Work Committee and the Education, Children and Families Committee. The Adult Care and Social Work Committee approved the report on 14th November 2023 and the Education, Children on 21st November 2023. More recently the report was also considered and endorsed by North Lanarkshire Partnership’s Strategic Leadership Board on 9th February 2024 and was reviewed by the North Support Care & Clinical governance committee on 22nd February 2024. 3. RECOMMENDATIONS It is recommended that the Integrated Joint Board: (1) Endorse this report (2) Note the approval route through Council committees.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background: 5.1.1 The requirement that each local authority appoints a professionally qualified Chief Social Work Officer is contained in Section 45 of the Local Government (Scotland) Act 1994. Statutory Guidance on the role of the Chief Social Work Officer was updated in 2016, to reflect the impact of Health and Social Care Integration, extending the responsibilities of the role to provide advice to the Integration Joint Board (IJB). In addition to providing advice both to the local authority and IJB in relation to the discharge of statutory social work functions, the role continues to carry key responsibilities for professional leadership, values, and standards both for directly provided and commissioned services. 5.1.2 Social Work Services in North Lanarkshire continue to play a lead role in supporting and safeguarding our communities. Adult Social Work and Social Care Services are delivered through Health and Social Care North Lanarkshire (HSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service. 5.1.3 The CSWO role requires to be undertaken by one designated individual, delegation of responsibilities is permitted where required by the scale of business. In North Lanarkshire this means that the Chief Officer Adult Social Work Services, routinely exercises delegated responsibilities for decision-making and professional standards within adult services as well as providing support and cover with respect to the wider functions of the CSWO role. 5.1.4 The Annual Chief Social Work Officer’s Report is intended to provide a key overview of social work service delivery and performance. The Office of the Chief Social Work Advisor (OCSWA) also produces a national report each year which draws on key themes and messages from CSWO reports across Scotland. Social Work Service Delivery: 5.2.1 Social Work in North Lanarkshire employs around 2,800 staff. In collaboration with commissioned services and 3rd Sector partners, support is provided to around 30,000 individuals and families at any one time. Social work also makes a key contribution to wider partnership and community activity. 5.2.2 As illustrated within the report partnership working is fundamental to social work service delivery at every level and a key aspect of the CSWO role involves developing and sustaining partnership working and relationships across a range of organisations and structures. In addition to the specific responsibilities of the CSWO to the council and HSCNL, the CSWO holds a key leadership role within several local partnerships as well as contributing to the wider national social work community. Our strong partnership ethos supports well balanced social work, with integrated working Yes ☐ No ☐ N/A ☒
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3 arrangements across Health and Social Care, Education and Families, the wider council and partners including the community and voluntary sector. Section 3 of the report describes our statutory partnership working responsibilities in more detail. 5.2.3 Income maximisation and tackling poverty continue to be key strands in the delivery of social work and social care in North Lanarkshire. These have become increasingly integrated into day-to-day practice and service delivery and have a strong fit with the core values of social work – promoting independence, self-help, and self-reliance. Equally important and threaded through the activity reflected within this year’s report, is a commitment to strengthen relationship based and trauma-informed practice. 5.2.4 A range of factors including the legacy impacts of the pandemic; the cost-of-living crisis; the increased demand for social work interventions and support; the increased number of people who have complex needs; and, staffing challenges in health and social care, have all meant that meeting demand within available resources has proved difficult, resulting in some elements of performance, notably with respect to care at home being impacted. As the report evidences, however, the service has continued to innovate to ensure not only that statutory duties are delivered to a high standard, but also to improve outcomes and people’s experiences of services. Throughout this period we have continued both to retain a strong balance of care across all care groups, supporting individuals to remain within their homes and communities wherever possible and to support and empower individuals and families to achieve positive outcomes. 5.2.5 External scrutiny of social work services if undertaken primarily through the Care Inspectorate and its partner agencies. The final report of the Joint Inspection for Adult Support and Protection was published on 22 November 2022. The inspection findings are largely positive and recognise the hard work and determination of staff across the partnership over the last two years. The report indicated strong multi- agency arrangements in North Lanarkshire, keeping adults who are at risk of harm safe and protected. A Joint Inspection of Services for Children and Young People at Risk of Harm in North Lanarkshire was announced in April 2023 and therefore beyond the period covered in this report, however, the positive findings from the Joint Inspection were considered by Education, Children and Families Committee also in November 2023 and by the Strategic Leadership Board at its meeting on 1 December 2023. This will be reflected further in next year’s annual report. 5.2.6 Staff commitment and resilience has continued to be remarkable during these challenging times. A range of initiatives to support staff recruitment and retention against a challenging backdrop is outlined in Section 5 of the attached report. As part of our wider approach to wellbeing, we also continue to have a focus on the wellbeing of staff within day-to-day practice and working arrangements and offer a wide range of staff wellbeing initiatives and supports. 5.2.7 Looking forward, the report reflects on the opportunities to continue our whole system approach, which includes the continued embedding of the Empowering Clusters’ model within Education and Families and the Good Conversations Model and GIRFE (Getting It Right for Everyone) within in Adult Services and the opportunities provided through the Council and HSCP’s programmes of work as well, as reflecting on the continued uncertainties related to elements of nationally driven change in particular the future shape of the National Care Service.
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4 6. CONCLUSIONS As set out above this report is presented to the Integrated Joint Board in order to provide an overview of social work activity and performance for the period 2022/23 in addition to providing context relevant to service delivery with respect to governance, resources, workforce, challenges and opportunities. Many of the areas covered within the report will already have been the subject of more detailed reporting to the Board over this period however in providing this information within a holistic context of all social work services the report is intended to facilitate the Board’s oversight, scrutiny and future planning with respect to social work services. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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5 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. None specific to the report – risk context and management measures are referenced within the body of the report 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. The report is a public facing document and therefore provides individuals and communities alongside governance groups with key information on social work performance and delivery. Whilst no specific engagement activity is undertaken with respect to the report itself the contents reflect the embedding of a co-production approach and the promotion of voice across a range of service delivery and development activity. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership
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6 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1- Annual Report of the Chief Social Work Officer 2022/23 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Alison Gordon, Chief Social Work Officer (Education, Families, Justice and Integrated Practice) Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☐
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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8 Appendix 1 CSWO Annual Report 2022-2023
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9 Contents 0BANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2022/23 ....................... 12 THE CHIEF SOCIAL WORK OFFICER FUNCTION ................................................................................ 12 3BANNUAL REPORT .............................................................................................................................. 13 1B1. GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS ................................................................ 14 1.1 NORTH LANARKSHIRE COUNCIL AND NORTH LANARKSHIRE PARTNERSHIP ........................... 15 1.2 HEALTH AND SOCIAL CARE NORTH LANARKSHIRE .................................................................... 17 1.3 SUPPORT, CARE, PRACTICE AND STAFF GOVERNANACE ARRANGEMENTS .............................. 19 1.4 CARE HOME ASSURANCE ........................................................................................................... 20 1.5 ENGAGEMENT WITH THE PEOPLE WHO USE SUPPORT SERVICES AND THE COMMUNITY AND VOLUNTARY SECTOR ......................................................................................................................... 20 2B2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE ................................................................ 23 2.1 PERFORMANCE AND IMPACT MEASUREMENT ......................................................................... 23 2.2 SUPPORT TO UNPAID CARERS .................................................................................................... 24 2.3 JUSTICE SOCIAL WORK SERVICES ............................................................................................... 26 2.3.1 CPO UNPAID WORK ............................................................................................................. 27 2.3.2 OTHER ACTIVITY .................................................................................................................. 29 2.3.3 DIVERSION FROM PROSECUTION ....................................................................................... 30 2.3.4 OFFENCE FOCUSED WORK .................................................................................................. 32 2.3.5 UP2U .................................................................................................................................... 33 2.3.6 MOVING FORWARD: MAKING CHANGES (MF:MC) ............................................................ 34 2.3.7 WOMENS SERVICES ............................................................................................................. 34 2.3.8 THROUGHCARE (BRIDGES AND BEYOND) ........................................................................... 35 2.3.9 CHALLENGES ........................................................................................................................ 35 2.4 CHILDREN AND FAMILIES SOCIAL WORK SERVICES ................................................................... 36 2.4.1 KEEPING THE PROMISE ....................................................................................................... 36 2.4.2 INVOLVING YOUNG PEOPLE ................................................................................................ 38 2.4.3 A GOOD CHILDHOOD: ACHIEVING A LOVING A CARING HOME ........................................ 39 2.4.4 MOVING ON: SUPPORTING CARE EXPERIENCED YOUNG PEOPLE WHO HAVE LEFT CARE 43 2.4.5 A RIGHT TO EDUCATION ...................................................................................................... 44 2.4.6 YOUNG PEOPLE IN CONFLICT WITH THE LAW/DECRIMINALISATION OF CARE EXPERIENCED YOUNG PEOPLE ..................................................................................................... 45 2.4.7 WHOLE FAMILY SUPPORT AND PROTECTING CHILDREN AND YOUNG PEOPLE AT RISK OF HARM ............................................................................................................................................ 47 2.4.8 GENDER BASED VIOLENCE .................................................................................................. 49 2.5 ADULT SOCIAL WORK SERVICES ................................................................................................. 50
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10 2.5.1 GETTING IT RIGHT FOR EVERYONE (GIRFE) ........................................................................ 51 2.5.2 MAKING LIFE EASIER ........................................................................................................... 51 2.5.3 ASSISTIVE TECHNOLOGY ..................................................................................................... 52 2.5.4 COMMUNITY ALARMS ........................................................................................................ 53 2.5.5 EQUIPMENT & ADAPTATION SERVICE (EAS) ....................................................................... 54 2.5.6 LOCALITY SUPPORT SERVICES ............................................................................................. 54 2.5.7 INTEGRATED DAY SERVICES ................................................................................................. 55 2.5.8 HOME ASSESSMENT TEAM ................................................................................................. 55 2.5.9 HOME SUPPORT SERVICE .................................................................................................... 56 2.5.10 TRANSFORMATIONAL SDS AGENDA ..................................................................................... 57 2.5.11 COMMUNITY LIVING CHANGE FUND/COMING HOME ........................................................ 58 2.5.12 MENTAL HEALTH OFFICERS SERVICE AND ADULTS WITH INCAPACITY ACT (SCOTLAND) 2000 .......................................................................................................................................................... 59 3 PUBLIC PROTECTION...................................................................................................................... 63 3.1 ADULT SUPPORT AND PROTECTION .......................................................................................... 63 3.1.1 ASP REFERRAL TRENDS ....................................................................................................... 63 3.1.2 ASP INVESTIGATIONS .......................................................................................................... 64 3.1.3 CASE CONFERENCES ............................................................................................................ 64 3.1.4 STATUTORY ORDERS ............................................................................................................ 64 3.1.5 APPROPRIATE ADULT SERVICES .......................................................................................... 64 3.1.6 LARGE SCALE INVESTIGATIONS ........................................................................................... 65 3.1.7 JOINT INSPECTION OF ADULT SUPPORT AND PROTECTION IN NORTH LANARKSHIRE ..... 66 3.2 MAPPA (MULTI AGENCY PUBLIC PROTECTION ARRANGEMENTS ......................................... 67 3.3 CHILD PROTECTION .................................................................................................................... 68 3.4 WIDER SAFEGUARDING ACTIVITY .............................................................................................. 69 3.4.1 CONTEXTUAL SAFEGUARDING AND PROTECTING YOUNG PEOPLE FROM HARM OUTSIDE THE HOME..................................................................................................................................... 69 3.4.2 SUICIDE PREVENTION .......................................................................................................... 71 3.4.3 DRUG RELATED DEATHS ...................................................................................................... 72 4. RESOURCES ....................................................................................................................................... 73 4.1 FINANCIAL MODELLING FOR SERVICE DELIVERY ....................................................................... 75 5. WORKFORCE ..................................................................................................................................... 76 5.1 WORKFORCE PLANNING ............................................................................................................ 76 5.2 SOCIAL WORK RECRUITMENT AND RETENTION ....................................................................... 76 5.3 RECRUITMENT AND RETENTION OF MENTAL HEALTH OFFICERS .............................................. 78 5.4 SOCIAL CARE ............................................................................................................................... 79
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11 5.5 ADMINISTATION AND BUSINESS SUPPORT ............................................................................... 80 5.6 CARE ACADAMY.......................................................................................................................... 80 5.7 WORKFORCE DEVELOPMENT AND STAFF SUPPORT ................................................................. 81 5.8 LEARNNL ..................................................................................................................................... 82 5.9 ASSESSMENT CENTRE AND REGISTRATION ................................................................................ 82 5.10 POST GRADUATE OPPORTUNITIES ........................................................................................... 82 5.11 PROFESSIONAL DEVELOPMENT AWARD IN PRACTICE LEARNING (PDA PL) SQA LEVEL 11...... 83 5.12 SOCIAL WORK DEGREE PATHWAY WITH THE OPEN UNIVERSITY ............................................ 83 5.13 STUDENT SOCIAL WORK HUB .................................................................................................. 84 5.14 NEWLY QUALIFIED SOCIAL WORK PROGRAMME .................................................................... 84 5.15 OTHER KEY TRAINING AND DEVELOPMENT ACTIVITIES ......................................................... 85 5.16 TRAUMA INFORMED PRACTICE ............................................................................................... 86 5.17 LIVED EXPERIENCE .................................................................................................................... 87 5.18 REFLECTIVE LEARNING: THE SCOTTISH CHILD ABUSE INQUIRY/HISTORICAL ABUSE .............. 87 5.19 SUPPORT FOR STAFF WELLBEING ............................................................................................. 87 6. LOOKING FORWARD – PRIORITIES FOR 2022-2023 AND BEYOND .................................................. 88
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12 0BANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2022/23 THE CHIEF SOCIAL WORK OFFICER FUNCTION Every local authority is required to appoint a professionally qualified Chief Social Work Officer (CSWO) as contained in Section 46 of the Local Government (Scotland) Act 1994. The CSWO provides professional leadership, accountability, and governance, for the delivery of social work and social care services, including commissioned services. The CWSO also provides advice on social work service delivery and on cross-cutting issues to the local authority Chief Executive, Elected Members and the Integrated Joint Board (IJB) to promote understanding of the range of social work and social care services and the complexities involved in delivering statutory responsibilities which require consideration of need and the management of risk and liberties. The then Scottish Office specifically recognised that the need for the CSWO role was driven by “the particular responsibilities which fall on social services in that they affect personal lives, individual rights and liberties to an extent that other local authority services do not.” (Circular: SWSG2/1995 May 1995). The CSWO also has a direct lead remit for decisions on specific statutory matters including in relation to secure accommodation, adoption and welfare guardianship as illustrated below. A further aspect of the CSWO role is to inform the delivery of wider services which support or impact on social welfare. The CSWO role within North Lanarkshire is held by the Chief Officer, Children, Families, Justice and Integrated Practice. The CSWO is supported by the Chief Officer, Adult Social Work Services who holds delegated responsibilities with respect to adult social work and social care, deputises in other areas as required and works alongside the CSWO in relation to the other
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13 functions of the role. 3BANNUAL REPORT In line with Scottish Government guidance the CSWO is required to provide an annual report. This report provides an overview of social work service delivery in North Lanarkshire for the period April 2022 to March 2023 and covers the following areas: Governance and accountability arrangements, including partnership working. Service Quality and Performance, including service developments. Resources Workforce Future Priorities The legacy impact of Covid, the continuing cost-of-living crisis, increased demand and challenges around recruitment and retention of staff within the social care and social work sectors have all been significant factors during the past year. These are reflected within the report as are the positive innovations and continuous improvement activity across the service as staff have worked with resilience and commitment to achieve the best possible outcomes for those we support. I would like to record my thanks and pay tribute to all staff involved in the delivery of social work services in North Lanarkshire for their work over the past year I would also like to thank all internal and external partners, carers, families and communities who have supported us in our work. Alison Gordon Chief Social Work Officer
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14 1B1. GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS Social Work Services in North Lanarkshire continue to play a lead role in supporting and safeguarding our communities. Adult Social Work and Social Care Services are delivered through Health and Social Care North Lanarkshire (HSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service, with local arrangements continuing to support close working across these areas in both service delivery and planning, particularly in relation to workforce issues and professional development. Social Work in North Lanarkshire employs around 2,800 staff. In collaboration with commissioned services and 3rd Sector partners, we are involved in providing support to around 30, 000 individuals and families at any one time in addition to contributing to wider partnership and community activity. Progress towards a National Care Service (NCS) is continuing and as reported last year, is likely to involve significant change in the future governance of social work services. A NCS Member Officer Group was stood up by the Council both to inform our response to national engagement on the NCS and to support local planning but was paused in line with the pause on the Bill process. Partnership working at local level remains fundamental to social work. A key aspect of the CSWO role involves developing and sustaining partnership working and relationships across a range of organisations and structures. In addition to the specific responsibilities of the CSWO to the Council and HSCNL the CSWO holds a key leadership role within several local partnerships as well as contributing to the wider national social work community, as illustrated below:
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15 1.1 NORTH LANARKSHIRE COUNCIL AND NORTH LANARKSHIRE PARTNERSHIP The direction for the council and partners is set out in the Plan for North Lanarkshire. This highlights shared priorities and a long-term vision and aspires to inclusive growth and prosperity. The plan aims to ensure that the benefits that this brings reach all our communities, and that there is a much fairer distribution of wealth - The Plan for North Lanarkshire | North Lanarkshire Council The plan focuses on: improving economic opportunities and outcomes supporting all children and young people to realise their full potential. improving the health and wellbeing of communities enhancing participation, capacity and empowerment across our communities and improving North Lanarkshire’s resource base During the reporting period an analysis of the area profile highlighted that North Lanarkshire has seen several successes in its first period, notably a rise average wage to above the Scottish average and a small reduction in child poverty, but there are also challenges. This analysis provided the evidence that informed the direction for The Plan for North Lanarkshire from the period 2023 – 2028. A five-year Programme of Work which was approved in March 2023, supports the plan and this comprises seven priorities for delivery: Transforming Places - To better plan and co-ordinate public and private sector investment to deliver transformational change across town centres and local communities at pace. Invest in North Lanarkshire - Accelerated outcome delivery and investment via a more streamlined advisory service and aligned operating model and infrastructure plan. Sustainable Futures - Focus commitments to Net Zero Carbon and climate resilience and the associated energy solutions and investments required to make it a reality. Resilient People - Deliver whole family support locally, when families need it, in a way that addresses the impacts of poverty and reduces inequality. Brighter Futures - Support and improve educational attainment, employment opportunities, entrepreneurship, and volunteering. Digital North Lanarkshire - Develop a skilled digital workforce, promote an innovative, sustainable culture and be the Digital Leader for a transformed North Lanarkshire. One Service - Ensure services are delivered, regardless of owner, in a streamlined, efficient, and supportive model, with the overall vision of inclusive growth and prosperity for all. The CSWO, Chief Officer Adult Social Work, Chief Officer Planning, Performance and Quality Assurance and other senior social work managers are actively involved in key areas of this programme, with the CSWO undertaking the role of SRO (Senior Responsible Officer) for the Resilient People Programme. This ensures connections are made across the range of corporate work programmes, in particular those which impact on areas that are important to those who use social work services, for example, employability services, homelessness
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16 prevention and community wealth and capacity building. As previously reported, from early 2022, the CSWO (Education, Family Justice and Integrated Practice) has also held operational responsibility for Tackling Poverty; Community Learning and Development and Resettlement functions, creating increased opportunities for integrated working in areas closely linked to social work. The Programme of Work continues to be shaped and overseen by the Corporate Management Team and through the council committee structure with the Adult Health and Social Care Committee and Education, Children and Families Committee having oversight of the delivery of social work. North Lanarkshire Partnership (NLP) brings together the major public sector agencies in the area along with Voluntary Action North Lanarkshire (VANL) the third sector interface in the area. NLP operates as the overarching framework for partnership working and the priorities for delivery across the partnership are included in The Plan for North Lanarkshire. The Children’s Services Partnership (CSP) continues to provide multi-agency governance, strategic planning and direction for children’s services in North Lanarkshire. Children’s Service Partnership Board membership includes Elected Members and HSCP/NHS Board representation to enhance the coherence of planning across key governance structures. There is also representation of young people through links with NL Youth Council, the Promise Development Team and Champion’s Board. Every three years the North Lanarkshire Children’s Services Plan is refreshed bringing together improvement priorities for the CSP. The North Lanarkshire Children’s Services plan for this period was published in 2021 and is framed around the foundations of the Promise and UNCRC. During this period representatives from the CSP reviewed the achievements and priorities of the partnership and undertook work in preparation for the CS Plan for 2023-26. This included a Joint Strategic Needs Assessment and engagement with children, young people, and parents/carers to refresh priorities based on evidence, stakeholder views and experience. The task groups supporting the delivery of the plan have reported on their achievements for this year. These include: Launch of MakeitRight Campaign, a peer education programme to raise awareness of UNCRC. Agreement on a revised youth participation and engagement infrastructure. Continued development and implementation of the Community Mental Health and Wellbeing Support and Services Framework. Planning to enhance our holistic approach to whole family support across the partnership supported by the new Whole Family Wellbeing Fund. The established Promise Development Team, young people with lived experience of care, continuing to support the redesign of our care system. The maintenance of effective GIRFEC practice for children, young people and families
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17 with improvements to our learning and development offer and our website for families. Continued embedding of a contextual safeguarding approach to improve our response to young people at risk of extra familial harm. Commitment to creating the conditions for trauma-informed practice as the underpinning approach to support children, young people, and their families. Full details are in the CS Annual Report 2022/23 Social Work places a key role in all the CSP priorities with Senior Social Work Managers co- chairing 3 of the 4 task groups and the Partnership’s Continuous Improvement Group. The CSWO is lead officer for the CSP and chairs the Improving Children’s Services Group which has oversight of the work of task groups together with the ‘Scaffolding’ and ‘People’ elements of the Children’s Services Plan. The Community Justice Partnership, currently also chaired by the CSWO has responsibility for the multi-agency oversight of Community Justice in North Lanarkshire. Due to both the pandemic and the timing of national work on a revised Outcome Performance and Improvement Framework our local NL Community Justice Outcome and Improvement Plan (NL CJOP) was extended to March 2023 and supplemented by annual action plans. https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=20573&p=0. The partnership has over this period benefited from strong collaboration with a wide range of partners and, in particular, has enhanced links with employability services and the NL Alcohol and Drug Partnership, strengthening throughcare and holistic support both for those exiting custody and formal orders and through our pilot Arrest Referral Service. Significant work was also undertaken to update our Strategic Needs Assessment and to engage with communities and those with lived experience to support preparation for our new CJOIP: North Lanarkshire Community Justice Partnership | North Lanarkshire Council . As previously reported nine Community Boards support community leadership, involvement and capacity building. Local outcome and improvement plans (LOIP) guide this work. Social work services play a part in supporting local partnership structures. The CSWO has the role of Community Co-Ordinator for one of the local boards and the Chief Officer Adult Social Work and Senior Managers for Quality Assurance and Strategy & Performance provide links to the Health and Social Care Partnership and its strategic commissioning activity across all Community Boards. Senior Social Work Managers also participate in area-based teams and the sub-groups which support the delivery of the LOIPs. 1.2 HEALTH AND SOCIAL CARE NORTH LANARKSHIRE The governance structure for the partnership is provided by the Integrated Joint Board (IJB) and its Performance, Audit and Finance Sub Committee. The CSWO (Education, Families, Justice and Integrated Practice) and the Chief Officer Adult Social Work Services provide professional social work advice to the IJB. The Mental Health, Learning Disability and
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18 Addictions Partnership Board (chaired by the Chief Officer Adult Social Work Services) and the Frailty and Long-Term Conditions Partnership Board (chaired by the Head of Health) have the role of informing and implementing strategic direction on behalf of HSCNL across their respective areas to promote best practice and guide the access for people to the right support at the right time, and right place. The Partnership Boards have been in place for several years and as reported previously, are under review as part of the refresh of the Integration Joint Board’s new Strategic Commissioning Plan (SCP) 2023-26. The SCP sets out how the Health & Social Care Partnership plans and delivers services for North Lanarkshire over the medium term and how these arrangements are intended to achieve and contribute towards achieving the national health and wellbeing outcomes. It was approved and published in March 2023, and it will cover the final period of our long-term Strategic Plan 2016-2026 and builds on the work established in our previous Strategic Commissioning Plan 2020-23. Despite the many challenges faced since March 2020, significant achievement and progress has been made in the last three years. The SCP plan gives an overview of some of these achievements and how they have helped to shape our priorities for the next three years. In developing the Strategic Commissioning Plan 2023 – 2026 an engagement and consultation process has been undertaken to ensure a wide range of staff, people who use services, carers and partner organisations have had an opportunity to participate in shaping the next three- year’s priorities. Several events took place to facilitate discussion in localities as well as targeted groups, Community Board members, elected members, Integration Joint Board members, and the Strategic Planning Group. The Board approved the draft version of the SCP at its meeting on 30th November 2022, subject to final consultation and the draft plan was published online in early December, alongside a survey questionnaire which allowed members of the public and any other interested parties to give their feedback. The feedback from the survey is published as an appendix to the final Strategic Commissioning Plan. A programme of work is set out within the plan outlining the key work programmes that will be undertaken over the three-year period to meet the key priorities within the Strategic Commissioning Plan. The Strategic Commissioning Plan 2023-26 sets out 5 key priorities: Increased focus on prevention, early intervention and tackling inequalities by working with people and communities Do the right thing first time. Develop and support a workforce for the future. Improve mental health and wellbeing. Support people through a whole family approach
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19 The plan is supported by a programme of work which interfaces with the wider Plan for North Lanarkshire and the wider council programme of work. North Lanarkshire Alcohol and Drug Partnership is hosted within HSCNL and has been considerably strengthened over the last two years, co-developing its 2021-2024 strategy around the themes of rights/respect/recovery through engagement with a broad range of stakeholders. Five ADP sub-groups have been established to develop actions covering: Prevention, Early Intervention and Education; Treatment Care and Recovery; Whole Family Approach; Public Health Approach in Justice and Reducing Alcohol Harms. In line with the cross-cutting elements within these key areas the interface between the ADP, CSP and CJP has also been strengthened and whilst the lead senior officer for the ADP is the Chief Officer Planning, Performance and Quality Assurance both the CSWO and Head of Adult Social Work Services have a role in the wider ADP structure. NLADP has increased investment across statutory and community sector services to reduce harms from substances for individuals and whole families. The investment is linked to local needs and a commitment to deliver the national drug mission priorities across North Lanarkshire. This includes contextual safeguarding, youth justice, standalone family support provision and justice throughcare support including DTTO and arrest referral which were all established or extended in 2022/23. All the projects and initiatives supported by the ADP can be found on their website service directory. 1.3 SUPPORT, CARE, PRACTICE AND STAFF GOVERNANACE ARRANGEMENTS The Health and Social Care Partnership’s Support Care and Clinical Governance Committee (SCCGC) continues to meet on a quarterly basis and is chaired on a rotational basis by the CSWO, Medical Director, AHP Director and Nursing Director. To maintain coherence in practice and staff governance across all social work functions and care groups, regular Social Work Leadership meetings and quarterly Social Work Workforce meetings are in place. Our Social Work Solutions forum also meets regularly to discuss and address cross-cutting business issues with social work Chief Officers, Senior Managers and HR Business Partners. There are a range of processes to support assurance around practice and service delivery across social work services. The Quality Assurance Team, hosted in Adult Social Work, operates across all social work functions. During 2022/23 capacity within the team was enhanced to support the CSWO with Care Home assurance and to develop and implement an In-House Monitoring Framework to ensure robust, quality service provision. Service responsibilities for the monitoring of the delivery of commissioned services continues. The team reports to the Chief Officer (Planning, Performance and Quality Assurance) and leads on a wide range of other functions critical to
