ITEM 9 Winter Planning Business Case Report 2024
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 REPORT Item No: 9 SUBJECT: Winter Planning Business Case Report 2024 TO: Integration Joint Board Committee Lead Officer for Report: Morag Dendy - Chief Officer (Planning, Performance and Quality Assurance) Author(s) of Report Graeme Cowan, Senior Manager, Strategy & Performance DATE: 19 June 2024 1. PURPOSE OF REPORT The purpose of the report is to provide the Board with a final report on the Winter Planning Business Case activity. 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: ☐ Senior Leadership Team 3. RECOMMENDATIONS i. Note the content of the report. ii. Endorse the achieved milestones and next steps set out in the report. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Scottish Government allocated additional funding in 2021/2022 and 2022/2023 to increase capacity across the health and social care system. In February 2022, the North Lanarkshire Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target nonrecurring reserves to implement a series of proposals. 5.2 The original business case was costed at just over £20m with a range of proposals to enhance assessment and planning capacity across the partnership, increase the direct provision of supports and services across a range of organisations, and invest in key infrastructure supports to deliver the wider change agenda. 5.3 Workstreams were established to implement plans and proposals against the following headings: Home Assessment Team Enhanced Integrated Rehabilitation Provision Community Nursing Increased Capacity Across Home Support Service Assistive Technology Team Hospital at Home Building Capacity of Independent Sector Providers Investment in Communities 5.4 The ambition set out in the original business case was to take action that had a lasting and sustainable impact on the whole health and social care system in North Lanarkshire. This report seeks to assess the extent to which this has been achieved and provide some specific milestones achieved within each of the workstreams. Further detail is attached to this covering report as Appendix 1. 6. CONCLUSIONS 6.1 Progress has been achieved across all the workstreams within the business case, with enhanced capacity and improvements evident across a range of services and settings. 6.2 Further work is required to ensure that the enhancements are further embedded within Enabling Hubs and the emergent. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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3 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 The additional funding provided has been incorporated into baseline budgets and as such are part of routine financial management arrangements. 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 High 7.5 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 N/A ☒ Provide stakeholders with information on how to get involved N/A
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4 ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs N/A ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services N/A ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery N/A ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings N/A ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff N/A ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership N/A 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Winter Planning and Enhanced Supports Business Case for North Lanarkshire Final Report 2024
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5 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Graeme Cowan, Senior Manager (Strategy & Performance) on 07946 702861.
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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 Winter Planning and Enhanced Supports Business Case for North Lanarkshire Final Report 2024 The Scottish Government allocated additional funding in 2021/2022 and 2022/2023 to increase capacity across the health and social care system. In February 2022, the North Lanarkshire Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target nonrecurring reserves to implement a series of proposals. The original business case was costed at just over £20m with a range of proposals to enhance assessment and planning capacity across the partnership, increase the direct provision of supports and services across a range of organisations, and invest in key infrastructure supports to deliver the wider change agenda. Workstreams were established to implement plans and proposals against the following headings: Home Assessment Team Enhanced Integrated Rehabilitation Provision Community Nursing Increased Capacity Across Home Support Service Assistive Technology Team Hospital at Home Building Capacity of Independent Sector Providers Investment in Communities The ambition set out in the original business case was to take action that had a lasting and sustainable impact on the whole health and social care system in North Lanarkshire. This report seeks to assess the extent to which this has been achieved and provide some specific milestones achieved within each of the workstreams. 1. Home Assessment Team Home Assessment Teams were established from April 2022 and have been introduced across all localities on a phased basis. The Home Assessment Team has created a designated workforce whose focus is enabling discharge from hospital and maximising function in the home environment. The Home Assessment Team incorporates time limited support at home, working alongside Allied Health Professional colleagues, and has allowed the partnership to increase the number of people assessed in their own home. The Home Assessment team approach has allowed ‘home first’ conversations to become the norm at every stage of a person’s journey, particularly during an admission to hospital (Why not home? Why not now?). There has been a phased approach to implementing the teams across the localities which has allowed a flexible approach to deploying staff where the need is greatest. The teams have built strong links with discharge facilitators in each of the hospitals discharge hubs and participate in daily Planned Date of Discharge (PDD) discussions in both University Hospital Wishaw and University Hospital Monklands to identify appropriate patients for the pathway.
