Item 3 (M) IJB 27.3.24
North Lanarkshire Council · 19 June 2024
Back to Health and Social Care Integration Joint Board — 19 June 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 27th March 2024 at 2pm-4pm 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 Stakeholders: Maddie Halliday Chief Exec, VANL Third Sector Rep Harry Robertson Carer Representative OFFICER IN ATTENDANCE: Stacey Anderson Support Services Project Manager Stacey Connor (Minutes) Governance Support Manager Nauman Dar (Left 2.30pm) NHS Lanarkshire Nominated Non Exec Director Morag Dendy Head of Planning, Performance & Quality Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Trudi Marshall Nurse Director NLHSCP Anne McCrory North Lanarkshire Council Nominated Councillor Cathy McGinty NHSL Partnership/Staff Side Rep Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Sharon Murray (Deputy Trudi Marshall) Associate Nurse Director Adults Dr Josephine Pravinkumar Director of Public Health Dr Tyra Smyth General Practitioner (GP) Maggs Thomson Head of Health North HSCP John Watson Employee Representative NLC Unison Maria Williamson Senior Manager, Quality Assurance APOLOGIES: Paul Carey Audit Scotland
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2 Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communications Manager Diane Fraser Head of Adult Social Work Services Jann Gardner Chief Executive NHS Lanarkshire James Muir NHS Lanarkshire Nominated Non Exec Director Fiona Owens Audit Scotland Elizabeth Seaton Carers Together 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 (27th September 2023) The previous minutes were agreed as an accurate reflection of the discussion. 4. Minutes of IJB PFA (21st February 2024) The minutes from the IJB PFA committee were acknowledged and approved by the IJB committee. 5. Matters Arising/ IJB Action Log Maddy Halliday drew the committee’s attention to a matter arising from the previous IJB, 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. Ross McGuffie provided the committee with an update on actions contained within the rolling action log as follows: No 2: IJB Self-Assessment Report –This will be built into a future liaison session. Previous self-evaluation will require to be updated. No 3: Improving Cancer Journey- There was a launch event last week which was positive, further updates will come to the IJB in due course. No 4: National Care Service- A programme board has been established around the roll out of Mosaic which will take roughly 18 months, will bring an update back to PFA in future. Will also update on NCS when updates are available- the bill has passed through stage 1 at present. 6. Chief Officer Update
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3 Ross McGuffie provided the committee with a verbal update as follows: Lot of work done from the national whole system planning group – coordinating learning from festive period and undertaking Easter planning. Requested Q4 updated for self-assessments. Doing national benchmarking with other Boards to connect partnerships Held a further collaborative response group session and also had a session with the minister and Cllr Kelly to set out the collective financial positon. New board setup for executive lead for prisoner and police custody healthcare developing a Memorandum of Understanding (MoU) around healthcare being pulled together to set out how we delivered health and care in the prison environment. Champions Board undertaking a review of action plan and planning around this year’s conference. Last Friday held strategic planning group- engagement and participation strategy will come to a future IJB as will the carers strategy. Taking part in quality leadership walk rounds Programme of HSCP walk round– been to mental health glencarn and Social work area wide services. Future visits are to Coatbridge and Motherwell locality. New target operating model being developed for prisoner healthcare- meeting taken place with Scottish Prison Service (SPS) to look at progress of the model. 7. Alcohol & Drugs The report sets out the progress of the Alcohol and Drug Partnership (ADP) for 2023. It 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. 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. 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. 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). ADP Priorities: Priority area 1 - Fewer people develop problem alcohol & drug use. Priority area 2 - People access and benefit from effective, integrated person-centred support to achieve their recovery. Priority area 3 - Children and families affected by alcohol and drug use will be safe, healthy, included and supported. Priority area 4 - Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported.