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20 the duties of the CSWO. These include regulatory activity, complaints management and overview, risk management, commissioning and procurement, information governance as well as provider sustainability. Activity is reflected within the Quality Assurance annual report for 2022/23. Additional arrangements for multi-professional oversight of Care Homes and Care at Home established during the pandemic were reviewed and adapted as the recovery from COVID continued as the year progressed but continue as part of our wider assurance arrangements as outlined below. A Home Care Board continues to oversee the wider redesign of the service, with new Terms of Reference developed. All Senior Managers within social work undertake regular performance reviews with their teams and support additional audit, development, and review activity to support practice standards, agreeing priorities with the CSWO and Chief Officer Adult Social Work Services. The CSWO and Chief Officer Adult Social Work also maintain an overview of referrals to, and investigations by, Scottish Social Services Council supported by HR Business Partners. Senior Social Work Leaders were conscious that their visibility as leaders and the opportunity for less formal but direct face-to-face dialogue with staff had been impacted by pandemic. This was addressed through visits by the CSWO and other key managers to teams over the summer of 2022 and beyond and this continues to be a priority looking ahead. 1.4 CARE HOME ASSURANCE Enhanced clinical and care oversight arrangements for care homes were put in place early in the pandemic to support care home staff to keep residents safe. There has been considerable learning and excellent examples of local partnership working during this time. A review is currently underway of the arrangements in place to ensure continuing enhanced support to adults and older people’s care homes. Engagement with stakeholders was scheduled to conclude May 2023 with key areas already identified including the need to: Recognise and build on the expertise within the sector. Continue collaborative improvement work with providers and home managers. Focus on residents having a meaningful quality of life. Ensure access to healthcare support when required. Support workforce development. 1.5 ENGAGEMENT WITH THE PEOPLE WHO USE SUPPORT SERVICES AND THE COMMUNITY AND VOLUNTARY SECTOR The CSWO plays a key role in ensuring that people who use and have experience of social work services inform the design and delivery of these services as well as in individual planning. The ultimate accountability for social work services is to the people who use them, their families, and the communities of North Lanarkshire. Examples of co-production in the design of service
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21 are reflected throughout this report and ensuring individuals and families, including children and young people are heard and empowered within individual support planning remains a key area of focus in both out delivery and assurance arrangements. Our approach is also informed by the wider Council vision as set out in Delivering for Communities and the importance placed on the role of Community Boards as outlined in section 1.1 above. The HSCC NL Engagement and Participation Strategy 2021-2024 was designed to ensure that HSC NL has the right systems and supports in place for effective engagement with, and the participation of stakeholders. The strategy facilitates the involvement and engagement of people who use services, carers, the community, and voluntary sector, as well as the independent sector and a “strategy into practice” approach has been supported by a Stakeholder Engagement and Participation Strategy, Framework and Working Group. Complaints Overall, complaint activity rose by 81% from 2021-2022. A significant increase: however, complaints are still slightly less than they were pre-pandemic. Overall complaints received for the reporting period totalled 221. Education and Families: - 81 complaints were received in relation to Education & Families services this year, 49 received last year, an increase of 32 [65%]. Adult Social Work Services: - 140 complaints for adult services this year, 73 received last year, an increase of 67 [92%]. It is likely that complaints numbers were supressed over the pandemic period in part as public expectations were moderated due to the recognition of pressure on services. Similarly it is likely that demand pressures as we emerge from the pandemic have contributed to the rise this year however, the principal reason for complaints continues to include poor staff communication, staff attitudes and quality of service with learning from all social work complaints this year highlighting: The importance of good communication. The need to ensure that those who use our services, and their carers are informed from the outset where they may need to contribute towards the cost of their care. The need to improve information and advice for those who need to contact and seek support from social work services. That people have the right to use their Self-directed Support (SDS) individual budgets as creatively as necessary to reach their agreed outcomes if the use of public funds are legal and do not bring the council into disrepute. As a partnership we are committed to improving learning from complaints which is also one of the key performance indicators that are reportable to the SPSO. We will, over the course of
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22 2023-2024 place further emphasis on identifying and applying learning from complaints, recording learning outcomes and evidencing subsequent improvements. We will also emphasise the need to ensure that all complaints are dealt with in the identified timeframes, with clear communication of outcomes. Compliments Across social work, seven compliments were made throughout 2022-2023 in relation to complaint handling. All referred to quick actions by responsive staff to provide resolution. Care Opinion Care Opinion a non-profit organisation, funded mainly through subscriptions from health and care organisations, has built a national and international reputation for their innovative and value-led approach to online feedback. Subscription to Care Opinion locally has given a further platform for people who use social work services to comment on the quality of the service that we provide but may also encourage people to make formal complaints. The usage of Care Opinion has been slow, however, there have been marked increases in comments posted about social care services throughout the period from January 2023 – March 2023. Anecdotal information from our partners in NHS Lanarkshire suggests that in the early stages, uptake can be poor, but that sustained promotion will drive traction and momentum. There is a Care Opinion implementation group who meet regularly to agree plans for increased promotion and shared learning. To support the use of Care Opinion as a vehicle to promote feedback on services, Quality Assurance revised our Contract Management Framework and requires all contracted providers, through their quarterly monitoring returns, to report on their use and promotion of Care Opinion as a method of seeking feedback. Carers Engagement with carers in North Lanarkshire remains equally critical to service delivery and development and is undertaken through the framework of the Carers Strategy 2019-24 NL- Carers-Strategy.pdf (carerstogether.org) which was developed in partnership with carers with a vision ‘to ensure, in partnership, that North Lanarkshire adult carers and young carers are supported, represented and enabled to build resilience, carry out their caring role and to live healthy independent and fulfilled lives’. North Lanarkshire Carers Together continues to provide an information and advice service but also a network for carers to represent individual and collective issues and to contribute to policy development, service provision and evaluation both locally and nationally, a role which has been particularly valuable and important in ensuring carers voices are heard and challenges understood during and as we emerge from the pandemic period. Voluntary Action North Lanarkshire (VANL) continues to provide the key local interface with the community and voluntary sector in North Lanarkshire and participates as equal partners in the partnership structures described above and in a wide range of linked improvement
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23 activity. This has included membership of the Children’s Services Partnership Board and the ongoing involvement and facilitation of endorsed third sector networks linked to the Community Justice Partnership. VANL have also continued to play a central role in developing voluntary and community sector involvement through community capacity and carers support work as reflected within the Community Solutions Strategy and delivery programme, Softening the Lines 2018-23. Using 9 thematic leads to guide best practice and 6 locality host organisations to ensure a community led approach a devolved budget of over £1milliion has been invested yearly by HSCNL in local organisations and community groups. The overarching aims are to prevent isolation and loneliness; to address inequalities using innovative approaches to support people to be more active; and to reconnect people to their communities A supporting commissioning plan and the programme approach have ensured a focus on key outcomes with the budget also helping to secure additional funding and/or in-kind contributions. The use of Community Solutions model has also been used within Children’s Services, aimed at addressing distress and promoting positive mental health. A significant portion of new Scottish Government funding was targeted at early intervention and community support through the Children and Young People’s Mental Health and Wellbeing Framework allocated to organisations through VANL to develop new supports in partnership with school clusters, children, young people, and their families. Engagement, inclusion, and empowerment are embedded in day-to-day practice with a focus on good conversations and strength-based approaches rather than being one off, or episodic events and this approach remains of key importance in social work across all care groups. 2B2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE 2.1 PERFORMANCE AND IMPACT MEASUREMENT Whilst measuring impact in the complex context of social work is challenging, there is a robust framework of formal scrutiny, oversight and governance. For each person supported, positive outcomes are planned for and agreed during assessment; and are subject to ongoing review throughout the person’s journey and evaluated using a variety of Social Work practice tools. Use of tools such as the outcome star within various settings allows for the measurement of change at individual level but can also be collated to support evaluation of wider service impacts. Proxy measures may also be used to measure the impact of interventions at both individual and service level whilst case studies/stories and service user feedback can provide depth and an equally valuable picture of how services are experienced and the impact of trauma informed and relationship based practice. A mix of quarterly, six monthly and annual reporting is in place for social work services including through the Council’s Strategic Performance Framework and HSCP detailing key
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24 performance areas such as access, operational performance, workforce, quality and outcomes. In addition to internal performance management arrangements all Social Work services provide validated performance and activity data to the Scottish Government and the various agencies who have a strategic interest in social work service delivery supporting national indicator sets, such as the Local Government Benchmarking Framework and the Integration Indicators which can then be used for benchmarking purposes. External scrutiny is provided primarily through the Care Inspectorate’s including through regulation of registered services including residential care, care at home and adoption and fostering service and through strategic inspection and thematic reviews. During 2022/2023 a strategic inspection took place with respect to the partnership’s delivery of Adult Support and Protection whilst services participated in national thematic reviews in relation to Carer support during the pandemic, support for Children with Disabilities and Secure Care. 2.2 SUPPORT TO UNPAID CARERS Unpaid carers continue to be the main source of support for people, including those who might otherwise need assistance from social work and health services. Supporting unpaid carers therefore continues to be of vital importance. Over 2022 / 2023 we continued to work with our existing partners as well as developing new initiatives to ensure that the range of support options that help meet unpaid carer needs and outcomes was in line with carer led and carer informed needs, expectations, and outcomes. Some of these approaches were aimed at maintaining carer health and well-being, some at preventative approaches or to help meet anticipated need, and some span all these areas. Last year’s report had a focus on the impacts of the COVID-19 pandemic on unpaid carers. These impacts still had resonance across 2022/23, and many carers continued to provide more care than in pre COVID times. Recruitment and staff retention issues combined with an increased need for support across social care, social work, and health sectors, both locally and nationally, remained challenging, compounding the issues experienced by unpaid carers. The cumulative impact on carer health and well-being was significant. The National Carer Strategy, launched in late 2022, had its first strand focused on “Living with Covid” and we are developing approaches to meet the aims of that. Locally, we have three commissioned carer organisations: Lanarkshire Carers – Direct Support for Adult Carers. Action for Children Young Carers Service – Young Carers Support Services. North Lanarkshire Carers Together (NLCT) – Campaigning,
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25 information, and representation services. These are further augmented by a diverse range of other 3rd Sector organisations including: Voluntary Action North Lanarkshire – Community Solutions Programme North Lanarkshire Disability Forum – Community Many others who also offered a variety of services including condition specific and\or age-related support organisations. We continued to work in close partnership with the commissioned carer service organisations as well as funded organisations where there was a direct, or indirect, carer support role. Estimates vary slightly, but approximately 13,000 carers were aligned to carer support organisations in North Lanarkshire or known to Health and Social Care in 2022/2023. The true number of unpaid carers in our area is likely to be significantly higher. Again, estimates vary, but it is considered that the real figure is around 50,000. That means that only one in four to one in five carers is known to us, making advance planning and preventative approaches that bit harder to design and deliver. Work is ongoing to ensure that non-aligned (“hidden”) carers are aware of carer support options and the importance of Adult Carer Support Plans and Young Carer Statements. Our focus continues to be on preventative and/or anticipatory approaches, promoting and supporting self-help and independence as much as possible, and ensuring that carers are aware of sources of help and support and can access these at an early stage, rather that when crisis arises. During 2022/2023, 914 Adult Carer Support Plans were progressed by Lanarkshire Carers. In situations where carer need was identified as being significant or critical and unable to be met through the range of carer support options described in this report, 48 individual carer budgets paid through a Direct Payment were agreed. These individual budgets to support people reflected individual carer circumstances, such as complex care related needs, caring responsibility for more than one person, or the carer’s own health related needs. More commonly carer circumstances were considered within the 2, 375 individual budgets for supported people, which were agreed during this period. In addition, over 900 small grants for carers were distributed through Lanarkshire Carers. In line with the Carers (Scotland) Act 2016 and the North Lanarkshire Carers Strategy the Action for Children Young Carers Service continued to ensure that every young carer referred to the service had a Young Carers Statement (YCS) and a review of this statement where appropriate. Short breaks provision continued to be of high importance with each young carer receiving a short break, and several families received additional short break support. Group work programmes and individual 1:1’s remained the main source of support within the service. Maintaining young carers' mental health remained a vital part of the work within the service, delivered in partnership with Kooth and other mental well-being organisations. Staff also had a presence in most high schools in North Lanarkshire during this period promoting awareness of young carers needs whilst financial support for young carer families was maximised through continued funding applications through carer partners and the Action for Children fundraising team.
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26 North Lanarkshire was one of a small number of areas across Scotland where in-depth activity linked to the Care Inspectorate’s national ‘Inquiry into carer’s experiences of social work and social care service delivery’ took place. Findings from this inquiry, released in late 2022 demonstrated that North Lanarkshire was performing relatively well in supporting carers compared to the national position. Lanarkshire Carers continue to operate a well-established short break service, and this continues to play an important role in supporting unpaid carers in enjoying a break from their caring role. Feedback from carers also highlighted a need for more regular, flexible ‘time out’ options accessible within their local community. This led to a range of new initiatives including a ‘Carer Breather’ programme, facilitated through North Lanarkshire Carers Together and introduced in April 2022. Positive feedback from unpaid carers regarding this approach resulted in an extended programme scheduled to commence in April 2023. Work to meet the requirements of the Carers Act to ensure that unpaid carers were as involved as they wanted to be in hospital discharge arrangements also continued over this period. This included involvement in decision making, as well as support at the point of discharge and beyond. Whilst this approach was welcomed, we continue to be aware through feedback from carer support organisations, advocacy providers, and individual carers that further work will be required in this area, to ensure that no involved unpaid carers are missed from discharge planning. In response to concerns regarding delayed discharge, we successfully piloted an innovative Hospital Discharge Carers Payment scheme between January and March, where carers were paid a fixed sum of £1000 in lieu of services, to help facilitate hospital discharge. This scheme proved to be a success, and based on carer feedback, as well as that of those being cared for, the intention is to reintroduce the scheme later in 2023. In response to the most recent Carer Census which identified that Dementia and Autism were the two most prevalent conditions impacting on those supported, we developed a Dementia Link Worker Service and progressed work to enhance support for carers involved in supporting people with autism. We remain aware also of the diversity and fluidity of the carer population and that despite our efforts some carers remain less visible to services and supports. We continue to innovate and use a range of methods to ensure information and support is accessible, from the more traditional information packs to the launch of a new podcast for carers and support for digital inclusion. 2.3 JUSTICE SOCIAL WORK SERVICES The strategic landscape for community justice social work over this period has been influenced by the new national ‘Vision for Justice’ published in February 2022 and the new ‘National Strategy for Community Justice’ published in June 2022 in addition to the continued indirect and direct impacts of the pandemic most notably the related backlogs within the justice
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27 system. At a local level additional temporary funding has been provided through Scottish Government to address demand pressures and whilst this has created some challenges including in recruitment the service has continued to innovate and enhance joint working to improve outcomes. 2.3.1 CPO UNPAID WORK During this reporting period 127,057 unpaid work hours were imposed by Court Services. This constitutes a 64% increase from the previous year 2020-2021. Prior to 1st October 2022, individuals made subject to Court mandated Unpaid Work Requirements had the timescale for completion extended by 12 months. This was implemented by the Scottish Government via The Coronavirus (Scotland) Act 2020 in a bid to assist Local Authorities to manage the unpaid work backlog of hours created by the Covid-19 pandemic however as of 1st October 2022 the extended timeframe to complete unpaid work ceased and reverted to the 6 months’ timeframe. Despite this shift, North Lanarkshire Council during this reporting period delivered a total of 75,465 unpaid work hours. The unpaid work undertaken was a combination of workshops, squad and single placements, home working, individual litter picking and other initiatives. Despite the national context, the significant rise in the hours imposed and the reduced timescales to complete them, Restorative Justice staff were able to respond innovatively. To absorb the additionality, Justice staff engaged and matched individual needs to a hybrid mix of single placements, squad placements, home working and other activity groups and interventions to the benefit of the local communities. This has reduced the need to request time extensions on an already strained Scottish Court Service. Examples of unpaid work projects completed in North Lanarkshire are as follows: Wood Workshop – Items made in our workshop are utilised for various community projects, such as pirate ships for schools and nurseries, benches, and planters for sheltered housing complexes. We also continue to use wooden pallets, in keeping with recycling and cost effectiveness central to our ethos. These are transformed into imaginative play items for school and nurseries, such as trucks, trains, boats and cars. Bike workshop – Refurbished bikes are donated to community groups, schools, and individuals. Over 115 bicycles were distributed to assist and support individuals within the community to maximise their health and wellbeing. In September 2022 a new initiative was launched to repair bikes for people who struggle financially in the local area. Laundry workshop – We have continued to work in partnership with the local school uniform banks and community charity groups and shops laundering donated clothes.
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28 Activity groups and Homeworking – In keeping with tackling poverty and our recycling ethos, recycled materials have been used to make draught excluders, rugs for dogs, hand warmers and mental health and anti-bullying plaques for schools, community groups and local walkways. These items were destined for landfill and repurposing items assists to reduce the council’s carbon footprint. as well as providing opportunities for service users who needs may require them to undertake unpaid hours from home. Squad placements – Projects completed in the local community have included landscaping, groundwork, clearance and building projects. These projects are carried out in schools, sheltered complexes, walkways and community gardens. Single placements – These are delivered within an array of settings including local churches, allotments, sheltered housing complexes and charity shops. Home improvement workshop – Teaches skills such as decorating, tiling, and plastering and this will continue to be developed over the next year to include more community projects. The work outlined above has benefited communities within North Lanarkshire in a range of ways including through environmental projects and support for community groups, with work also supporting active travel and health and well-being outcomes for both unpaid work participants and the community. In addition, there continues to be a focus on reducing waste and the council’s carbon footprint and on addressing financial hardship and the cost-of-living crisis both directly through income maximisation for service users and the delivery of support to individuals as well as indirectly through the provision of support and equipment to community and voluntary groups. During 2022-23 Christmas and New Year meals were provided by local business and were distributed to vulnerable adults and families by Justice staff whilst throughout the year various produce that is grown in our allotments in Wishaw and Coatbridge has been distributed to people in need across the authority. Whilst foodbanks rely on and provide non-perishable food donations, our community allotments supplement this by providing the vitamin and nutrient rich fresh fruit and vegetables. The examples outlined demonstrate a creative, meaningful combination of approaches to delivering Unpaid Work for the benefit of the North Lanarkshire community fostering a hybrid mix of traditional unpaid work, home working, other activity, anti-poverty, and health interventions. This demonstrates the core values of Community Payback which are reparation, reintegration, and rehabilitation of service users. Some examples of beneficiary feedback received includes:
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29 “The Squads carrying out work makes it so much easier for our plot holders and now the private placements have kept the allotments looking good” – Greenlink Allotment Group. “The Restorative Justice Service redeveloped a piece of waste ground, at the back of the veteran's hub in Craigneuk into a fabulous garden area that will improve the mental health and wellbeing of the veterans. This transformation could not have been done without the help of the Restorative Justice Service” – Veterans Community (Lanarkshire) SCIO. “The work was completed to an exceptionally high standard; staff were excellent and kept me right in what to purchase. The place is looking great and finished in time for the tenants to sit out and enjoy the summer” – Sheltered housing staff. The following comments were obtained from service users: “I loved the healthy cooking group and the allotments. I learned loads about growing and using vegetables and was involved in distributing produce to local sheltered housing complexes”. “My placement in the bike workshop gave me a sense of pride, I fixed and built bikes for those who cannot afford to buy one, whilst learning new skills”. “I learned new skills and knowledge by attending the CPO Connect sessions via the Wise Group, including managing my emotions and addiction awareness”. 2.3.2 OTHER ACTIVITY Continued use of Scottish Government funding enabled the service to work in conjunction with third sector organisations to support the ‘other activity’ element of unpaid work. The commissioned third sector organisations and their interventions include - CPO Connect - The Wise Group delivered an online programme on a group basis which provides information and awareness raising on an array of topics such as, emotional regulation, mental health and wellbeing. Love Learning – Love Learning provided one to one support to address issues, such as registering with a GP, attending appointments, learning basic online skills, literacy and numeracy skills and constructive use of time. Creative Change Collective – The Creative Change Collective uses the creative arts to support people to explore and address a variety of current societal issues impacting on their lives. Participants devised songs, poems and scripts and performed them live to an audience.
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30 This ongoing engagement with third sector and creative arts has led to positive feedback from those undertaking unpaid work with individuals reporting an increase in self-esteem and confidence, as well as a reduction in social isolation. “CPO Connect allowed me to share my experiences and consider other people's perspectives, whilst receiving advice and guidance.” Service User Quote. Service users are also supported to complete ‘other activity’ by undertaking offence focused workbooks to explore a wide range of criminogenic needs whilst justice staff utilise online educational courses, parenting courses, employability, and further education resources with service users and facilitate interventions other services such as addiction recovery services, employment support services, mental and physical wellbeing services. Justice staff continue to refer service users to Venture Trust to enhance daily living skills including, problem solving, team working through goal setting, leading to group and individual achievements. Our Health & Wellbeing Agenda promotes health checks with the Keep Well Nurses, suicide awareness and prevention and mental health support. Additionally, service users have undertaken first aid training as well as having access to interventions which promote positive physical health, this includes healthy eating and exercise. In November 2022, Community Payback Supervisors were trained in the delivery of Naloxone, a life-saving medication that can reverse an overdose from opioids, including heroin, fentanyl, and prescription opioid medications. As North Lanarkshire Council Unpaid work service operates a 7 day a week service, it is hoped that this intervention may contribute to reducing the national picture of opioid-related deaths. It is anticipated that this will provide a foundation for delivery across the whole of the Justice Service over the coming year, as part of our ongoing commitment to reducing the impact of drug use and reducing preventable drug deaths. Justice staff have continued to use the Justice Outcome Star a visual and person-centred tool which provides a focus for discussion and intervention. The Action and Support Plan formulation, identifies areas of need which individuals are supported to address, and this is regularly reviewed with the service users. 2.3.3 DIVERSION FROM PROSECUTION In line with the Vision for Justice in Scotland the service continues to prioritise the promotion of Diversion from Prosecution. To ensure consistency of practice in this area multi agency briefing events have continued to take place with relevant social work staff, police colleagues within their local police stations as well as the voluntary sector colleagues. Diversion from Prosecution referrals in North Lanarkshire continues to be above the Scottish Average, and the numbers have been consistently high beyond the Covid-19 pandemic as detailed below.
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31 Age Group No of Reports Sent Male Female Main Recommendation Diversion NS +ve NS - ve Recom Not Recorded Under 16 0 0 0 0 0 0 0 16 - 17 32 25 7 26 0 5 1 18 - 20 53 40 13 38 1 12 2 21 - 25 17 13 4 4 0 11 2 26 - 30 20 17 3 10 3 7 0 31 - 35 31 18 13 15 2 14 0 36 - 40 28 14 14 21 0 7 0 41 - 45 36 26 10 24 3 9 0 46 - 50 34 30 4 13 2 19 0 51 - 55 13 11 2 8 2 3 0 56 - 60 10 5 5 7 0 3 0 61 - 65 3 1 2 3 0 0 0 65+ 4 3 1 1 2 1 0 Total 281 203 78 170 15 91 5 Number of Individuals Commenced Age Group Q1 2022/23 Q2 2022/23 Q3 2022/23 Q4 2022/23 Total Financial Year Male Female Male Female Male Female Male Female Under 16 0 0 0 0 0 0 0 0 0 16 - 17 5 1 5 1 9 0 3 2 26 18 - 20 5 3 9 1 6 2 8 4 38 21 - 25 2 0 0 0 1 0 2 0 5 26 - 30 1 1 0 0 3 1 2 1 9 31 - 35 2 0 1 2 1 1 5 4 16 36 - 40 3 3 1 0 1 2 2 2 14 41 - 45 4 6 1 2 5 0 4 1 23
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32 46 - 50 6 2 0 0 2 1 2 0 13 51 - 55 1 2 0 0 4 0 1 0 8 56 - 60 1 2 0 0 0 1 1 0 5 61 - 65 1 0 0 0 0 0 0 1 2 65+ 1 0 0 1 0 0 0 0 2 Total 32 20 17 7 32 8 30 15 161 2.3.4 OFFENCE FOCUSED WORK Offence focused intervention continues to be central to the delivery of Justice Social Work services, regardless of whether that engagement is mandated through Community Payback Order, Statutory Licence, Structured Deferment or Diversion from Prosecution. Social Workers employ a trauma informed approach, considering wellbeing and individual responsivity and support others to recognise the links between wellbeing and risk. Support is provided to address areas of both risk and need. Education, employment, and leisure are key elements of this and remain a key component of ongoing assessment and intervention. The service also continues to collaborate with Active Leisure to promote exercise and wellbeing for all, with emphasis on the physical, emotional, psychological, and social benefits of exercise. Similarly, collaboration continues with third sector partners to support individuals access employment, education, and training in order that they are supported to achieve and develop their interests and potential. Collaboration with people with lived experience, including the Recovery Community has further developed and supported individuals develop hobbies, interests and relationships which contribute to their support and wellbeing beyond their experience within the formalised supports of the wider justice system. Alongside this, specific offence focussed intervention occurs on a one-to-one basis and within groupwork settings and often involves work around managing strong feelings, handling conflict, improving relationships, and managing impulsive behaviour. Service users are supported to develop individual intervention plans, informed by structured assessment, to identify priority areas of need and to collaboratively develop a support plan that can measure progress and outcomes. In respect of groupwork, more intensive interventions include MFMC (Moving Forward Making Changes) and UP2U (Creating Healthy Relationships). These continue to be delivered through effective collaboration between supervising social workers and programme delivery workers. These are intense and demanding interventions which require a high level of commitment and reflection from participants as they are supported to better understand the
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33 connection between their thoughts, feelings and behaviours, and to develop safer, more effective strategies in complex and challenging situations. Of significance within the past year has been the extension of Structured Deferred Sentence as a disposal option which was extended to Airdrie Sheriff Court in July 2022, building on the positive progress seen at Hamilton and Lanark Sheriff Courts. This extends an opportunity to young people to engage in services effectively and at an earlier stage and provides Court with a viable alternative to imposing a statutory order. Further developmental work has progressed throughout the year and this has included the development of an Arrest Referral service and the development of an Alcohol and Drug Solutions Court. Both will offer real opportunities to collaborate effectively with partners to offer effective interventions at an earlier stage with a sharp focus on well-being, reducing risk and supporting safer communities. 2.3.5 UP2U The UP2U ‘Creating Healthy Relationships’ programme continues to be delivered on a one to one and two to one basis to people who are subject to a statutory order because of a domestic abuse offence. The central UP2U team lead on UP2U developments and oversight of the programme across the service and provide the intervention to service users considered to be high risk of further domestic abuse offending. As the courts and parole board have become more familiar with UP2U there has been an increase in the number of conduct requirements and licence conditions mandating service users to complete the UP2U programme. In March 2023, the first evaluation of the UP2U service commenced and service user feedback was gathered. Most service users have had a positive experience of the UP2U process. Almost all service users consulted felt that UP2U sessions helped them understand how their abusive behaviour could impact their partner and/or their children. Almost all service users found sessions helpful and felt listened to and respected. Other sources of feedback were accessed and reviewed including end of programme reports and end of module reports undertaken by the central UP2U team. Most participants reported improved relationships with their intimate partners and children due to the new skills learned. For the small number of service users who completed the programme during this period, no reported domestic abuse incidents have been recorded. The UP2U partner support service is offered to any partner and/or ex-partner of an UP2U participant. All service users who provided feedback reported a greater sense of safety/reduced risk because of being linked with UP2U partner support. Intimate ex/partners of UP2U participants stated that being signposted or assisted to access other services has positively impacted their lives. Impact statements from women who have accessed the UP2U partner support service include: “My partner support worker knows exactly what’s going on and I can talk freely...I don't feel blame or shame”.
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34 “I know what an UP2U safety plan is and was involved in creating this”. “I would recommend the partner support service for anyone who’s partner is starting the UP2U programme”. A focus group with partner support staff from across Justice Services was held for this evaluation and similarly identified key strengths in respect of enhanced access to practical and emotional support, safety planning and access to specialist domestic abuse supports. Some challenges were identified in relation to safe meeting spaces and the undermining of work by some partners It was noted that some women were also wary of statutory services in which case signposting or referral to Aura or Women’s Aid services will be offered. UP2U Family Practice is the non-mandated version of the programme and therefore delivered through children and family social work with the support of the central UP2U team This has been delivered to a small number of families in various localities across North Lanarkshire. expanding access to a behaviour change intervention. The impact of Family Practice has not yet been evaluated and is currently in the early stages of implementation. 2.3.6 MOVING FORWARD: MAKING CHANGES (MF:MC) NLC Justice Services deliver the Moving Forward: Making Changes (MF:MC) programme which is a national intensive cognitive behavioural programme for men over the age of 18 who have committed sexual offences and looks to assist participants address their offending and reduce their risk of reoffending as part of a Court Order or release Licence. The MF:MC programme is currently being revised with the official MF2C pilot launched in July 22 and NLC Justice Services participating. The new programme has been adapted to ensure it is up to date with developing research evidence and, suitable to all settings in which it will be delivered. Involvement in the MF2C pilot meant that 8 key staff had the opportunity to complete the MF2C Pilot Transition Training in May/June 2022. The Programme Delivery Service is currently maintaining delivery of the MF:MC programme to relevant service users, while at the same time 2 service users are completing the pilot MF2C programme. When the pilot has been evaluated and rolled out, we will transition to increasing MF2C delivery while reducing and phasing out MF:MC delivery. 2.3.7 WOMENS SERVICES North Lanarkshire Women’s Service was set up in 2014 in response to the Commission on Women Offenders by Dame Elish Angiolini. The service works with women who are in involved in the justice system. In the main they are subject to Community Payback Orders with requirements of supervision and/or unpaid work, but also to parole board licences, bail supervision and alternatives to prosecution. We work in partnership with each woman to assess, plan, intervene/support and review their needs to assist them to build on their strengths and work towards achieving their goals and aspirations. Where appropriate the female specific service also allows for female only unpaid work activities.