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8 The teams consist of a range of disciplines with input from Occupational Therapists, Social Workers and Home Support Service Delivery Co-ordinators. People are generally supported by the Home Assessment for a period of up to two weeks and if ongoing needs are identified people are referred or signposted to the appropriate support or service. As illustrated by the chart below, there has been a natural, gradual build and expansion of the team as staff have been recruited and trained. This is reflected in the gradual build-up in the volume of referrals. All localities are now operational, with in excess of 120 new individuals supported by the service every month. Those people who are referred to HAT are also being discharged quicker from hospital to be fully assessed in their home environment, with 82% of individuals referred to HAT and discharged from hospital on the same day. As the teams have become established they were able to accept more complex cases and fully support the multi-disciplinary team working that is required to support a “Home First” approach for individuals. We can see below that over time, as more complex cases were being accepted in financial year 2023/24, that the proportion of people recorded as completing the service with no further service required decreased, however we know from our monitoring of delayed discharges that the HAT approach is improving flow. 25% 67% 33% 55% 48% 58% 70% 78% 73% 78% 80% 64% 58% 69% 62% 63% 61% 59% 57% 55% 54% 54% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% People completing service with no further service noted as being required by month
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9 The contribution of the Home Assessment Team also appears to be having an indirect impact on the partnership’s overall performance in relation to patients’ discharge being delayed in hospital. The charts below illustrate the significant reduction in the number of bed days delayed per week in both acute sites and off- site wards, particularly towards the end of 2023 and into early 2024. The Home Assessment Team is now embedded as a key aspect of the overall approach to supporting people’s discharge from hospital within North Lanarkshire. HAT is aligned with wider teams and approaches within North Lanarkshire, including Hospital Discharge Hubs, Home Support, Community Integrated Rehabilitation Teams and Locality and Hospital Social Work Teams.
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10 2. Enhanced Integrated Rehabilitation Team Linking closely with the Home First principles of the Home Assessment Team, the business case allowed for further investment in the Integrated Rehabilitation Teams across the six localities, with additional capacity created across all teams and roles, including Occupational Therapists, Physiotherapists and Occupational Therapy Assistants. The summary referral data shows the upward trend in the total number of referrals received by the teams in the period December 2021 – April 2024, with some variation from month-to- month. It is important to consider the whole system effect of changes that have been made possible by the additional funding and that there is a dynamic relationship between the additional capacity offered by IRT with our extant Home Support, Reablement and other Locality services. While waiting times within the service continue to be a challenge, the continuing development of the Locality Enabling Hubs offer opportunities to ensure people get the right response from the right person at the right time and locality Integrated Rehabilitation Teams are integral to this. 3. Enhanced Community Nursing Capacity The funding was used flexibly across Community Nursing teams to introduce a wide variety of roles within the service. Trainee Advanced Nurse Practitioners were introduced to Community Nursing teams and once qualified, will support a reduction in the volume of escalation to GP care and also a reduction in outflow from GP practices to Community Nursing Teams for ongoing patient management and monitoring. The trainee ANPs have supported the medical provision for the 15 interim beds that have been successfully used to support flow from acute hospitals. Band 3 Health Care Support Workers (HCSW) were introduced to all teams to increase capacity to provide enhanced care, particularly for those people who are on Pathway 4. The funding was used to supplement and support existing teams and we are currently supporting over 3,600 patients on Community Nursing caseloads and the additional resource has supported the service to stop utilising off-framework agency resource and reduce our overall Community Nursing agency utilisation by 30%. Band 4 Practitioner assistants have been introduced to the service and are currently undertaking their education, training and development programmes. The implementation and embedding of these roles in our systems ensure that we have a sustainable workforce
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11 offering clear career development pathways from practitioner to registered status, which is particularly important as we know that projections for the number of new nursing students continues to reduce. The funding has also allowed for additional Band 5 Registered Nurses to be introduced to help support enhanced flow from hospital and implement new models of care. The additional resource also addressed a significant proportion of unmet need that was identified in the system due to staff sickness absence, increasing levels of patient dependency and an overall increase in demand. Practice teachers have been introduced to support the increased numbers of staff who are undertaking the District Nursing, ANP, Practitioner and Newly Qualified training pathways. Having additional, dedicated and focussed resource to support and promote training and development creates capacity for Team Leaders to make improvements in other areas and also to be assured that the correct clinical supervision for trainees is in place and a positive learning environment is maintained. A Clinical Project Lead and Senior Nurse have been employed to support a transformational review of Community Nursing and develop service models that focus on preventative care, unscheduled escalation and supporting people to be cared for within their own home wherever possible. Although the funding for the posts is non-recurring they are being employed in this way to create capacity in the system to undertake a robust review. 4. Home Support Expansion The funding allowed the partnership to provide a longer term solution to the inhouse Home Support Service which, previously, had relied on temporary funding for a range of posts. This has facilitated improvements in both the capacity and quality of the service, as the service has refocused its efforts on recovering its reablement capacity and focusing on reducing unmet need in both hospital and community settings. From the charts below, the number of people starting and completing the reablement process within the Home Support Service has shown a gradual recovery quarter-to-quarter and in the last six months has recovered to pre-covid levels.