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4 Priority area 5 – Less harm is caused by alcohol North Lanarkshire. Morag Dendy drew the committee’s attention to the ADP website which focus on how you access support through short videos and information. There was an event held in Dec 2023 to bring together those involved to give an opportunity to share good practice. It was agreed at the event that the NL ADP and key partners would host a summit this year which would look at both drugs and alcohol. Cllr McBride requested that the website link be shared with committed members; this was noted. Cllr Barclay asked how often is the send a message function on the website monitored and is there data to show if the website has not been used correctly. Morag Dendy advised the responses are checked daily and majority have used the service correctly, if anyone has not this will be used as lessons learned. Cllr Kelly asked about the local support fund, is there a limit to the money and for the protected funding from Scottish Government is this secure. Morag Dendy advised the closing date is this month so the next report can provide more details on funding bids. Working on the basis that the funding pack is secure at the moment but this may not be the case in future. Maddy Halliday noted will look at ways to strengthen connectivity between the ADP and community solutions. Phillip Couser queried if we could have some context around outcomes. Morag Dendy will consider how to include in future reports. The IJB Committee agreed the following 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. SC 8. Medical Assisted Treatment (MAT) Standards The report shared 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. 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.
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5 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 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. Brian Moore asked if prescribing in community pharmacy is going to be developed to assist implementation and would it make a significant difference. Lucy Munro advised community pharmacies are not doing better than GP practices so need to be thoughtful if that’s as viable option as we would like it to be. Would also need to consider having speciality prescribers given the level required, which is challenging given the number of GPs per population. Maggs Thomson added discussion are at a very formative stage challenges are sustainability and recognising that its part of a national context is emerging. Community pharmacy is being considered as potential test of change but nothing has been progressed. The IJB: 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. 9. Staff Health & Wellbeing 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. 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.
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6 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. The paper outlines the approach and outcomes of this will be brought back to a future meeting. Maddy Halliday noted need to look at rewarding staff when they have an increase in workload which not been mentioned in the report. Suggested looking at system wide workforce issues to be inclusive of 3rd and independent sector. Morag Dendy advised reward and workload work is ongoing. There are appointments being made to staff health and well-being posts to support whole system working which will assist. Cllr Barclay asked how much of staff absence rates is covid related such as those with long covid. Morag Dendy replied very little is covid related directly but some is indirectly related to other factors of covid such as mental health. Lucy Munro added that Lanarkshire has a long term covid rehab group which has engagement from a number of stakeholders and has been running for 2 years. Cllr Kelly asked could there be any additional support offered to absent staff. Morag Dendy noted we have taken structured reports to the strategic leadership team and core to share any active methods that could be offered. The IJB committee agreed: 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. 10. Strategic Academic Partnerships Report In the past year, there has been a significant development in the strategic academic collaborations within the Lanarkshire system. With NHS Lanarkshire updating its Service Level Agreements with the University of Strathclyde, Glasgow Caledonian University and University of West of Scotland, work was also undertaken to develop strategic Memorandums of Understanding (MoUs) with both Councils. Through these developments, MoUs have now been agreed with Glasgow Caledonian and both Councils, with the two Health and Social Care Partnerships now granted University Status with GCU. Work continues to develop this approach
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7 with the other two Universities as we continue to develop our strategic academic approach. Overall, significant progress continues to be made across the NHS Lanarkshire and the Health and Social Care Partnerships in academic collaboration with partner universities. There has been an expansion not only in the volume of collaborative work undertaken but also in the complexity of projects and in the increasing diversity of links between NHSL and multiple departments and individuals across our strategic partnerships. The IJB: 1. Reviewed the content of the paper 2. Noted 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). 11. IJB Directions Letters The 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. 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. The letters of direction are included within the report and, following the approval of the IJB, will be issued to North Lanarkshire Council and Lanarkshire Health Board by 31st March 2023. The focus for the year ahead will be on implementation of the programme of work of the IJB’s Strategic Commissioning Plan 2023-26. The IJB is agreed the following recommendations: 1. Approve the issue of the directions to North Lanarkshire Council for the financial year 2024/2025 attached at Appendix 1. 2. Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2024/2025 attached at Appendix 2. 12. Long Term Financial Plan 2024-2034 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
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8 developments, employee costs and inflation alongside potential partner funding contributions in future years. 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. 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. 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. 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. 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 The IJB committee agreed the following recommendation: (1) Acknowledge the assumptions and context of the financial plan; and (2) Approve the Long Term Financial Plan 2024-2034. 13. 2024-25 Delegated Health and Social Care Budget 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. 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