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35 Most of the women using the service have experienced trauma and much of the work involves supporting them with their emotional and mental health needs with some women facing challenges accessing specialist mental health support. As in other areas of social work multi agency and relational working is key with the following a practice example: A woman subject to CPO with unpaid work was not engaging and refused supports offered. Through persevering and persisting in building a relationship with the woman over a lengthy period the woman accepted a referral to housing and was given accommodation. Work was undertaken to build her confidence in order that she felt able to undertake a placement. The service user completed her unpaid work hours within the Women’s Service activity group. 2.3.8 THROUGHCARE (BRIDGES AND BEYOND) The NLC Justice Throughcare service have successfully delivered the Community Bridges Project in partnership with HMP Addiewell for a number of years. The small support team is funded jointly by NLC and the North Lanarkshire Alcohol and Drug Partnership and focuses on the reintegration and support of those leaving custody who are not supported through statutory throughcare arrangements. During this period rough additional funding from the ‘No-one left behind’ employability fund, the community bridges project has been expanded through the recruitment of a support worker who offers the service in other prisons under the ‘Bridges and Beyond’ and is in the early stages of planning and implementation. This will enable the service to offer voluntary throughcare and support to more service users who are impact by short term prison sentences and experience a range of wellbeing issues as a result. 2.3.9 CHALLENGES There have remained several challenges impacting on the delivery of justice social work services over this period including: Compliance with CPOs – Pandemic related factors such as loss of routine and social isolation have impacted on the compliance of some service users with the conditions of their Community Payback Orders. Staff have addressed this by using motivational interviewing techniques and providing support. Staffing - As reflected elsewhere in this report the service has had some difficulties recruiting new staff to vacancies, particularly those temporarily funded by the Scottish Government Covid Recovery Grant. This is a national issue which has impacted both on workloads and on the services’ ability to maximise the use of intensive groupwork programmes. In response, managers have continued to support staff and, where required, contingency plans were introduced to support a service wide response to demand challenges for example, report writing rotas, and continuing to enhance the
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36 agility and flexibility of the staff group to ensure that teams can work effectively across organisational and geographical boundaries. Decline in Wellbeing - We have utilised local authority policies incorporating stress assessments and a range of resources to support staff and service users to address issues including signposting to NHS, voluntary and third sector services as well as North Lanarkshire’s Time for Talking Service. Cost of living – We continue to support people by referring them to North Lanarkshire Council’s Tackling Poverty Team, the DWP, Social Security Scotland and third sector services with a new pathway to the Tackling Poverty team enabling quicker access to key financial supports. The geography of North Lanarkshire Council can at times require individual service users to travel to identified placements and collection points. This has been difficult at times due to individuals’ financial circumstances. Where possible, adjustments have been made individuals have been matched to a local site placements. Effective collaboration between the Justice service, the Court Social work Service and the Tackling Poverty Team has also resulted in those leaving Court having access to written information and advice covering a range of issues and signposting towards support options, including support with benefits, Housing, Food and Fuel Poverty. 2.4 CHILDREN AND FAMILIES SOCIAL WORK SERVICES 2.4.1 KEEPING THE PROMISE Children and Families Social Work has continued to play a key leadership role in the Council’s commitment to keep The Promise. With reference to the National Promise Plan 21-24, we have focused on supporting care experienced children and young people live with or establish links with brothers and sisters, their right to an education and improving support when moving on from care. We have also worked with the wider partnership in developing plans for whole family support to prevent care and reduce families experiencing crises. A Promise Conference was held on February 2023 which drew attention to, and shared, good practice and areas for development including moving on, working with families impacted by domestic abuse and trauma. The conference programme was co-chaired and co-produced by our care experienced development workers. Our balance of care data continues to demonstrate a commitment to protect and support children with their families and communities, for example through Family Group Decision making. The provision of flexible and integrated family support also ensured that the number of children cared for in out of authority residential care continued to reduce. We are however beginning to see increased demand in relation to our children’s house in part due to young people presenting with increasing complex needs from within our communities, in part due to a greater number of unaccompanied asylum-seeking children arriving through the National Transfer Scheme and in part also because of our commitment to continuing care for older
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37 young people. There was a notable increase in the number of children living with our own North Lanarkshire carers despite a reduction in carer numbers which is due to our carers team working with, and supporting, our carers to look after brothers and sisters to keep them together in North Lanarkshire - Continuing to achieve this balance of care is significant as it must also be seen in the context of an increase in demand for children and families social work support in the post-pandemic period as shown in the table below. Although referrals decreased very slightly in 22/23, there has been an overall increase of 13 % since 2019. Year Number of Referrals 2022/23 10793 2021/22 10858 2020/21 10253 2019/20 9077 2018/19 9519 There has also been a significant rise (65% 18/19 to 22/23) in child protection referrals as illustrated below - This is due to our child protection framework supporting increased consistency in practice, recognition of all forms of harm, strengthened by refreshed IRD guidance. While we have not seen a rise in the numbers of children whose names are placed on the Child Protection Register, there has been an increase in registration of older children aged 12 +. What this indicates, in part, is that practitioners, supported by our commitments to keep The Promise and UNCRC and investment in contextual safeguarding, are increasingly focussing on and recognising the protection of older children and their rights. The service has continued to work with the partners in the Child Protection Committee to monitor and understand the
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38 relationship between child protection referrals and rates of registration to ensure the right children get the right support when they need it. 2.4.2 INVOLVING YOUNG PEOPLE Our team of Care Experienced Promise Development Workers continued to take a key leadership role in the development of social work services, influencing policy and practice and helping us to involve children and young people in the design of our service improvements. Including – Our review of services for children in conflict with the law Re-design of the materials and approach to pathway planning, now called ‘My Future Plan’. A revised framework for family time Our Champion’s Board has continued to go from strength to strength. We have 3 linked groups the TNT (Today Not Tomorrow), the Mad Middles and Crafty Foxes who ran a development session with the Champions Board that included the Chief Officers Group and elected members. Following work to identify need, TNT were involved in co-producing a bespoke counselling service for care experienced young people and took a lead role in all stages of the process including the formal selection of the provider, working with our procurement team.
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39 2.4.3 A GOOD CHILDHOOD: ACHIEVING A LOVING A CARING HOME Adoption, Fostering, Kinship and Continuing Care The Children’s Carers Service provides support to kinship carers, supported carers of young adults, as well as to adopters and foster carers to achieve permanent loving homes for children and young people into adulthood. The adoption and fostering service was inspected in January 2023, the following are areas were identified as strengths: • Children experienced a high level of warm and nurturing care within their families. There were limited moves between caregiving families as plans progressed in a timely manner. The service has consistently performed in the top quartile in Scotland in this area with only 6.9% of children experiencing more than one placement in 2021/22 (latest available data). • There were strong, positive relationships between adoptive parents and their link social workers. Adoptive parents felt well supported and valued by the service. There was evidence of positive outcomes for children. This was supported by good quality assessments of adoptive parents and in the support provided following the placement of children. Our planning to achieve permanence for children has continued to improve, Children experienced love and compassion from their foster carers. Foster carers were well supported and felt valued by their link workers. They had access to a comprehensive training programme and regular support groups. A number of areas for improvement were also identified including the need to ensure more timeous reviews where carers were providing support for children and young people out with their registration (additional children or out with agreed age category).
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40 Recruitment of foster carers Significant challenges continued in the recruitment of new foster carers with North Lanarkshire facing similar difficulties to that experienced across Scotland. However, the team worked to develop its local partnerships to have a wider local base in addition to the normal media outlets. Presentations were made to strategic groups as well as articles specifically shared with our health, education, and voluntary sector colleagues. Enquiries to the service remained relatively high with 120 enquiries made up to March 2021- 22 for fostering and adoption however the conversion rate for approval, particularly for fostering was low. The conversation rate from people who attended preparatory groups who then applied decreased to 35.7%. The following table shows the trends between 2018-2023: Moving forward we will drill down on why the enquires remain relatively high compared to the conversion rate for progressing to full assessment. We will consider how we can strengthen our efforts to discuss in more detail when an individual, family do not progress to full fostering assessment. Recruitment of adopters remained high, and the service saw a marked increase in the request for post adoption support. The following table identifies the trend for the number of approved assessments, the total and split across adoption and fostering from 2019/20 to 2022/23. Initial Enquiries Initial Interviews Attended Prep Group Progressed to Full Assessment 2018/19 139 83 25 17 2020/21 68 30 16 7 2021/22 120 63 21 8 2022/23 128 68 28 10 0 20 40 60 80 100 120 140 160 Axis Title Initial Enquiries and All Outcomes 2018-2023
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41 Kinship Most children and young people experiencing care away from home are supported through kinship arrangements there was increasing demand for completion of kinship assessments over this period with the team having around 24 ongoing kinship assessments at any given time. Overall, in the past 5 years, there has been a 14% increase in the number of kinship carers. There also continued to be an increase in new enquiries to the service from families looking to be assessed as kinship carers. The following table highlights, assessment activity in this area with approved assessments increasing by 53% since 2020 - 0 10 20 Approved Assessments Adoption Foster Care 2019/20 17 10 7 2020/21 10 7 3 2021/22 14 7 7 2022/23 11 8 3 Approved Assessments by Type of Resource 2019-2023 0 50 100 150 2020/21 2021/22 2022/23 No of Kinship Assessments 82 102 105 Total Approved 64 93 98 82 102 105 64 93 98 Table 4. Number of Kinship Assessment Approved 2020-2023 No of Kinship Assessments Total Approved
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42 The kinship team supported 150 kinship families over the year, with other kinship families receiving support through our localities. Emotional, practical, and financial support was provided to kinship carers on a one-to-one basis to help them in their kinship role and meet the needs of the children placed in their care. Support groups adoption, fostering and kinship Providing support to carers of children and young people is recognises within the Promise as critical to improving outcomes and the experience Carer support groups took place regularly, held centrally for fostering and adoption and in seven local areas, for kinship carers with support groups for kinship carers facilitated by the kinship care team and a colleague from Nurture Scotland. Due to the increasing numbers attending the kinship support groups, the team will be expanding the options available to all carers, and we are now developing a shared training strategy to extend the training available to as many carers as possible. Brothers and Sisters Existing North Lanarkshire carers have offered commitment and flexibility to maintain children within their local communities and keep brothers and sisters together. Development in this area is complex; analysis in March 2022 demonstrated that 65% of children in care were separated from at least one brother or sister. In response to this, the team developed a new strategy, co-led by our care experienced development workers and involving carers, to support brothers and sisters stay together when they need to be cared for away from home. This comprises specific support to carers as well as a focus on recruiting carers with the capacity to look after brothers and sisters together. This led to 86% of children who were required to be looked after in foster placements during this period, remaining with their brother and sisters. There were also two groups of three siblings who have been secured with their adoptive families. In addition, there is an ongoing focus on the assessment and promotion of family time, with the voice of children and parents central to how we can be more creative in our approach, while keeping children safe. National Transfer Scheme (NTS) Throughout the year, North Lanarkshire continued to participate in the National Transfer Scheme, (NTS), supporting the organised transfer of unaccompanied asylum-seeking children scheme. All young people who arrived were allocated to Social Work staff via the Resettlement team and benefited from a partnership approach to support. Over the period we supported 11 young people arriving through NTS, the majority placed, at least for an initial period, in one of our children’s houses allowing them to build relationships with the staff and the other young people who live in the house leading to learning about each other’s cultures, values and others’ experiences.
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43 We have also strengthened staff confidence and learning and development around human trafficking and exploitation, which ensured our workforce are confident to address any emerging risks. The challenges of increasing numbers of children and young people arriving in North Lanarkshire through the NTS scheme during the period of this report has however created additional pressures across our systems, especially in terms of capacity in our 5 children’s houses. We remain committed to make sure the children, young people have positive experiences to support the to deal with their trauma and when they can, take advantage of further educational opportunities, keeping their cultural identity as well as helping them to reconnect with their origins and their families. Our children’s houses, resettlement team and locality staff have responded well and provided a high-quality level of care and support. Children’s Houses In addition to the commitment to unaccompanied asylum-seeking children, our children’s houses created stability for 6 young people through continuing care and responded to the needs of 4 children who returned to North Lanarkshire from independent foster placement which had ended in an unplanned way. Staff have been trained in PPB (Promoting Positive Behaviours), trauma informed practice and contextual Safeguarding which has increased confidence and competence of the residential workforce and will ultimately benefit the young people in our care as staff have better understanding of their needs. We also had a significant focus on improving recording practice and language in partnership with our Care Experienced Development workers. This led to a positive impact in how we record children and young people’s case notes and in how we save photographs and store other positive milestones in our young people’s lives. 2.4.4 MOVING ON: SUPPORTING CARE EXPERIENCED YOUNG PEOPLE WHO HAVE LEFT CARE As at March 2023, 687 young people and adults were eligible for aftercare support, with 259 in receipt of direct social work support. We therefore strengthened the development of our Aftercare Hub and improved the awareness of the rights and entitlements of care leavers and a ‘no wrong door’ approach. The Aftercare Hub has two social workers and three support workers who can work exclusively with care leavers in need of intensive support across 7 days weeks and supported over 100 care leavers in 2022/23. A Care Experienced young people Housing Operation Group was established to review the challenges and barriers to young people accessing and sustaining their own home after leaving care. This resulted in a review of the Joint Housing and Education and Families Protocol for Care Leavers. A significant development to support young people leaving care and care leavers accessing accommodation has been the identification of Housing Champions as the main point of contact. This has enhanced the co-ordination of accommodation options through
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44 Housing Services and the youth housing supports and improved communication between services to prepare and plan for care experienced young people to secure and sustain their home in. In recognition of the complex barriers facing young people the Operational group expanded its remit and now comprises Barnardo’s, DWP, NLC Revenue and Benefits, Skills Development Scotland, the Tackling Poverty Team as well as care experienced young people. Lifelong Links In January 2022, we were able to expand the Family Group Decision-Making (FGDM) team by two social workers through a successful joint application from NLC and the Family Rights Group to the Promise Partnership Fund to implement a Lifelong Links service. This is an approach to support care experienced children and young people reconnect with family and important people when relationships have broken down or been severed through life changes. Our year one priority was to set up the service focusing on care leavers in the transition out of care and into adulthood to ensure they could reconnect with important people in their network, including brother and sisters, before widening the service to include other young people. Following successful implementation in May 2022, the service worked with 20 young people and adults from 13 to 28 years. Those involved with the service were supported to understand their family background, their care experience and identify the important family and others they want to reconnect with. Early indicators are the service is being received positively and making a difference to the young people, including some reconnecting, and establishing relationships with birth parents, former foster carers and support staff and in so doing strengthening their natural support networks. 2.4.5 A RIGHT TO EDUCATION Our Virtual School, which is an integrated service comprising social work and education staff, has a focus on inclusion, providing bespoke packages of support based on a child’s needs, strengths, interests, and future career aspirations. Working in partnership with schools and other colleagues, the Virtual School has been pivotal in reducing exclusions by 89% since its establishment in 2019/20.
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45 In session 2022, 93.3% of relevant young people experiencing care at home achieved SQA passes; Nat 3 and Nat 4. This is the highest level recorded since 2016. 75% also achieved Highers in session 2022. Attainment data for care experienced learners at S4 and S5 has risen across almost all indicators, as shown in the table below. We will continue to build upon this progress by supporting CEYP to gain further qualifications in S6. Since 2019/20 105 CEYP at risk of leaving school without formal qualifications achieved 239 Nat 3 or 4 awards. 2.4.6 YOUNG PEOPLE IN CONFLICT WITH THE LAW/DECRIMINALISATION OF CARE EXPERIENCED YOUNG PEOPLE In December 2022, we concluded our review of the support that we provide to young people in conflict with the law (youth justice) to ensure that the services we provide meet the outcomes and priorities outlined in Justice for children and young people – a rights respecting approach (Scottish Government, 2021). The review was started from a focus on practice as well as the experiences and outcomes for young people rather than organisational arrangements.
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46 During the period of 2022/23 there was 211 children referred to Scottish Children’s Reporters Administration (SCRA) on offence grounds and 86 reports jointly considered by the Procurator Fiscal and Reporter. We recognised that we had higher numbers of children referred to the Reporter on offence grounds relative to the national position and that exploitation and other harms are often factors when young people come into conflict with the law. In January 2023, we therefore started a pilot, in partnership with SCRA and South Lanarkshire Council (SLC), for children referred to the Reporter on offence-based grounds. The aim is to improve outcomes for children by increasing their understanding of their rights, improving relationships and family support with the important people in their lives and ensuring orders are the scaffolding of the care plan, To reduce the risk of secure care and remand we enhanced our intensive support to young people through ADP funding and introduced a dedicated speech and language service to assess unmet need and enable young people to exercise their rights in children’s hearings (or court) by expressing their views more effectively through bespoke support in communication skills. Speech and Language Therapists provided support to 9 young people and offered specific advice and guidance to their social workers: Diversion from Prosecution is a non-conviction disposal. There were 27 diversion reports requested in 2022/23, this was a slight decrease from 2021/22 in which 29 reports were requested. Each of these Diversion reports were completed successfully and the young people were provided with bespoke interventions to address their needs. This disposal was traditionally used for lower-level offences, however, over the course of the year young people were referred by the Fiscal for diversion in more serious situations. In response to these changes the diversion process was enhanced to improve assessment and increase support. Locally the number of young people either remanded or sentenced to custody has continued to decrease in line with national trends. Nevertheless, there were 25 new admissions to Polmont YOI from North Lanarkshire in 2022/23. Four of these young people were under the age of 18. To support this group of young people, staff from Youth Bridges (part of our intensive service) engage with all young people under the age of 21 who have had their liberty restricted. They will meet with all young people within 3 days of being received into custody and work in partnership with prison, health and other staff to support the young people and arrange family contact prioritising building relationships with young people, so they have a trusted worker to support them through the transition back to the community. With the support of Youth Bridges, nearly 90% of the young people who returned to the community were not involved in further offending and 69% reported a reduction in alcohol and drug use. I found the consultation very helpful as it allowed me to gain a better understanding of the young persons use of speech. I think that this is something that is often overlooked as Social Workers are trying to manage risk and relationships rather than assessing understanding and use of language
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47 Structured Deferred Sentences provide time limited, intensive support that can be delivered with a greater degree of flexibility than statutory Community Payback Orders. This approach aims to prevent young people being drawn further into the justice system. During the period of 2022/23 there were six young people under the age of 18 made subject to SDS, this had doubled from three the previous year. An SDS court was established in Airdrie Sheriff Court in July 2022. 2.4.7 WHOLE FAMILY SUPPORT AND PROTECTING CHILDREN AND YOUNG PEOPLE AT RISK OF HARM Family Group Decision Making (FGDM) FGDM is a strengths-based approach to support children remain in their family. This is facilitated through a family led decision making process where a child or young person’s family and friends are supported and prepared to come together in a Family Group Meeting to develop a plan which protects and supports the child and or young person. Through this approach this service continued to make considerable progress in successfully supporting children and young people remain within or return to their family. Over the past year there has been an increase in referrals to the FGDM service, from 58 (2021/22) to 99 (2022/23). During this period 57 families participated in FGDM Meetings and a further 15 families achieved a plan of support without the need for a formal meeting. Of the 57 families’ plans 34 children remained with their families or kinship carers or were returned to their families, 7 families identified supports to increase their network of support and 2 families were supported to reconnect and establish a plan of contact. Feedback from children, young people and families has been positive. No Circumstances Outcome 10 Pre-Birth 9 babies' home with parents 1 – baby – friends/family 22 Prevent Accommodation 11 –Home with parents 8 - With family/friends 1- Foster Care 16 Rehabilitation Plan 8 – Returned to parental care 6 – with friends/family 1 – Foster Care NLC 1 -Children’s House NLC 7 Family Support 7 – Remained with parents
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48 2 Family Time (Contact) Plan 2 – Reconnected with parents/extended family Families found this process inclusive, enabling and empowering: Intensive Services Our Intensive Service provides support to children, young people and their families to reduce the likelihood of a breakdown in family relationships and children being cared for away from home and through additional investment since 2021 the service also supports care experienced young people who have left care across 7 days a week. Support comprises intensive one to one support, parenting and family work, and group work programmes. Over 2022/23 the service provided support to 901 children and young people, representing at 29% increase compared to 20/21. The service provides support to over 30 young people and families each weekend and works closely with the Social Work Emergency Service (SWES) to co-ordinate the response required in relation to any children and families’ referrals received at SWES. Joint Investigative Interviews – Implementation of the Scottish Child Interview Model The Scottish Child Interview Model (SCIM) is a new approach to joint investigative interviewing (JII) by Police and social work for child victims and witnesses. This approach is trauma informed, maintaining the focus upon the needs of the child in the interview and minimising the risk of further traumatisation, whilst seeking to achieve to best evidence through improved planning and interview techniques. Lanarkshire was the first area to implement the SCIM for JII model in Scotland in February 2020. The team have undertaken 1482 interviews utilising the SCIM for JII in the first three years of practice. Between Feb 2022 and Jan 2023 460 interviews were undertaken, with a disclosure rate of 71%. The three areas of highest concern underlying the reason for JII are consistently children experiencing physical abuse, sexual abuse and thirdly, domestic abuse. The data indicates that the age range of children being interviewed is from 3 to over 16 years. As the interviewers have grown in confidence, they have been successfully undertaking increasingly complex interviews involving younger children and children who experience significant learning and or I am just so happy, my family are finally chatting It was just brilliant. It is really a really worthwhile thing to do. We are now all singing from the same hymn sheet
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49 communication needs. A significant shift in the SCIM approach to interviewing is in the preparation and planning for the interview specific to the child’s needs and circumstances. This has been supported across the local partnership and through contact with families to enable interviewers access appropriate and relevant information to support the interview plan for the child or young person. Feedback from children and their families has been positive about the experience of the interview. Many children reported that they were “scared” or “worried” approaching the interview venue, but on arrival the surrounding were “warm” and “friendly” with lots of “colour” and “pictures”. 2.4.8 GENDER BASED VIOLENCE Domestic Abuse is a key priority for social work and its partners. In 2022-2023 there were 3221 domestic abuse referrals. Domestic abuse was also the second highest recorded concerns for children at the time of child protection registration. We therefore continued to invest in two key approaches: Safe and Together and Family Practice Up2U. Safe and Together The Violence against Women Strategic Group and Child Protection Committee have provided direction for the implementation of Safe and Together with social work staff having a key role in embedding the model locally There are now 527 staff trained in Safe and Together (core and overview), this includes social work, education, NHS, housing and community and voluntary sector. NLC had support from Improvement Service in 2022 to carry out a Baseline Evaluation of Safe and Together Implementation in North Lanarkshire. The information gathered from this evaluation allowed an Action Plan to be created with a focus on Communication of the Safe and Together Model, delivery of Training to reach wider groups of professionals, to Support Learning into Practice, and How to Measure the Change.
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50 There are Safe & Together (S&T) Champions in each of the 6 Social Work teams, Intensive Services and Corporate Parenting and locality managers and practitioners’ access and contribute to Safe and Together Case Consultations. Practitioners who are working with families where domestic abuse is an issue, can access support from the Safe and Together champions and Trainers to look at a case through a Safe and Together lens. Work will continue with the Safe and Together Institute and Improvement Service to support ways in which we can measure change and the impact of the model and its approaches on families affected by domestic abuse. This will include multi-agency case file audits and focus groups with social work staff, trained in the model in their role as the lead professional. UP2U Family Practice Model The approach to addressing domestic abuse and tackling its impact on families, is a partnership approach. Social workers as the lead professionals are integral to assessment and planning for families. As referenced in 2.3.5 above in collaboration with Justice Services, Children and Families, have implemented this model to engage with individuals who are not mandated by the court but who have recognised the need to address their abusive behaviours and its impact on partners and as parents. The model is a trauma informed, relational based, therapeutic behaviour change programme. with implementation supported by high quality training. It provides a framework to work in partnership with parents and children, young people to address the impact of domestic abuse in their lives. It includes partner support to consider safety planning as well as offering practical and emotional support and includes 1:1 and groupwork support. The model allows for trusting relationships to be developed which support children/young people and their voice to be heard, led around a family’s own experience and support network. The Up2U Family Practice Model compliments the Safe and Together Model, providing additional tools for social workers and support workers to use, supporting families in the model and approach which best meets their needs. 2.5 ADULT SOCIAL WORK SERVICES As can be seen throughout this year’s report, there continues to be a range of challenges to meet in the delivery of Adult Social Work Services. These include the legacy impacts of the COVID pandemic, the increased demand for support across cared for/ supported people, as well as unpaid carers, recruitment challenges, and the cost-of-living crisis. This report reflects the challenges experienced in sustaining quality care in line with statutory and regulatory requirements as well as work in redesigning and improving services to help progress outcomes for individuals in receipt of support or services.
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51 During 2021/22 investment through the Winter Planning and Enhanced Support funding stream from the Scottish Government was introduced to increase capacity in direct provision as well as to improve assessment capacity connected and aligned through our business plan to local operational and strategic priorities. Whilst some of this investment, for example in the Home Assessment Team (HAT) is beginning to impact positively at service as well as individual level, the volume and complexity of demand in 2022/23, alongside ongoing workforce challenges continue to create capacity pressures. Specific pressure points continue in areas such as: Support at Home Mental Health Officer capacity and in adult protection. The narrative below provides further detail on service activity, performance, innovation and improvement as well as areas of challenge. EARLY AND PREVENTATTIVE INTERVENTIONS – RIGHT SUPPORT, RIGHT TIME 2.5.1 GETTING IT RIGHT FOR EVERYONE (GIRFE) Getting it right for everyone (GIRFE) is a Scottish Government multi-agency approach to health and social care support and services. It builds on existing adult best practice, as well as learning from Getting It Right for Every Child (GIRFEC.) It aims to provide a model to deliver the Community Health and Social Care Integrated Services framework which supports person centred outcomes. In line with practice developments in North Lanarkshire and nationally over the past decade, GIRFE is focused on providing a more personalised way to access help and support when people need it. It aims to place the person at the centre of all decision making that affects them, with a joined-up consistent approach regardless of the support needed at any stage of life. It is intended that the GIRFE approach will ultimately form the future practice model of all health and social care professionals and shape the design and delivery of services, ensuring that people’s needs are met from young adulthood to end of life care. GIRFE is being co- designed by pathfinder projects located in different local authority areas alongside the Scottish Government and will be tested and developed to enable the approach to be more widely interpreted and implemented in wider contexts. North Lanarkshire Health and Social Care Partnership (NL HSCP) is one of 10 pathfinders with the progression of this work supported by the Scottish Government’s GIRFE Design School. North Lanarkshire’s focus is on Frailty and Older People with the pathfinder linking to a range of local as well as national aspirations, policies and strategies including: The Plan for North Lanarkshire; the Health & Social Care North Lanarkshire Strategic Commissioning Plan and the Frailty Strategy. It is planned that over the next 12 months, NL HSCP will progress a GIRFE pathfinder initiative in Wishaw. Learning from this will inform a national sense-making process for future expansion of GIRFE across North Lanarkshire and Scotland. 2.5.2 MAKING LIFE EASIER
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52 The Making Life Easier team has two Disability Information Officers and a newly recruited Resource Worker. Making Life Easier (MLE) is an online resource offering all residents of North Lanarkshire the tools to live active and healthy lives, self-manage their health conditions and providing access to direct supports and services. The team is actively promoting Making Life Easier and the services available across North Lanarkshire through participation in events, presentations to local support groups and most recently with information stalls working in partnership with NL Libraries, University Hospitals, RNIB and St. Andrews Hospice. Whilst new additions to the website include Long Covid Rehab Team and Assistive Technology Team services. Planned development work includes changes to the user journey, simplifying assessment outcomes and an interactive body map. In 2022/23, 11,566 people in North Lanarkshire used MLE, this is a 43% increase on the previous year. Of these users, 87.7% were new visitors and 1,023 people completed a self- assessment with a further 465 people completing a LifeCurve™ assessment. Making Life Easier continues to be a reliable support for all. Making Life Easier website X (Twitter Account) 2.5.3 ASSISTIVE TECHNOLOGY The ethos of the team is to ‘Think Tech First’ and the ambition is to achieve better outcomes for people and their carers. From the team’s inception they have worked tirelessly to promote technology across the partnership. There is a simple accessible referral process and the team assist from advice to installation and instruction in the use of equipment. During 2022/23 the team has participated in 53 events, meetings and presentations across the partnership and for external agencies and built strong links in locality teams, have been providing a tech advice duty service for Access Social Work and are about to embed the same model into the HAT (Home Assessment Team) to further the ‘think tech first’ agenda. The aim is that the consideration of a technology solution is at the start of any assessment journey in health and social care North Lanarkshire. The assistive technology flat remains an innovative project showcasing a mixture of service- provided equipment and mainstream technology, focusing on promoting safety, enhancing wellbeing, and supporting choice for people. Over the reporting period there have been 406 referrals to the assistive tech team. There has been a marked increase of uptake from other staff members as well as internal and external agencies in visiting the assistive technology flat. This has in turn seen an increased interest in technology and more requests for NLC-provided items. From January to June 2022 to January to June 2023 there has been an increase of 162% in tech flat visits.