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12 The number of people assessed and waiting in hospital for a home support service has fallen from approximately 50-70 in December 2022 - January 2023 to approximately 10 people in recent weeks (May 2024). In the same time period, the number of people assessed and waiting for a home support service in community has fallen from over 200 to approximately 50 people. The aspiration is to have zero people waiting in any setting and, while there is still room for improvement, service performance across this time period has shown significant improvement. 0 100 200 300 400 500 600 700 Q1 2022/23 Q2 2022/23 Q3 2022/23 Q4 2022/23 Q1 2023/24 Q2 2023/24 Q3 2023/24 Q4 2023/24 Number of people completing reablement Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw pre covid average 0 50 100 150 200 250 300 Number of people assessed and waiting for Home Support Service Assessed and waiting hospital Assessed and waiting community
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13 Expansion of Hospital @ Home Services The additional funding allowed for the extension of working hours for our Hospital at Home service. In 2022, the Hospital at Home service undertook a large scale project to expand the service and extend the operating hours to later evenings and weekends. Over the course of 2022 and 2023 the additional funding allowed for the implementation of twelcve virtual stepdown beds to assist with hospital flow. Inpatients within the Care of the Elderly (COTE) wards who were still acutely ill and met the Hospital at Home clinical criteria could be discharged home and vacate an inpatient bed, with the remainder of their care being delivered by Hospital at Home. Although this was implemented in response to C19, it is now a well-established part of the Hospital at Home service. The funding also allowed for extended working hours and the development of clinical criteria & referral pathways using the Trakcare Workbench function to accurately record the patient’s movement and transfer the care record. The service now has coverage in South Lanarkshire Clydesdale locality, with 12 virtual beds and there are 3 beds for identified Cardiology Heat Failure patients that require infusion. AVERAGE REFERRALS 2022 VS 2023 SITE 2022/23 2023/24 Patient Increase % Increase Hairmyres 60 66 6 10% Monklands 77 85 8 11% Stepdown 36 46 10 28%
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14 Wishaw 49 69 20 40% Grand Total 221 265 44 20% 5. Development of Assistive Technology Team North Lanarkshire Health and Social Care Partnership agreed an innovative approach and wanted to accelerate their approach of using assistive technology solutions to support people differently. The Assistive Technology Team (ATT) was created in January 2023, consisting of a Senior Officer, four Resource Workers and eight Technology Support Assistants. The team focuses on embedding technology into assessment and planning processes, providing training to all staff groups around technology and its use in care and support, supporting with risk assessments, and ensuring technology support advice is embedded around self-directed support and to provide high level data around the technology being used within our communities. The ethos of the team is to ‘Think Tech First’ and the ambition is to promote the use of assistive technology to improve quality, delivery, and safety in care planning across the partnership. The Team is based in the Dalziel Building, Motherwell with regular presence in localities. Since the team’s establishment in late 2022, over 1,000 referrals have been received and continues to grow month-on-month. Assistive Technology Flat We have recently relocated the assistive technology flat to a new build property in Bellshill. The property is used to highlight technology solutions and facilitate training to staff groups across the partnership and council. Visits to the facility have continued to increase since the Assistive Technology Team have been in place, and the new location has received positive feedback from both service users and staff. The technology flat offers the opportunity to see technology in use and the ways in which it can promote independence and enhance quality of life. Engagement with the technology flat is now recognised as an integral part of induction processes for new members of staff across health and social work. To date over eighty-five training sessions have been undertaken in the flats for internal teams and twenty-five with external agencies. The technology flat is also a platform to compliment and promote North Lanarkshire Council’s self-management platform, Making Life Easier (MLE) which allows individuals to access information, professional advice and
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15 direct access to services and support. There has been a noted increase in individuals self-purchasing technology following visits to the Assistive Technology Flat, with the ATT team assisting individuals to set up newly purchased devices. Key Issues and future developments The team continues to engage with community and voluntary sector groups to identify their needs in relation to assistive technologies. Engagement with North Lanarkshire Community Connectors has been undertaken to promote technology within their operational spaces and development work continues with Making Life Easier (www.makinglifeeasier.org.uk) to allow members of the public to self-assess for possible technology solutions.