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9 partner organisations is set out in the Integration Scheme, however, utilisation of this funding is delegated to the IJB. 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. 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. 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. 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. 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. Ross McGuffie shared a presentation to outline work being undertaken to look at NHS areas of cost pressures. The new model for MH HB CCC will come to a committee in future for approval. Brian Moore noted need to consider timelines for bringing items back for approval as we only have 4 IJB meetings per annum. He acknowledged that we may need to split between IJB and IJB PFA; this was noted. Cllr Kelly asked are we mapping out what will be staffing required for models and will reserve information come back to future meetings. Ross McGuffie acknowledge staffing challenges will drive service models and doing everything that can be done to protect frontline staff. Reserve updates will be shared as required. Recommendations agreed: (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;
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10 (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. 14. IJB Integration Scheme 2024- Update Following Consultation Period 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. 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. 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. 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. Ross McGuffie added the scheme has been to the policy and strategy committee and also the NHS Health Board meeting, where it has been approved. The IJB acknowledged the feedback received as part of the IJB Integration Scheme Consultation Process and Confirm that the final draft of the Integration Scheme can now be submitted to Scottish Government for endorsement. 15. Annual Chief Social Work Officer Report
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11 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. 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. The 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. Brian Moore noted reference to partnership boards within the report, he asked where they sit in the current governance framework. Morag Dendy advised there is focus on these at locality levels to consider how to join this up to fit current need. Brian Moore also noted in future should be an opportunity to get complaint information from both areas. Alison Gordon advised complaints are reviewed from both social work and the NHS at the North Support care & clinical governance committee. Phillip Couser asked is this report considered the best way to present the information or is there others method that could be considered particularly for the public. Alison Gordon acknowledged would like to modernise the report and need to consider making it more assessable for a broader audience; work has already started for next years report. The committee noted the report and endorse its approval route through council committees. 16. NRS – Public Records(Scotland) Act (PRSA) 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
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12 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 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 IJB committee acknowledge and note the report. 17. Reporting Duties for Local Authorities & Integration Under Health & Care Staffing (Scotland) Act 2019 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. 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. 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. 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. 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. The included 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. Once the official template and report guidance has been issued, a further report will be shared with the IJB. The IJB 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.
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13 18. Risk Update The report provides a summary to the IJB on risk management activity, noting any amendments or additions to the current risk register. There are currently two risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 17/22 – Unscheduled Care 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 The IJB currently has 17 risks identified on its IJB risk register with 10 risks rated as high or very high. Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 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. Recommendations agreed by the IJB committee: 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. 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. 19. Mental Health Hospital Based Clinical Complex Care 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
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14 intensive setting, which is very positive for improving the quality of life of the individual. 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. In November 2022, approval was granted by both Lanarkshire IJBs to terminate the contract at Cumbernauld Care Home, taking effect in July 2024. 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. At present, there are 39 patients supported at Hatton Lea, with an annual contract cost of £3,270,493. 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. 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. 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. Used the large scale closure of Hillend view as part of lessons learned to ensure we get the right outcome for all patients. The new model will come back to a future meeting. The IJB: 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. 20. Risk There were no new risk identified. 21. A.O.CB The committee note their thanks to Maddy Halliday for her contribution over the years and acknowledged this will be her last meeting.
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15 Maddy Halliday advised VANL are out to advert to recruit to her post, in the meantime have got an interim post holder from 13th April who will represent VANL on the IJB. 22. Date of Next Meeting 19th June 2024 9.30am-12pm