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53 An interactive magazine using the Paper Tiger platform to provide more information about the service is accessible via the link below. Assistive Technology Team Page Tiger Assistive Technology catalogue Page Tiger 2.5.4 COMMUNITY ALARMS The Community Alarm Service supports vulnerable service users to remain safely in their own homes. providing a service that gives both the service user and their family reassurance that help is always available if required. The service operates 24 hours a day, every day of the year and supports over 7,000 people living within their own homes across North Lanarkshire. A community alarm can consist of a standard alarm base unit and pendant alarm and, depending on the person’s level of need, additional devices such as bed and epilepsy sensors, fall detectors and GPS devices can be used to ensure any safety concerns are satisfied. The Community Alarm Service provides a full call monitoring service with calls received at a central alarm receiving centre where handlers assess each contact to gain insight into presenting issues and needs and risks. These can include matters such as falls, failure to reply to the call handler and activation of smoke alarms with responses including dispatching a home support worker, contacting family/friends to respond, or contacting emergency services. On average the response teams attend more than 400 service users who experience uninjured falls per month. This is of significant benefit to the Scottish Ambulance Service and the individual, as it minimises the time someone waits for assistance while easing resource requirements for ambulance staff to attend quickly. Recognising the benefit of high service standards, the team are members of the Telecare Services Association and registered with the Care Inspectorate. The recent inspection of the service was positive, in relation to the quality of service provided. Analogue to Digital The analogue to digital telecare transition is a major change project with considerable associated challenges for our Community Alarm Service through the transition. This work is progressing and to date 2820 of 6500 Community Alarms have been exchanged with new hybrid Digital Alarms. This workstream will continue over the next 18 months to ensure all our community alarms are replaced prior to the 2025 deadline. The current Alarm Receiving Centre will also be transitioned to a fully digital solution in the next 18 months, bringing with it many benefits including increased resilience, enhanced end user experience and opportunities for proactive person-centred solutions to be implemented.
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54 2.5.5 EQUIPMENT & ADAPTATION SERVICE (EAS) The Equipment & adaptation service, continues to support residents of north Lanarkshire, proving equipment and adaptations. In addition, we provide NHS Lanarkshire equipment pan Lanarkshire. The service has continued to deliver full services despite remaining challenges of waiting list from covid and staff vacancies and have recently appointed to most outstanding posts. Over the last year 209,837 pieces of equipment were delivered by the service and a total of 3353 adaptations spanning privately owned, public rented and Housing Association properties. We have recently commenced a review of the service to ensure that we are meeting the future demand needs of service users and their carers’. In addition, we are in the process of purchasing a new computer order system to streamline processes and improve service delivery spanning the Partnerships. 2.5.6 LOCALITY SUPPORT SERVICES The six Locality Support Services (LSS) provide self-directed, strength-based support to adults who have a disability/long term health condition to have healthy, active, inclusive lives in their communities. LSS use “service last,” approach – ensuring that people exercise choice and control over progression to outcomes. Following assessment, LSS provides people with appropriate support to help meet their needs and desired outcomes. The aim is early intervention, to maintain independence and to promote self-management. Reviews take place at least six monthly with the supported person central to the process. The service offers flexible support across 7 days including evenings. At referral, to minimise reliance on services, people are supported to identify and consider opportunities available to them through natural connections such as family as well as through their local community. Support may be for example, to strengthen connections, provide travel training or budgeting support. Effective community mapping and local area co-ordination has furnished LSS with detailed knowledge of local resources. Sharing buildings has increased opportunities for connection with other team and has been benefited partnership working. Strong links with parents/carers are maintained and LSS work closely with Lanarkshire Carers who progress Adult Carer Support Plans. This includes working with families to access support and forward plan, including to a time when they may no longer be able or around to provide care. This support often incudes supporting families to consider support for the cared for person through an individual budget or a carer budget, within the wider approach to Self- Directed Support (SDS).
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55 The Care Inspectorate grades for the LSS’s are currently overall 5 (very good) with no areas for improvement or requirements. 2.5.7 INTEGRATED DAY SERVICES Integrated Day Services for Older Adults have continued to work with an aim to support people with complex support needs to continue to live in their own homes safely, often preventing admissions to hospital. All services have now returned to working as a building- based service and Locality Link community groups are now fully up and running. This support is still reduced for 5/6 services due to non-site interventions from health professionals. Since returning to full-service the Integrated Day Service has noted an increase in pressures due to challenges in other areas of the system and further review activity is planned to ensure service design meets ongoing need. SUPPORT AT HOME 2.5.8 HOME ASSESSMENT TEAM The Home Assessment Team (HAT) has a multi-disciplinary approach to person centered care and consists of Home Support staff, AHP’s, Clinical Responders and Social Work staff facilitating ‘Home First’ principles, enabling people to be supported to return home for a period of assessment. This also reduces the pressures associated with having to make life- changing decisions around longer-term care from a hospital setting. As reported in the 2021-2022 CSWO report, The HAT soft launch took place in Wishaw on the 25 April 2022 taking referrals from University Hospital Wishaw/ Monklands and on the 15 August 2022 this launch was extended to both University Hospital Wishaw (UHW) and University Hospital Monklands (UHM) considering the North Locality. By the 26 August 2022, 73 patients in total had been referred to and supported by HAT across Cumbernauld and Wishaw rising to 172 by November 2022 as team capacity expanded through recruitment. As of 31 March 2023, 442+ individuals had been discharged through HAT from our acute settings across Lanarkshire. All involved have successfully been assessed in their own home. The largest service provided to date through HAT remains our Home Support service with an input of 67%, down 4% from the previous year however most recent North Lanarkshire figures inform us that by the end of the 2-week assessment period input from Home Support in 51% of cases support decreased to zero with a 16% decrease in those who continue to receive a service. A further 30% remained the same with 2% requiring an increase. As well as continuing to work collaboratively with hospital discharge hubs and clinical teams to support these timely discharges HAT have now begun to work alongside Hospital @Home
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56 to develop a pathway to enable people to remain at home or to support avoidable admission due to social/personal care requirements. 2.5.9 HOME SUPPORT SERVICE The Home Support Service continues to provide care to around 3200 people at home in any one day. The service received more than 3,500 referrals during this reporting period from individuals seeking a Home Support Service. This resulted in nearly 6,000 people accessing the service at some point throughout the year a 10% increase on 2021/22. The service provides on average 25,500 hours of support on a weekly basis again a 10% increase on the previous year, with around 70% of this provided by NLC in house services. The remaining 30% is delivered by our partners in the independent sector. As noted in the 21/22 CSWO report maintaining responsive, high-quality support at home for those who require this has continued to present challenges over the past year, due to continuing increase in demand. As illustrated above work has continued to focus on early intervention and prevention with the Home Assessment Team (HAT) driving a programme of reablement, ensuring that service users potential is maximised, thus reducing the reliance on paid supports with early intervention and technology-based solutions being provided. Recruitment and retention of key posts within the Home Support Service has remained challenging, resulting in key gaps within each of the locality Home Support Teams impacting on the responsiveness of the service and staff morale Whilst this also reflects national challenges in recruitment and retention in social care and pending ongoing service redesign activity interim actions have been taken to try to address this position as reflected in Section 5 of this report. As part of a wider review of the Home Support Service it was evident that the new structure and model of service delivery within the partnership did not have the impact expected, with some of the operating difficulties attributed to the current service delivery model. A benchmarking exercise is planned and the learning from this will be incorporated into the workstreams leading on the review of the service. The current operating model was originally devised in 2018 and implemented in 2020, however the current operational landscape has changed significantly over the last three years and a review of our current operating model has been moving forward at pace, with a new model being devised to address current challenges and provide sustainability. The overall intention is to develop and deliver support arrangements that have a stronger fit with the national personalisation agenda.
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57 Approval was given for the service to move forward with a tender for a dynamic scheduling system which will benefit Home Support workers in the community and for those who schedule the care and support for the wider workforce. In addition, implementation will have a positive impact on service efficiency and improvement. The service has continued to work with Care Inspectorate colleagues, in delivering improvements within the service. From inspections, several requirements and areas for improvement were identified as consistency and quality of care for some people in receipt of support were impacted by demand and staffing pressures. Whilst strengths highlighted through inspection included good infection prevention and control practices, staff and a supportive management team, gradings in two localities temporarily fell to ‘weak’ before being raised to ‘adequate’ following improvement priorities being met. While progress has been made, significant work is ongoing to work towards restoring the previously high-level grades and to ensure that all those who receive as service have a positive experience, 2.5.10 TRANSFORMATIONAL SDS AGENDA The overarching aim of the SDS transformation in North Lanarkshire is aligned with the intention and values underpinning the SDS Act 2013 - to support and empower people to achieve the outcomes that are important to them, to lead full and meaningful lives, and to participate in and contribute to their communities. Our approach and refreshed strategy continue to have a sustainable impact in building resilience in the whole system supporting people and communities in North Lanarkshire and upon the strong foundations and value base we have created. Locally, our approach to SDS starts with the person and their personal resources, wider family and friends, community resources and community solutions, as well as targeted supports or services. This approach reinforces that self-directed support encompasses everything available that helps someone live their life and moves away from SDS as being seen solely as an individual budget to our approach to delivering outcomes and social care in North Lanarkshire. Over the past year, several workstreams were established to take forward the aims of our Transformational Agenda. These workstreams are progressing the development of an updated local SDS Strategy for North Lanarkshire.
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58 The membership of each workstream includes representation from community and third sector organisations, independent care providers, health and education colleagues and carer organisations enabling co-production of the SDS Strategy while also strengthening the key principle of partnership working to promote earlier preventative and proactive approaches to meeting outcomes. Individual Budgets While there is a focus on preventative and proactive interventions, significant support continues to be provided in North Lanarkshire by way of individual budgets for those with critical or substantial ongoing need. The number of people receiving an individual budget within the 22/23 year was 2381. With a total of 347 Direct Payments (Option 1). As with SDS budgets noted above, these figures include all children, adults and carers. Individual Budgets have increased by 56% since last year. A contributory factor to the increase has been the introduction and embedding of the Self-Directed Support with Care at Home Flexible Framework which has seen the move for many people from traditional home support service provision to Individual Budgets, to date a total of 1019. 2.5.11 COMMUNITY LIVING CHANGE FUND/COMING HOME In line with Scottish Government recommendations made within the Coming Home Implementation Report, and more recently the allocation to North Lanarkshire Health and Social Care Partnership of £1,298,332 from the Community Living Change fund, a program of work is being undertaken over a three-year period (2021-2024), to support the strategic objectives of: Reducing delayed discharges of people with complex needs. Repatriating those people inappropriately placed outside of Scotland. Redesigning the way services are provided for people with complex needs. This initiative will build on the work already well established in North Lanarkshire and evidenced through our positive balance of care data. North Lanarkshire has the highest proportion of people aged 18 and over with long term needs who receive personal care at home in mainland Scotland and has the lowest placement rate for all adults aged over 18 in Scotland, which is over 30% lower than the Scottish average.
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59 This additional investment has provided an opportunity to review the current situation post- pandemic and compliment the national work being undertaken to develop a dynamic discharge register for those with the most complex needs. A multi-agency team lead by Health and Social Care Partnership has been established and has begun the personal action planning process. A Coming Home Implementation group has also been established with two subgroups overseeing the individual circumstances and planning requirements and planning the strategic developments required to minimize the risk of people needing to leave the area to receive the support and care they need. For the relatively small number of individuals currently placed out with North Lanarkshire and following appropriate assessment including risk assessments, planning will facilitate appropriate interventions to ensure individuals can come home safely. STATUTORY INTERVENTIONS: 2.5.12 MENTAL HEALTH OFFICERS SERVICE AND ADULTS WITH INCAPACITY ACT (SCOTLAND) 2000 Mental Health Officers (MHO) are social workers with a minimum of two years post qualifying experience who have gained Mental Health Officer Award (MHO award) Statutory duties for MHO’s are set out in the Adults with Incapacity (Scotland) Act, 2000; the Mental Health (Care and Treatment) (Scotland) Act, 2003 [MHCTA]; the Criminal Procedures (Scotland) Act, 1995; Criminal Justice (Scotland) Act 2016 and the Adult Support and Protection (Scotland) Act, 2007. The implications of emergent court judgements emphasising the significance of European Convention of Human Rights and the United Nations Convention on the Rights of Persons with Disabilities in statutory decision making, combine to place heavy demands on the current resource. Additionally, new duties for mental health officers were introduced in the implementation of the Mental Health (Scotland) Act, 2015. The Chief Social Work Officer holds overall statutory responsibility for the governance and the management of welfare guardianship orders granted to the local authority, and for overseeing the supervision of private guardians in their role and function as welfare guardians. The day-to-day management of these statutory responsibilities are delegated to Mental Health Officers and Social Workers and overseen by managers within adult social work. Adults with Incapacity Act (Scotland) 2000
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60 The above chart shows the monthly running total of private and local authority welfare/financial guardianship orders held for individuals in North Lanarkshire over the period April 2022 until March 2023. The total number of guardianship orders in place in the North Lanarkshire Council area at the end of March 2023 was 1051 with 804 private and 207 local authority orders. The North Lanarkshire total figure constitutes 6.15 % of the national total. The local authority has a statutory responsibility to provide supervision and support to all Private Guardians and to undertake reviews of how the powers are being used on a regular basis, unless it is formally agreed that this is not required. In relation to local authority welfare guardianship powers, these are also reviewed regularly either by a Designated Mental Health Officer or Social Worker During this period as referenced in 3.1.6 below, two Large Scale Investigations were undertaken under Adult Protection processes with respect to Care Homes/Establishment for those with complex needs. The co-ordination of these investigations and associated statutory activity, required liaison with home local authorities, to ensure individuals rights were safeguarded and needs appropriately supported. As in the previous year this placed substantial additional demands on North Lanarkshire MHO and social work resources. New requests for Private AWI
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61 AWI Orders April 2022 - March 2023 Over the period April 2022 to March 2023, 218 requests were received for Mental Health Officer reports to accompany new guardianship applications. In comparison with the previous year this shows an increase of 83 reports. These applications were inclusive of welfare guardianship orders and renewals both private and Local Authority which is an Increase in all applications since the previous year. Mental Health (Care and Treatment) Act 2003 and Mental Health (Scotland Act 2015) National trends for civil detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 have continued to rise both nationally and locally. In North Lanarkshire there has been a decrease in the number of Emergency Detention Certificates (down 38%) and Short- Term Detention Certificates (down 7.9%), whilst the number of Compulsory Treatment Orders has increased (2%) since the previous year. The total number of supervised Forensic orders has also decreased. We continue to maintain a higher than the national average rate of consent to Emergency Detention Certificates, an area of national focus given the checks and balance this provides within the system. This year, MHO’s have however refused consent to 11 Short Term Detentions, 27 less than the previous year. Total Emergency Detention consents [164] 101 Total Emergency Detentions where no consent was sought [35] 76 Consent refused by MHO - Emergency Detentions [3] 0 Total Short Term Detention consents [236] 247 Consent refused by MHO - Short Term Detentions [38] 11
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62 Total Compulsory Treatment Orders [186] 191 Total Forensic Report requests [32] 28 Total Forensic orders supervised (CORO\CO) [30] 17 2021-2022 data highlighted in red. Quality Assurance, Continuous Improvement and Involving Lived Experience North Lanarkshire Council recognise that, MHO involvement in the social work and care management role of adults with complex needs in relation to decision making capacity and/or or those who experience severe and enduring mental health difficulties, can offer much better outcomes for individuals because of the knowledge and skill base MHOs retain whilst ensuing human rights are central to intervention. Nevertheless, the increasing demand on the service coupled with decreasing numbers of MHO’s and the national difficulty around retention and recruitment has necessitated the decision to that MHO workloads are ring fenced and deal with statutory work only. Care management inclusive of SDS has started to be reallocated to locality social work teams from the MHO service. This will be reviewed regularly and when the MHO service is in a better position a move to return to a more holistic approach will be considered. As part of our quality monitoring approach, we have introduced new arrangements for seeking feedback directly from people who access services and their families/carers, which will help us shape and improve service delivery. We are also introducing self-evaluation and auditing processes for statutory MHO reports and have undertaken a trauma informed walk through of the service to ensure best practice and continuous improvement. Service Recovery and Redesign As discussed in previous reports the pandemic on service required rapid development of remote working and centralising processes across the MHO service. Whilst there has been a return to face-to-face assessments, meetings, and MHO forums we have also continued to benefit from the flexibility remote ways of working can offer service users and staff alike with MS TEAMS and ‘Near Me’ service. The centralisation of key functions created many benefits to managing pressures across the service in relation to staffing, workload and sharing knowledge and experience and a centralised priority allocation process continues to be in place as a way of addressing the pressures across the service however in response to concerns that a fully centralized model may inhibit integrated working at local level a survey was conducted across the MHO service and a follow up development day held to discuss findings From the development day an agreed Action Plan was formulated to move towards a Locality Based MHO Service. To support service recovery and in line with the agreed Action Plan it was identified that recruitment would be integral to this success. Further information on how the service is innovating and using temporary capacity funding to support recruitment and development of MHOs to address capacity issues in the face of a chronic shortage of MHOs nationally is included in Section 5 of this report.
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63 3 PUBLIC PROTECTION 3.1 ADULT SUPPORT AND PROTECTION 3.1.1 ASP REFERRAL TRENDS During this period North Lanarkshire, received 3034 ASP referrals, an increase of 25% compared to 2021/22 (2,434 to 3034). This is the fourth consecutive year that an annual increase has been measured. Referrals from NHS colleagues continue to rise, showing a 23% increase compared to last year from 473 to 583 whilst adult support and protection referrals from Police Scotland have decreased 13% from 380 to 330. Social Work referrals increased 10% from 370 to 408. While Scottish Fire and Rescue increased 30% from 86 to 110. Care homes were the highest ASP referrer group in 2022/23 with 31% (933) of all ASP referrals received to localities and SWES. This demonstrates a steep rise in referrals from care homes in comparison to 2021/22 measuring a 105% increase from 455 to 933 in part reflecting the challenges in managing increasing complexity of care needs within group living settings. Monitoring and support in this area is provided by colleagues in Quality Assurance. In addition, a pan Lanarkshire task group has been set up by North and South APCs with all care home stakeholders involved and the aim to provide support to care homes to achieve a balanced and consistent approach in relation to ASP referrals and decision making. This will involve undertaking a survey with care home staff on their current level of understanding of ASP and targeting future training needs based on the responses given. Whilst Police ASP referrals have decreased, Police ‘Adult Concern reports’ continue to increase. there were a total of 4,009 Police ‘Adult Concern’ Reports received during this period. Since the same reporting period last year there has been a 3% increase in police ‘Adult Concern’ reports (from 3885 to 4,009). In a change from the previous reporting year, Physical harm was the most common referral type (48%) 1442 of all referrals received. In analysing the reason behind the sharp increase in referrals featuring physical harm this can be closely linked to the large number of care home referrals received often resulting from a witnessed/unwitnessed fall of a resident. As noted above, ongoing work with care homes and key stakeholders in relation to ASP referrals and decision making. Emotional and Psychological harm remains high, measuring (26%) 802 of referrals received. It has been recognised in research that self-neglect cases can be some of the most complex to manage for practitioners, as they are fraught with issues that cut across ethical, legal and practical considerations. Raising awareness of such issues for multi-agency practitioners has been a key focus within the Multi agency forums and within ASP multi agency training. For this period, there were 278 self-neglect cases which measure 9% of total ASP referrals. Self- neglect referrals continue to rise, referrals have increased 15% in comparison to last year (from 241 to 278).
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64 3.1.2 ASP INVESTIGATIONS There were 399 investigations carried out in 2022-23 which marks an 8% reduction from last year (from 433 to 399). 13% of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has reduced by 5% since the same time last year (from 18% to 13%). 3.1.3 CASE CONFERENCES There were 69 ASP initial case conferences and 117 ASP Review case conferences held for 2022 - 23. This means there has been an 8% decrease in those cases that progress from investigation onto initial case conference (from 25% to 17%). 3.1.4 STATUTORY ORDERS For the period 2022/23, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire implemented thirteen (15) ASP Protection Orders, as follows: Types of Protection Orders Number of Protection Orders granted Assessment Order 0 Removal Order 7 Temporary Banning Order 1 Banning Order 0 Temporary Banning Order with Power of Arrest 4 Banning Order with Power of Arrest 3 Total 15 North Lanarkshire Council’s ASP policy and procedures are currently under review. These will be updated in line with new Scottish Government codes of practice. Revised policy and procedures will be built into the new ‘mosaic’ social work system, the first draft of new procedures is expected November 2023. 3.1.5 APPROPRIATE ADULT SERVICES In January 2020, Appropriate Adults (AA) Services across Scotland became a statutory function via part implementation of the Criminal Justice (Scotland) Act 2016. This now means that a
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65 statutory duty is placed upon Police Scotland to request an Appropriate Adult, while the Council has a statutory duty to provide Appropriate Adult Services, and the training of AA’s. The Care Inspectorate has the duty to assess the quality of AA Services. In North Lanarkshire, AA Services are currently arranged, delivered, and fully funded by North Lanarkshire Council. Currently, there are 28 employees trained to perform the AA role whilst balancing the day-to-day commitments across Council Services e.g., Social Work and Home Support Services. Training is outsourced and delivered through partnership with Edinburgh City Council. Another training cohort will take place in October where it is anticipated a further 20 staff will be AA trained. AA service operates within office hours and via SWES. In 2022/23 the AA service responded to 59 referrals from Police Scotland. On 2 occasions the AA service was unable to provide an appropriate adult to police at the time of the request whilst on 2 occasions police cancelled their AA request. The primary reason police requested an AA was due to an adult being diagnosed with a learning disability (33 of 59 requests). 28 police requests related to facilitating a victim/witness statement and 22 requests involved multiple police procedure e.g., Police Interview Rights of Suspects (PIROS), Caution, Interview, Charge The primary crime type AAs were requested to attend involved crimes of indecency (38 from 59). North Lanarkshire Council have recently recruited a social worker to the adult social work team based in headquarters who will, as a test of change, temporarily lead on and develop the appropriate adult coordinator role. This is in line with local authorities' statutory duty to create a designated post for the appropriate adult service. 3.1.6 LARGE SCALE INVESTIGATIONS An LSI may be required where there is reason to believe that adults who are residents of a care home, supported accommodation, an NHS hospital or other facility, or who receive services in their own home may be at risk of harm due to another resident, a member of staff, some failing or deficit in the management regime, or in the environment of the establishment or service therefore in circumstances where risk may pertain to more than one individual North Lanarkshire Council commissioned and carried out two ASP Large Scale Investigations (LSI) relating to care homes during this period, one of which was commenced in the previous reporting year. The first LSI commenced in March ‘22 and was concluded mid-June ’22 in response to several practical and procedural areas within the care home which caused or was likely to cause direct harm to residents. Following evidence gathered by social work and partners, an action plan was developed in conjunction with the care home with the view of reducing risk to residents which was successful in reducing multiple areas of risks for residents and achieving better outcomes in their lives.
