ITEM 3 Minute of Meeting of the IJB held on 24 January 2024
North Lanarkshire Council · 27 March 2024
Back to Health and Social Care Integration Joint Board — 27 March 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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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