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16 6. Support to Independent Providers A local provider sustainability fund was established to facilitate an individualised approach to: Supporting recruitment and retention Supporting staff wellbeing Supporting cross sector support to Level 2 SVq Enhance Scottish Care support to the sector The fund was supported by a programme of activity to strengthen the support across the sector and to facilitate allocation of local supports to evidence direct benefit. The table below outlines the activities that the funding supported and the number of providers accessing the fund. How funding has been spent Providers using funds for this purpose Staff training and development including SVQ qualifications, trainer's courses and driving lessons. 12 Staff retention incentives including weekend working incentives, bonuses, refer a friend scheme, hardship monies, induction/check ins, health plans and gym memberships, implementation of mental health and wellbeing policies for staff including staff activities including therapies and staff access to activities. 9 IT equipment for staff training and development. 2 Recruitment including online and tv advertising, physical marketing materials and recruitment of staff to various roles. 9 All providers noted a positive impact on building capacity within their respective organisations. Information on impact and how outcomes have been met include: Training Identification of areas of the service where further training and development is required for staff. Allowing for a person-centred approach to the fair work practice of ensuring the appropriate training is given to each employee. Full inductions and mandatory training for staff has ensured staff are well prepared for their role. Staff achieving their own personal development outcomes through the new training opportunities on offer. Allowing training and development of staff to be carried out on-site with the introduction of new IT equipment. Strengthened links to college and college staff in terms of training for staff and prospective candidates. Training and upskilling of staff leading to a stronger workforce who are supported to carry out their roles effectively. Better trained staff enabling people to live in their own homes for longer, receiving good quality care by competent carers.
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17 Recruitment Significant increase in recruitment to a wide variety of roles within organisations through increased advertising using various media. Recruitment of staff has been quicker than previously through increased advertising. Increase in applications for advertised posts. Reduced number of individuals awaiting care in North Lanarkshire. Retention Incentives allow for greater staff retention and opportunities for development. Boost in staff morale and motivation through introduction of incentives. Improvement in staff mental health and wellbeing through introduction of a new Mental Health Wellbeing Policy and associated access to therapies and activities for staff. Less employee absence and therefore, less disruption to the continuity of care for supported individuals. Funding has allowed providers more creativity in terms of the recruitment and retention of staff. 7. Development of Community Solutions – Community Connectors Additional investment was identified to enhance the Community Solutions Programme and support a new Improving Lives Initiative (ILI) and support the Improving Cancer Journey programme. A new team of Community Connectors have been established to provide support to people who will benefit from informal community-based support and help accessing formal statutory support should they need it. The Community Connectors signpost people to community supports provided by Community and Voluntary Sector (CVS) Organisations and where appropriate link to statutory services such as Home Assessment Teams and Integrated Rehabilitation Teams. Ten community connectors are now in post and fully operational, with two senior connectors overseeing four staff each. Average case load is approximately 30 per staff member, across both the Improving Lives Initiative and the Improving Cancer Journey service. Between January and March 2024, 150 people from North Lanarkshire were supported by the Improving Cancer Journey programme with Community Connectors carrying out a holistic needs assessment and linking people to other supports and services as appropriate.