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66 The second LSI was commenced in December 2022 and continued beyond end of March 2023. The social work locality response has been timeous and robust and involves a significant resource in investigating harm and coordinating a response to the identified risks. This LSI involves several agencies who continue to implement the agreed protection plan in reducing risk to residents. It should be noted there is no timescales on how long an LSI should last, the average length of an LSI is between 2 and 4 months however the key outcome for every LSI is that adults will be safer, better supported and enjoying a better quality of life. 3.1.7 JOINT INSPECTION OF ADULT SUPPORT AND PROTECTION IN NORTH LANARKSHIRE The final report of the Joint Inspection for Adult Support and Protection was published on 22nd November 2022. The inspection findings are largely positive and recognise the hard work and commitment of staff across the partnership over the last two years. The inspection evaluated local performance against two key questions: 1. How good were our key processes for adult support and protection? The inspectors concluded that our key processes for adult support and protection were effective. There were clear strengths supporting positive experiences and outcomes for adults at risk of harm, which outweighed the areas for improvement. 2.How good was our strategic leadership for adult support and protection? The inspectors considered that our strategic leadership for adult support and protection was effective and demonstrated major strengths, supporting positive experiences and outcomes for adults at risk of harm. Key strengths and areas for improvement were identified as follows: Strengths: Adults at risk of harm had improved safety, health and wellbeing because of the diligent work of partnership staff. The partnership conducted initial inquiries into the circumstances of adults at risk of harm efficiently and effectively. Independent advocacy for adults at risk of harm was a key strength for the partnership. Adults at risk of harm derived considerable benefit from the support they got from capable independent advocates. The partnership’s strategic leaders enabled a culture of strong, credible, strategic partnership working for adult support and protection. Strategic leaders initiated rigorous, multi-agency quality assurance and audit work for adult support and protection. This was a key facet of the partnership’s convincing capacity for improvement. Areas for Improvement:
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67 1.a. The partnership should improve the quality of chronologies for adults at risk of harm. 1.b. The partnership should improve both the presence and quality of protection plans. 2. The partnership should always hold initial adult protection case conferences promptly when required. The police should attend all initial adult protection case conferences they are invited to. 3. The adult protection committee should consider securing the direct representation from adults at risk of harm and their unpaid carers. Thus, it would benefit from their lived experience of adult support and protection. Inspectors noted a small number of other areas for consideration by the partnership but also reflected within the report confidence in the partnership’s capacity for improvement. Next Steps: The Partnerships’ Inspection Improvement plan has been agreed by the Care Inspectorate who will monitor progress for 1 year. The Care Inspectorate continue to express confidence regarding our proven ability to make improvements. This report was welcomed as a fair assessment of our practice which largely reflects our own understanding of our position. The findings were reported by the Inspectors as ‘strong and sound’ for the partnership. Recognition of our clear strengths are welcomed, along with those improvements, which the Inspectorate indicate they are confident of our capacity to meet. 3.2 MAPPA (MULTI AGENCY PUBLIC PROTECTION ARRANGEMENTS Justice social work services have a key role in respect to MAPPA arrangements as lead agency for high-risk offenders subject to statutory supervision. As such the service works closely with the council’s housing service and other responsible authorities including, Police Scotland, NHS and the Scottish Prison Service to assess and manage the risk posed by sexual, violent and other risk of serious harm offenders. Whilst activity is operationally managed within relevant agencies. Multi-agency oversight and co-ordination is supported by a small pan-Lanarkshire team and Strategic Oversight Group (SOG) which is chaired on a rotational basis by North and Lanarkshire CSWOs and the Public Protection Superintendent, Police Scotland. An annual MAPPA report provides information on the ongoing local implementation of MAPPA arrangements, key priorities and activity statistics. The report for 2022/23 will be published on 27/10/23. Add link when available. Of the 787 individuals in custody or in the community in Lanarkshire subject to MAPPA as of 31/3/23, 54% (425) were the responsibility of North Lanarkshire authorities. Overall, the number of individuals managed under MAPPA have grown significantly since arrangements were established 16 years ago. This slowed during the Covid-19 Pandemic but has increased annually since then, with a 9% growth last year alone. In both North Lanarkshire and pan-
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68 Lanarkshire previously there was again a small increase between 20/21 and 21/22 however as in other areas of the justice system it difficult to clearly separate underlying trends from the impact of the pandemic. MAPPA related activity is however a key aspect of justice social work workloads. In March 2022, MAPPA partners attended a practice event to consider collective practice in terms of Environmental Risk Assessment. This was informed by a recent Significant Case Review from another area where development opportunities had been identified. The event provided opportunity for operational partners to physically meet in a way that had not been possible for some time because of pandemic restrictions. Such was the response to the event that partners have committed to a continuous schedule of themed operational development events, hosted across both North and South Lanarkshire which will contribute to the ongoing strengthening of practice and the establishment and maintenance of key professional relationships. Whilst the statutory activity above is categorised in distinct strands there is a clear interface across the different areas of public protection requiring joint working across all social work care groups and partnership arrangements. For example, there is an increasing number of older individuals and those with substantial care needs who are managed under MAPPA requiring close working between adult and justice services. There is also a strong interface between justice services and child protection whilst domestic abuse and violence against women link strongly to wider public protection processes. All social work staff are therefore trained and expected to develop core knowledge of the range of protection procedures and responsibilities. Statutory public protection interventions and processes are also part of a wider continuum of safeguarding and community safety activity in which social workers are involved, some of which are reflected in earlier sections of this report. Additional examples of key priority areas for social work and partners where practice is evolving and innovating to strengthen the protection and wellbeing of our communities are detailed within this report. 3.3 CHILD PROTECTION There has been a significant rise (65% 18/19 to 22/23) in child protection referrals as illustrated below – Year Number Of Referrals Investigations % of Referrals Proceeding to Investigations Number of Investigations that Proceeded to Case Conference Number of Registrations from Case Conferences 2022/2023 1895 775 41% 264 198 2021/2022 1714 754 44% 229 177 2020/2021 1482 831 56% 261 199 2019/2020 1617 800 49% 339 254 2018/2019 1150 642 56% 329 251 2017/2018 1030 692 67% 340 252
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69 This is due to our child protection framework supporting increased consistency in practice, recognition of all forms of harm, strengthened by refreshed IRD guidance. While we have not seen a rise in the numbers of children whose names are placed on the Child Protection Register, there has been an increase in registration of older children aged 12 +. What this indicates, in part, is that practitioners, supported by our commitments to keep The Promise and UNCRC and investment in contextual safeguarding, are increasingly focussing on and recognising the protection of older children and their rights. The service has continued to work with the partners in the Child Protection Committee to monitor and understand the relationship between child protection referrals and rates of registration to ensure the right children get the right support when they need it. In April 2023, the partnership was informed that a Joint Inspection of services for children and young people at risk of harm would take place over the period from April to September 2023. The outcome of this inspection will be reported through committee and within the next CSWO Annual Report 3.4WIDERSAFEGUARDINGACTIVITY 3.4.1CONTEXTUALSAFEGUARDINGANDPROTECTINGYOUNGPEOPLEFROMHARMOUTSIDE THEHOME The service has continued its work towards embedding the Contextual Safeguarding approach to protect young people who are at risk of harm and or exploitation in the community. Alongside our bespoke online training module, where approximately 400 staff from across the council have undertaken the two hour learning- we developed a theory of change to illustrate what we want to achieve and identify priorities: Developing North Lanarkshire’s Response to Extra-Familial Risks and Harms - Overview | Rise 360 (articulate.com) The approach has now been strengthened through the embedding of a multi-agency Young People’s Safeguarding panel (to coordinate actions to protect young people) and over 2022/23, around 30 young people were considered through this panel alongside discussions about their periphery peers, dynamics of key relationships, safety of places they spend time and key conversations around choice, empowerment, voice and trust. Staff have access to consultations to promote their confidence and to offer containment with the emotional and
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70 ethical demands associated with managing complex risks. As a service we have worked to ensure that the trauma young people experience is understood and sensitivities to this are integrated into our practice. The University of Sussex has been researching our work, with early evidence that trauma informed practice is beginning to make a difference. Some key highlights have been that the approach supports workers to: Prioritise who young people are and what they could be – rather than the risks that they face – when describing them to others Identify young people’s experiences of trauma and consider these when developing plans to support them and meet their needs. Identify services and relationships in community settings that could offer sustainable safety to young people beyond the life of an intervention. Another key aspect of addressing the harms faced by children and young people in the community is our approach to responding to children reported as missing to the Police. Recognising the importance of early support for children who are reported missing, the social work service continues to lead a weekly meeting to discuss the circumstances of all children and young people reported to the Police as missing. We also continued to commission a dedicated service from Barnardo’s to undertake Return Discussions available to all children and young people who are reported missing, regardless how many times, in recognition of the potential harms. The meeting is multiagency and discusses the circumstances of the missing episode and looks at what, if any, additional supports the child, young person or their family may need to prevent further missing episodes. Although the number of young people reported as missing has continued to rise since 2020 (342 as opposed to 185), there has been a significant change from where the children and young people have been reported missing. In 2020/21 49% of missing episodes were of children living in Children’s houses within North Lanarkshire. Last year this reduced to 17%. This change is in part due to the proactive and relationship-based approaches taken by our Children’s house staff in collaboration with the police. Most children and young people reported missing from home are not known to social work services (as seen in diagram below). Over 22/23 167 return home discussions (RDs) were completed for 115 young people. Of these 79% were not reported missing again following up to 3 RDs. Of note is that 10 children disclosed protection concerns within RDs previously unknown to agencies prompting action such as a child protection investigation, family group decision making or planning for a child’s wellbeing within the GIRFEC pathway.
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71 3.4.2 SUICIDE PREVENTION During 2022 the Scottish Government and COSLA collaborated in launching a new plan and strategy to tackle suicide in Scotland: Creating Hope Together: Scotland’s Suicide Prevention Action Plan 2022 -2025; Creating Hope Together: Scotland’s Suicide Prevention Strategy 2022 – 2032. In North Lanarkshire, the Suicide Prevention Partnership Group lead on the local suicide prevention strategy and action plan. This includes a range of awareness raising activities use of online and digital platforms and training across services and local communities. The table below includes data from 2018 until 31st December 2021, indicating that North Lanarkshire sadly lost 171 people to completed suicides in that period. There continues to be an increase in deaths of younger people under the age of 39: these have mostly been young males. Suicide rates did not significantly vary throughout the lockdown period (2020/2021); however, as we continue to recover from the emotional and fiscal effects of the pandemic there is concern that the cost-of-living crisis may impact an increasing number of individuals mental health and wellbeing with an associated risk of a rise in suicide rates. In this context continuing to review and enhance the local action plan is clearly essential. Number of Suicides by Year (2018-2022) - North Lanarkshire Year Number 2018 58 2019 57 64% 27.10% 8.90% YP missing from a family or family-based placement Not know to SW at the time of reporting S22 Experiencing Care
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72 2O20 62 2021 52 2022 50 The local action plan remans framed around the following areas: Reducing the risk of suicide in high- risk groups Tailoring approaches to improve mental and physical health in specific groups. Reducing access to means of suicide, including identified locations of concern. Learning from reviews and investigations into unexplained deaths Providing better information and support to those bereaved or affected by suicide. Supporting research, data collection and monitoring Building community capacity to help reduce the stigma and taboo associated with suicide, Distress Brief Intervention is now embedded within North Lanarkshire as early connected and compassionate support whilst suicide awareness and prevention training are being delivered across social work, health, education, third sector and voluntary organisations. Within social work a nominated Senior Officer based in Adult Service leads on Suicide Prevention. 3.4.3 DRUG RELATED DEATHS North Lanarkshire continues to have high levels of drug-related deaths as illustrates in the tables below:
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73 A pan-Lanarkshire multi-agency Drug Death Review Group is in place supported by a drugs death review officer to gather the statistical information to identify patterns working closely with services to look at drug related deaths. This post holder attends all meetings related to drug related deaths, engages with the teams, ADP development officers and information officers. Measures to target drug deaths locally and nationally have been implemented via MAT standards and more recently a newly commissioned service to respond to crisis and assertive outreach has been established. A name has yet to be sought but the initial steering group has met, and a standing operating procedure is being discussed. Including criteria for referral based on risk management. Whilst reducing drug death is a critical priority actions have the wider aspiration to improve quality, choice and to create connections to keep people safe, well and thriving to realise a North Lanarkshire where: Fewer people develop drug and alcohol use. People access and benefit form effective, integrated and person-centres support to achieve recovery. Children and Families affected by alcohol and drug abuse are safe, healthy, included and supported. Vulnerable people are diverted from the justice system wherever possible. Less harm is caused by alcohol. 4. RESOURCES For the financial year 2022/23 North Lanarkshire Council had a gross annual social work budget, inclusive of Covid & winter planning funding, of almost £292m. This was allocated as £242m for Adult Social Work and Social Care and £50m for Children, Families & Justice Services. The equivalent funding for the previous financial year was £266m.
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74 During 2022/23 the Scottish Government was in regular discussions with HSCP’s with respect to in-year IJB Covid costs. The service recorded a spend of £1.342m which related to partner sustainability payments. As reported in the 2021/22 report, North Lanarkshire received a share of £300m funding from the Scottish Government to protect health and adult social care services over the winter and to provide longer term improvement in service capacity across health and social care systems. This resulted in circa £7m new recurring investment for the service. A business case was approved of how this would be utilised which highlighted that the majority of this would be used to increase staffing levels in key areas across the service: https://mars.northlanarkshire.gov.uk/egenda/images/att97950.pdf Unfortunately, there have been recruitment difficulties across the sector therefore some slippage in spend against this business case was reported in 2022/23. Following council and IJB budget setting processes social work services had a savings target of £2.094m, split £2.025m Adult Social Work and Social Care and £.069m Children and Families, the service achieving 31% of this in year. The shortfall was within Adult Social Work and Social Care and was funded using reserves with the saving expected to be fully implemented in early 2023/24. In totality Social Work activity during 2022/23 was undertaken within the overall budget resource and resulted in an underspend position. Within Adult Social Care the underspend was almost entirely because of the recruitment issues, both internally but also within the care at home sector reducing the payments made to these bodies. This is similar overall to the 2021/22 position however due the nature of these underspends they are non-recurring in the long term. Financial pressures are being seen across the following areas: Home Support Independent Care Homes
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75 Self-Directed Services Integrated Equipment and Adaptation Service Family Placements Children’s Houses As in the previous year the core Sec 27 grant for the delivery of statutory justice social work services (5.789 m) was enhanced through additional funding (0.920 m) to support targeted government priorities including women’s services, structured deferred sentences, diversion from prosecution, PASS and third sector commissioning. Additional funding of 0.953m was also provided to enhance capacity to address pandemic related backlogs within the system and to enhance bail supervision. 4.1 FINANCIAL MODELLING FOR SERVICE DELIVERY Financial Planning and monitoring continue to be a key responsibility for the management team. The Council’s financial strategy includes Service input to four key processes. These are: Preparation of detailed single year budget In–year budget monitoring and projections Preparation of rolling 3-year budgets Preparation of a Medium-Term Financial Plan Alongside this the Council Finance Team works closely with the IJB Chief Finance Officer to prepare a medium-term financial plan for the Health and Social Care Partnership. In terms of financial modelling the Management Team increasingly take a whole systems approach to delivering new and more efficient operating models which often requires joint working with other Council services and key external partners. In addition to the wider financial modelling described above, work has also been undertaken to support the business plan for Adult Health and Social Care. With respect to Children’s Services the council and local partnership is one of three areas who have committed to working with the Promise team nationally on ‘Human and Economic Cost Modelling’, work which is intended to support longer term change both nationally and locally by identifying how money is currently spent and the system changes required to move the balance of spend toward early intervention and family support in line with the aspirations of Christie. Following some early scoping this area of work is now integrated into the ‘Resilient People’ strand of the Council’s Programme of Work. A significant risk in children’s social work is the reliance on a range of temporary funding streams, some ‘bid-in’ and some, principally partnership monies, allocated via national distribution formulae to support longer-term transformational change and service improvement with none of these strands committed beyond 2025/26. Similarly in justice services there is uncertainty around the level of recovery funding which will continue beyond the current year.
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76 5. WORKFORCE 5.1 WORKFORCE PLANNING Workforce planning within social work is integrated thought the social workforce group but informed by the Council’s corporate ‘Workforce for the Future Strategy’, and interfaces also with the wider HSCP workplan. As reflected in other parts of this report the direct and indirect impacts of the pandemic and cost of living crisis along with underlying demand pressures continue to impact on the ask of the social work workforce over this period. Challenges in the labour market continue to impact on recruitment and retention of staff, North Lanarkshire is not immune to these challenges and whilst many of these also require action at national level, there is substantial work ongoing locally to address key issues and support workforce resilience. 5.2 SOCIAL WORK RECRUITMENT AND RETENTION In February 2023, a report entitled ‘Social Work Workforce Sustainability’ was tabled at Corporate Management Team. It outlined the range of challenges impacting on the sustainability of the Social Worker workforce and the consequent vulnerabilities with respect to service delivery. The report also set out key proposals to address these challenges, which included a revised and strengthened recruitment model, alongside further work to enhance whole career support and development allied to the wider ambitions of Workforce for the Future. In relation to recruitment, the service made a commitment to a mixed model of internal and external recruitment, re-establishing the Social Work Trainee Scheme for NLC Social Work staff. The Trainee Scheme has been progressed with 8 successful applicants being offered courses, due to commence from September 2023. Courses vary in length from 12 months to 4 years, depending on applicants’ previous educational qualifications. As part of the scheme NLC is also committed to offering rotational experience across residential, day and fieldwork services according to learning needs. In addition to this scheme, we are sponsoring 6 self- funded employees as they complete their Social Work qualification. External recruitment has also continued with over 60 external appointments made in the last 12 months (since Sept 2022). A commitment to offer permanent contracts whenever possible has continued even if this requires a temporary placement in the first instance. This will be reviewed regularly but it has been agreed on the basis that normal levels of turnover mitigate any associated financial risk. Temporary cover requirements, which exist for several reasons including the movement of Social Workers to temporary promoted opportunities and the creation of temporary funded posts, are being closely monitored. Whilst a temporary opportunity can be appealing to the current Social Work workforce, this can cause issues ensuring backfill for their substantive post. The opportunity for newly qualified Social Workers
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77 to join NLC as Social Work Assistants until their full qualification has been confirmed, has also been utilised. External adverts, through myjobscotland, have been generic and specific. Generic adverts have been developed to attract applicants to NLC with preferences given in relation to the care group they wish to work with. Specific adverts have been progressed for specialist teams, for example, Addiction Recovery Services. North Lanarkshire continues to successfully recruit Social Workers, including attracting students who have had positive placement experiences with the authority. This has impacted on experience levels and stability at the frontline, for example in Children, Families and Justice alone 48 external appointments were made to the role of social worker over this period, 38 of whom were newly qualified. Whilst these staff bring skills, creativity and commitment to the service, the impact of the pandemic on pre-qualifying opportunities has impacted on learning needs and the changing balance between newly qualified and more experienced workers, alongside an increasing complexity in the demand profile, has created clear pressures with respect to the allocation of work within localities with a requirement to provide more support across teams. Frontline managers continue to monitor caseloads and assist their workers in the prioritisation of their statutory responsibilities. In Justice Social Work a revised structure has allowed for a more flexible approach to the deployment of staff across the authority to support the teams who are dealing with the most urgent and pressing demands and authority wide teams continue to support localities across all care groups. Whilst not favored as a core element of our ongoing workforce strategy, where necessary limited use of agency social workers has also been employed in Adult and Justice services. A close partnership approach has developed and will be maintained between the service and our HR colleagues in terms of ongoing recruitment strategies. Advertising frequency and dates have been reviewed to streamline processes and quicken the employee onboarding experience. This will continue to be reviewed and improvements made wherever possible. The service also commissioned research into the recruitment of Social Workers from Black and Minority Ethnic Communities. It is hoped that the findings of this research will shape recruitment policies and practices, ensuring they are not just non- discriminatory but anti racist, to the benefit of applicants from these communities and the service as we endeavor to recruit a more diverse workforce. To assist in the retention of Social Workers, a regrade was actioned on 1 May 2023. Following a re-evaluation process undertaken during 2022 which recognised the evolution in the social work role in response to both nationally driven expectations, a more complex and integrated service delivery landscape and the need for an empowered workforce. As a result of this NLC Social Workers increased from grade NLC10 to NLC11, moving NLC from 23rd place, on a list of 32 Local Authorities, when looking at starting salary, to 2nd place. Job Descriptions are being updated and it is hoped that these actions will bring several benefits including reflecting of the professionalism in the role and ensuring NLC’s competitiveness in the market.
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78 As outlined in 4.2 below, a commitment to support Practice Learning, the Supported Year in Practice and to both Continuous Professional Development and Health and Wellbeing, are all critical to longer-term recruitment and retention strategies. This support will continue to be updated and reviewed. Ultimately however action will also be required at national level on social work workforce issues including on areas which create barriers to entry to the profession such as the lack of training bursaries. Our Senior Practitioner Scheme continues to contribute to retention and the building of a skilled workforce. It allows social workers and occupational therapists to progress to an enhanced salary scale on completion of relevant post qualifying training and commitment to undertake additional responsibilities. The scheme remains a key component of our model, with over 60 practitioners within the service carrying the status alongside tailored work plans identifying their additional contribution to the service. Social workers who meet the criteria have immediate access to temporary Senior Practitioner status, pending a process to confirm status. Our strong commitment to the provision of Practice Learning as part of Learning Network West has been maintained providing quality learning experiences. The service has benefitted significantly from the input of the students and as noted above this also supports recruitment. Our hubs are currently supporting 25 newly qualified Social Workers, in their first year of employment, in addition to students training to be Social Workers. All student placement opportunities are overseen by a dedicated Senior Officer in our Training and Organisational Development team. Feedback highlights the value of this support to new social workers and students whilst also providing flexibility of deployment to support service needs. 5.3 RECRUITMENT AND RETENTION OF MENTAL HEALTH OFFICERS North Lanarkshire Council remains committed to developing social workers through the MHO Traineeship Scheme, which supports Social Workers in gaining an MHO award. 1 qualification was supported in 2022/23 and 3 Social Workers are undertaking the course in 2023/24. Recruitment is supported from all care groups with colleagues across Education and Families, Adults and Justice Services showing an interest in being considered for the Award. To support a steady flow of candidates to prepare for the opportunity to undertake the PQ MHO Certificate we have also established a temporary social worker (non-MHO) post within our Community Mental health Team. This post will allow social workers to gain knowledge, experience, and suitable expertise to allow them the opportunity to apply for PQ MHO Certificate, hopefully encouraging a smooth pathway from the social worker to MHO role. Mental Health Officer forums continue every 6 weeks, offering discussion on practice issues, case studies, national reports/guidance and providing feedback to Scottish Mental Health Law Review.
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79 North Lanarkshire continue to offer MHO’s the opportunity to obtain, and maintain, Senior Practitioner status and to share their knowledge and experience with MHO and social work colleagues in relation to various aspects of AWI and MH legislation as well as Self Directed Support. We recognise the breadth of knowledge, experience, and skill across the MHO service and plan to restart consultation sessions regarding human rights, AWI and MH Act as well as establishing MHO champions who have areas of practice interest, in relation to neurodiversity, forensic work, and complex trauma. Remote external training and development opportunities continue to be available to MHO’s, for example via the Scottish Forensic Network, Mental Welfare Commission and MHO community of practice (SASW). To strengthen the structure a stand-alone Practice Assessor, to support Mental Health Officer training, has been appointed. In addition, a Mental Health Officer post for complex discharge planning has also been added, on a temporary basis, to the NLC structure with a postholder in place. We have also appointed on a Temporary basis a Mental Health Officer within the coming home team in line with Scottish Government proposal in this area. Since December 2022 we have secured 3 full time MHO and 3 sessional MHO. Currently the Mental Health Service is under review. The return to a locality-based model referenced earlier in this report will also see and expansion of Senior Social Workers/MHOs from 4 to 6. 5.4 SOCIAL CARE As reflected in Section 2.6.9 above there remain significant recruitment, retention, and capacity challenges with respect to the Home Support Service. The roles of Support Officer and Service Delivery Coordinator have been particularly challenging. A review of Home Support Services is ongoing but considering the current challenges, the decision was taken to redesignate the post of Support Officer to Home Support Scheduler, and the posts of Service Delivery Coordinator to Home Support Team Leader. It is felt that the new designations are more descriptive of the roles and that this may assist in the understanding and expectation of applicants for these posts. Work is also ongoing to ensure Home Support Workers are aligned to appropriate teams, with a focus on re-ablement and Home Assessment Team, to support hospital discharge. Other areas in which recruitment challenges are also evident include Locality Support Services and some roles within residential childcare, significant factors being wider labour market changes and comparative pay. In addition to wider strategic actions, service areas are themselves active in seeking solutions, for example, locality support services have continued to build links with education, encourage apprenticeship schemes and promote the idea to young people that a career in social care is rewarding and full of possibilities for promotion,
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80 further education and development. A group has been set up with a focus on promoting succession planning and preparedness of workers interested in promotion, staff development and the introduction of the principles of creating a working environment that is trauma informed. 5.5 ADMINISTATION AND BUSINESS SUPPORT The Administration and Business Support personnel within Social Work play a vital role in strengthening service delivery. However, they are currently experiencing difficulties with the substantial challenges in recruitment and staff retention. The volume of vacancies and turnover, especially in primary positions, have had a significant impact on both the service and its workforce. Many staff members are leaving for other opportunities, either within the Council or in the private sector. To address these issues, there are plans in place to conduct a comprehensive review of Administration and Business Support across Adult Health & Social Care, Children & Families and Justice Services. The goal is to implement a revamped Business Support model that enhances efficiency and offers roles tailored to the specific needs of the services, thereby making them more attractive and providing better career advancement prospects for staff members. 5.6 CARE ACADAMY Health and Social Care is the largest employment sector within North Lanarkshire and experienced significant increases in demand and ongoing workforce challenges over the year. In terms of future workforce planning, through the UK Shared Prosperity Fund, NLC will make further investment in its staff - to support workforce development and give staff the opportunity to develop and further enhance their careers. We have secured £88,000 over the next 2 years, to develop the skills of the workforce within Adult Health and Social Care. This will be delivered in three projects: Project 1 – Trainee Social Worker Scheme NLC has a successful and respected Trainee Social Worker Scheme where we offer opportunities to a small number of staff each year to train in their role to become a Social Worker. The monies received from the UK Shared Prosperity Fund have allowed us to offer staff who are currently on the trainee pathway fully funded qualifications to support them on their journey to becoming a Social Worker. The fund can also fast track students who are already part way through their qualification to achieve it in a shorter timescale and receive a robust and meaningful placement to allow them to train as a Social Worker. More information can be found in the Social Work Student Hub update below. Project 2 – Upskilling for Home Care Workers As part of a commitment to professional development requirements set out by the SSSC, Home Support Workers require to have a basic Health and Social Care Qualification. Recruitment for these roles is difficult and trying to attract already qualified staff is a challenge.
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81 To address this challenge, we recruit people who have yet to gain their qualification and fully support them to attain it whilst employed by the Council. The monies from the fund will allow us to put through an additional forty candidates over the next two years who require this qualification for their registration. It also allows us to target Home Care Workers who are keen to progress in their career further and achieve the next level of qualification, helping us to build a pipeline of talent for the future. Project 3 – Home Care Support Officers Support staff are a vital resource for the Home Support Service. Investment in this group of staff is paramount to ensure we retain them and increase morale within the service. Allowing them access to an early qualification in Health and Social Care can create a pathway to future employment opportunities in the service. The fund allows us to offer up to thirty opportunities across the service for staff to gain a qualification essential to their progression within the service. The monies from the UKSPF are allowing us to expedite access to qualifications in a Service where it is difficult to recruit and retain staff. It will help to promote a sense of commitment to the development of staff and hopefully lead to greater retention, improved morale as well as a secure pipeline of talent for the future. 5.7 WORKFORCE DEVELOPMENT AND STAFF SUPPORT Getting it Right in Child Protection Course – 17th to 23rd May 15 Social Workers trained. There continued to be a wide range of learning and development opportunities open to staff over the year, supported and planned both corporately and at service, team and individual level with a focus on alignment to service and corporate ambitions and redesign but also on more specific team and individual development needs, the latter through our PRD processes. Prior to the pandemic the council invested in LearnNL a cloud-based learning management system designed to support a more inclusive and accessible approach to learning whilst improving digital literacy. Going forward, as part of the Learning and Development Strategy, there will be a fully comprehensive learning and development offer for all colleagues within Children and Families, Justice Services and Adult Health and Social Care. This will include pathways for learning for job roles, highlighting the mandatory and essential training for all jobs within the Service. It will also give access to aspirational learning to support career progression within the services. In relation to the development of this platform, there has also been ongoing sessions delivered to Adult Health and Social Care service management to highlight the use of Learn NL and its functions as a Learning Management System, using the available functions to record and maintain records in relation to mandatory training. This will be particularly beneficial when determining Care Inspectorate compliance issues or highlighting areas of concern that require
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82 attention across the services. Work has also been ongoing in relation to the development of the management toolkit and PRD management for all health and social care staff. A summary of key activity over the period with respect to Learn NL, Assessment Centre, and training activity to supporting registration and the social care workforce and Post-qualifying Awards is as noted below: 5.8 LEARNNL Total number of activities undertaken on LearnNL including mandatory learning – 11,001 Leadership Development – 29 activities Fundamental Leadership – 5 Influential Leadership – 9 5.9 ASSESSMENT CENTRE AND REGISTRATION The Assessment Centre continues to support SVQ, and PDA qualifications required to meet registration, role and CPD requirements. This is achieved through both in-house assessment and access to SVQs through external providers. Awards completed (2022 – present) SCQF Level 6 (SVQ2) – 32 SCQF Level 7 (SVQ3) – 5 SCQF Level 9 (SVQ 4) – 1 Active Candidates – External Programmes (2022 – present) New College Lanarkshire – 20 West Lothian College – 1 Active Candidates – Internal Programmes (2022 – present) SCQF Level 6 (SVQ2) – 2 SCQF Level 7 (SVQ3) – 4 SCQF Level 9 (SVQ4) – 3 5.10 POST GRADUATE OPPORTUNITIES Advanced Practice skills – 1 completed 2022 Postgraduate in Management and Leadership – 1 completed 2022 Postgraduate in Child Welfare and Protection @ Stirling University – 4 started in 2022 and due to be completed June 2023. A further four will commence September 2023 due to finish June 2024. Postgraduate Certificate in Child Welfare – 4 started in June 2022, due to be completed June 2023 Postgraduate in Adult Support and Protection – 2
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83 Postgraduate in Contemporary Drug and Alcohol Studies -1 Exploring the Theory and Practice of Psychological Trauma – 1 MSc In Leading People Centred Care – 1 PDA in Health and Social Care Supervision – 1 MSC Applied Professional Studies Child Protection Module - 1 Part funding of final year of PHD qualification – 1 5.11 PROFESSIONAL DEVELOPMENT AWARD IN PRACTICE LEARNING (PDA PL) SQA LEVEL 11 Over the past five years we have promoted practice learning and successfully built a strong cohort of competent and confident link workers and currently have a waiting list to become a practice educator. Three social workers are due to qualify as practice educators in 2023 with a further five being put forward for the next cohort starting March 2024. 5.12 SOCIAL WORK DEGREE PATHWAY WITH THE OPEN UNIVERSITY Over the year fifty-five staff members across different Social Work services from admin staff to support workers and managers expressed interested in gaining a Social Work Degree - requiring them to study in their own time and commit to self-funding. Eight of these staff members were recruited to the Trainee Social Work programme. The qualification for this group is fully funded by the Health and Social Care partnership reserves; four of the trainees are undertaking the fast-track route to qualifying within eighteen months and the remaining four are undertaking the BA degree in Social Work and will qualify 2026/27. As mentioned above in the UK Shared Prosperity Fund update, a further fourteen members of staff who were already part way through their qualification with the Open University are being financially supported to achieve their modules. These staff are from across Home Support, Justice, Access Social Work and Education and Family support workers. There are six employees completing their last year of the Social Work degree and their first assessed placement was fully funded and due to be completed in July 2023. These six employees will then be progressing onto their final assessed placements starting February 2024 and will qualify around October 2024. The level of interest in completing social work training from a group of staff across the service whose position provides a good insight into both the rewards and challenges of a career in social work is encouraging and provides a strong base to further expand qualifying training opportunities should national investment in this area be forthcoming to supplement action taken to date.
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84 5.13 STUDENT SOCIAL WORK HUB Between April 2022 to August 2022: thirty-nine student social workers were placed across service users’ groups. Thirty-one were placed in traditional placements with on-site Practice Educators and Link Workers. Due to the on-going issues following the pandemic, these placements were initially more challenging due to remote working and limitations on the office environment. The Hub worked as best it could with the students to still provide meaningful learning opportunities and successfully support them in their placement. Following their final placement in the Hub, twenty-five students gained employment with North Lanarkshire Council and are in post on the newly qualified Social Work supported year. Our first generic student hub was development as a “test for change.” Eight students from Strathclyde University were placed in the hub with an on-site Practice Educator from Talent and Organisational Development. Following a successful pilot, five of the eight students from this hub secured employment with NLC and transitioned onto our NQSW supported year and remain in post to date. Between August 2022 to March 2023 two generic social work hubs were created - one in the North based at Cumbernauld Locality which had ten students who worked across Airdrie, Coatbridge, and Cumbernauld. The other hub was in the South and worked across Bellshill, Motherwell and Wishaw, this hub also had ten students. A full time Practice Educator was allocated to each Hub to work with the students during this time. Work was undertaken within the hub by student social workers included kinship, childcare and community care assessment and criminal justice social work reports. Between August 2022 and March 2023 there were nineteen student Social Workers placed in traditional placements across different service users’ groups. Six of these students were North Lanarkshire Council employees on their first assessed placement which was provided by the Hub. There are currently another two student hubs which have twenty-two students from external universities with two on-site full-time Practice Educators. These hubs support Community Care and Justice. In addition, we have again implemented two “test for change” sites in progress: one student based within the Virtual/Forest school base in Airdrie and two based in Access Social Work. 5.14 NEWLY QUALIFIED SOCIAL WORK PROGRAMME North Lanarkshire Council is one of 12 local authorities in Scotland who are working with the SSSC on the early implementation of a support year for Newly Qualified Social Workers (NQSW).
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85 The Grant funding agreed by the SSSC for the year 2022-2023 was £30,000. This amount, along with further internal funding was used to employ a Practice Learning Officer to lead the development and implementation of a supported year for all NQSW recruited to North Lanarkshire Council. This decision was made to promote equality of opportunity across all NQSW employees, promote the consistency of support in adherence with SSSC recommendations, and further promote staff retention. A consistent and quality induction was a Core Element of the supported year, and the NQSW development lead alongside colleagues from Talent and Organisational Development created a virtual social work induction that was placed on LearnNL. This can be used to update and inform all new employees to North Lanarkshire about the roles, functions, models, and aspirations of social work in North Lanarkshire. Building on previous Early Professional Development sessions, the NQSW are now encouraged to attend twelve, 4 -weekly face to face sessions where support and learning directly align to the NQSW Standards that quantify the social work registration requirements for the SSSC. Between April 2022 and March 2023, a total of 40 NQSW were recruited across all social work disciplines. Thirty-five of these had been students on placement at North Lanarkshire Council. All have been involved in the supported year. Of this number, 3 NQSW have successfully completed the requirements of the supported year to date and have submitted their work to SSSC. A further seventeen will end their supported year by November 2023 with the remainder by April 2024. All have received training in relation to the expectations of the supported year, their Senior Social Workers have also received training in their changed role, as has senior management. As a result, the needs of our NQSW recognised as a priority, and NQSW learning, and development has been a focus of allocations of work, supervision, and training opportunities. With a further 25 NQSW anticipated to join the supported year after March 2023, the ongoing development of the year remains paramount. Indications are that the NQSW supported year will be ratified by Scottish Government for it to be a mandatory requirement across all of Scotland from October 2024. North Lanarkshire Council are well placed to recruit and retain NQSW because of our current and future development. 5.15 OTHER KEY TRAINING AND DEVELOPMENT ACTIVITIES March 2023 saw the introduction of a newly established Health and Social Care sub team within Talent and Organisational Development. The sub team was developed due to the recognised needs and ongoing challenges the Adult Health and Social Care workforce continues to face in responding to competing priorities such as the registration agenda, recruitment and retention of staff as well as ensuring that staff have adequate access to learning and development pathways; all in keeping with our workforce development plans. One of the key priority areas for the sub team is the co-ordination and management of the registration agenda. This area of work will be ongoing as we look at allocation of resources to
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86 meet the needs of services to ensure a sustainable and reliable model of delivery; whilst ensuring compliance levels are maintained and improved. Work has already commenced regarding identifying priority areas of mandatory training particularly in relation to Level 1 Adult Support and Protection training made available for all Home Support staff and Level 2 for Service Delivery Coordinators. This will be a collaborative effort involving all Adult Health and Social Care Teams throughout the Home Support services and the Adult Protection Committee. Furthermore, during this time priority is given to the delivery of mandatory Infection Control, Moving and Handling and Medication training. As of March 2023, a total of 1989 staff have attended events in relation to these key areas. As well as the above we have also continued to offer core training in relation to Adult Support and Protection, Council Officer training, Appropriate Adult, Child Protection and Promoting Positive Behaviours. We have also continued with the delivery of essential mental health learning including ASIST, Suicide Alert, Safe Talk, Scottish Mental Health First Aid and Mental Health Stigma Workshops. There are further ongoing developments in relation to the roll out of Trauma Informed Practice. There are two sessions of the Getting it Right in Child Protection training arranged to take place in May and October 2023. This will result in approximately 40 additional Social Workers being trained in this area. To date 293 people have registered to participate in Understanding Child Neglect eLearning module and 262 people have completed this. There have been 1349 registrations for Child Protection Awareness training and 1136 people have completed. 377 people have registered for Assessment and Planning for Children and Young people and 251 have completed. In addition to the above mandatory and core programmes we have also commissioned access to widely requested training such as Autism and Neurodiversity, Sensory Impairment Awareness and Dementia Support Skills all of which were delivered using a blended approach of online and face to face learning. Due to the popularity of these courses, we envisage further opportunities to be developed in these areas in the future. 5.16 TRAUMA INFORMED PRACTICE In line with the National Trauma framework, a significant priority continued to be changed to the delivery of social work services across systems and within organisations to improve outcomes for individuals and communities. Senior leadership in North Lanarkshire committed to organisational change and the development of staff knowledge and skills. This was evident in the transformative change of the Hub implementation plan and whole family support approach based upon meaningful collaboration with people with lived experience of trauma. To support the implementation of Trauma informed practice, build on, and add pace to the work, the Trauma training programme was integrated into training plans. Furthermore, a Senior Officer was appointed in late Feb 2023. This role supported the vision and actions of the steering group and the implementation of trauma training.
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87 The training plan included all 4 levels of the National Trauma Training Programme. A universal element was also developed. This approach was mandatory for all staff to support understanding of trauma, its impacts and how to reduce re traumatization for people using our services and staff. Further methods and support are planned to be delivered to staff on a phased basis dependent on their service area and role. 5.17 LIVED EXPERIENCE As has been reflected throughout this report, throughout 2022/23, the increased involvement of people with lived experience in influencing and shaping what we do has been very beneficial – across training, development activities and targeted employment of those with lived experience. Further work is planned across the service to enhance engagement with, and the participation of, people with lived experience. Alongside this, we anticipate that joint development sessions alongside people with lived experience for those staff involved in ethical commissioning will help to further embed lived experience into our overall approach. 5.18 REFLECTIVE LEARNING: THE SCOTTISH CHILD ABUSE INQUIRY/HISTORICAL ABUSE Improvement work continues to take account of the reflective learning from the Scottish Child Abuse Inquiry, with many themes aligned with the ambitions of the Promise and associated development work. Both the Inquiry and the Promise highlight the power of language and the importance of robust record keeping, detailing the involvement of services with children and families, often at times of significant and life altering change. A particular focus has been a review the language used and recording practice by staff in in a range of settings to promote record keeping that is rights based, written in an accessible format and is trauma informed. A language leaflet was developed to support the workforce embed the key principles in practice. Records are often accessed by individuals to support their understanding of past events in their life. The service has seen a significant increase in requests for access to records. To increase confidence and competence across the workforce to engage with the requester and to complete the request, a range of development sessions were undertaken. The sessions were attended by 91 workers with follow up forums scheduled for the future. 5.19 SUPPORT FOR STAFF WELLBEING As highlighted throughout this report, staff commitment and resilience has continued to be remarkable during these challenging times. As with any workforce, anywhere, staff are more than just staff, they are people too, with lives and families, and needs of their own. Workplace pressures, issues with staff recruitment and retention, in meeting the very high levels of demand, working within an agenda of significant change and the residual impacts of the COVID pandemic all have a degree of impact on staff well-being. As part of our wider approach to wellbeing, we continue to have a focus on the wellbeing of staff within day-to-day practice and working arrangements, to manage and thrive. Our service continues to offer a wide range of staff wellbeing initiatives and supports, which helps meet many of the work-based challenges mentioned above. One of our key priorities in 2023/24 is
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88 to further embed a framework of well-being at work to ensure all staff have maximum opportunities to flourish, in turn being more equipped to support the people of North Lanarkshire to meet their outcomes. 6. LOOKING FORWARD – PRIORITIES FOR 2022-2023 AND BEYOND As highlighted in previous reports, several interrelated factors including COVID legacy issues, the cost-of-living crisis, the increased demand for social work interventions and support, the increased number of people who have complex needs and staffing challenges in health and social care, all mean that meeting demand within available resources will continue to prove difficult in the forthcoming year and beyond. Challenges in other parts of the public sector, such as the acute health services, can also reasonably be anticipated. However, within North Lanarkshire this is partially mitigated by a strong partnership ethos, and integrated working across Health and Social Care, the Education and Families Service and the wider Council and Partnership and we will also continue with our whole system approach to help meet these challenges. This includes the Empowering Cluster’s model within Education and Families, the 3 Conversations Model in Adult Services and our approach to whole family planning and support, a key part of the Council’s new Resilient People Programme of Work and the Health and Social Care Partnership’s Strategic Commissioning Plan. Equally, and both despite and because of, the challenges created by financial restrictions including those of the increasing reliance on short-term funding for transformational activity, we will continue efforts to develop and embed a more strategic approach to investing in prevention to support good lives and our balance of care. This is critical to preventing and mitigating greater need and also to longer term sustainability but will require ongoing facilitation at national as well as local level. Income maximization and tackling poverty continue to be key strands in the delivery of social work and social care in North Lanarkshire. These have become increasingly integrated into day-to-day practice and service delivery and have a strong fit with the core values of social work – promoting, independence, self-help, and self-reliance. The challenges faced by the people who require our support are significant. The close association across poverty, health inequalities and statutory interventions across all social work care groups and the disproportionate experience of poverty also impacting on unpaid carers mean that tackling poverty in all its forms will continue to be a priority for us. Workforce pressures and issues in social work and social care continue to need attention at both national and local level to reduce the risk to the delivery of statutory responsibilities to maintain the quality of care and support, and to ensure capacity. Measures set out in this
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89 report including most recently the re-evaluation of frontline social work posts should bring some benefit. Digital developments will continue to be essential and create opportunities for wider engagement. We have invested in an enhanced assistive technology team. Whilst technology can’t ever replace face to face human contact, it can play a vital role in offering virtual support, minimizing risk, maximizing independence, and reducing isolation. Our intention ensures that where appropriate, assistive technology is introduced at the right time, as a preventative or anticipatory support, rather than as a reactive measure. Our focus on building trauma informed systems and organisations continues, as well as to strengthen practice in this area. This will be fundamental in creating a healthy service which supports staff to deliver excellence for our communities. As intimated in last year’s report, the conclusion of a tender for a new social work case management system was anticipated to be completed early in 2022/23. This process has now concluded, and work is well under to migrate to the new MOSAIC system. Whilst this will require significant transitional work over the coming year it will ultimately more effectively support practice and will enhance performance management information. Work has also progressed towards the introduction of a dynamic scheduling system within Home Support. As highlighted in last year’s report, the context for the delivery of social work services will continue to be impacted by key national policy drivers including the Promise, the yet to be finalised incorporation of UNRC into Scots Law, the Vision and Strategic Priorities for Justice, and perhaps most significantly by the planning and legislative process for the proposed National Care Service which continues to have the potential to significantly change local integration and service delivery arrangements both in respect to Adult and Education and Family Services. Additionally wider and emerging demands on social work services include the National Transfer Scheme for Unaccompanied Asylum-Seeking Children and, with the resettlement support needs arising from the conflict in Ukraine. The overall scale of change, alongside the demand and workforce pressures for social work will continue to challenge capacity. Looking ahead there will be a need to maintain the benefits of local best practice and partnership working whilst progressing the system transformation required to address longstanding problems and to support outcomes. Continued strong leadership will be required to support staff and to balance pressures with core service delivery, and the associated risk to those we support, with the change and improvement capacity required for the scale of envisaged over the coming years.
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REPORT 1 Item No: 16 SUBJECT: NRS - Public Records (Scotland) Act (PRSA) TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie NL HSCP Chief Officer Author(s) of Report Ross McGuffie NL HSCP Chief Officer DATE: 27 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☐X 2. ROUTE TO THE BOARD This paper has been: Prepared By: The National Records of Scotland Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS The IJB committee acknowledge and note the report. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No x N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire Integration Joint Board (“IJB”) was established under the Public Bodies (Joint Working) (Scotland) Act 2014. The IJB was formally established on 1st April 2016. 5.2 The IJB is responsible for the planning and oversight of delivery of health and social care functions, delegated to it by NHS Lanarkshire & North Lanarkshire Council. Functions include Adult Social Work & Social Care Services, Community Health and Social Care Services for Children and Adults and some hospital services. The area covered by the IJB is coterminous with North Lanarkshire Council and is divided into six localities. 5.3 The IJB operates as a separate legal entity from NHS Lanarkshire and North Lanarkshire Council. The IJB is made up of eight voting members appointed in equal number by NHS Lanarkshire and North Lanarkshire Council, with a number of representative members drawn from other sectors, including the independent and third sectors, and to represent other stakeholders including staff, carers, service users and professional advisors as set out in the Public Bodies (Joint Working) (Scotland) Act 2014. 5.4 The Public Records (Scotland) Act 2011 (the Act) received Royal Assent on 20 April 2011. It is the first new public records legislation in Scotland since 1937 and came into force on 1 January 2013. Its primary aim is to promote efficient and accountable record keeping by named Scottish public authorities. 5.5 Under appendix 1 the letter acknowledges the boards progress and under appendix 2 the full report 6. CONCLUSIONS 6.1 This Report sets out the findings of the Public Records (Scotland) Act 2011 (the Act) Assessment Team’s consideration of the Progress Update template submitted for North Lanarkshire Integration Joint Board. The
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3 outcome of the assessment and relevant feedback can be found under sections 6 – 8. 6.2 The National Records of Scotland (NRS) have recognised the good work and progress made by the North Joint Integration Board around our records management to date. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐
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4 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No x N/A ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details □ Involve stakeholders in the development work aimed at achieving the national outcomes □ Provide stakeholders with information on how to get involved □ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs □ Measure how well we involve community stakeholders in the planning, design and delivery of our services □ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery □ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings
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5 □ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff □ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☐x EQIA added to website: Yes / Date added ☐ No x☐ N/A ☐ 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1Progress Update Review (PUR) Final Report: North Lanarkshire Integration Joint Board Letter Appendix 2Progress Update Review (PUR) Report by the PRSA Assessment Team Report
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6 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk
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6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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7 Appendix 1 HM General Register House Edinburgh EH1 3YY T: +44(0)131 535 1314 www.nrscotland.gov.uk Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board (Health & Social Care North Lanarkshire) Kirklands Hospital Fallside Road Bothwell G71 8BB 11th January 2024 Dear Mr. McGuffie, Progress Update Review (PUR) Final Report: North Lanarkshire Integration Joint Board Thank you for your authority’s submission of a Progress Update Review (PUR) for assessment and comment by the Public Records (Scotland) Act 2011 Assessment Team. We commend participation by authorities in undertaking, and reporting on, regular self- assessments and reviews of their records management arrangements. We anticipate that through uptake of the PUR tool, a stronger sense of collaboration and mutual support will be achieved between authorities and the Assessment Team. This will continue to enhance the culture of records management across Scotland’s public authorities. The Assessment Team has now evaluated the submission and consider that North Lanarkshire Integration Joint Board continues to take their statutory obligations seriously and are working to bring all the elements of their records management arrangements into full compliance with the Act and fulfil the Keeper’s expectations. I enclose the Assessment Team’s findings in the accompanying Report. We would welcome you publishing this Report as an indication of the good work and progress your authority is making in its record management arrangements and to aid
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8 colleagues by sharing good practice with other authorities. The National Records of Scotland will publish the Report on its website in due course. The PUR process is offered to all public authorities each year on the anniversary of the agreement of their Records Management Plan. North Lanarkshire Integration Joint Board can therefore expect to receive its next PUR invitation in February 2024. Yours sincerely, Iida Saarinen Public Records Officer Direct Email: iida.saarinen@nrscotland.gov.uk 6810920 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review R) - 2023 Final Report Letter - 11 January 2024
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1 A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 Appendix 2 The Public Records (Scotland) Act 2011 North Lanarkshire Integration Joint Board Progress Update Review (PUR) Report by the PRSA Assessment Team 11 th January 2024
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2 A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 Contents 1. The Public Records (Scotland) Act 2011………………………………………... 3 2. Progress Update Review (PUR) Mechanism…………………………………… 4 3. Executive Summary……………………………………………………………….. 5 4. Authority Background……………………………………………………………… 5 5. Assessment Process……………………………………………………………… 6 6. Records Management Plan Elements Checklist and PUR Assessment…….. 7-12 7. The Public Records (Scotland) Act Assessment Team’s Summary…………. 13 8. The Public Records (Scotland) Act Assessment Team’s Evaluation………… 14
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3 A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 1. Public Records (Scotland) Act 2011 The Public Records (Scotland) Act 2011 (the Act) received Royal Assent on 20 April 2011. It is the first new public records legislation in Scotland since 1937 and came into force on 1 January 2013. Its primary aim is to promote efficient and accountable record keeping by named Scottish public authorities. The Act has its origins in The Historical Abuse Systemic Review: Residential Schools and Children’s Homes in Scotland 1950-1995 (The Shaw Report) published in 2007. The Shaw Report recorded how its investigations were hampered by poor recordkeeping and found that thousands of records had been created, but were then lost due to an inadequate legislative framework and poor records management. Crucially, it demonstrated how former residents of children’s homes were denied access to information about their formative years. The Shaw Report demonstrated that management of records in all formats (paper and electronic) is not just a bureaucratic process, but central to good governance and should not be ignored. A follow-up review of public records legislation by the Keeper of the Records of Scotland (the Keeper) found further evidence of poor records management across the public sector. This resulted in the passage of the Act by the Scottish Parliament in March 2011. The Act requires a named authority to prepare and implement a records management plan (RMP) which must set out proper arrangements for the management of its records. A plan must clearly describe the way the authority cares for the records that it creates, in any format, whilst carrying out its business activities. The RMP must be agreed with the Keeper and regularly reviewed.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 4 2. Progress Update Review (PUR) Mechanism Under section 5(1) & (2) of the Act the Keeper may only require a review of an authority’s agreed RMP to be undertaken not earlier than five years after the date on which the authority’s RMP was last agreed. Regardless of whether an authority has successfully achieved its goals identified in its RMP or continues to work towards them, the minimum period of five years before the Keeper can require a review of a RMP does not allow for continuous progress to be captured and recognised. The success of the Act to date is attributable to a large degree to meaningful communication between the Keeper, the Assessment Team, and named public authorities. Consultation with Key Contacts has highlighted the desirability of a mechanism to facilitate regular, constructive dialogue between stakeholders and the Assessment Team. Many authorities have themselves recognised that such regular communication is necessary to keep their agreed plans up to date following inevitable organisational change. Following meetings between authorities and the Assessment Team, a reporting mechanism through which progress and local initiatives can be acknowledged and reviewed by the Assessment Team was proposed. Key Contacts have expressed the hope that through submission of regular updates, the momentum generated by the Act can continue to be sustained at all levels within authorities. The PUR self-assessment review mechanism was developed in collaboration with stakeholders and was formally announced in the Keeper’s Annual Report published on 12 August 2016. The completion of the PUR process enables authorities to be credited for the progress they are effecting and to receive constructive advice concerning on-going developments. Engaging with this mechanism will not only maintain the spirit of the Act by encouraging senior management to recognise the need for good records management practices, but will also help authorities comply with their statutory obligation under section 5(1)(a) of the Act to keep their RMP under review.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 5 3. Executive Summary This Report sets out the findings of the Public Records (Scotland) Act 2011 (the Act) Assessment Team’s consideration of the Progress Update template submitted for North Lanarkshire Integration Joint Board. The outcome of the assessment and relevant feedback can be found under sections 6 – 8. 4. Authority Background North Lanarkshire Integration Joint Board (“IJB”) was established under the Public Bodies (Joint Working) (Scotland) Act 2014. The IJB was formally established on 1st April 2016. The IJB is responsible for the planning and oversight of delivery of health and social care functions, delegated to it by NHS Lanarkshire & North Lanarkshire Council. Functions include Adult Social Work & Social Care Services, Community Health and Social Care Services for Children and Adults and some hospital services. The area covered by the IJB is coterminous with North Lanarkshire Council and is divided into six localities. The IJB operates as a separate legal entity from NHS Lanarkshire and North Lanarkshire Council. The IJB is made up of eight voting members appointed in equal number by NHS Lanarkshire and North Lanarkshire Council, with a number of representative members drawn from other sectors, including the independent and third sectors, and to represent other stakeholders including staff, carers, service users and professional advisors as set out in the Public Bodies (Joint Working) (Scotland) Act 2014. The key IJB functions are to: • Prepare a Strategic Commissioning Plan for integrated functions in accordance with national and local outcomes and integration principles; • Allocate the integrated budget in accordance with the this Plan; and • Oversee the delivery of services that are within the scope of the Partnership.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 6 5. Assessment Process A PUR submission is evaluated by the Act’s Assessment Team. The self-assessment process invites authorities to complete a template and send it to the Assessment Team one year after the date of agreement of its RMP and every year thereafter. The self-assessment template highlights where an authority’s plan achieved agreement on an improvement basis and invites updates under those ‘Amber’ elements. However, it also provides an opportunity for authorities not simply to report on progress against improvements, but to comment on any new initiatives, highlight innovations, or record changes to existing arrangements under those elements that had attracted an initial ‘Green’ score in their original RMP submission. The assessment report considers statements made by an authority under the elements of its agreed Plan that included improvement models. It reflects any changes and/or progress made towards achieving full compliance in those areas where agreement under improvement was made in the Keeper’s Assessment Report of their RMP. The PUR assessment report also considers statements of further progress made in elements already compliant under the Act. Engagement with the PUR mechanism for assessment cannot alter the Keeper’s Assessment Report of an authority’s agreed RMP or any RAG assessment within it. Instead the PUR Final Report records the Assessment Team’s evaluation of the submission and its opinion on the progress being made by the authority since agreeing its RMP. The team’s assessment provides an informal indication of what marking an authority could expect should it submit a revised RMP to the Keeper under the Act, although such assessment is made without prejudice to the Keeper’s right to adopt a different marking at that stage. Key: G The Assessment Team agrees this element of an authority’s plan. A The Assessment Team agrees this element of an authority’s progress update submission as an ‘improvement model’. This means that they are convinced of the authority’s commitment to closing a gap in provision. They will request that they are updated as work on this element progresses. R There is a serious gap in provision for this element with no clear explanation of how this will be addressed. The Assessment Team may choose to notify the Keeper on this basis.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 7 6. Progress Update Review (PUR) Template: North Lanarkshire Integration Joint Board Element Status of elements under agreed Plan 11FEB21 Status of evidence under agreed Plan 11FEB21 Progress review status 11JAN24 Keeper’s Report Comments on Authority’s Plan 11FEB21 Self-assessment Update as submitted by the Authority since 11FEB21 Progress Review Comment 11JAN24 1. Senior Officer G G G Update required on any change. No change. The Assessment Team understands that the Chief Officer, Mr McGuffie, continues to be the named individual senior staff member is identified as holding corporate responsibility for records management. Update required on any change. 2. Records Manager A G G The Keeper is aware that the NHS Lanarkshire records manager has recently retired and that [the Head of IM] has assumed some of his duties while a replacement is sought. With this in mind, the Keeper can agree that […] the Head of Information Management, is a suitable individual to be temporarily identified under this element. However, the Keeper’s agreement remains at amber (under improvement) until a records manager is in post or until the IJB can provide the Keeper with evidence that [the Head of IM] has the necessary skills, support and formal responsibility (such as annual objectives) to permanently undertake the role. Following a restructure, the Head of Information Management has now been appointed in the role of Head of Information and Records Management. She fulfils the role of Record Manager in respect of the Records Management Section 1(2)(a)(ii) of the Act specifically requires a RMP to identify the individual responsible for ensuring the authority complies with its plan. This person should be the Keeper’s initial point of contact (‘Key Contact’) for records management issues. It is noted that the former Head of IM is now formally Head of Information and
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 8 Plan for NHS Lanarkshire. Records Management. As a records manager is now in post, this Element has been turned Green to celebrate this progress. The Assessment Team thanks you for this update. North Lanarkshire IJB now has two records managers listed under Element 2, but it is noted the Ms Hughes should remain the IJB’s primary Key Contact. 3. Policy G G G Update required on any change. Both bodies continue to revise their policies on a regular basis. Thank you for confirming that North Lanarkshire IJB continues to revise its Records Management Policy on a regular basis. Update required on any future change. 4. Business Classification A G A In June 2017 the Keeper agreed this element of the North Lanarkshire Council Records Management Plan. However he did so under ‘Improvement Model’ terms. This means that he acknowledges that the Council had identified a gap in provision (the authority being in a state of transition between electronic records management solutions) and has put processes in place to close that gap. The Keeper’s agreement was conditional on his being updated on progress as the project develops. The Keeper confirms that the Council has been keeping the Keeper appropriately updated on No change to the process other than progress in BCS development as noted in the NLC PUR. Thank you for letting the Assessment Team know that there have been no major updates to Business Classification Arrangements, and that these remain under North Lanarkshire Council’s systems. This Element will remain at Amber while the Council continues to work on its
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 9 the transition project as required. The IJB Plan recognises that certain elements of the Council records management plan was agreed under improvement model terms (IJB Plan introduction page 3). The Keeper agrees this element of the North Lanarkshire Integration Joint Board’s Records Management Plan under the same ‘improvement model’ terms as its ‘host’ authority. business classification arrangements while it implements a change in its electronic records management system. The Team welcomes updates on any future change. 5. Retention Schedule G A G The Plan (page 8) refers to the approval of the council Information Management Working Group for the IJB records to be included. The Keeper requests sight of the minutes confirming this in the same way that he was provided with Council confirmation of the DPO under element 9. The Keeper agrees that North Lanarkshire Integration Joint Board has ensured that all their public records are managed against an operational retention schedule. However, the evidence column remains at amber until the Keeper can be supplied with minutes confirming the IMWG approval for the inclusion of IJB records. Minutes attached with this document. The Assessment Team thanks you for providing the IMGG minutes referred to in the original Agreement; these have been received with thanks. While the RMP Evidence status does not change, the Team is happy to indicate that North Lanarkshire IJB has now met the Keeper’s requirements under Element 5. 6. Destruction Arrangements A G A The Keeper agreed this element of North Lanarkshire Council’s Records Management Plan in June 2017. However, he did so under ‘improvement model’ terms. This means that he acknowledges that the authority has recognised a gap in provision (the systematic destruction of electronic records held on shared drives could be improved). He agrees that the authority has instigated processes to No change to the process other than progress in BCS development as noted in the NLC PUR. Thank you for letting the Assessment Team know that there are no major updates to this Element. While the Keeper noted that the systematic destruction of electronic records held on shared drives could be improved, it is clear that this
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 10 close that gap (migration to the new O365 solution). The Keeper’s agreement is conditional on him being updated as this project progresses (see element 4). The Council has satisfactorily updated the Keeper and the project remains ongoing. The IJB Plan recognises that some elements of their partner’s records management plans were agreed under improvement model terms (IJB Plan introduction page 3). Therefore, the Keeper can agree this element of the North Lanarkshire Integration Joint Board’s Records Management Plan under the same ‘improvement model’ terms as its ‘host’ authority. relies on changes in the systems in use at IJB’s partner organisations. This Element will remain at Amber while the Council continues to work on its systems’ record destruction capabilities. The Team welcomes updates on any future change. 7. Archiving and Transfer G G G Update required on any change. No change. Update required on any change. 8. Information Security G G G Update required on any change. No change. Update required on any change. 9. Data Protection A G G The Keeper would expect North Lanarkshire IJB, as Data Controller, to publish a privacy notice on its website. The Plan suggests this may be on its way - it states (page 12) “The NLC data protection page provides a link to the mailbox of the Data Protection Officer in respect of Subject Access Requests …The NLC Privacy statement is also available on the this page. Work is currently underway in refining documents that are more specific to the IJB.” The Keeper agrees that, once developed and approved, an IJB specific Privacy Policy, explaining public rights under DPA2018, The IJB has developed and approved a privacy notice and published this on their website Privacy and cookies | Health and Social Care North Lanarkshire (hscnl.org.uk). As part of their commitment to Thank you for providing the Assessment Team with the linked Privacy Notice, available on the IJB’s website. It is positive to know that this will have been reviewed and updated by the time this PUR has been finalised. This Element can now be
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 11 should be appropriate to comply with data protection expectations if it is made available from the IJB website pages. The Keeper agrees this element of the North Lanarkshire Integration Joint Board Records Management Plan under ‘improvement model’ terms. This means that the authority is working towards full compliance and has provided evidence of this (a statement around a bespoke IJB privacy statement). The Keeper’s agreement is conditional on his being updated as this work progresses. The Keeper will provide the IJB with the opportunity to submit a Progress Update Review a year after agreement. He would expect the Privacy Policy to be in place by that time. ongoing improvement this notice is currently under review and the revised notice will be approved by the IJB in September. turned Green for the PURs to celebrate the progress made. If this was a formal resubmission, it is likely that this Element would receive a Green status. 10. Business Continuity and Vital Records A G A In June 2017 the Keeper agreed this element of the North Lanarkshire Council Records Management Plan. However he did so under ‘Improvement Model’ terms. This means that he acknowledges that the Council had identified a gap in provision. This was around the identification and prioritisation of vital records. The Keeper notes that the IJB have determined that all their public records are vital, but the recovery processes remain those of the Council. The Keeper’s agreement with the Council was conditional on his being updated on progress as the project develops. The Keeper confirms that the Council has been keeping the Keeper appropriately updated as required. The IJB Plan recognises that certain elements of the Council records management plan was agreed under improvement model terms (IJB Plan introduction page 3). No change to the process other than progress in BCS development as noted in the NLC PUR. Element 10 stipulates that Record recovery – prioritising vital records – is an integral part of the authority’s business continuity planning, and that those arrangements should include the recovery of records made temporarily unavailable due to an unexpected event. Thank you for letting us know that there have been no major changes to this Element. This Element will remain at Amber while the partner authority, North Lanarkshire Council, continues to work on
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 12 The Keeper agrees this element of the North Lanarkshire Integration Joint Board’s Records Management Plan under the same ‘improvement model’ terms as its ‘host’ authority. its business continuity arrangements. The Team welcomes updates on any future change. 11. Audit Trail A G A In June 2017 the Keeper agreed this element of the North Lanarkshire Council Records Management Plan. However he did so under ‘Improvement Model’ terms. This means that he acknowledges that the Council had identified a gap in provision and had put processes in place to close that gap. The IJB Plan recognises that partner records management plans were agreed under improvement model terms (IJB Plan introduction page 3). The Keeper can agree this element of the North Lanarkshire Integration Joint Board’s Records Management Plan under the same ‘improvement model’ terms as its ‘host’ authority. No change to the process other than progress in BCS development as noted in the NLC PUR. Thank you for letting the Assessment Team know that there are no major updates to this Element. This Element will remain at Amber while the Council continues to work on its systems’ audit trail capabilities. The Team welcomes updates on any future change. 12. Competency Framework G G G Update required on any change. No change. Update required on any change. 13. Assessment and Review G G G Update required on any change. No change. Update required on any change. 14. Shared Information G G G Update required on any change. No change. Update required on any change.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 13 7. The Public Records (Scotland) Act Assessment Team’s Summary Version The progress update submission which has been assessed is the one received by the Assessment Team on 13th July 2023. The progress update was submitted by Fiona Hughes, Records Manager. The progress update submission makes it clear that it is a submission for North Lanarkshire Integration Joint Board. The Assessment Team has reviewed North Lanarkshire Integration Joint Board’s Progress Update submission and agrees that the proper record management arrangements outlined by the various elements in the authority’s plan continue to be properly considered. The Assessment Team commends this authority’s efforts to keep its Records Management Plan under review. General Comments North Lanarkshire Integration Joint Board continues to take its records management obligations seriously and is working to bring all elements into full compliance. Section 5(2) of the Public Records (Scotland) Act 2011 provides the Keeper of the Records of Scotland (the Keeper) with authority to revisit an agreed plan only after five years has elapsed since the date of agreement. Section 5(6) allows authorities to revise their agreed plan at any time and resubmit this for the Keeper’s agreement. The Act does not require authorities to provide regular updates against progress. The Keeper, however, encourages such updates. The Keeper cannot change the status of elements formally agreed under a voluntary submission, but he can use such submissions to indicate how he might now regard this status should the authority choose to resubmit its plan under section (5)(6) of the Act.
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A46803649 - NRS - Public Records (Scotland) Act (PRSA) - Integration Joint Board North Lanarkshire - Progress Update Review (PUR) - 2023 Final Report - 11 January 2024 14 8. The Public Records (Scotland) Act Assessment Team’s Evaluation Based on the progress update assessment the Assessment Team considers that North Lanarkshire Integration Joint Board continue to take their statutory obligations seriously and are working hard to bring all the elements of their records management arrangements into full compliance with the Act and fulfil the Keeper’s expectations. The Assessment Team recommends authorities consider publishing PUR assessment reports on their websites as an example of continued good practice both within individual authorities and across the sector. This report follows the Public Records (Scotland) Act Assessment Team’s review carried out by Iida Saarinen Public Records Officer
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1 REPORT Item No: 17 SUBJECT: Reporting duties for local authorities and integration under Health and Care (Staffing) (Scotland) Act 2019 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie NL HSCP Chief Officer Author(s) of Report Stacey Anderson Support Services Project Manager DATE: 27 March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Stacey Anderson, Support Services Project Manager
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2 3. RECOMMENDATIONS To note the content of the report and be advised of the reporting duties for local authorities and integration authorities under Health and Care (Staffing) (Scotland) Act 2019. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Reporting duties for local authorities and integration authorities under Health and Care (Staffing) (Scotland) Act 2019 applies to the provision of adult services, children and young people’s services and early learning and childcare services. 5.2 Reporting duties apply to all sectors where local authorities and integration authorities plan or secure service from another person under contract, agreement, or other arrangements. This includes funded providers. 5.3 Part one, section 3 of the Act makes provision for local authorities and integration authorities to publish annual information on the steps they have taken to comply with the requirements when planning or securing a care service. 5.4 The Scottish Government HCSSA Implementation Team intend to liaise with the ministerial teams who have responsibility for children, young people, and justice services regarding these new duties. 6. CONCLUSIONS 6.1 To support reporting, the Scottish Government have devised a template which consists of two questions. Ministers may review or revise these questions after enactment on 1 April 2024. You will find these below: 1) Please detail the steps you have taken as an organisation to comply with section 3(2) of the Health and Care (Staffing) (Scotland) Act 2019 2) Please detail any ongoing risks that may affect your ability to comply with the duty set out in section 3(2). Yes ☐ No ☒ N/A ☐
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3 6.2 The attached HCSA Q2 Reporting Template details the most recent update report to Scottish Government from a North Lanarkshire Health and Social Care Partnership Nursing perspective. This template and submission has been used as part of a pilot to test the quarterly return report prior to enactment. 6.3 Once the official template and report guidance has been issued, a further report will be shared with the IJB. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership
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5 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Health and Care (Staffing) (Scotland) Act 2019 (legislation.gov.uk) 9. APPENDICES Please include a glossary of terms if not already included. 9.1 Appendix 1- HCSA – Q2 Reporting Template CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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7 Appendix 1 1 2 3 4 Summary report Please answer the questions below, to provide an overall assessment of how the organisation has carried out its duties under section 2 of the 2019 Act, and sections 12IA, 12IC, 12ID, 12IE, 12IF, 12IH, 12II, 12IJ and 12IL of the 1978 Act (inserted by section 4 of the 2019 Act). Please advise how the information provided in this report has been used or will be used to inform workforce plans. Please summarise any key achievements and outcomes as a consequence of carrying out the duties and requirements in the Act. For the quarterly returns this will be key acheivements and outcomes in preparation for compliance. Please also detail the objectives for the next quarter. Please summarise any key learning and risks identified as a consequence of carrying out the duties and requirements in the Act. For the quarterly returns this will be key learning and risks identified in preparation for compliance. Reasonable Assurance Please indicate the overall level of assurance of the organisation's compliance with the Act, reflecting the report submitted. For the quarterly returns this will be overall level of assurance of the organisation's preparedness for enactment in April 2024. The information contained in this workplan has been used to identify outstanding work to hep us prepare for implementation of the act and we now have a action plan which we are monitoring closley. Training has been undertaken with all senior leaders in the organisation to senior charge nurse/ team leader level on safe staffing legislation and also safe rostering. Staff feedback from both these sessions have been extremely positive. Challenges in running tools within integrated tools where full staffing and skill mix is not included. It is not clear how useful this information will be in workforce planning. If staff don’t see the direct link there is concern that participation in tool runs will dip.
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8 1 Guiding principles for health and care staffing 2 Guiding principles etc. in health and care staffing and planning Guidance chapter link Section Status 12IA(1) Green 12IA(2)(a) Green 12IA(2)(b) Green 12IA(2)(c) Green 12IA(2)(d) Green 12IA(2)(e) Green 2(1) Green N/A Green These are steps taken to comply with 12IA in general. Examples could include information about workforce planning, national and international recruitment, retention, retire and return, service redesign, innovation, staff wellbeing, policies around supplementary staffing, This should include, but not be limited to data in relation to patient safety and quality of care measures and outcomes, patient feedback and adverse event reporting. These systems and processes include having regard to the local context in which it is being provided These systems and processes include having regard to the number of patients being provided it These systems and processes include having regard to the nature of the particular kind of health care provision 12IA Duty to ensure appropriate staffing RAG status Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups to ensure that at all times suitably qualified and competent individuals, from such a range of professional disciplines as necessary (see guidance for details of professional disciplines included within the Act) are working in such numbers as are appropriate for the health, wellbeing and safety of patients; the provision of safe and high- quality health care; and in so far as it affects either of those matters, the wellbeing of staff. These systems and processes include having regard to the guiding principles when carrying out the duty imposed by section 12IA Please provide information on how these systems and processes, and their application, have improved outcomes for service users Please provide information on the steps taken to comply with section 12IA. Comment There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include having regard to appropriate clinical advice Processes are in place to provide assurance that appropriate staffing is in place and that guiding principles are taken into account when decisions relating to staffing requirements are made. Processes are in place to provide assurance that where risk exists that appropriate mitigation is in place. Processes are in place to enable staff to comment on staffing levels and for staff to be informed of decisions relating to staffing. Processes are in place to provide assurance that where a Health Board or Integration Authority are commissioning Health Services from another provider that the provider complies with the general duty and principles of this Act and to record any challenges faced. The PRAG tool has provided evidence of high risk areas that has allowed us to focus recruitemnt drives and also to support use of supplementary staffing due to the risk. This has resulted in safer enviroments for our patients and staff These systems and processes include having regard to the needs of patients being provided it
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9 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Local Real Time Staffing Assessment Tool developed in line with national resources and completed at start of each shift on a daily basis. Trend data Risk Register PRAG reports Action Plans Clinical and Staff Governance Groups Team Meetings 1:1 in place for all staff to provide opportunity for feedback and discussion. Trend data, iMatter Surveys, Action Plans Governance Groups Minutes Workload Tool reports This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, application of eRostering has allowed senior personnel to be able to see staffing in real-time across all areas, allowing staff to be reallocated as required to reduce level or risk. This should describe how the success, achievement or learning could be used in the future. Continue the roll out of eRostering across the organisation, using learning from areas that have already implemented. Workforce tools including PJ and workforce reviews carried out annually which will take congnisance of guiding principles and duties within the legislation. Reporting Template developed in line with CSM. Dashboards developed locally to provide current and trend workforce data. Staff and Patient Expeience Survey, Complaints, Imatter, Datix, EIC Dashboard Reporting template developed in line with the Common Staffing Method to complete local context/triangulation process for all worklaod tool results/outcomes. These will be presented via Clinical and Staff Governance Groups. SG Progress Reports, Rosters, Workforce Plans, AOP. orforce tools/PRAG by Senior Nurses/Service Managers and associated actions. Leadership walkrounds Reasonable Assurance Full engagement and completion of PRAG over 7 day period. Real Time Staffing Assessment tool. Post mitigation risks must be completed at all times. Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, there may be difficulty with recruiting a particular staff speciality or in a remote / rural location. Attendance and engagement at Workforce Governance Groups, Safety Huddles, Team Meetings.Sharing of information and feedback to and from teams. Understanding and application of Workload Tools Reportign/Review, PRAG Daily Safe Staffing Assessment Tool Limited staff engagement around staffing levels and associated decisions related to staffing Area of escalation / challenge / risk Integrated working groups - no workload tools or real time staffing assessments in place currently. Poor data quality dependent on staff engagament in prep/planning/housekeeping/training and data capture. Specialty Specific Workload and Workforce Planning Tools do not exist for some clincial areas, especially those with integrated services - Scoping excercise to be completed for these areas re PJ only Tool. Availabilty of workforce is a national challenge Tool is not completed or not completed accurately. Staff understanding of tool and how to use in practice Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Action This should describe what actions have been / are being / will be taken to address the situation. For example, if there is difficulty in recruiting in a particular speciality or remote / rural location, the relevant organisation may have investigated retire and return schemes or upskilling and career development for existing staff. It may also have looked at how the service could be redesigned. Apply local context where appropriate. Develop worklaod tools nationally that are fit for purpose. Oversight Group will monitor risks re preparedness and complaince with legislation. Review absence management processes and return to work support. Review of blueprints and funded establishment using workload and workforce planning tool outcomes/triangulation and RTS resources as evidence. Encourage engagement and completion of Real Time Staffing Assessments daily especially post mitigation. Review risk registers. Develop national annual risk assessment process for reporting. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Further action
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10 Guidance chapter link Section Status 12IC(1) Yellow 12IC(2)(a) Green 12IC(2)(b) Green 12IC(2)(c) Yellow 12IC(2)(d) Green 12IC(2)(e) Yellow 12IC(2)(f) Yellow 12IC(2)(g) Yellow N/A Green 12IC Duty to have real-time staffing assessment in place RAG status Item These systems and processes include means for encouraging and enabling all staff to use the systems and processes available for identifying and notifying risk to the individual with lead professional responsibility. These systems and processes include the means to provide training to relevant individuals with lead professional responsibility on how to implement the arrangements in place to comply with this duty. Clearly defined systems and processes are in place, and utilised, for the real-time assessment of compliance with the duty to ensure appropriate staffing, in all NHS functions and professional groups. These systems and processes include means for ensuring that individuals with lead professional responsibility receive adequate time and resources to implement those systems and processes. There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include the means for any member of staff to identify any risk caused by staffing levels to the health, well-being and safety of patients; the provision of safe and high-quality health care; or, in so far it affects either of those matters, the wellbeing of staff. These systems and processes include the means for the initial notificaiton / reporting of that risk to the relevant individual with lead professional responsibility. These systems and processes include the means for mitigation of risk, so far as possible, by the relevant individual with lead professional responsibility, and for that individual to seek, and have regard to, appropriate clinical advice as necessary. These systems and processes include means for raising awareness among all staff of the methods for identifying risk, reporting to the individual with lead professional responsibility , mitigation, and seeking and having regard to clinical advice. Comment PRAG tool is available but still issues with staff completion compliance Mitigation of risk is taking place but not always recirded as well as could be ongoing staff training with the tools ongoing staff training with the tools system pressures are impacting on lead nurses ability to monitor as closely as we would like and to keep records up to date 24/7 discussed at every nursing workforce meeting and compliance monitored. Areas for improvement identified
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11 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Real Time SResources beign carried out daily withn most clinical settings. Allows for overview of risks by ward/team/division/locality/site etc. Trend data, risk registers, patient/staff experience surveys, EIC quality measures. Action Plans Clinical and Staff Governance Groups Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, areas that have implemented and are using SafeCare are finding it easy to be able to record risks that are identified and the mitigation measures implemented and clinical advice received. Reports extracted from the system are demonstrating an auditable trail of decision-making. This should describe how the success, achievement or learning could be used in the future. This success is being used to demonstrate to other areas the benefits of using SafeCare and supporting its implementation. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. This should describe the situation: what is the challenge or risk identified? For example, there may be difficulty with encouraging and enabling certain professional groups to use the systems and processes. Data is not completed or updated on a daily basis, especially post mitigation. This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. Accurate and consistent completion of PRAG Daily Safe Staffing Assessment Tool currently hosted on excel platform and PJ used for metric to calculate staffing levels in relation to patient dependency. Reasonable Assurance Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Area of escalation / Challenge / Risk Details Action This should describe what actions have been / are being / will be taken to address the situation. For example, if there is difficulty in engaging certain professional groups, what measures have been put in place with regard to increasing this such as using professional networks, staff representatives etc. Review of risks an escalation plans enacted as appropriate.
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12 Guidance chapter link Section Status 12ID(1) Yellow 12ID(2)(a) Yellow 12ID(2)(b) Green 12ID(2)(c) Yellow 12ID(2)(d) Yellow 12ID(2)(e) Yellow 12ID(2)(f) Green 12ID(2)(g) Yellow 12ID(2)(h) Yellow 12ID(2)(i) Yellow 12ID(2)(j) Yellow N/A Green Areas of success, achievement or learning There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) Please provide details of areas of success, achievement or learning associated with carrying out the requirements. These systems and processes include means for ensuring that individuals with lead professional responsibility and other senior decision-makers receive adequate time and resources to implement the arrangements. These systems and processes include the means to provide training to relevant individuals with lead professional responsibility and other senior decision-makers on how to implement the arrangements in place to comply with this duty. These systems and processes include means for raising awareness amongst all staff of the arrangements stated in (a) to (g) above. 12ID Duty to have risk escalation process in place Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, for the escalation of any risk identified through the real-time staffing assessment processes which has not been possible to mitigate. These systems and processes include the means for the lead with professional responsibility to report the risk to a more senior decision-maker. These systems and processes include the means for that senior decision-maker to seek, and have regard to, appropriate clinical advice, as necessary, when reaching a decision on a risk, including on how to mitigate it. These systems and processes include the means for the onward reporting of a risk to a more senior decision-maker in turn, and for that decision-maker to seek, and have regard to, appropriate clinical advice as necessary, when reaching a decision on a risk, including on how to mitigate it. These systems and processes include means for this onward reporting in (c) to escalate further, as necessary, in order to reach a final decision on a risk, including, as appropriate, reporting to members of the relevant organisation. These systems and processes include means for notification of every decision made following the initial report, and the reasons for that decision, to anyone involved in identifying the risk, attempting to mitigate the risk, escalation of the risk and providing clinical advice. These systems and processes include means for anyone involved in identifying the risk, attempting to mitigate the risk, escalation of the risk and providing clinical advice to record any disagreement with any decision made following the initial identification of a risk. These systems and processes include means for anyone involved in identifying the risk, attempting to mitigate the risk, escalation of the risk and providing clinical advice to request a review of the final decision made on an identified risk (except where that decision is made by members of the relevant organisation). compliance monitored via PRAG Comment documentation of mitigating actions being impacted by system pressures needs built into escalation SOP Escalation SOP in development. Local agreement that any risks that cant be mitigated to Red to be escalated to associate nurse director and any purple risks to be escalated to nurse director. Escalation is not happening consistently as above as above as above
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13 Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Risk Register, Action Plan, Workforce Plan, Legislation requirements Development of board wide NMAHP risk esclation Process/SOP is currentlyunderway Trend data - review of risks before and after mitigation Risk Register, Action Plan, Workforce Plan, Legislation requirements Development of board wide NMAHP risk esclation Process/SOP is currentlyunderway Risk Register, iMatter, Huddles, 1:1 meetings Workload Tool reports, Action Plan, Workforce Plan Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, senior decision-makers in paediatric nursing were identified and chain of escalation communicated to all personnel. Individuals are now much better aware of who to contact during any particular shift in the event that a risk needs to be escalated. This should describe how the success, achievement or learning could be used in the future. The procedures for identifying the chain of escalation that were used in paediatric nursing are now be trialled and rolled out across other areas. Evidence of escalation details facilitated within PRAG Daily Safe Staffing Assessment Tool Trend data, Risk Register, Action Plans Action Plans, workforce reports Risk Register stil to be developed incorporating details of further mitigation/actions/feedback etc. Awareness of mitigation and actions Reasonable Assurance Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, there may be difficulty with ensuring relevant individuals involved in reporting, mitigating, escalating or giving clinical advice on a risk are notified of decisions made the reasons for them. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Area of success / achievement / learning Details Development of board wide NMAHP risk esclation Process/SOP is currentlyunderway Trend data - review of risks before and after mitigation Briefings, Team Meetings, one to ones, Huddles Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Action This should describe what actions have been / are being / will be taken to address the situation. For example, if there is difficulty in notifying relevant individuals about decisions made and the reasons for them, what measures have been put in place to ensure this happens, such as providing training, increasing awareness and auditing to identify root causes. Escalation plans enacted. Staff supported Team Briefs, Workforce Governance Meetings, Escalation plans Action logs, briefing logs Maintance of proportionate risk escalation due to the impact of COVID 19 and continued staffing challenges nationally Risks are not identified or managed. Availabillity of staff to mitigage risk Development of board wide NMAHP risk esclation Process/SOP is currentlyunderway Risks are not identified or managed. Availabillity of staff to mitigage risk Risk Register stil to be developed incorporating details of further mitigation/actions/feedback etc. Decision making around risk is not fully evidenced and understood
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14 12IE Duty to have arrangements to address severe and recurrent risks Guidance chapter link Section Status 12IE(1)(a) Green 12IE(1)(b) Green 12IE(2)(a) Green 12IE(2)(b) Green 12IE(2)(c) Green 12IE(2)(d) Green N/A GreenThere is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include means for identification of actions to prevent the future materialisation of such risks, so far as possible. Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, for the collation of information relating to every risk escalated to such a level as the relevant organisation considers appropriate. Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, to identify and address risks that are considered severe and / or liable to materialise frequently. These systems and processes include the means for recording risks that are considered severe and / or liable to materialise frequently. These systems and processes include the means for reporting of a risk considered severe and / or liable to materialise frequently, as necessary, to a more senior decision-maker, including to members of the relevant organisation as appropriate These systems and processes include means for mitigation of any risk considered severe and / or liable to materialise frequently, so far as possible, along with a requirement to seek and have regard to appropriate clinical advice in carrying out such mitigation. Comment
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15 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Workforce Governance, Dashboard Workforce Tool Run Reports, new staffing models for services, role development, escalation plans Risk Registers Workforce Plans, Annual workforce reports Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, a recurrent risk was identified in the capacity of one laboratory, leading to a delay in testing samples and communicating sample results. Following investigation, the process for booking in samples was streamlined and an admin coordinator was appointed. This has improved performance and the lab is now meeting its targets. This should describe how the success, achievement or learning could be used in the future. For example, the organisation is now looking at whether the changes implemented in the one lab could be applied to other labs, to improve performance across the division. Safety Briefs and Workforce meetings to review risks. Datix reports reviewed at Unit Governance Groups Risk Register, Datix Reports, Unit Workforce Reports Workforce Governance Groups, Workforce Action Plans, Dashboard Monitoring process of current risks and issues Monitoring process of current risks and issues Monitoring process, ongoing review of service Staff engagement to complete PRAG tool and complete datix for recurring risks Accurate completion of PRAG tool and risk severity is not clearly identified. Ongoing review of metrics Consitency of approach, availability of staff, recruitment challenges Wider awareness of risk and escalation Consitency of communication of risk and mitigation Move to untested staffing models, accuracy of data/information Substantial Assurance Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, collation of data in a particular NHS function has identified a risk that materialises frequently, however identification of actions to prevent future materialisation has not improved the situation. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details PRAG tool in place and reviewed. Local meetings and Workforce Governance to escalate risks Trend Data, risk register, Datix an Workforce Reports Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Action This should describe what actions have been / are being / will be taken to address the situation. For example, if identification of actions to prevent a frequent risk has not improved the situation, measures to address could have included establishing a working group to investigate and make recommendations, observing practice in the area, interviewing staff, addressing the staff skills mix, allocating additional assistance, redesigning the service etc.
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16 12IF Duty to seek clinical advice on staffing Guidance chapter link Section Status 12IF(1) Green 12IF(2)(a) (i) and (ii) Green 12IF(2)(a) (iii) and (iv) Green 12IF(2)(b) Green 12IF(2)(c) Green 12IF(2)(d) Green 12IF(2)(e) Green 12IF(3) Green N/A GreenThere is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include the means to raise awareness among individuals with lead clinical professional responsibility for a particular type of health care in how to implement the arrangements in this duty. These systems and processes include means for ensuring that individuals with lead clinical professional responsibility for a particular type of health care receive adequate time and resources to implement the arrangements. These systems and processes include means for the relevant organisation to have regard to the reports received. These systems and processes include the means for individuals with lead clinical professional responsibility for a particular type of health care to report to the members of the relevant organisation on at least a quarterly basis about the extent to which they consider the relevant organisation is complying with the duties in 12IA to 12IF and 12IH to 12IL. These systems and processes include the means for individuals with lead clinical professional responsibility for a particular type of health care to enable and encourage other employees to give views on the operation of section 12IF and to record those views in the reports to the members of the relevant organisation. These systems and processes include the means whereby if a relevant organisation makes a decision which conflicts with clinical advice received, any person who provided clinical advice on the matter is notified of the decision and the reasons for it and this person is able to record any disagreement with the decision made. Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, to seek and have regard to appropriate clinical advice in making decisions and putting in place arrangements relating to staffing under sections 12IA to 12IE and 12IH to 12IL and to record and explain decisions which conflict with that advice. These systems and processes include the means whereby if a relevant organisation makes a decision which conflicts with clinical advice received, any risks caused by that decision are identified and mitigated so far as possible. Comment
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17 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, the views of employees included in the reports prepared by individuals with lead clinical professional responsibility for a particular type of health care identified a potential improvement in working practices in one area. This should describe how the success, achievement or learning could be used in the future. For example, the potential improvement is being trialled in the one area and if successful will be rolled out across other areas in the organisation. Testing of Guidance Chapter was undertaken allowing for understanding of this duty and any gaps in process - swot analysis completed and fedback Substantial Assurance Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, in compiling the reports made to the members of the Health Board, there is are good mechanisms in place for the Medical Director to enable and encourage medical employees to give their views, but the mechanisms for seeking the views of other professional groups for which they are responsible, such as pharmacy employees, are not well established. Hence, the views of these employees are not being sought or incorporated into the reports. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Action This should describe what actions have been / are being / will be taken to address the situation. For example, if the views of all professional groups are not being sought, what measures have been put in place to engage these groups and proactively seek out their opinions.
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18 12IH Duty to ensure adequate time given to clinical leaders Guidance chapter link Section Status 12IH Yellow 12IH Yellow 12IH Green 12IH Green 12IH Green 12IH Yellow N/A GreenThere is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include the means to consider outputs from activities carried out to meet this duty in order to inform future workforce planning and protect the leadership time required for clinical leaders. Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, to ensure that all individuals with lead clinical professional responsibility for a team of staff receive sufficient time and resources to discharge that responsibility and their other professional duties. These systems and processes include the means to identify all roles, and therefore individuals, with lead clinical professional responsibility for a team of staff. These systems and processes include the means to determine what constitutes sufficient time and resources for any particular individual. These systems and processes include time and resources for these individuals to supervise the meeting of the clinical needs of patients in their care; to manage, and support the development of, the staff for whom they are responsible; and to lead the delivery of safe, high-quality and person-centred health care. These systems and processes include the means for ensuring this duty has been reviewed and considered within the context of job descriptions, job planning and work plans, as appropriate. Comment system pressures are impacting on capacity system pressures have resulted in SCN/ TL having to work clinically during protected time Evidence can be limited but work underway to strengthen via clinical supervision and care assurance
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19 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Team Leaders have protected time for leadership Workforce reports to identify trends. imatter Pyschological safety questionnaires. Workforce reports Review compliance of management of LTSand RTW across HSCP Progress of Assurance priorities Staff feedback via imatter, Psychological safety Team Leaders have protected time for leadership. Development sessions for Team Leaders and for teams Staff feedback Psycholgical safety reports Staff engagement Progress of Assurance priorities Staff feedback via imatter, Psychological safety Development session for Team Leaders. Clinical supervision & Assurance framework Staff feedback Psycholgical safety reports Staff engagement Progress of Assurance priorities Staff feedback via imatter, Psychological safety Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Reasonable Assurance Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, the process in place to identify the roles, and therefore indivduals, with lead clinical professional responsibility for a team of staff does not consistently identify who these individulas are, and therefore sufficient time and resources for these individuals to discharge their responsibilities has not been considered. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Team Leaders have protected time for leadership. Clinical Supervision & Assurance work Workforce reports. Ongoing assurance reports. Staff feedback This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, senior physiotherapists and team leaders convened a working group to determine what sufficient time and resources would look like for individuals with lead clinical professional responsibility for a team of staff. The outcome of the project was a determination of time and resources for different team leaders and feedback so far has been positive. Action This should describe what actions have been / are being / will be taken to address the situation. For example, if the process in place to identify the roles, and therefore individuals, does not consistently identify who those indivduals are, what measures have been taken to address this, e.g. working with all staff groups / clinical areas / teams to identify job titles / roles, utilising HR processes and data, utilising eRostering to identify team leaders etc. Further action This should describe how the success, achievement or learning could be used in the future. This has now been extended to other AHP areas and trialled to see applicability.
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20 12II Duty to ensure appropriate staffing: training of staff Guidance chapter link Section Status Comment 12II Green 12II Green 12II Green 12II Green N/A Green Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups, to ensure that all employees receive such training as considered appropriate and relevant for the purposes set out in section 12IA(1)(a) and (b) and such time and resources as considered adequate to undertake this training. These systems and processes include means to determine the level of training required, and time and resource to support this, for all relevant employees. These systems and processes include the means to deliver the agreed level of training to all relevant employees. These systems and processes include the means to ensure all relevant employees receive both time and resources to undertake the training. There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met)
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21 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, the psychology division, in conjuction with HR, has just completed a project to promote more accurate capturing of information relating to continued professional development for psychology colleagues. Feedback from employees is that they have found the new system much easier to use and are now recording relevant CPD. This should describe how the success, achievement or learning could be used in the future. AHP colleagues have now expressed interest in the new system and are undertaking a project to see if they could implement something similar. Protected time for compulsory/mandatory training Learnpro Score card to review compliance of training. Pychological safety results , I Matter Progress of Assurance priorities Staff feedback via imatter, Psychological safety Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Substantial Assurance Area of escalation / Challenge / Risk Details Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Action This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, clearly defined processes and procedures exist for some groups of staff, e.g. nursing and midwifery, but don't exist for other groups of staff, e.g. healthcare scientists. This should describe what actions have been / are being / will be taken to address the situation. For example, if procedures and processes are not in place for healthcare scientists, what measures need to be put in place to ensure this, such as working with HR and healthcare scientist representatives to define an appropriate training programme, assess training needs of employees and plan for required training to be undertaken.
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22 12IJ Duty to follow the common staffing method (*The relevant organisation must only report on the types of health care, location and employees as detailed in section 12IK) Guidance chapter link Section Status 12IJ(1) Yellow 12IJ(2)(a) Green 12IJ(2)(b) Yellow 12IJ(2)(c)(i) Green 12IJ(2)(c)(ii) Green 12IJ(2)(c)(iii) Green 12IJ(2)(c)(iv) Green 12IJ(2)(c)(v) Green 12IJ(2)(c)(vi) Green 12IJ(2)(c)(vii) Green 12IJ(2)(c)(viii) Green 12IJ(2)(c)(ix) Green 12IJ(2)(c)(x) Green 12IJ(2)(c)(xi) Green 12IJ(2)(d) Green 12IJ(2)(e) Green N/A Green These systems and processes include means to decide what changes (if any) are needed to the staffing establishment and the way in which health care is provided as a result of following the common staffing method. These systems and processes include taking into account appropriate clinical advice. These systems and processes include taking into account any assessment by HIS, and any relevant assessment by any other person, of the quality of health care provided. These systems and processes include taking into account experience gained from using the real-time staffing and risk escalation arrangements under 12IC, 12ID and 12IE. These systems and processes include taking into account comments by patients and individuals who have a personal interest in their health care, which relate to the duty imposed by section 12IA. These systems and processes include taking into account comments by employees relating to the duty imposed by section 12IA. These systems and processes include means to identify and take all reasonable steps to mitigate any risks. There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met) These systems and processes include taking into account patient needs. Item Clearly defined systems and processes are in place, and utilised, in all the types of health care, locations and employees listed in section 12IK, to follow the common staffing method no less often than the frequency prescribed in Regulations. These systems and processes include use of the relevant speciality specific staffing level tool and professional judgement tool as prescribed in Regulations, and taking into account results from those tools. These systems and processes include taking into account relevant measures for monitoring and improving the quality of health care which are published as standards and outcomes under section 10H(1) of the 1978 Act by the Scottish Ministers (including any measures developed as part of a national care assurance framework). These systems and processes include taking into account current staffing levels and any vacancies These systems and processes include taking into account the different skills and levels of experience of employees These systems and processes include taking into account the role and professional duties of individuals with lead clinical professional responsibility for the particular type of health care. These systems and processes include taking into account the effect that decisions about staffing and the use of resources taken for the particular type of health care may have on the provision of other types of health care (particularly those to which the common staffing method does not apply). These systems and processes include taking into account the local context in which health care is provided. Comment tools are being run as outlined but quality of completed tools is variable. As tools become more familiar it is hoped that accuracy of completion will improve. Care assurance work has commenced and ongoing. utilise care opinion and patient complaints but no direct involvement
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23 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Testing of Guidance Chapter was undertaken allowing for understanding of this duty and any gaps in process - SWOT analysis completed and fedback Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, application of the common staffing method in adult inpatient provision identified some areas where the staffing establishment needed to be changed and some areas with potential for service redesign. These changes are now in progression and will be trialled to monitor the outcomes. This should describe how the success, achievement or learning could be used in the future. For example, following completion of the trials regarding changes in staffing establishment and service redesign, decisions will be taken as the changes made. These could then be used as case studies to inform training for staff about the use of the common staffing method. Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, the common staffing method was followed at the required frequency in all areas except emergency care provision with an explanation of why this was not completed, e.g. lack of knowledge / training of personnel. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Reasonable Assurance Action This should describe what actions have been / are being / will be taken to address the situation. For example, if the common staffing method was not followed in emergency care provision and this was due to lack of knowledge / training, what measures were put in place to address this, e.g. identifying key personnel, provision of training, assistance from experienced personnel in other areas etc.
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24 12IL Training and consultation of staff (*The Health Board and Agency must only report on the types of healthcare, location and employees as detailed in section 12IK) Guidance chapter link Section Status 12IL Green 12IL(a) Green 12IL(b) Green 12IL(c) Green 12IL(d) Green 12IL(e) Green N/A Green These systems and processes include providing information to employees engaged in the types of health care mentioned in section 12IK about its use of the common staffing method, including the results from the staffing level tool and professional judgement tool; the steps taken under 12IJ(2)(b), (c) and (d) and the results of the decisions taken under 12IJ(2)(e). These systems and processes include ensuring that employees who use the common staffing method receive adequate time to use it. Clearly defined systems and processes are in place, and utilised, in all the types of health care, locations and employees listed in section 12IK, for the training and consultation of employees. These systems and processes include means to encourage and support employees to give views on staffing arrangements for the types of health care described in section 12IK. These systems and processes include means for taking into account and using views received to identify best practice and areas for improvement in relation to staffing arrangements. These systems and processes include training employees (in particular those employees of a type mentioned in section 12IK) who use the common staffing method on how to use it. CommentItem There is a clearly defined mechanism for monitoring compliance with this duty and escalation of non-compliance (when this cannot be adequately met)
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25 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Substantial Assurance Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Action This should describe what actions have been / are being / will be taken to address the situation. For example, arranging and delivering training, provision of mentoring from experienced personnel, job planning to ensure adequate time is available for designated personnel to follow the common staffing method. This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, issues were identified with the lack of training and adequate time for personnel in emergency care provision. Area of escalation / Challenge / Risk Details Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. For example, key personnel who were very experienced in using the common staffing method were engaged to train and mentor other personnel involved in the process. This should describe how the success, achievement or learning could be used in the future. For example, those key personnel have now decided to meet regularly in a forum to discuss shared learning and to ensure the common staffing method is used consistently across all relevant areas in the organisation. Testing of Guidance Chapter was undertaken allowing for understanding of this duty and any gaps in process - swot analysis completed and fedback
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26 1 Guiding principles for health and care staffing 2 Guiding principles etc. in health and care staffing and planning Guidance chapter link Section Status 2(2) These are steps taken to comply with 2(2) in general. Examples could include information about procurement and commissioning processes, how the guiding principles are taking into account and what procedures are in place for obtaining information about staffing arrangements. This should include, but not be limited to data in relation to patient safety and quality of care measures and outcomes, patient feedback and adverse event reporting. RAG status Item Clearly defined systems and processes are in place, and utilised, in all NHS functions and professional groups to ensure that when the Health Board is planning or securing the provision of health care from another person, it has regard to the guiding principles for health and care staffing and the need for that person from whom the provision is being secured to have appropriate staffing arrangements in place. Please provide information on the steps taken to comply with section 2(2) Please provide information on how these systems and processes, and their application, have improved outcomes for service users Comment work is underway to ensure that as part of any externally commissioned service we have safe staffing embedded as part of the quality assurance and monitoring framework.
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27 Areas of success, achievement or learning Areas of escalation, challenges or risks Level of risk (RAG) This is the residual level of risk, taking into account the actions taken. Level of Assurance: Please indicate level of assurance provided Declaration: The relevant organisation has systems and processes in place to meet the requirements of this duty, and has carried out this duty through the presence and use of appropriate systems and processes as detailed above. Please provide details of areas of escalation where the relevant organisation has been unable to achieve or maintain compliance or any challenges or risks associated with carrying out the requirements, and the actions in place to address these. Action This should describe what actions have been / are being / will be taken to address the situation. For example, engaging with service providers to ensure they understand what information is required, seeking alternative service providers etc. Limited assurance Area of escalation / Challenge / Risk Details This should include details of the NHS function / professional group etc. that the area of escalation, challenge or risk relates to. This should describe the situation: what is the challenge or risk identified? For example, there may have been difficulties in planning or securing services from in a particular speciality in relation to having regard to the need for that service to have appropriate staffing arrangements in place. Please provide details of areas of success, achievement or learning associated with carrying out the requirements. Area of success / achievement / learning Details Further action This should include details of the NHS function / professional group etc. that the area of success, achievement or learning relates to. This should describe the situation: what is the success, achievement or learning. This should describe what actions have been / are being / will be taken to address the situation. For example, if there is difficulty in recruiting in a particular speciality or remote / rural location, the relevant organisation may have investigated retire and return schemes or upskilling and career development for existing staff. It may also have looked at how the service could be redesigned.
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1 REPORT Item No: 18 SUBJECT: Risk Management Report TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie , NL HSCP Chief Officer Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 27th March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ The purpose of this report is to provide a summary to the IJB on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP.
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 Following changes to the financial position across NHS Lanarkshire, North Lanarkshire Council and North Lanarkshire IJB it is recommended that the financial challenges risk is reviewed and consideration made to increasing the risk level of the risk from High to Very High. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 A full review of the risk management reporting within the IJB has taken place as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. This review included how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session was held at the IJB Liaison Session in November 2023. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. 5.4 There are currently two risks rated as Very High on the IJB risk register.
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3 IJB 06/21 – Prescribing Activity and Costs IJB 17/22 – Unscheduled Care 5.5 There are eight high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 14/22 – CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service IJB 19/23 – Service sustainability IJB 20/23 – Workforce sustainability 5.6 There are a number of high/very high rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services and these are highlighted within the Risk Register (Appendix 1) and Risk Dashboard (Appendix 2). 5.7 The financial challenges risk (IJB 0.1/ 21) was added to the IJB risk register in April 2021. The current risk level of the risk is high with a target risk level of medium. A range of mitigation and actions have been put in place to try and mitigate some level of risk however following further reports on the financial challenges of the NHS board, Council and IJB, for 2024/25, it is recommended that the IJB further review this risk and determine if an increase of the risk level is required and if any further mitigations and actions need to be implemented.
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4 6. CONCLUSIONS 6.1 The IJB currently has 17 risks identified on its IJB risk register with 10 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 6.3 Following changes to the financial position across NHS Lanarkshire, North Lanarkshire Council and North Lanarkshire IJB it is recommended that the financial challenges risk is reviewed and consideration made to increasing the risk level of the risk from High to Very High. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centered on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐
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5 People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☒ N/A ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Risk Register Choose an item. Multi 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details □ Involve stakeholders in the development work aimed at achieving the national outcomes □ Provide stakeholders with information on how to get involved □ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs
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6 □ Measure how well we involve community stakeholders in the planning, design and delivery of our services □ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery □ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings □ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff □ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☒ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS None.
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7 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Register Appendix 2 – Risk Overview Dashboard CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14.The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15.The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. HIGH CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023‐26 and reserves strategy 2023‐24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget HIGH MEDIUM Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.02.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and updated Jan 2024. IJB02. 21 Financial Reputational 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.03.24 Previously IJB6. Reviewed and updated on March 2023. Reviewed and Updated Oct 2023, (previously title ineffective governance arrangements).
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1. There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2022/23 ACTIONS 1. The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 HIGH MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Jan 2024 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. MEDIUM MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.02.2024 Reviewed Jan 2024 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. Medium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.02.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed Jan 2024 IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1. The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. 2. Updated SLA with VANL nearing completion LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.03.24 Previously IJB16.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. MEDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP ACTIONS 1. Staff health and wellbeing is a key priority for both partners and all key stakeholders. The commitment to staff health and wellbeing is being actively promoted through all available forums. 2. Work is being carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse events MEDIUM LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.03.24 Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. 2. Face to face Q3 performance reviews taking place throughout May 23 with sectors/units LOW LOW Ross McGuffie M orag Dendy SLT, IJB PFA, IJB 31.12.23 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation 4. Audits of adherence to sickness absence policy being undertaken HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. All care homes advised to use PPE in line with national addendum. 4. Development day on 12th May 23 to agree structures and approach for year ahead medium medium Ross McGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 28.02.2024 Reviewed and updated Oct 2023.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Controls ‐ 1. Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model 2. CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion 3. Refurbishment of North Lanarkshire facilities commences early summer 2023 High medium Ross McGuffie M orag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living 4. NLC approved cost of living contract increases in May 2023 ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.03.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups 3. SG/COSLA working groups being established ‐ local reps nominated for each High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.23 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equipment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand 8. 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) 9. Firebreak implemented Jan 2024. Very High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Controls ‐ 1. Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model 2. CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion 3. Refurbishment of North Lanarkshire facilities commences early summer 2023 High medium Ross McGuffie M orag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living 4. NLC approved cost of living contract increases in May 2023 ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.03.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups 3. SG/COSLA working groups being established ‐ local reps nominated for each High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.23 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equipment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand 8. 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) 9. Firebreak implemented Jan 2024. Very High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High CONTROLS 1. Working group established to coordinate all activity 2. Oversight through Home Support Programme Board 3. Reporting to Adult Social Work, Care and Wellbeing Committee 4. Reporting to IJB ACTIONS 1. NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas 2. NLC part of SG once for Scotland procurement process for a new digital alarm receiving center 3. Communication out to all community alarm service users 4. Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational 5. Engagement with telecommunication suppliers to ensure sight of roll out plans across NL Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 28.02.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. IJB.19. 2023 Performance 27/02/2023 Service Sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety High Controls 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan is regularly reviewed and agreed. 7. Capacity plans in place to maximize efficiency. 8. Consultation and involvement with key stakeholders including service users and carers. 9. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 10. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 11. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions 1. Sustainability plans to be reviewed regularly 2. Re‐introduction of scrutiny panels 3. Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. 4. Review of reporting process into IJB to ensure continuous review of services/ service developments. 5. Development of the programme of work to ensure regular reporting structure in place for service review. 6. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. IJB.20. 2023 Workforce Sustainability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. High CONTROLS 1. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 2. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 3. Development of the Care Academy 4. Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS 1. Annual workforce plan being prepared 2. NHSL programme underway to support international recruitment 3. On the day recruitment events being trialed in Home Support 4. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 5. Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24
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Appendix 2 NORTH LANARKSHIRE IJB RISK REGISTER OVERVIEW March 2024
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Details of IJB Risk Movement/ Update of Actions Risk (Reference Date Risk Review Current Trend Target Commentary Actions for the and Title) Added to Date Score Score risk Register IJB.01/21 Financial Strategic Financial Challenges 01/04/2021 28/03/24 High Medium 'CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2023/2024 has been agreed and is being reviewed regularly. 7. IJB medium term financial plan 2023‐25 and reserves strategy 2023‐24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. ACTIONS 1. Annual budget setting processes within each of the partners takes place before the start of each financial year. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget
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12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. IJB04.21Financial Strategic Notional Set‐ Aside Budget 01/04/2021 28.03.24 High Medium CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐ aside concept. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level.
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IJB05.21 Financial Strategic Prescribing Activity and Costs 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. 01/04/2021 28/03/24 Very High Low CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and potential carry forward from 22/23 budget ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch.
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factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically, to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. IJB.1121 Performance Staff Health & Wellbeing 30/08/2021 28/03/24 High Low Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g. Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports,
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5. Well established Occupational Health supports available to support staff sickness. access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation 4. Audits of adherence to sickness absence policy being undertaken
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5. Findings of the audit to be shared with IJB. IJB.13.2021 Performance Care Homes Actions Establishment of Care Home Assurance 1. Public Health teams providing Escalation Process in place. guidance on National protocol to support discharge of infection control. Covid 19 patients in place. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3.All care homes advised to use PPE in line with national addendum. Development day on 12th May 23 to agree structures and approach for year ahead.
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IJB.14.2022 Strategic & Performance CAMHS IJB.17.2022 Strategic & Performance Unscheduled Care 30.4.22 28/03/24 High Medium Controls ‐ 1. Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 6. Continuous review and validation of the waiting list 05/09/22 28/03/24 Very High Medium CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance Action 1. Incremental implementation of the new service model 2. CAPA appointments begin on 1st May 2023 3. Refurbishment of North Lanarkshire facilities commences early summer 2023 4. Progress report will be submitted to IJB approx. Nov 23. ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. New CSW roles in District Nursing teams to proactively
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4. Daily PDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equipment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐ term service demand 8. 5 Task and Finish groups now established to roll
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out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23)
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IJB02-21 Ineffective Governance Arrangements now titled Prevention of Fraud, Bribery and/or Corruption 01/04/2021 28/03/24 Low Low 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA.
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1 REPORT Item No: 19 SUBJECT: Mental Health Hospital Based Clinical Complex Care TO: Integrated Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer, NL HSCP Author(s) of Report Ross McGuffie, Chief Officer, NL HSCP DATE: 27 March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ This paper has been prepared by Ross McGuffie, Chief Officer and has been shared with partners of the NHS Lanarkshire Board and North Lanarkshire Council. 3. RECOMMENDATIONS The IJB is asked to: 1) Acknowledge that HC One have formally notified us of their intention to terminate the existing contract for HBCCC services at Hatton Lea. 2) Note the proposed next steps include patient and family consultation and development of a new model to support HBCCC patients.
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2 3) Note the use of a proportion of the savings achieved to establish an alternative delivery approach for the impacted patients. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 NHS Lanarkshire’s Mental Health services are hosted within the North Lanarkshire Integration Joint Board, in line with the respective integration schemes of the two Lanarkshire partnerships. 5.1.2 Mental Health HBCCC beds are largely used for patients with dementia exhibiting aggressive or challenging behaviours. Previously, patients would largely remain in HBCCC beds for life, but following a definition change in 2015, when a patient’s presentation changes they are now expected to be moved to a more suitable and homely environment, such as a mainstream Care Home. There is now a simple eligibility question of ‘can your care needs be properly met in any other setting than a hospital?’, and if so, the aim is to support the patient to be moved to a less intensive setting, which is very positive for improving the quality of life of the individual. 5.1.3 Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was signed off by the NHS Board in 2017, which included a specific action around reviewing the model of Mental Health Hospital Based Complex Clinical Care (HBCCC). This resulted in the aim of the consolidation of contracted HBCCC provision onto one site, at Hatton Lea care home in Bellshill. 5.1.4 In November 2022, approval was granted by both Lanarkshire IJBs to terminate the contract at Cumbernauld Care Home, taking effect in July 2024. 5.1.5 On 25th January 2024, HC One notified NHS Lanarkshire of its intention to terminate the contract for HBCCC beds at Hatton Lea. Extensive discussions have been taking place with the provider since this date. 5.1.6 At present, there are 39 patients supported at Hatton Lea, with an annual contract cost of £3,270,493. 5.2 NEXT STEPS 5.2.1 Following notice of the termination of the contract with Hatton Lea, a review of the HBCC model across Lanarkshire has commenced in order to ensure that there is limited impact to patient care and wellbeing. Yes ☐ No ☒ N/A ☐
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3 5.2.2 As part of their engagement planning, HC One contacted all families impacted on the 19th March, and issued a follow up letter on the same day. 5.2.3 There is a planned face to face sessions for families on 26th March with representation from HC One, NHS Lanarkshire and the Social Work departments from North and South partnerships. 5.2.4 All HBCCC patients at Hatton Lea will be reviewed individually by Health and Social Work staff to agree suitable next steps. 5.2.5 Any patients identified at the review stage as being able to be stepped down to mainstream care (in line with the 2015 HBCCC guidance) will be fully supported on that journey. 5.2.6 Work is already underway to repatriate this service back into the NHS Lanarkshire estate. 5.2.7 An appropriate Equalities Impact Assessment will be undertaken in association with the Engagement Planning Group. 5.2.8 Following the notice of the contract termination, the aim is to ensure the new model is able to maintain the wider benefits anticipated from the original review of HBCCC services: Care on one central site with good transport links will be easier to access for families and carers as well as to assess and follow up by all disciplines of NHS Lanarkshire staff and partners in both North and South Lanarkshire. Opportunity exists to reinvest a proportion of the savings achieved in the service through employment, skills and training to provide best evidence care, treatment and rehabilitation. By consolidating some functions under a single site, the organisation eliminates the possibility of different standards and practices being applied in different areas. This is a major benefit to the patient’s wellbeing. Enhanced medical/nursing/AHP input within the current NHS Lanarkshire Mental Health estate would enable an improved care pathway, including robust multi-disciplinary assessment prior to admission and review focussed resident’s individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes. Meeting each patient’s changing care needs through robust multi-disciplinary assessment will ensure more positive patient /carer outcomes whilst identifying changing care requirements that would precede residents moving to future clinically appropriate care settings. Achievement of NHS Lanarkshire’s strategic objective of achieving best outcomes and value for money, ensuring that all resources are deployed to best effect, achieving transformational change in desired outcomes and value for money.
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4 6. CONCLUSIONS 6.1 Following the national change in definition of HBCCC, demand for Mental Health Continuing Care has continued to decrease, resulting in reducing occupancy levels in the contracted beds in Cumbernauld Care Home and Hatton Lea. The number of HBCCC patients has halved since the changes in 2015. 6.2 The termination of contract between HC One and NHS Lanarkshire has resulted in the need for a further review of the HBCCC model to ensure patient care is continuously delivered and patient needs are being met as per the HBCCC guidelines. 6.3 A multi-agency group is in place to coordinate individual patient reviews, engagement with families and the development of a new in-house model for HBCCC services. 6.4 The IJB is asked to acknowledge the termination of the contract between HC One and NHS Lanarkshire and note the next steps being proposed within the paper. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL
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5 This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Yes ☒ No ☐ N/A ☐
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6 ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1– Hospital Based Complex Care (HBCCC) in Lanarkshire FAQs CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk Yes ☐ No ☒EQIA will be developed N/A ☐ Yes / Date added ☐ No ☐ N/A ☒
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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8 Appendix 1 Hospital Based Complex Clinical Care (HBCCC) in Lanarkshire FAQs What is HBCCC? It is the care of old age psychiatry patients with a dementia diagnosis and associated behaviours requiring clinical support. This group requires specialist on-going healthcare and care provided in a specialist nursing home or care facility. What is the current service provision? University Health & Social Care North Lanarkshire currently has a contract with a care company called HC-One to provide the HBCCC service across the whole of Lanarkshire. HC-One provides the service at its Hatton Lea Care Home in Bellshill. What is changing? University Health & Care North Lanarkshire’s intention was for this contract to remain in place. However, HC-One has issued notice that it intends to terminate the contract and no longer provide the service in Lanarkshire. This decision was not the choice of University Health & Social Care North Lanarkshire. When is this change taking place? We are now working hard to identify a new location for the service in a comfortable and homely environment. A key consideration in identifying a new location for the service is that care is provided on one geographically central site with an appropriate environment for the patients and good transport links. This will provide easier access for families and carers from both North and South Lanarkshire.
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9 Once a new location is identified for the service, we will let you know. We are providing support as necessary to staff to ensure the service’s patients remain everyone’s number one priority throughout this process. Will all the patients remain in the HBCCC service when it moves to a new location? A multi-disciplinary team (MDT) group has been established to carry out a full review of each patient’s care. This MDT group is made up of a consultant and a range of clinical and social work staff. Our overriding priority for each and every patient is ensuring their continued safety, minimising any distress and supporting them and their families/carers through this process. While some patients in the HBCCC service will remain in the service to continue receiving complex care that can only be provided in a specialist setting, others may benefit from transferring to a mainstream care home. What is the criteria for establishing if my relative/person I care for still requires HBCCC? Receiving long-term care in a hospital or hospital-style setting should always be the last resort. This led to NHS Continuing Healthcare being replaced by HBCCC across Scotland on 1 June 2015. Assessment on whether a patient continues to require HBCCC focuses on one key question: can a person’s needs be properly met in any other setting than a hospital/hospital-style setting? Patients in the HBCCC service are reviewed regularly to see if this is the most appropriate care for them. Your relative/person you care for will be assessed by one of our consultants and our older peoples’ MDT to determine if they still require the specialist intensive on-going healthcare provided in HBCCC. This assessment may find that because their care needs are no longer as complex they can now be cared for in a mainstream care home. Our consultant and other members of the team will be able to discuss this further with you if you have any questions. if my relative/person I care for no longer requires HBCCC what is the next step?
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10 Following assessments, some patients may now be best placed to have their care needs met in a mainstream care home. This is because our multi-disciplinary team which manages their care believes their symptoms are now more manageable. We will work with our colleagues in social work to help support your decision making and the necessary processes for moving in to mainstream care. If my relative/person I care for no longer requires HBCCC can they move to the mainstream Hatton Lea Care Home or do they need to transfer to another care home? We understand that patients in the HBCCC service may have built up relationships with the staff and any move or change is an anxious time for both patients and their relatives/carers. It is important for us to allow time for you to consider your preferred option regarding the best future place of residence for your relative/person you care for. If my relative/person I care for moves in to a mainstream care home what happens next? If your relative/person you care for can now have their needs best met in a mainstream care home, University Health & Social Care North Lanarkshire will pay the full costs of their care until they move in to another care home. This is to ensure a smooth transition into mainstream care. From this point, this payment will stop and responsibility for funding the care home bed will transfer to you. Your relative/person you care for will be offered a financial assessment to support income maximisation to check which, if any, benefits they are entitled to. We will have staff available to help you through this process. There are also local money advice services available to you plan future funding: North Lanarkshire residents can access: https://www.northlanarkshire.gov.uk/benefits-and-money South Lanarkshire residents can visit: https://www.southlanarkshire.gov.uk/info/200150/managing_your_money/1850/mone y_matters_advice_service
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